St. Andrew’s College

Of Arts, Science and Commerce

St.Domnic Road, Bandra (W)

Mumbai 400050

Certificate

This is to certify that the above mentioned students have done the project on 18

September 2009 as a part of Service sector management Subject.

This study has been carried out by the students under my guidance and

supervision during the period of 2009-10. The project work is original and

authentic to best of knowledge.

Place: Mumbai

Date:

Signature of the guide

TABLE OF CONTENTS Page No.

1. Introduction to Service Sector

2. Concept of Service Marketing

3. Hospitals in India

4. History of Hospitals

5. PEST Analysis

6. Unique Characteristics of Hospitals

7. Classification of Hospitals

8. 7 P’s of Hospital Sector

9. Market sementation

10.Quality Dimension

11.Conclusion

INTRODUCTION- SERVICE SECTOR

The service sector has been growing significantly for more than fifty years to the

extent that in the developed world, more people earn their living from producing

services than making manufactured goods. In fact around three quarters of the

population in the United States and the European Union are employed in service

industries. Services therefore have a major impact on national economies. The

subject of Services Marketing has grown in response to this. Latterly however,

manufacturing and technology industries have also recognised the need to

provide services not only as a means of adding value to the physical products

which they market but also as the basis for a different orientation to the

management of their businesses. This module will address the key issues,

concepts and models which form the core of Services Marketing theory, focusing,

as far as possible, on the service industries of relevance to students taking the

module.

What is a Service?

Services include all economic activities whose output is not a physical product or

construction, is generally consumed at the time it is produced and provides added

value in forms (such as convenience, timeliness, comfort or health). That is

essentially intangible concerns of its first purchaser.

Concept of ‘Service Marketing’

The perception of service marketing focuses on selling the services in the best

interest of users/ customers. Marketing a service is meant marketing something

intangible. It is marketing a promise. In the marketing of services, we go through a

number of problems directly or indirectly influencing the business index. The

problems like market segmentation, marketing information system, behavioral

management are studied minutely which simplify the task of formulating a sound

mix for marketing, such as Product mix, Promotion mix, Price mix and the Place

mix. It is important to mention that we find “People” an important mix of

marketing services. If we market the services in a right direction, the available

opportunities can be capitalized on optimally and also it contributes substantially

to the process of development. In view of the above, we observe the following

key points regarding the concept or perception of services marketing:

It is a managerial process of managing the services.

It is an organized effort for providing a sound foundation for the

development of an organization.

It is a social process helping an organization to understand the emerging

social problem and to take part in the social transformation process to

justify its existence in the society.

THE HOSPITAL INDUSTRY

Service Management is:

1) To understand the utility the customers receive by consuming or using the service

offering of the organization

2) To understand how the organization (personnel, technology, physical resources,

systems and customers) will be able to produce and deliver this utility

3) To understand how the organization should be developed and managed so that the

intended quality can be achieved

4) To make the organization function so that this quality can be delivered on a

continuous basis.

Today the hospital is a place for diagnosis and treatment of human ailments and

restoration of health and well being. The basic function of a hospital is to give

proper treatment to the injured and sick without having any social, economic and

racial discrimination.

Some of the other important functions and services of modern hospitals are

training of the doctors and nurses, support to medical research and assistance to

all activities carried out by public health and voluntary agencies to prevent

diseases. It is also a center for training of health workers and bio-social research.

Today it also acts as an institution that provides accommodation to patients for

medical nursing and care. Medical services are primarily provided by the central

and state governments.

Hospitals are not for profit making, they are social institutions that make the

required medical services available to society. With time the classes and quality of

hospitals have changed a lot . 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

The last two decades have seen the mushrooming of corporate and privately run

hospitals. Most large trust and corporate hospitals have invested in modern

equipment and focus on super-specialties.

The private sector accounts for 70% of primary medical care and 40% of all

hospital care in India. They employ 80% of the country’s medical personnel.

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. Key therapeutic areas are cardiology,

nephrology, oncology, orthopedics, geriatrics, maternity and trauma/critical care.

Hospitals are not for profit making, they are social institution to make available to

society the required Medicare services. However this may not be true for private

hospitals. Today hospitals are 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. WHO states that hospitals are socio-medical

organization whose functions are: Curative, preventive, patient services and

training of health workers in biosocial research.

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.

Hospitals in India

By the late 1980s, there were approximately 128 medical colleges--roughly three

times more than in 1950. Data for 1987 shows that there were 320,000 registered

medical practitioners and 219,300 registered nurses. Various studies have shown

that in both urban and rural areas people preferred to pay and seek the more

sophisticated services provided by private physicians rather than use free

treatment at public health centres.

The fast pace of development of the private medical sector and the burgeoning

middle class in the 1990s have led to the emergence of the new concept in India

of establishing hospitals and health care facilities on a for-profit basis.

Current Scenario

India, the growing economic power in Asia is witnessing frenetic growth of its

health care sector. India’s much-noted economic growth is rapidly improving

living standards and the healthcare industry will be a major beneficiary of the

overall increase in incomes. Recent major regulatory reforms have improved the

growth prospects for health insurance and, as a result, a large section of middle

income families will be able to afford healthcare services leading to high demand.

The report of the National Commission on Macroeconomics and Health had

estimated the size of private healthcare sector in India to be worth Rs 69,000

crore and projected that size to double to Rs 156,000 crore by 2012,besides an

additional Rs 39,000 crore if health insurance picks up. With the current pace, the

corporate segment in the private medical service sector is likely to absorb a good

share of this business.

Large domestic market is well complemented by inflow of overseas Medical

tourists. The number of Medical tourists has increased ten-fold from 10,000 in

2000-01 to about 100,000 in 2004-05.

HISTORY OF HOSPITALS

Etymology

During the Middle Ages the hospital could serve other functions, such as

almshouse for the poor, or hostel for pilgrims. The name comes from German

“hospes” (host), which is also the root for the English words hotel, hostel, and

hospitality.

Early history

In ancient cultures, religion and medicine were linked. The earliest known

institutions aiming to provide cure were Egyptian temples. Greek temples

dedicated to the healer-god Asclepius might admit the sick, who would wait for

guidance from the god in a dream. The Romans adopted his worship.

The Sinhalese (Sri Lankans) are perhaps responsible for introducing the concept of

dedicated hospitals to the world.

Institutions created specifically to care for the ill also appeared early in India. King

Asoka founded 18 hospitals in 230 BC. There were physicians and nursing staff,

and the expense was borne by the royal treasury. State-supported hospitals later

appeared in China during the first millennium A.D.

StatisticsNumber of Hospitals:

States Government Private TotalPunjab 174 39 217Haryana 58 20 78Maharashtra 445 2583 3115Gujarat 263 2031 2370Rajasthan 218 0 218H.P 46 6 57Karnataka 209 56 293W. Bengal 242 129 392Kerala 141 1899 2040Assam 141 80 268A.P 141 1722 1863U.P 534 139 652Tamilnadu 282 119 408M.P 363 0 363Bihar 237 90 328Orissa 250 29 284

PEST ANALYSIS

In India even after 60 years of independence we all have to accept that the

government has failed to provide the basic health care facilities in many areas.

Health care sector is one of the most neglected which is only meant for slogans by

most of our politicians. Following are the list of factors that affect the health care

sector:

POLITICAL FACTORS

There are non- merit quotas in medical institutions which is adversely

affecting the quality & perhaps, the availability of trained and skilled

medical professionals. It is said that because of these reservations the

quality of the future Indian doctors will be very poor.

It is mandatory for the hospitals to keep 20% of the beds free for those

from the lower classes who cannot afford costly treatments.

Providing subsidized land and equipment to Hospitals will help them cater

to their poorer patients better.

Reduction in Import duties will help Hospitals acquire new, modern and

more sophisticated medical equipment and technologies.

ECONOMIC FACTORS

Because of the increase in the per capita income amongst the higher and

middle classes of the society there has been an increase in the spending

from these classes in the health care sector.

Service Tax on Hospital services @ 12.24% has increased the costs of

services provided by the Hospitals. In addition, the cost of input services

(electricity, cleaning, maintenance, laboratory, laundry, patient care,

transportation, ancillary services etc.) has increased due to imposition of

service tax and a hike in Tax rate from 10% to 12%.

Cost advantage in healthcare that India offers coupled with technologically

advanced medical treatment system has helped in the growth of medical

tourism.

The cost of making and maintaining a hospital is extremely high.

Introduction of Private Medical insurers has increased the reach of medical

insurance amongst the Indian public. This is helping the hospitals service

more patients.

Third Party Administrators (TPA’s) has increased the claims settlement rate

at increased cost of medical insurance.

SOCIAL FACTORS

Certain percentages of beds have to be kept for poor people. For example

in Bombay 20% of the beds have to be kept reserved for poor people

whether it is a private or a public hospital.

Look after the needs of local poor people.

Open counseling and relief centres.

Safe disposal of hospital wastes like used injection needles, waste blood etc

& taking care of the environment is to be given high priority.

Campaigns and free medical checkups have to be conducted whenever

necessary.

In brief the social aspect of the hospital 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.

TECHNOLOGICAL FACTORS

A large number of technically qualified professionals have made it possible

to expand the medical services.

Computerization and telecommunication services have made remote area

treatment a reality.

Use of new age equipments is making the delivery of medical treatment

better.

Stem cell research has opened up a whole new arena of Hospital services,

wherein, a new body part can be grown to replace a dead or a diseased

organ within the body of the patient.

Robotics micro-surgery: - a greater degree of robotics technology in

operating room to provide precise and less traumatic as well as less

destructive surgery.

Laser technology

Employment of information technology tools for networking of

examination rooms, treatment rooms, operating rooms and diagnostic

reporting rooms.

Deployment of information technology tools for generation of specific

disease related databases, classified by a number of variables.

UNIQUE CHARACTERISTICS OF SERVICES With Respect To

Hospitals

There are four commonly cited characteristics of services that make them

different to market from goods: Intangibility, Inseparability, Variability and

Perishability.

INTANGIBILITY:

Intangible means that which cannot be seen or touched. Intangible services

are difficult to sell because they cannot be produced and displayed ahead of time.

They are therefore harder to communicate to prospective customers.

Example – A services of a surgeon cannot be seen, it can only be felt and the

difference in the patient can be noticed when he recovers, hence the doctor

charges a premium for the services offered by him.

INSEPARABILITY:

This characteristic is interpreted differently by different service marketing

marketers, but all interpretations point out that special operation problems exist

for the firm's managers. One interpretation of this term is the inseparability of

customers from the service delivery process. In particular, many services require

the participation of the customer in the production process.

In case of the hospital industry, patient has to present for experiencing the

services being offered. Only then can he be treated. In case if he is not present in

person he would have to communicate with the doctor to get some feedback, the

doctors can work only when there are patients, A Hospital Industry will not work

if there are only patients and no doctors.

VARIABILITY :

The fact that service quality is difficult to control compounds the marketer's task.

Intangibility alone would not be such a problem in customers could be sure that

the services they were to receive would be just like the successful experiences

their neighbors were so pleased with. But in fact, customers know that services

can vary greatly. Even the same service provider has good days and bad days or

may be less focused at different times of day. Services are performances, often

involving the cooperation and skill of several individuals, and are therefore

unlikely to be same every time. This potential variability of service quality raises

the risk faced by the consumer.

In the hospital industry, the services offered by one doctor cannot be indentical

to the services of another doctor as it may vary due to several reasons such as

experience, degree , knowledge etc. Also the services provided by one doctor to

one patient cannot be the same when he operates the same patient again as all

these things are even situational.

PERISHABILITY:

The fourth characteristic distinguishing services from goods is their time

dependence. Services cannot be inventoried, since they are performed in real

time. And time periods during which service delivery capacity sits idle represent

revenue-earning potential that is lost forever. Periods of peak demand cannot be

prepared for in advance by producing and storing services, nor can they be made

up for after the fact. A service opportunity occurs at a point in time, and when it is

gone, it is gone forever. This can present great difficulty in facilities planning

In the hospital industry, the injection used for one Patient cannot be used for the

other patient, there has to be a new set up for the other patient, hence the other

items used by one patient cannot be inventoried by the others.

CLASSIFICATION OF HOSPITALS

There are different types of hospitals established with the motto of offering the

medcare services and educational and training facilities. In a natural way, we find

distinction in their structure, function and performance. The classification is found

based on different criteria as mentioned below.

Classification on the basis of objective

On the basis of the objective, there are three types of hospitals, Teaching-cum-

research for developing medicos and promoting research to improve the quality

of medical aid. General hospitals are for treating general ailments and Special

hospitals for specialized services in one or a few selected areas.

This shows what is the main intention or motive of setting up the hospital

On the basis of the OBJECTIVE there are three types:

Classification of Hospitals on the basis of objective

Teaching cum research

This is for developing and promoting research to improve the medical aid. These

hospitals are affiliated with universities for medical research and the training of

medical personnel. Large teaching/ research hospitals have a variety of goals. In

addition to treating patients, they are training sites for physicians and other

health professionals. Teaching institutions are almost always affiliated with a

medical school, which means patients have access to highly skilled specialists who

teach at the school and are familiar with up-to-the-minute technology.

E.g. Pravara Medical Hospital & College, Pravara is a Teaching-cum-research

hospital.

General

The best-known type of hospital is the general hospital which is set up to deal

with many kinds of disease and injury, and typically has an emergency ward to

deal with immediate threats to health and the capacity to dispatch emergency

medical services. A general hospital is typically the major health care facility in its

region, with large numbers of beds for intensive care and long-term care; and

specialized facilities for surgery, plastic surgery, childbirth, bioassay laboratories,

and so forth. General hospitals minister to all types of illness.

Special

This is for treating specialized ailments or providing specialized services in one or

a few selected areas. Types of specialized hospitals include trauma centers,

children's hospitals, seniors' hospitals, and hospitals for dealing with specific

medical needs such as psychiatric problems. Special hospitals are concerned with

only one disease or group of diseases.

VIMHANS is known for gamma-knife therapy and is a preferred centre for brain

and spinal surgery. Every year this hospital gets 60-70 patients, half of them from

Mauritius with neurological disorders requiring micro-brain surgery.

Classification on the basis of ownership

On the basis of ownership, there are four types of hospitals. This shows who owns

a hospital or in other words who are the owners or have possession of the

hospital. It can be divided in the following ways:

On the basis of the OWNERSHIP , there are four types:

Classification of Hospitals on the basis of ownership

Government

This is owned managed and controlled by government. Government hospitals are

operated and maintained wholly by the national, provincial, city or municipal

government, or other political unit; or by any department, division, board or

agency thereof.

E.g. Nair Hospital and St. George are Government Hospitals.

Semi-Government

This is partially shared by the government. Semi-Government hospitals are

operated and maintained partially by the national, provincial, city or municipal

government, or other political unit; or by any department, division, board or

agency thereof.

Private

Private hospitals are privately owned, established and operated with funds

through donation, principal, investment, or other means, by any individual,

corporation, association, or organization. They are profit-making institutions.

Proprietary hospitals are owned by corporations or, less often, by individuals such

as doctors who practice at the hospital. Hospital corporations usually own a chain

of institutions located in several states, and they often own nursing homes or

other types of health care facilities as well.

Voluntary Agencies

These agencies are the ones that run hospitals. Hospitals run by voluntary

organizations. Many hospitals have hospital volunteer programs where people

(usually students and senior citizens) can volunteer and provide various ancillary

services. A voluntary hospital is a nonprofit community facility operating under

religious or other voluntary auspices. Ultimate responsibility for all that takes

place at the hospital rests with its board of trustees, generally selected from the

community's business and professional people, who serve without pay. To

manage the hospital the trustees appoint a paid administrator.

Classification on the basis of path

On the basis of path of treatment, we find allopath, the system which is promoted

under the English system. This shows the path or trail of treatment. Ayurved is

based on Indian system where herbals are used for preparing the medicine. Like

this we find Unani and others

On the basis of PATH OF TREATMENT , there are:

Classification of Hospitals on the basis of Path of Treatment

Allopath

This term is generally used to describe the conventional approach to medicine or

"Western" medicine. It is the system that is promoted under the English system. It

is the method of treating disease by the use of agents that produce effects

different from those of the disease treated. It’s the system of medical practice

which treats disease by the use of remedies which produce effects different from

those produced by the disease under treatment. A system, which treats a disease

with drugs having opposite effects to existing symptoms, each successive

discovery and development in Allopathy, is the result of extensive research. Each

new remedy has helped alleviate pain and suffering and increased the life span of

people.

Ayurveda

It is based on the Indian system where herbal are used for preparing medicines. It

is India's traditional, natural system of medicine that has been practiced for more

than 5,000 years. Ayurveda provides an integrated approach to preventing and

treating illness through lifestyle interventions and natural therapies. Published

studies have documented reductions in cardiovascular disease risk factors,

including blood pressure, cholesterol, and reaction to stress, in individuals who

practice Ayurvedic methods.

Homeopath

A system of therapy based on the concept that disease can be treated with drugs

(in minute doses) thought capable of producing the same symptoms in healthy

people as the disease itself. According to homeopathy, symptoms are the body's

way of fighting disease. It is a system of alternative medicine that strives to treat

"like with like". Homeopathy rests on the premise of treating sick persons with

therapeutic agents [drugs, remedies] that are deemed to produce similar

symptoms in a healthy individual.

Unani

It is a comprehensive system encompassing virtually all of the known healing

systems of the world. As an alternative medicine, Unani has found favor in Asia

especially India. In India, Unani practitioners can practice as qualified doctors, as

the Indian government approves their practice. Unani medicine is very close to

Ayurveda.

Others

Many hospitals are maintained solely for the treatment of military personnel and

veterans. Some hospitals are placed on special high priority segments of the

public works or utilities infrastructure to ensure continuity of care during a state

of emergency.

Classification on the basis of size

On the basis of size, we find variation in the size of hospitals.

On the basis of the SIZE, there are:

Classification of Hospitals on the basis of size

Teaching

These hospitals have 500 beds and differ according to the tune of students.

District

They have 200 beds which can be raised to 300 beds according to the changing

requirements.

Taluka

These generally have 50 beds that can be raised to 100 depending on the needs.

Primary Health Centers

They consist of beds from the range of 6-10.

SEVEN P’S

PRODUCT

A product is a set of attributes assembled in an identifiable form. The product is

the central component of any marketing mix. The product component of the

marketing mix deals with a variety of issues relating to development, presentation

and management of the product which is to be offered to the market palce. It

covers issues such as service package, core services and peripherals, managing

service offering and developing service offering.

Hospitals today offer the following services:

1. Emergency services

2. Ambulance services

3. Diagnostic services

4. Pharmacy services

5. Casualty services

Emergency Services: Emergency services and care at most hospitals is unique

and advanced. The hospitals have state of the art ambulances. The CCU’s on

wheels under supervision by medical and para-medical staff. There is hi tech

telecommunication available to a patient in an emergency at any given time.

Ambulance Services: Hi Tech ambulances linked by state of the art

telecommunications are fully equipped with doctors that are available to render

medical attention and assistance in case of emergencies at the patient’s doorstep.

Diagnostic Services: Modern hospitals are muti-speciality and muti-

disciplinary, that can handle any kind of ailment, they offer a wide range of

facilities for e.g : orthopaedics, Oncology, Neurology, plastic surgery etc.

Pharmacy Services: Most hospitals also have a pharmacy which is open 24

hrs. It caters to the needs not only of the inpatients and out patients, but also

patients from the other hospitals who require emergency drugs.

Casualty services: Includes a 24 hrs casualty department, which attends to the

accident or emergency cases.

Apart from the above services, hospital also offer “Health diagnosis

programme” which is a comprehensive, complete, periodic health check up

provided for busy executives, professional businessmen.

The health diagnosis programme consists of the following:

1. Master health check up.

2. Executive health check up.

3. Diabetic’s health check up.

PRODUCT LEVELS

Core product:

The core product of the service is the service the customer is really getting or the

reason why the customer wants the service. In the hospitals the core service is the

cure that the customer is expecting. For example, a person who is suffering from

“appendicitis” expects relief from the pain and surgical removal of the appendix.

Every hospital provides a core service.

Basic service:

The basic product is what is necessary to satisfy the core benefit or need. In the

hospital sector, the basic product is the bed that is provided, the various qualified

doctors and the nurses that are there in the hospital to look after the patients. The

basic product in the hospitals sector also includes the advanced equipment required

for diagnosing, operating and curing the patient. This basic service also includes

the ward boys who are required for keeping clean and hygienic conditions that are

necessary for the patients.

Expected service or benefits:

The expected benefits refer to the standard of the services the customer expects.

These are the types of services that the hospitals have to provide, if such services

are not provided then the customer may not opt for the service.

Here the expected benefits are that the beds should be hygienic and the services

provided by the doctors and the nurses should be according to the industry norms.

The hospital premises should also be clean. The equipments should be in proper

working conditions and there should be a pleasing environment for the patients to

rest and get cured quickly.

Augmented benefits or additions:

These refer to the various additions to the services over and above the consumer

expectations. These benefits play an important role in attracting patients to the

hospital. In India most of the hospitals have tried to adapt the marketing strategies

of the western countries. Most of the hospitals provide private air-conditioned

rooms for their patients. A few private hospitals also provide maternity wards

wherein the babies and their mothers are taken care of. The children’s ward is a

special section in which hospitals provide special treatment and care for the

children. They are given toys and various other games to play with.

Some hospitals have nurses and doctors that provide exceptional services that

exceed the customer expectations. They provide the patients with pathology

services, a blood bank, there are also the radiology departments. They also have

pharmacies within the hospital building itself.

PRICE

Price is one of the prominent elements in the marketing mix. Price charged must

be acceptable to target customers and it should co ordinate with other elements

of the marketing mix.

According to Philip Kotler, one should try to “Sell Value, Not Price”. Price is a

major determinant of a buyer’s choice, as a person must have the need,

willingness and ability or financial backing to buy the product. In hospital & health

care sector 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.

Public sector pricing

In the public sector hospitals the subsidies received from the government are

significant sources of income. The public hospitals provide free treatment to

those who hail from the poor sections of the society. These costs are incurred by

the government. The customers who are above the poverty line have to pay

nominal charges to the public hospitals for their treatment. The rest of the

amount is acquired from the respective governments.

Private sector hospitals

The private sector hospitals have a distinctive pricing strategy. They charge low or

no price to the poor people. This depends on the subsidy programs offered by the

government. Some private hospitals charge a very high price as compared to the

cost of the services provided. Most of the private hospitals have extremely good

quality services and this justifies their pricing strategies. Now-a-days there are the

facilities like medi-claim available that help attract customers to the superior and

expensive services.

Private Charity hospital

In private charity hospitals the pricing strategy adopted is different from that of

the public hospitals. What the private charity hospitals do is that they provide

free treatment to the people from the poor strata of the society; they charge a

minimal rate or subsidized rate to the low and middle income groups who can

afford to pay and lastly they charge high fares to those belonging to the upper-

middle class and high class.

PLACE

This is an important element of the marketing mix which is known as place mix,

which focuses on the location of the service factory. It refers to the contact point

between the service provider and the customer.

It is very important to form the place mix properly in case of hospitals because of

the very fact that the customer himself comes to the service factory, also herein

quiet a number of factors and limitations come into play like the cost of the place

and the area required. Certain hospitals require a lot of space for the building and

all the facilities that are necessary for the treatment of the patient; hence they

may have to locate the hospital at a place where there is lot of space available

and at a cheaper.

Some of the essential features which may be taken into consideration are as easy

and convenient accessibility, safety or protection availability of the infrastructural

facilities, attractive and healthy surroundings.

The selection of place is very important in order to avoid the inconveniences to

the users in reaching to the hospital in time. Adequate transport and

communication facilities should be available where the hospitals are located.

Hospitals should be located at easily accessible places i.e. areas which have an

easy access to all modes of transport. Every hospital must provide transport by

way of properly equipped ambulances to deal with emergencies.

The service product is closely linked to its delivery and nature of the delivery

system also has a powerful impact on the patient experience. Example: Tata

memorial hospital specializes in cancer treatment and is located at a center place

unlike other normal hospitals, which you can find all over other places

PROMOTION

Promotion is an element in an organization’s marketing mix that serves to

inform, persuade and/or remind people about an organization’s or

individual’s goods, services, image, ideas, community involvement or

impact on society. Promotion is used in hopes of influencing the recipient’s

feeling, beliefs, or Behaviour through any form of communication.

In Hospital Sector, it is considered to be extremely “UNETHICAL” to

advertise or promote one’s medical services. This is so because, it is not a

good thing to say that you can save someone’s life better than somebody

else. Also it is very bad to say that you are profiteering from people’s

misery.

Hospitals conduct camps in rural areas to give medical check ups at a

reasonable price so that the rural people approach the hospital again in the

future. Hospitals generally advertise in health and fitness magazines.

Promotional Strategies

Word of Mouth

This strategy is considered to be the godfather of promotional strategies in

Hospital sector. A patient who has been successfully treated in a hospital

will always suggest this to another customer. This is also used to create

customer loyalty among potential customers before any actual service has

been rendered to them. This is why most of the hospitals have to be very

efficient in the service delivery.

Periodicals

Several Medical Magazines, newspapers and Journals are printed in order

to create awareness about the hospitals among the general public. This

system is also used by specialists to make a great doctor referral network of

specialists in other fields.

e-Promotions

Websites of several hospitals are coming up as a means of promoting

oneself without breaking the “ethical code”. The websites serve as

information medium to those people who seek treatment for a particular

problem. Also they can be used to provide some tangible evidence about

the facilities.

Mail Campaigns

These can be called as post service techniques used to enhance one’s image

in eye of the patient. In this technique the doctor’s send a review mail

inquiring about the patients’ health and also asks for a feedback regarding

the facilities. This is also being started by the hospitals in order to spread

good word of mouth among potential customers.

Education of Customers

In this system hospitals inform the general public about a particular disease

i.e. they create awareness about a particular disease and inform these

people about all the necessary symptoms of the disease. This serves in

creating customers and a trust among the two as well as this serves as

increasing ones market access, this happens as these people who have

been informed will further spread the word out thus, increasing coverage.

This is termed as “MISSIONARY PROMOTION”.

Referrals

Doctors who operate from clinics, polyclinics give referrals of Hospitals to

get the treatment of their patients done. For the service provided by the

referrer the Hospital gives an acknowledgement in the form of a

commission also called as a referrer fee. This leads to internal promotion of

both the hospital as well as the doctor.

PEOPLE

People refer to both the people inside the organization (employees) as well as

outside the organization (customers). People in Service Sector Marketing

represent both the employees of the company as well as the customers of the

company. However, in case of hospital sector the customer cannot be relied on as

this is an extremely high knowledge driven sector where it is difficult to filter

down the complex information in simpler forms for the customers. The people

have to be trained properly in order to keep the customer satisfied. The

employees have to be trained properly so that they interact well with the

customer. Employee here does not only mean the high level ones but also the

lower level ones. Employees are the Human Face to the service delivery provided

by a service provider.

Clinical Employees

Doctors

Nurses

Medical Assistants

Paramedics: Provide Physiotherapeutic treatment to recovering patients

Pharmacists

Non – Clinical Employees

Ward Boys: Aids to nurses who run errands for them

Cleaners: Sweepers, toiletry maintenance etc…

Laundry Department: Replacing and Washing linens

Sterilizers: Sterilizing Equipment and Facilities

Equipment Handlers: X-Ray Machine Operators etc…

Administrative Staff: Accountants, Cashiers, Bills Collection etc…

Catering & Dietetics: Provide for nutritional needs of the patients

PHYSICAL EVIDENCE

The physical evidence is defined as the environment in which the service is

delivered and where the firm and the customers interact; and any tangible

commodities that facilitate performance or communicate the service. It plays a

role in enhancing customer’s perception of the service quality. The acceptance of

services is communicated through the physical evidence; therefore, it is of great

significance to the service marketers.

How important is the physical evidence of “Wockhardt” or “Lilavati”. In a city like

Mumbai where the income of people is higher as compared to the other parts of

India, one is ready to spend on one’s health and hence the look of a hospital too

would matter.

The environment in which the service is delivered and where the customers and

firm interact, and any tangible components that facilitate performance or

communication of the service.

The physical evidence of services includes all of the tangible representations of the services such as brochures, letterhead, business cards, report formats, signage and equipment. Physical evidence makes a huge impact on the customer. Physical evidence provides customers means of evaluating the service

Elements of Physical Evidence

Often customer evaluates the services on the tangible clues of physical evidence,

before its purchase. The general elements of physical evidence are:

EXTERIOR ELEMENTS OF HOSPITALS

Exterior elements include the outer look of the place of delivery of service. The

exterior gives a formal introduction to the customer as to the kind of service he/

she is to receive. In the case of hospitals, the physical evidence is a very crucial

element as one is seeking medical help relating to one’s health and no one would

take chances in such cases. Hence, exterior as well as interior factors should be

kept in mind.

Some of the exterior factors essential in Hospitals are as follows:

Exteriors Design

Entrance

Signage

Parking

Surrounding Environment

Security

INTERIOR ELEMENTS OF HOSPITALS

In case of hospitals, the interiors play a very vital and important role. If the

hospital is not hygienic, does not look up to the standard as it promises to be and

the equipment used is not of good quality, patients would hesitate coming for any

treatment to such a hospital.

Given below are some interior elements in context of hospitals:

Interior Design

Safety Signs

Rooms

Washrooms

Equipment

OTHER TANGIBLES

Along with the exterior and interior elements in hospitals, other tangibles also help

in putting up a good impression of the hospital in the eyes of the customer.

Sometimes, small elements too may make a big difference. This section refers to

those small elements. The other tangibles are as follows:

Uniforms.

Staff

Equipment

Visiting Card

ATM Centers

Telephone service

Ambulances

Service sector management

PROCESS

Process is a set of activities that take an input, convert it and add value to the

input and finally, create an output. Process has only recently been given much

attention in the service sector although it has been the subject to study in

manufacturing for many years. Blueprints design processes, which sets a standard

for action to take place and to implement the service.

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Joining Phase

The Intensive Consumption Phase

Detachment Phase

Feedback

Service sector management

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 be 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 the patient. Patient’s suggestions are always considered for

improving the hospital services.

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General Process Organization in a Hospital

Within the hospital, if we look at each individual department, we notice that each department serves the needs of another department, for instance, the purchase department serves the need of the stores, the billing department serves of the finance department etc. So in each way, each department is a customer to another department, while at the same time it might be a supplier to another department. Each department is an ‘internal customer’ or the other departments.

Only when each unit of the hospital understands who their customers are and what their needs are, will the hospital develop basis for giving the best service in the most efficient way to the patient.

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Finance Dept Billing

Purchase Dept Stores Doctors

Nurses

Patient ( External customer)

Service sector management

Market Segmentation

Market segmentation is a useful business tool to identify new and expanded ways

to improve services and enhance revenues. This tool identifies unique subsets of

the population to target for specialized services and marketing initiatives.

SEGMENTING

Segmenting variables such as geographic, demographic, Psychographic and

behavioral segmentation helps in knowing consumer wants needs and responses

of various services and products. It is very essential to know which segment would

be right for setting up our hospital as only after studying the diseases and the

people who are diseased or at high risk of getting those diseases form our

segment.

Geographic Segment

It calls for dividing the market into different geographical units such as nations,

states, regions, countries, cities or neighborhood. One can operate in few

geographic areas, or operate in all but pay attention to local variations. It is

advisable to target all sections of people, by and large the entire mass by

delivering varied services to a specific disease.

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Demographic Segment

The market is divided into groups on the basis of variable such as age, family size,

family lifecycle, gender, income, occupation, education, religion, race, generation,

nationality and social class. With these variables of segmentation we get to know

the preferences and the usage rates associated with different consumers

Psychographic Segment:

This segmentation is done as per the lifestyle, personality of the people. Different

people have different lifestyles and different personality, so for them the

expectation of service also differs, so keeping all such points in mind the hospitals

provide services.

People living with very high level of sophisticated lifestyle prefer hospitals which

provide best quality service.

On the other hand people having very simple lifestyle may also go to public

hospital.

Behavioral Segmentation

In this the segmentation is done as per the following variables i.e. knowledge of,

attitude towards, use of, or response to a product or a service. These behavioral

variables – occasions, benefits, user status, user rate, loyalty status, buyer

readiness stage and attitude- are the best starting points for constructing market

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Service sector management

segments. For e.g person having diabetes would go to the hospital after knowing

the facilities that they offer and the care, comfort they provide. This would help in

creating loyal patients and create goodwill for our hospital.

Quality dimensions

Quality refers to the inherent or distinctive characteristics or properties of a

person, object, process or other thing. Such characteristics or properties may set

a person or thing apart from other persons or things, or may denote some degree

of achievement or excellence. When used in relation to people, the term may also

signify a personal character or trait.

For example, hospitals have to decide what quality of food to buy for their

patients. The buying objective here is not profit, because the food is provided to

the patients as part of the total service package. Nor is cost minimization the sole

objective, because poor food will cause patients to complain and hurt the

hospital’s reputation. The hospital purchasing agent has to search for institutional

food vendors whose quality meets or exceeds a certain minimum standard and

whose prices are low. Knowing this, many food vendors set up a separate division

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to respond to the special needs of institutional buyers. Thus, Heinz, for example,

will produce, package, and price its ketchup differently to meet the different

requirements of hospitals, colleges, and prisons.

Quality dimensions by Parasuraman

The quality customer service is the foundation for long run businesses. This

quality dimensions will regulate the business process, solutions and services.

Quality of service is the most important and the most critical component for a

customer. These are five quality dimensions, which can be taken into account for

the assessment of service quality.

BY Parasuraman et al – Parasuraman, Valerie Zeithaml and Leonard Berry

identified five dimensions with which consumers judge services.

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Service sector management

RELIABILITY

It shows the ability of the service provider to perform the promised service

accurately and dependably. It means that the service provider should be able to

identify and provide business solutions to their customers to achieve their goals

and objectives. Reliability assures performing the promise given to the customers

in the most effective and efficient manner.

In the case of hospital industry it is consistently shown to be the most important

determinant of service quality because this is the main reason why the customer

i.e. patient comes to a hospital for his treatment and as soon as he enters in a

hospital, it becomes an implied promise of the management of the particular

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hospital that they will try their level best to treat him properly. A person should

be assured of the acute physical and mental disorders also. So this is the most

vital promise which a hospital gives to its customers and if it is broken then it will

cause a great problem to its customer as well as it affects the reputation of the

hospital but as such there is no hard and fast rule in any of the hospital that a

patient will be cured.

Basically the main service, which a hospital gives, is cure and treatment only and

they shouldn’t compromise a bit in this criteria. Hospitals should hire the best

doctors affordable and available to them in the industry, which can provide the

best of the services. Hospitals should also provide all the other services like the

accommodation, medicines, timely appointments, appropriate diagnosis, and etc.

to their level best to the patients.

ASSURANCE

Assurance is all about trust and confidence. It comes with the brand equity, trust

and loyalty towards consumers. Consumers should be assured about the service

and they should have trust on the brand. This dimension is particularly important

for hospital industry because it involves a high risk and there is a great

uncertainty of the outcomes. Trust and confidence may be embodied in the

person who links the customers directly to the company for example securities

brokers, insurance agents, etc. but in the hospital industry the customer is not

directly linked to the whole organization but with only a part of it in the way of

some particular doctors and attendants.

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Service sector management

So in the early stages customer may use the tangible evidence to assess the

assurance dimension like the degrees, honors, awards, and special certifications in

this type of professional services. So if the hospital is rated 5 star, than the patient

may be assured that at least they are getting treated by the best professionals in

the industry and the probability of they getting cured is high in a critical disease

with such hospital other than low graded hospitals. So here the knowledge, skills,

credentials and reputation of hospital and its employees is of immense

importance to assure the customers about the service.

TANGIBILITY

Tangibility means representing the service physically. It stands for the appearance

of facilities, equipments, personnel and communication material. Making

customers happy with business environment is the motto of service providers. All

of these provide physical representations or images of the service that customers,

particularly new customers, will use to evaluate quality.

Hospital is a type of service in which the customer himself comes to the service

factory hence there is more interaction with the tangible cues. In a hospital the

tangibles are the waiting rooms, examination rooms, surgical and operational

tools, and facilities inside the rooms, modern infrastructure, essential drugs,

equipments for investigations, etc. on which a patient can make out the service

quality of a particular hospital.

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Service sector management

Hospitals should also take good care of their kitchen and canteens. They should

be kept absolutely clean and clear to insure hygiene. This is the main aim for a

hospital to attract more and more customers. As there is no particular tangible

service like in real estate industry or in catering industry in which you can actually

try a product and then can approve it. But in this case a patient can’t just try the

service of the doctors in the hospital so he will have to rely on these type of

tangible goods and the profile of the surgeons and doctors to take a decision to

get admitted in a particular hospital.

EMPATHY

Empathy means the individualized attention and customized service given to the

customers by the organization. Understanding the customer’s needs, goals, and

objectives and providing solutions with good quality and helping them to

overcome their problems. A hospital should acknowledge patient as a person,

should remember his previous problems and should than hear to him with

patience to treat him in the best possible manner. This industry is all about giving

customized service to everyone because every patient has different problems so

he should be treated with a great empathy.

More than the treatment, what a patient wants is care and comfort. A patient

gets distressed when he is alone, when there is no one to hear him and there is

nothing to pass his time on. So staff and doctors should always be friendly and

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Service sector management

there should be a friendly environment in the hospital because it relieves the

mental pressure of the patient and so he can be recovered soon. He should be

given the best of the food and best of the services, which he demands taking care

of his treatment so that he feels good.

A patient is the customer of the hospital but not a regular customer so whatever

he is experiencing and getting will be his perception throughout his lifetime and

this is the only time when a customer can be satisfied and there will be no second

chance. This will also create the word of mouth publicity when he is discharged

from the hospital and he will tell about his experiences to others.

RESPONSIVENESS

Responsiveness reveals the service providers awareness in problem solving with

viable business solutions. It can be defined as the way the service provider

responds to the customers and his willingness to help. The foremost thing is that

the service provider must be accessible to solve the problem whenever it occurs

and there the service provider should see through it that there should be no

waiting after that. Than the service provider should be willing to listen to the

problem and solve it as soon as possible.

Attentiveness and promptness is something on which a hospital should emphasis

on while dealing with them at the time of their treatment, problems and

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Service sector management

complaints. To excel in this dimension the hospital must view the process of

service delivery and handling the requests from the patient’s point of view and

should try to minimize the time taken to respond to the patient problems. Speed

and the promptness are the two main criteria, on which a hospital’s

responsiveness dimension can be evaluated.

In the case of any emergency or critical matter the responsiveness of doctors and

staff are very important so they should be alert for such situations at any time of

the day. So responsiveness of a hospital is communicated to the patient by the

length of time taken to assist them, answer their questions or giving attention to

their problems. Training is the most vital tool given to the employees i.e. doctors

and the staffs to deal with even the worst conditions during emergency and they

should be responsible enough to deal with it then and there.

BY David A. Garvin eight dimensions of quality were identified by Garvin:

1. Performance: every product is supposed to deliver benefits and the

measure of its quality is performance of the offer. A dish scourer, which can

clean plates completely and quickly, would be a performance.

2. Features: these are in addition to the core product, which does not come as

standard ‘features’, like add-ons.

3. Reliability: this is a measure of the degree of probability of the product

delivery what had been promised.

4. Conformance: delivery quality meeting design standards.

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Service sector management

5. Durability: this is a measure of the length of time that a product can deliver

benefits, without deterioration.

6. Serviceability: if the product can be repaired with ease and speed than it is

a measure of quality. It could include the behavioural dimension of service

of personnel like their politeness

7. Aesthetics: this is a measure of the product’s looks, design, touch and feel.

8. Perceived Quality: consumers develop a perception due to company –

controlled stimuli like advertising, publicity and brand promotion, and

social effects like word-of-mouth.

Quality

Some matters which influence perception of quality of service in a hospital are

While making inquiries or giving instruction, nurses and other staff refer to

patients by bed numbers or by the disease he suffered from. It makes a lot

of difference if the patient is identified by his name.

Letting patients know what they are suffering from, what is being done to

them, why particular tests are being conducted, what they can expect in

terms of discomfort, caused by a particular medical procedure, etc. Open

communication is very satisfying.

Letting patient having an option regarding their treatment or continued

hospitalization, because of high costs involved. Hospitals tend to treat

patient like captives or hostages, who cannot escape, and on whom any

treatment, at any cost, can be forced, without their consent.

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Service sector management

Letting accompanying relatives know what is being done to the patient and

about options.

Patients being escorted by someone senior when they have to be taken

else where, for X-rays, Scanning, etc. instead of their being left alone in

corridors on wheel chairs or stretchers, waiting for their turn.

Removing particular serious cases from general ward. Patients get

depressed when they see other patient in acute distress, or in a terminal

condition with a lot of anxious relatives moving around and medical staff

rushing about.

A primary nurse being assigned, as an aid to every patient to take care of

his need throughout his stay in the hospital.

3-room Intraoperative MRI Suite (IMRIS)

This is India's first 3-room intra operative diagnostic and imaging solution where

the patient is never moved. IMRIS brings MRI surgical imaging to patients

undergoing surgery and enables surgeons to leverage the unique ability to

provide better outcomes for their patients. It is the world's most patient-safe

intra-operative imaging solution that allows the surgeon to accurately depict

changes in brain position and anatomy during surgery. IMRIS provides complete

360° surgical access to the patient and can service multiple operating rooms. At

Kokilaben hospital, a 1.5 Tesla ceiling-mounted MRI is stationed in a diagnostic

bay with two adjacent operating rooms on either side.

Orthopedic, ENT and Neuro Navigation Systems

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Service sector management

World over, navigation systems are redefining the way surgeries are performed.

They enable surgeons to achieve greater precision by providing electronic

guidance using computers, infrared cameras and wireless instruments. Surgeons

can effectively make data-driven decisions in the operating room by incorporating

the three technological innovations that provide a data-rich, visual surgical

environment that helps reduce procedure invasiveness, risk and operative times.

Radiation Oncology Linac Suites

The Trilogy stereotactic system is the most advanced, sophisticated machine of its

kind in the world. As the leading image-guided radiotherapy (IGRT) system,

Trilogy marks the beginning of a new generation of cancer care. The versatile

system combines imaging and treatment technologies, and can be used to deliver

the widest range of external beam radiotherapies: 3D conformal radiotherapy,

IMRT, fractionated stereotactic radiation therapy and intensity-modulated

radiosurgery for cancer and neurosurgical treatments. Advanced imaging

capabilities built into the system allow therapists to position patients for

treatment with sub-millimetre accuracy. A respiratory gating system compensates

for any tumour movement that occurs as a patient breathes. The system at

Kokilaben hospital is powerful and can deliver radiotherapy doses at least 60 per

cent faster than conventional accelerators. This shortens the length of time

patients need to spend undergoing treatment. In addition, the radiation beam is

highly precise, allowing clinicians to deliver treatments with unprecedented

accuracy.

Stereotactic Radiosurgery

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Service sector management

The Novalis Tx at Kokilaben hospital is among the world's first whole radiosurgery

systems for indications in the brain, liver, pancreas, prostate and lung. It enables

small, deep-seated tumours to be treated by radiation without open surgery and

offers a versatile combination of advanced technologies for the treatment of

tumours and other anatomical targets. With this platform, the Kokilaben hospital

offers state-of-the-art, non-invasive treatment for a wide range of cancers and

other potentially debilitating conditions, without harming nearby healthy tissue

and without involving traditional surgery.

3 Tesla MRI

Patients today demand the highest quality of care, including a comfortable exam

experience and the assurance that the diagnosis is the most accurate possible.

When you combine 3T with a 70 cm open bore, you give them just that. More

space limits claustrophobic rejections, fewer patients need to be sedated, and

sharper images are captured thanks to less anxiety-related movement. The 3T

system at Kokilaben hospital accommodates patients with special needs and

conditions including spinal deformities, respiratory problems and those with pain

and mobility issues. It also allows us to expand care to a wider range of patients

including obese, paediatric, elderly, ICU patients or those dependent upon

medical equipment. The 3T broadens clinical possibilities with easy access in

interventional MRI and opportunities to perform more functional studies (using

the functional MRI tool).

40-slice PET/CT

India's first, Positron EmissionTomography - Computed Tomography (PET-CT) is a

medical imaging device that combines both a Positron Emission Tomography and

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Service sector management

an x-ray Computed Tomography, so that images acquired from both devices can

be taken sequentially, in the same session, from the patient and combined into a

single superimposed image. PET-CT has revolutionised medical diagnosis by

adding precision of anatomic localisation to functional imaging, which was

previously lacking. For example, in cancers, surgical planning, radiation therapy

and cancer staging have been changing rapidly under the influence of PET-CT.

Dual Source Cardiac CT (DSCT)

The latest revolution in CT is the new Dual Source CT technology that pioneers

new clinical opportunities. Our DSCT is faster than every beating heart, c an

obtain full cardiac detail at half the dose of radiation, serves as a one-stop

diagnosis in emergencies, and goes beyond visualisation with dual energy. Twice

as fast as other cardiac CT scanners and less influenced by irregular heart

rhythms, it eliminates the need for beta-blockers to slow down the heart rate

prior to cardiac scanning. The DSCT at Kokilaben hospital opens the door to a new

world of characterisation, visualising the chemical composition of the human

body. The result: two spiral data sets acquired in a single scan providing diverse

information, which allows us to differentiate, characterise, isolate, and distinguish

the imaged tissue and material composition.

SPECT

Single photon emission computed tomography (SPECT) is a nuclear medicine

imaging technique using gamma rays. SPECT can be used to complement any

imaging study where a true 3D representation is needed, such as tumour,

infection, thyroid or bone imaging. As SPECT permits accurate localisation in 3D

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space, it is used to provide information about localised functioning of internal

organs; for instance, functional cardiac or brain imaging.

CONCLUSION

The nature of surgical operations has changed considerably. Alternate

procedures, without resorting to conventional surgery, are becoming available,

thanks to new technology, using lasers, micro instruments, etc. therefore, there is

little post surgical care. Patients can return home the same day, with verry little

discomfort, and hardly any possibility of complications.

Patients, the world over, are finding it cheaper to arrange for nurses and

equipment at home, because of the heavy cost of hospitalization. Equipments can

be hired. Care provided at home is more comforting.

For these reasons, the occupancy of hospital beds is going down. Similar trends

are expected in India. The data on patients, given earlier, points to the need of

restructuring hospitals, to meet new usage patterns.

Speciality hospitals are being connected to similar hospitals in other parts of the

world, through satellite communication networks. Through data exchanges and

teleconferences, doctors in one place can confer and consult with colleagues

anywhere in the world.

Doctors from one city, visit hospitals in other cities, other countries, for short

durations, to demonstrate their skills, to teach, and to learn.

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Service sector management

A good hospital is a place for learning, if the experience gained in the case of a

patient is properly recorded and stored in a library. Doctors enhance their

knowledge and skills by accessing such records. The quality of both the doctor

and the hospital can be enhanced in this way.

Bibliography

Websites

www.expresshealthcaremgmt.com

www.ficci.com

www.dogpile.com

http://en.wikipedia.org/wiki/Hospital

http://en.wikipedia.org/wiki/Healthcare

http://en.wikipedia.org/wiki/Tertiary_sector_of_the_economy

http://www.economywatch.com/world-industries/services-sector/

http://www.economywatch.com/world-industries/health-care/

http://www.economywatch.com/world-industries/health-care/india.html

http://www.himpub.com/frontend/home.asp?UserId=319903243

Reference Books:

Christopher Lovelock and Jochen Wirtz, Service Marketing, Pearson Education

publication house, Fifth edition

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Service sector management

Zeithmal & Bitner, Services Marketing, 3rd edition

C. Bhattacharjee, Service Sector Management- An Indian perspective, Second Edition.

Arun Kumar, Hospital Mangemnt, Second Edition.

Talluru Sreenivas, Service sector in Indian Economy, 2nd Edition.

Vasanti Venugopal and Raghu V.N, Services Marketing, First Edition

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