How to prepare project report for new hospital

INTRODUCTION TO HEALH CARE Health care means a wide and intensive form of services, which will be related to well being of human beings. Health Care is a social sector. Health Care services are provided at state level with the help of central government. Health care is a wide and intensive industry, which covers Hospitals, Health Insurances, Medical software, Health- equipments and Pharmacy in it.

Major inputs of health care industry The major inputs of health care industries are as listed below: I.

Hospitals

II

Medical insurance

III.

Medical software

IV.

Health equipments

Overview of health care sector in India: 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. The healthcare industry in India expected to grow in size to Rs 270,000 core by 2012. The healthcare industry employs over four million people, which makes it one of the largest service sectors in the economy of our country. Healthcare is dependent on the people served; India’s huge population of a billion people represents a big opportunity. People are spending more on healthcare. The rise in literacy rate; the higher levels of income; and an increased awareness through the deep penetration of media, has constituted to greater attention being paid to health. India has a very low density of doctors. Infant mortality is amongst the highest in India.

SERVICE SECTOR MANAGEMENT

1

Hospitals in India are running at 80-90% occupancy. Major corporations like the Tatas, Apollo Group, Fortis, Max, Wockhardt, Piramal, Duncan, Ispat, Escorts have made significant investments in setting up state-of–the-art private hospitals in cities like Mumbai, New Delhi, Chennai and Hyderabad. Good Healthcare in India is in extreme short supply and it is this gap that Corporate are looking to plug. Most users of healthcare prefer private services to government ones. The private Healthcare segment has grown into a formidable industry estimated to be Rs.8,00,000 crores. Using the latest technical equipment and the services of highly skilled medical personnel these hospitals are in a position to provide a variety of general as well as specialists’ services. “India is well positioned to tap the top end of the $3 trillion global healthcare industry because of the facilities and services it offers, and by leveraging the brand equity of Indian healthcare professionals across the globe”, said Vinod Khanna, Union Minister of State for External Affairs. 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. This would improve the quality of life of our people, leading to greater socioeconomic progress of the country. As medical costs sky rocket in the developed world, countries like India have immense potential for what is called "Medical Tourism", highlighted Harpal Singh, Conference Chairman, in his theme address. “India, with outstanding human resource talent and the setting up of world class medical facilities, was now poised to take leadership in the fast emerging arena of healthcare management which is witnessing the first signs of globalization”.

SERVICE SECTOR MANAGEMENT

2

MARKET ANALYSIS Market Overview India has a fairly comprehensive healthcare system comprising of government and private service providers. However, the system reaches barely fifty percent of the population – mainly on account of general infrastructure bottlenecks. 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. The density of doctors is also low. There are only 43 doctors for a population of 10,000. Size of Market India's healthcare industry is estimated at Rs 1000 billion. Of this, pharmaceuticals account for Rs 200 billion. As per some estimates, Rs 185 billion is spent on healthcare annually. On average, Indian families spend 600 per month on healthcare which is 11% of the household income, showing that they are willing to spend provided the service they get is of high standard. According to The World Health Report 2000, India's health expenditure is 5.2% of its GDP. Public and private health expenditure is 13% and 87% respectively. CII-McKinsey Study A joint study "Healthcare in India: The Road Ahead" done by the Confederation of Indian Industry and McKinsey & Company in 2002 mentions that India has 1.5 beds per 1000 people while China, Brazil & Thailand have an average of 4.3 beds. The study projects that changing demographic and disease profiles and rising treatment costs will result in healthcare spending more than doubling over the next 10 years. Private healthcare will be the largest component of this spending in 2012, rising to Rs 1560 billion from the current level of Rs 690 billion. In addition, public spending could double from Rs 170 billion if the Government reaches its target spending level of 2% of the GDP, up from 0.9% today.

SERVICE SECTOR MANAGEMENT

3

PEST ANALYSIS Political factors Most of the healthy nations are also wealthy nations. In India even after 53 years of independence we all have to accept that government has failed to provide basic healthcare. Healthcare is the neglected field, only meant for slogans by our politicians. To improve healthcare facilities we have to provide special assistance to private healthcare sector. The reality in private healthcare sector is that as an industry it has long gestation period and so most of the bigger projects fail. Government has to give certain concessions to private health sector. It can be in the form of free land for small hospitals at district levels or concession in power tariff. Government later on gets back revenue in the form of tax when these institutions start making profits. Concessions can be limited to first five years or so. Maharashtra government is playing an important role in the development of the hospital sector. Economic factors The Indian healthcare is the next boom in the country after the IT euphoria. Setting up hospitals is not an easy task. 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. In the rural areas one village has only one doctor, who may not be very well qualified. The other governments of other states should take up a cue from the Maharashtra government, in setting up similar Joint ventures all over the state with the assistance of World Bank. The World Bank can make available funds of around Rs 700 crore for state health systems and development projects.

SERVICE SECTOR MANAGEMENT

4

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. This in turn will increase the employment opportunities to many people.

Social Factors 1. 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. 2. Look after the needs of local poor people. 3. Open counseling and relief centers. 4. Teach hygiene, sanitation among the poor masses. 5. Safe disposal of hospitals wastes like used injection needles, waste blood etc. and taking due care of environment. 6. Spreading awareness about various diseases through campaigns and free medical check ups. 7.

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.

Technological Factors We are witnessing Information technologies transforming the way health care shall be delivered. 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 communications, quick distribution and reliable image transfers.

SERVICE SECTOR MANAGEMENT

5

INTRODUCTION TO HOSPITALS Until the early 1980s, Government-run hospitals and those operated by charitable organizations. 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, orthopaedics, 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.

SERVICE SECTOR MANAGEMENT

6

CLASSIFICATION OF HOSPITALS The classification of Hospitals on the basis of objective, ownership, path and size. 1.

On the basis of the OBJECTIVE there are three types:

•

Teaching cum research for developing medicines and promoting research to improve the quality of medical aid.

•

General hospital for treating general ailments.

•

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

2.

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

•

Government hospital, which is owned, managed and controlled by government

•

Semi-government hospital, which is partially shared by the government.

•

Voluntary organisations also run hospitals.

•

Charitable trusts also runs hospitals.

3. On the basis of PATH OF TREATMENT, there are: •

Allopath which is the system promoted under the English system.

•

Ayurved, which is based on the Indian system where herbals are used for preparing medicines.

•

Unani

•

Homeopath

•

Others

SERVICE SECTOR MANAGEMENT

7

4. On the basis of the SIZE, there are: •

Teaching hospitals – generally have 500 beds, which can be adjusted in

tune with number of students. •

District hospital – generally have 200 beds, which can be raised to 300 in

contingencies. •

Taluka hospital – generally have 50 beds that can be raised to 100

depending on the requirement. •

Primary health centres – generally have 6 beds, which can be raised to 10.

SERVICE SECTOR MANAGEMENT

8

I’S OF HOSPITAL INDUSTRY Intangibility Intangibility indicates that the service has no physical attributes and as a result, impossible for customer to taste, hears, feel or smell before they actually use it. Hospital industry is where the customers (patients) get treated for physical problems they have. The customers can’t really realize the service provided until they get well. For this they have to provide good supplementary services.The only way they can provide tangible clues to make the service provided a success. For e.g. the hospitals provide extra facilities like television, or then friendly personnel’s can make a difference. Inconsistency It’s also referred to as heterogeneity or variability. The inconsistency occurs largely because of •

Different service providers perform differently on different occasions.

•

Interaction between customer and provider may vary from customer to customer.

Standardization is hard to maintain. Every doctor is not the same and may not give the same diagnosis. Also a patient may not each diagnosis in a different way. Also since the quality of work done can be determined only after the service is performed the providers have to be well trained in case of performing the service process. Inseparability Inseparability means that the service can not be separated from the creator-seller of the service. Infact there are many services which are created, delivered and consumed simultaneously through interaction between customer and service producers. Here too the customer, i.e. the patient has to come upto the hospital to get the treatment. The customer has to be present when the service is performed. Infact in case of hospitals the service is created and delivered simultaneously. The type of service to be provided depends on the customer.

SERVICE SECTOR MANAGEMENT

9

Inventory Services can not be easily saved, stored or inventoried. This is all due to the perishable nature of the services. Also there’s cost also associated with the carrying of inventory. Here the costs are more subjective and are related to capacity utilisation for e.g. if a doctor is available but there’s no patient during that period, the fixed cost of the idle physicians salary is a high inventory carrying cost. Also due to demand fluctuations the services can not be stored. E.g. there’s a lot of rush at the dentists clinic in December and January as that’s the time when there are lots of tourist visiting India.

SERVICE SECTOR MANAGEMENT

10

INTRODUCTION TO DIABETES

"Diabetes" is a Greek word meaning "a passer through; a siphon". "Mellitus" comes from the Greek word "sweet". Apparently, the Greeks named it thus because the excessive amounts of urine diabetics produce (when blood glucose is too high) attracted flies and bees because of the glucose content. Diabetes is the common term for several metabolic disorders in which the body no longer produces insulin or uses the insulin it produces effectively. In 2004, according to the World Health Organization, more than 150 million people worldwide suffer from diabetes. Its incidence is increasing rapidly, and it is estimated that by the year 2025 this number will double. Diabetes is in the top 5, of the most significant diseases in the developed world, and is gaining in significance. It’s almost hit the world like an epidemic.

What is diabetes? It is a common condition and is characterized by abnormally high blood sugar levels. Diabetes is a number of diseases that involve problems with the hormone insulin. Normally, the pancreas (an organ behind the stomach) releases insulin to help the body store and use the sugar and fat from the food we eat. Diabetes occurs: •

When the pancreas does not produce any insulin, or

•

When the pancreas produces very little insulin, or

•

When the body does not respond appropriately to insulin, a condition called

"insulin resistance."

SERVICE SECTOR MANAGEMENT

11

Diabetes is a lifelong disease. As yet, there is no cure. People with diabetes need to manage their disease to stay healthy. India has currently the world's largest population of diabetics, with an estimated 30 million people suffering from the disease. According to the World Health Organization (WHO), India is expected to encompass 57 million people, ailing from diabetes by 2025 and this would become 80 million in by 2030. Diabetes is characterized by a partial or complete lack of insulin production by the body. the classification of diabetes mellitus include five clinical classes. Type 1, type2, other specific types of diabetes, gestational diabetes, and pre-diabetes. Type1 diabetes is characterized by absolute insulin deficiency. Type2 diabetes which has relative insulin deficiency combined with defects in insulin action account for 95-97% of adult population suffering from the disease. One specific to our country is malnutrition related diabetes mellitus and fibro calcus pancreatic diabetes. Gestational diabetes is described as diabetes related to pregnancy. Pre-diabetes is a tern coined for people who have only fasting high blood sugar and have no other sign and/or symptomsofdiabetes. The persistent rise of blood glucose levels in diabetes can lead to long term complications (if not treated properly) involving important organs like: eyes, kidneys, nerves, heart, blood vessels.

SERVICE SECTOR MANAGEMENT

12

Who is at risk? People who are: •

In children with unexplained weight loss, fever, nausea and vomiting.

•

Obese

•

Aged 40 years above

•

Having family history of diabetes (any body in the family affected by diabetes),

•

who have sedentary lifestyle (not exercising) and

•

Unhealthy dietary habits are at risk of developing diabetes.

•

Women who have suffered from Gestational diabetes (diabetes you have during your pregnancy) or have given birth to a baby who weighs more than 9 pounds may also have increased risk of developing diabetes.

Consequences of Uncontrolled Diabetes: When diabetes isn't well controlled, a number of serious or life-threatening problems may develop, including: •

Retinopathy. This eye problem occurs in 75% to 95% of adults who have had diabetes for more than 15 years. Diabetic retinopathy diabetes is extremely rare before puberty no matter how long they have had the disease. Medical conditions such as good control of sugars, management of hypertension and regulation of blood lipids are important to prevent retinopathy. Fortunately, the vision loss isn't significant in most people with the condition.

•

Kidney damage. About 35% to 45% of people with diabetes develop kidney damage, a condition called nephropathy. The risk for kidney disease increases over time and becomes evident 15 to 25 years after the onset of the disease. This complication carries significant risk of serious illness -- such as kidney failure and heart disease.

SERVICE SECTOR MANAGEMENT

13

•

Poor blood circulation. Damage to nerves and hardening of the arteries leads to decreased sensation and poor blood circulation in the feet. This can lead to increased risk of injury and decreased ability to heal open sores and wounds, which in turn significantly raises the risk of amputation. Damage to nerves may also lead to digestive problems such as nausea, vomiting and diarrhea.

SERVICE SECTOR MANAGEMENT

14

INTRODUCTION TO EMERALD DIABETES HOSPITAL Diabetic Association of India was formed in 1955. The association was formed to educate and disseminate information concerning diabetes to the public, it soon became the apparent that members of the medical profession also need to be educated, trained and upgraded in these fields as per recent innovations due to progress of research and development. To accomplish this goal, the All India Institute Of Diabetes was established under the aegis of the diabetic association of India in 1974. Diabetes as an ailment found new combatants as the institute educated and trained a whole new generation of doctors, nurses and the required medical staff in the field of diabetology. It was then that S.L. Raheja hospital at Mahim was set up as a specialty hospital in diabetes. Now they too have moved on, and have expanded their services for curing ailments such as cancer and have become a multispecialist hospital. It is finally now, EMERALD DIABETES HOSPITAL. It is situated at Worli, with a view facing the sea, a very accessible location, the hospital promises to provide quality diabetic care to patients.

Also helps in prevention of the disease, as it is not curable. It super specializes in juvenile diabetes. Our aim is to specialize in one area and then move on to another. Our services are the core specialties that provide comprehensive and affordable care to patients suffering from various diabetes related ailments. The bed capacity of our hospital is 50 beds, which will be increased in near future. EMERALD will be a renowned name in the field of medicine. At EMERALD we are aware of are social responsibilities, for which we run various health care camps and sessions that educate the general public about common health problems, their prevention and cure. The hospital has been designed as per the norms and the rules laid down by the All India Association Of Hospitals. Also the technology and the equipments are as per SERVICE SECTOR MANAGEMENT

15

international standards. It is started to set a benchmark in quality care, ethical practice, appropriate cost and training for those in the profession.

OUR VISION “To be a leader in health care services”

OUR MISSION “To provide quality care in key specialities, exploiting the full potential of technology, with medical and managerial expertise”

A PIECE OF WORD FROM THE MANAGEMENT “We at EMERALD DIABETES HOSPITAL believe in our motto- let the sweetness remain. For this end we attempt to provide more than just the best possible medical treatment to our patients. Our faith lies in the miraculous power of human touch. In keeping with this faith, our patients are treated with personal care and medical expertise. We strive continuously to invest in technology and healing techniques. Our aim is to combine expertise, state-of-art-equipment and care- to control the spread of diabetes and manage the lives of diabetic individuals”.

Why EMERALD? VALUE STATEMENT •

Offer international standard of quality at reasonable cost.

•

Care with human touch.

•

Maintain a high standard of awareness towards social issues, environment and ecology and contribute towards quality of life of the present as well as the future generations.

•

Maintain mutually beneficial relationships with other agencies involved in healthcare and related areas, both governmental and non-governmental.

SERVICE SECTOR MANAGEMENT

16

•

Support healthcare research.

ORGANIZATIONAL STRUCTURE

MEDICAL DIRECTOR

CONULTANT DIABETOLOGIST

CHIEF EXECUTIVE

ACCOUNTANT

DEVELOPMENT OFFICER DIRECTOR OF NURSING

ADMINISTRATION

CLINICAL NURSE MANAGERS

CATERING

STAFF NURSES

NURSE ASST.

SERVICE SECTOR MANAGEMENT

ESTATES

LAUNDARY

17

MARKET ANALYSIS STP For Our Hospital We have done the STP i.e. Segmenting, Targeting and Positioning to help us carry the research forward; 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. After doing research we decided on setting a specialized Hospital which would target all sections of people, by and large the entire mass by delivering varied services to a specific disease. The location for our hospital is Mumbai having population of around 13343 thousand people. Apart from being one of the most populous city’s it is also a metropolitan and the financial capital of India. In Mumbai there are thousands of people being diseased everyday with hardly any medical centers or Hospitals to treat them. In Mumbai there are lot of people who have Diabetes, some of them don’t even know that they have the disease. 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

SERVICE SECTOR MANAGEMENT

18

different consumers. After doing a research on the following variable sour result showed that Diabetes can be either be inherited or caused due to lifestyle disorders such as wrong eating habits. However Diabetes can happen at any age. Our Hospital would target Section A and Section B people. However people who are from low income groups also form our segment because EMERALD is the only hospital specializing in Diabetes with super specialization in Juvenile Diabetes thereby providing best services required to treat these ailments. Psychographic Segment: As per this segmentation we have divided the patients into categories such as children below 20 who have Juvenile Diabetes and the others who inherit or get Diabetes because of incorrect lifestyles such as wrong eating habits. As told to us by diabetologist at S L Raheja hospital that most people who have greater purchasing power and are relatively rich are the ones who suffer from Diabetes. 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 segments. As per research and analysis any person having diabetes would come to our hospital after knowing the facilities that we offer and the care, comfort we provide. They would slowly develop trust in us. This would help in creating loyal patients and create goodwill for our hospital.

SERVICE SECTOR MANAGEMENT

19

TARGETING The entire population is our target audience because a lot of people already have the disease but don’t know about it and the others can anytime fall prey to the disease. EMERALD in this case, would study the different regions in the city of Mumbai inspect those areas, initially carry on free checkups to do this and draw inferences from those check ups that which people have diabetes and in which area mostly are there diabetic people. These would be the case histories and be helpful in forming our data base. Since EMERALD is a specialty hospital for Diabetes at present its target audience is diabetic people and people who are at high risk. However it has future plans of becoming a multi specialist hospital and then would expand its services. This is called segment by segment invasion.

POSITIONING EMERALD Diabetes Hospital has been set up after proper research and study conducted on different needs of customers and varied groups in the market place. Also specific targeting of those needs and groups are done to understand which services would be superior and entice patients towards our hospital. Being a new hospital it is very important for us to convey our services and offer facilities which would help in generating a favorable word of mouth and thereby creating the much needed trust factor amongst the masses. The end result of our positioning has led to successful creation of a patient focused value proposition and why diabetic people should come to EMERALD.

SERVICE SECTOR MANAGEMENT

20

DIFFERENTIATION •

Juvenile diabetes

•

In house pharmacy

•

Chemist in the hospital premises used by outsiders also

•

Diet food with a sugar free department: health and grocery store accessed by outsiders also.

Differentiation is like oxygen in Todays competitive environment to survive. It is very difficult for an organisation to survive without differentiation. EMERALD specializes in diabetes with super specialization in JUVELINE DIABETES. This will be the first hospital to specialize in JUVELINE diabetes in Mumbai. Thus, we have gone one step further by not only differentiating our service but introducing something for the first time in mumbai. Also the service delivery will be our differentiating factor will be explained further.

SERVICE SECTOR MANAGEMENT

21

OUR VALUE OFFERINGS Specialities Medical speciality • Diabetology (All the below in the connection to diabetes) • Ophthalmology • Dentistry • Gastroenterology • Dermatology • Nephrology • General medicine • Neurology • Paediatrics • Psychiatry • Rheumatology • Gynecology and obstetrics. Surgical speciality •

Ophthalmology

•

E.N.T

•

Pediatric surgery

•

Dental

•

General surgery

•

Orthopedic surgery

•

Urology

•

Nuero-surgery

Health check-ups •

Basic, Executive and Comprehensive packages.

•

Well woman (basic and special packages).

SERVICE SECTOR MANAGEMENT

22

•

Sweet package (Diabetes).

•

Nana-Nani package (senior citizen).

•

Pre-employment package.

FACILITIES/SERVICES OFFERED AT EMERALD… •

Highly qualified doctors and paramedical, friendly nurses and ward boys.

•

I.C.U. and Operation theaters with latest technology.

•

Blood banks.

•

State of art laboratory.

•

Casualty ward. Tie ups with Jaslok and Breach Candy hospital.

•

24hours chemist shop.

•

Availability of stretchers and wheel chairs easily.

•

Lobby on every floor with proper sleeping and sitting facilities.

•

Good infrastructure facilities.

•

Coffee/tea/juice vending machines on every floor.

•

Dieticians and consultation.

•

Library.

•

Prayer room.

•

Phone booth center.

•

Cyber café.

•

Ambulance.

•

6 lifts and 3 exits.

•

Diet store.

•

Cafeteria with clean and hygienic food.

•

Good sanitation conditions.

•

Gift shop.

•

24hours ATM facility.

•

Dust bins at short distances.

SERVICE SECTOR MANAGEMENT

23

•

Signage.

Medical tourism can be broadly defined as provision of ‘cost effective’ private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry - both private and public. THE most recent trend in privatisation of health services is medical tourism, which is gaining prominence in developing countries. Corporate run institutions are seized with the necessity to maximise profits and expand their coverage. In this background, corporate interests in the Medical Care sector are looking for opportunities that go beyond the limited domestic “market” for high cost medical care. This is the genesis of the “medical tourism” industry. The rendering of such services on payment in foreign exchange will be treated as ‘deemed exports’ and will be made eligible for all fiscal incentives extended to export earnings”. . According to a study by McKinsey and the Confederation of Indian Industry, medical tourism in India could become a $1 billion business by 2012. The report predicts that: “By 2012, if medical tourism were to reach 25 per cent of revenues of private upmarket players, up to Rs 10,000 crore will be added to the revenues of these players”.

SERVICE SECTOR MANAGEMENT

24

CHRONOLOGICAL SCHEDULE OF ACTIVITIES A standard schedule of the day is described below. TIME OF DAY

ACTIVITY

05.30 a.m. 06.00 a.m. – 7.00 a.m. 07.30 a.m. –8..30 a.m. 08.30 a.m. – 09.00 a.m. 09.00 a.m. – 10.00 a.m. 10.00 a.m. – 11.00 a.m. 11.00 a.m. – 12.00 p.m. 12.00 p.m. – 01.00 p.m. 01.00 p.m. – 04.00 p.m. 04.00 p.m. – 04.30 p.m. 04.30 p.m. – 05.00 p.m. 05.00 p.m. – 07.00 p.m. 07.00 p.m. – 07.30 p.m. 07.30 p.m. – 08.00 p.m. 08.00 p.m.

Wake Up and cleaning Sponge/bath Breakfast Organizing the patients charts Doctors routine check-up Medication and rest time Visiting hours Lunch time Medication and rest hours Tea/Snacks time Freshing up and Doctors routine check-up Visiting hours Dinner Medication sleep

S.W.O.T ANALYSIS

SERVICE SECTOR MANAGEMENT

25

Strength •

Quality of the doctors, nurse and staff

•

Medical facilities and equipment and infrastructure (room is a/c, phone lines….)

•

Ambience and the general atmosphere of the hospital

•

Attitude of the staff, even the menials (human touch)

•

Specialization

•

Pricing is reasonable.

Weaknesses •

The patients are completely at the mercy of the doctors.

•

Not a general hospital.

•

The Doctor: Patient ratio is low.

Opportunities •

More training to the staff for improving their behavior and medical knowledge

•

To increase the facilities they provide.

•

To become more specialized in various fields.

Threats •

The government is reducing the grants given to hospitals, thus making it impossible to cater to the poor people.

•

Competitions.

•

Unawareness among public.

•

The unions of the menials and even doctors: they can go on a strike, disrupting the functioning of the entire health care unit.

8 P’S OF HOSPITALS SERVICE SECTOR MANAGEMENT

26

PRODUCT Phillip 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.

The product of a hospital can be any of the following: •

Medical Services

•

Medical Training

•

Medical Education

•

Medical Research

AT EMERALD we believe that the ultimate aim is to make available the best possible medical services and to prepare and train the best medics. Thus, it is very essential for our service providers to be aware of the nature, behavior, requirements and status of the users. This helps them in planning and development of the services in the background of users’ changing needs and requirements. The product should be developed keeping in mind the users’ psychology.

THE PRODUCT MIX SERVICE SECTOR MANAGEMENT

27

Levels of service: 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 product:

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.

Level 3. Augmented product: In this, along with the basic and minimum offering, there is something different which enables the product or service to be differentiated from that of the competitors. Hi-tech equipments, good infrastructure, personalized assistance, prayer room, cell charging facilities, gift shop, ambulances, a terrace garden for patients to walk, exercise all form a part of the augmented product.

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. For example, in EMERALD beds are provided for ICU attendants free of charge along with other communication facilities like internet.

SERVICE SECTOR MANAGEMENT

28

SUPPLEMENTARY SERVICES: SERVICE FLOWER 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. At EMERALD, this is done in a number of ways. Information to the general public: The hospital has its own website at www.emerald.com, containing details about the location, services, etc. New customers or patients in general: A ‘patient guide’ is made available in each room. This guide provides various points for the patient’s knowledge and information, right from booking and cancellation procedures, admission rules and procedures, visiting hours, meals, and facilities for relatives and discharge procedures, to procedure for payment of bills. During the patients stay in the hospital: Information regarding services, facilities or various procedures is also provided by the employees as and when the required or on the patient’s request. For example, at the time of discharge, the ward sister gives the patient a summary as to the formalities like processing papers with insurance company etc. Consultation In any hospital, treatment is provided only after a preliminary check-up and/or various tests. Preventive healthcare facilities at EMERALD include a range of sophisticated tests and consultations.. The hospital has 24 hour diagnostic services and state-of-the-art laboratories that help the medical team (doctors and surgeons) diagnose the patient’s problem and suggest treatments.

SERVICE SECTOR MANAGEMENT

29

Order taking In a hospital, this is usually in the form of admitting or registering the patient. The process of admission in any hospital should be simple, easy to understand, fast and accurate. Means of quick registration must also be provided for in the case of emergencies. At EMERALD the registration and necessary formalities are done immediately. 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 EMERALD 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 SECTOR MANAGEMENT

30

Service to relatives: The EMERALD hospital in Mumbai provides 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 hygenic cafeteria, prayer rooms, library, public call booths, coffee machines, a gift shop etc. Safety /Caretaking Safety and hygiene is of utmost importance in any hospital. On the safety front, the EMERALD measures up to the highest international standards, including major/minor operation theaters, keeps a dust free environment, special peat filters for maintaining air quality and highest degree of sterility etc. Bills/Billing Hospitals should ensure that billing and payment procedures are quick so as to enable the patient to return home soon after discharge. At EMERALD, 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 There is a separate business centre for payment of bills. An approximate bill amount is collected as deposit before discharge, which is considered at the time of final bill.

SERVICE SECTOR MANAGEMENT

31

Exceptions These usually occur in the form of emergencies. Hospitals must be well prepared to face any kind of unexpected emergency.

For example, EMERALD has special

procedures for emergency cases. Quality dimensions The rapidly expanding scope of healthcare has led to increasing complexity in its delivery. Patient satisfaction is increasingly taken as an important measure of quality. There is increasing willingness to provide protection against illnesses by way of healthcare insurance. This has made it pertinent that management of quality is done on a wider basis than mere medical audits. Implementing quality system controls the cost by: a. Reducing unnecessary interventions. b. Getting it right first time of repeat surgery. c. Avoidable complications e.g. post-operative infections. d. Imbalances of resources: Lack of theatre time or lack of access to diagnostic facilities leading to increased length of stay. e. Employee turnover and consequent training costs. RATER •

Reliability - Reliability refers to the ability to perform the service promised, dependability and accurately.

•

Assurance - Assurance refers to freedom from danger, risk or doubt. It includes creditability, competence, security and courtesy. EMERALD is high in assurance. The hospital also has a world-class team of doctors and surgeons.

SERVICE SECTOR MANAGEMENT

32

•

Tangibility - Tangibility refers to the appearance of physical facilities, equipment, personnel and communication material.

•

Empathy - This includes access, communication and understanding of the consumers.

•

Responsiveness - EMERALD is also high in responsive i.e. the willingness to help the customer and provide prompt service. It has special procedure in place for emergencies and quick complaint handling procedures. The employee also goes out of their way to help both the patients as well as their relatives.

The main products of hospitals are medical services. In addition to medical care, EMERALD DIABETES HOSPITAL also imparts education, training and research facilities and also educates and train paramedical officers, nurses and other technical staff. With the changes in environmental conditions, the staff at emerald has put in tremendous amount of efforts for acquiring sophisticated equipment and appliances, put in process the state-of–art-technology, aquired various quality certifications and also ventured into strategic tie-ups with renowned research and development companies. Medical Care At EMERALDthe most important functions are to give care to the sick, to render services to the injured and restore the health of diseased persons. We believe in controlling and managing the entire life of a diabetic patient. All the services like line, staff and auxiliary divert a close attention.

SERVICE SECTOR MANAGEMENT

33

LINE SERVICES At EMERALD the line services can further be classified as follows: Emergency Services The casualty services are made available round the clock. This department is specially meant for patients having illnesses of grave nature requiring immediate treatment. It is also meant for injured persons. The casualty department needs to apply more precautions especially in cases of poisoning and accidents. This department takes added responsibility of removing emotional strain, suspense and anxiety of attendants by rendering the best treatment made available to patients. To attend quickly and effectively, we have the necessary set up, co-ordination with other departments, well-defined procedures and work distribution. Casualty Dept Reception & Enquiry Registration Examination Observation Admission

Dressing Discharge

Normal Health

•

Death

Out Patient Services

SERVICE SECTOR MANAGEMENT

34

In our out patient department (OPD) all patients are examined irrespective of the degree of illness, whether minor or serious, acute or chronic. Accordingly the OPD renders diagnostic, curative, preventive and rehabilitative services. The examination or investigation of diseases is the most significant aspect of services rendered by the OPD. •Our OPD is well connected with the X-ray Department, laboratories and other facilitative services. •The doctors, para-medical officers and nurses should be well trained so that customers never feel dissatisfied. Writing prescriptions, dressing and treatment and further admission of patients to in-patient ward need time-honored arrangements. •We have an extensive appointment and scheduling system that reduces the waiting time and offer a comfortable and timely visit to the consultants. •Our panel, consisting of doctors from various specialties, offers consultations on diabetes related problems. •The presence of support services in close proximity reduces time consumption and offers better and quicker services.

SERVICE SECTOR MANAGEMENT

35

In Patient Services After the examination of patients in OPD, the patients are advised admission to inpatient wards, if necessary. The patients are required to make decisions regarding their admission to a particular ward, whether private or general. Each ward has a doctor’s duty room, dressing room, nursing staff station, and other facilities required for patient care.

Intensive Care Unit •

The ICU is considered to be the heart of the hospital. It is for those

patients demanding acute, multidisciplinary and special treatment. •

The staffing pattern of our ICU is planned in a scientific way so that

related patients get proper medical aid without a break or gap. •

Our 10-bedded ICU is equipped with life saving and support systems

handles medical as well as surgical emergencies. •

Round the clock monitoring by nursing staff ensures efficient patient

care. •

There is one nurse per patient; to give the much needed care and

attention.

•

Wards

Centrally air-conditioned wards provide accommodation and services to patients. •

Least expensive are the general wards where there are10 beds.

•

The deluxe ward has 20 beds.

•

The super deluxe wards include a drawing room, a kitchen, a T.V and exclusive facility. We have20beds.

SERVICE SECTOR MANAGEMENT

36

• •

Day Care Service Unit

Our day care services cater to those patients who require a single day stay at our hospital. Uniquely designed unit offers a comprehensive package of services offered globally.

•

Equipped with sophisticated, state-of-the-art technology, it combines care with medical expertise to tender complete treatment.

•

It’s on the same floor of the OT, which helps us to provide both pre-op and postop care in the same department.

•

Artificial kidney dialysis unit

•

Our 24- hour Dialysis unit is a haemodialysis one.

•

Open round the clock, it is extremely feasible for office goers who can make use of this facility and then return to work

•

The unit exploits the expertise of renowned specialist and the advantages of recent technology to formulate a complete treatment plan.

SURGICAL SUITE AND QUALITY CONTROL Operation Theatres AT EMERALD OT comprise of 6 highly sterilized operating rooms, including one septic and one minor operation room. •

The management has made available technologically advanced and sophisticated equipment and appliances to facilitate surgeries such as diabetic foot, general surgeries, Nuerosurgeries, orthopedics, ENT, ophthalmology and non-invasive surgeries.

•

The sterilized environment ensures minimal infection while trained nurse and aseptic techniques assure best care and treatment.

SERVICE SECTOR MANAGEMENT

37

•

Our OT also incorporates digital recording and audio-visual connectivity with the auditorium that assist information sharing with the experts during clinical meetings.

•

Professionals designing it take important factors such as stand-by power arrangements, proper ventilation into consideration.

•

Efficient doctors, paramedical staff and nurses are there in the OT.

•

Our OT has a pre-anesthesia room and a sterilization room. There is a scrub room for nurses and doctors. The OT is in close integration with the blood bank.

•

CSSD

•

CSSD uses autoclave for steel, ETO sterilization to sterilize heat sensitive reusable items and ultrasonic and water disinfector for cleaning and disinfecting used items.

•

This ensures that all surgical and other reusable equipments used in the hospital remain infection free

•

Department process issues and control all professional supplies used by various medical and surgical units of the hospital to ensure our patients safety.

•

Quality Assurance And Infection Control Committee

•

It ensures good quality patient care by reducing hospitals acquired infection.

•

It informs the hospital authorities about communicable/ infectious diseases

•

Holds regular audits and imparts CME to staff members

•

The department is also responsible for internal and external quality control procedures.

DIAGNOSTIC SERVICES •

Laboratory Services

•

Radiology

•

We have multi slice Spiral CT scan

•

Mammography (DMR plus) with stereo tactic

•

X RAY with image intensifier

SERVICE SECTOR MANAGEMENT

38

•

Ultra sonography and color Doppler

•

Per procedural counseling by well known radiologist • •

Laboratory medicine Fully automated laboratory offers services in the fields of bio

chemistry, clinical pathology, hematology, histopathology, immunology and sito genetics. •

Technologies like florescence and Karyotyping ensure instant and

accurate results. • •

Blood Bank Our blood bank is capable of providing whole blood as well as

blood components. •

All prescribed tests are performed before issuing blood to patients

•

Endosonography

Our endoscopy department is one of the only few hospitals in Mumbai that has digital Video Sono Endoscope facilities. The Facility enjoys unmatched expertise and supervision by renowned consultants. REHABILITATIVE AND SUPPORTIVE UNITS • Physiotherapy •

It uses a combination of state – of - the –art equipment and medical expertise to provide our patients with the best possible treatment

Our treatment plan is divided into •

Exercise therapy- That includes Connective Tissue Mobilization Techniques, exercises with different gadgets that aids movement

•

Electrotherapy that includes ultra sound, infrared, wax bath, stimulation, Traction.

SERVICE SECTOR MANAGEMENT

39

•

Diet And Nutrition

•

Our Dieticians and other experts provide individual diet counseling to patients

•

Diet consultation is available for all major and minor ailments like diabetes and other related complications

•

Our cafeteria, open to all, includes an in staff dietician who keeps a check on the nutrition value of the food served

•

They also provides diets for weight gain or weight loss and create awareness about importance of diet •

Nursing

Our nursing services are benchmarked and the best in the industry. The care and the attention provided by our nurses is so comforting that patients feel that they are recuperating at home. •

24 Hour Pharmacy

We have two pharmacies One in-house and one in the premise. Open round the cock our pharmacies offer invaluable services to the IP, OP, and Day Care and Emergency departments. It also ensures that medicines are purchased from authorized sources and thus guarantees the authencity of all medical supplies.

SERVICE SECTOR MANAGEMENT

40

THE STAFF / SUPPORTIVE SERVICES Certain supportive services are important e.g. sterilisation, supply and maintenance of instruments, materials and garments etc. At emerald these are the support services: The catering department comprises the kitchen, bulk food stores and dining rooms and supplies meals in the hospital. Heated trolleys have to be used to transport meals to patients. Pharmaceutical services play an important role. An official laundry provides bacteria free garments and clothes. The patients are provided with disinfected and clean linen. The laboratories are properly manned and proper diagnosis is given by them to enable right medical prescription. The establishment of laboratories should be between the OPD and indoors so that both areas are covered without delay or disruption. Clinical pathology, blood bank and pathological anatomy are important areas to streamline functional management of hospital laboratories. The radiology department should have hi-tech facilities. Currently ultrasound scanning and CAT scanning have been found significant in improving services of the radiology department. A matron who is assisted by a sister-in –charge, manages the Nursing services. The norms accepted by the Indian Nursing Council should be followed. An ideal nurse-patient ratio is 1:5, however at EMERALD we ensure 2:5.

SERVICE SECTOR MANAGEMENT

41

THE AUXILIARY SERVICES Auxiliary services consist of registration and indoor case records, stores management, transportation management, dietary services, engineering and maintenance service etc. At EMERALD these services are maintained properly which govern the successful operation of a particular department. The security arrangements, supplies, transport facilities etc are not ignored. The central stores department issues bulk items. There are different types of stores like pharmacy stores, chemical stores, linen stores, glassware stores, surgical stores etc. For carriage of supplies and patients, trolleys, wheelchairs and stretchers are used. The dietics department plays a vital role as it provides menu to meet the needs of patients. The services of well-qualified and trained dieticians help in providing nutritious diets. The engineering and maintenance services are concerned with hospital building, furniture and other equipment. Awe have a security force to provide protection to the hospital property. Personnel related with defence or police are given preference while appointing the security force.

SERVICE SECTOR MANAGEMENT

42

PRICING In the words of 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. At EMERALD 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. We have experienced doctors and also specialist who come from abroad whose salaries along with those of the skilled nurses and helpers constitute a great part of the cost. Sophistication can’t be possible unless we change our pricing strategies. The main thing in the pricing strategy is to link it with the paying capacity of the users so that all the classes get medical aids without any discrimination. There are 4 types of costing: Free, subsidized, cost based subsidy and cost plus subsidy.

EMERALD follows 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. 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.

SERVICE SECTOR MANAGEMENT

43

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. How should prices be communicated to the target market? Patients must be made aware of the prices of different treatments/ services as well as how, where and when that price is payable. This must be done in an intelligible and unambiguous way. In hospitals, generally, customer’s service representatives give responses to customer queries about pricing, payment and credit. Hospital bills sometimes run to several pages and contain dozens of items. Thus the hospital must ensure that such an itemized bills are accurate and intelligible. At EMERALD, the ‘patient guide’ in each patient’s room provides information with regard to billing and payment procedures. Patients can also contact the billing department for any clarification. For the patient’s convenience, the hospital generates an ‘interim bill’s a bi-weekly basis. This gives the patient an idea about a charge payable for the specified period and avoids confusion at the time of generating final bills.

SERVICE SECTOR MANAGEMENT

44

3. PLACE Place refers to the contact point between the service provider and the customer. Two main issues considered regarding the decision of the place are accessibility and availability of the service to the customer. EMERALD is easily accessible, that is, it is not located in a heavy traffic zone as this would prove detrimental to the very existence of the hospital. Areas around hospital are silent zones i.e. EMERALD is located near Worli sea face and is near a prominent road so that it can be reached easily. Having in house ambulance services to pick up patients on the other hand increases accessibility to EMERALD. We also have contracts with ambulance services to bring our patients from whichever location to the hospital.

4. PROMOTION EMERALD relies on favorable word of mouth and not on aggressive promotion. We conduct camps in rural areas to give medical check ups at reasonable prices; we sponsor visits to old age homes and donate them a good amount of food and medicines. We continuously introduce different health services and we generally advertise in health and fitness magazines and also conduct free check ups. EMERALD holds seminars and conferences relating to Diabetes and latest technology, where we involve the doctors from all around the country, for detailed discussion.

SERVICE SECTOR MANAGEMENT

45

PROMOTIONAL MIX • 1)

Personal communication

Personal selling:

This involves an immediate and interactive relationship between two or more persons. We at EMERALD 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 our marketing executive who personally approaches the corporate or the doctor so as to pitch and finalize the deal. 2)

Customer service and training:

In EMERALD, 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 are 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, we 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 check-up camps and talks. An important way of internal marketing is analyzing feedback from regular customer

SERVICE SECTOR MANAGEMENT

46

satisfaction surveys and improves service delivery so that the way of service delivery itself is the marketing of the service. As mentioned before under service recovery, one way in which EMERALD ensures good customer service is by holding training programs for nurses every 15days, enlighting them about how to handle various patients etc. 3) 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, we also get a lot of promotion by way of word of mouth.

•

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, print media 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 EMERALD, sales promotion takes place usually by way of •

Sign up rebates or discounts

•

Gift premiums, for ex. Doctors are offered various gifts and benefits in return for patient referrals.

•

Instructional materials

SERVICE SECTOR MANAGEMENT

47

Although service personnel plays an important role in educating the customers about the service they may not always be available to help in the locations where or when the customers need them. EMERALD, thus uses traditional approaches like printed materials, ranging from brochers and instruction manuals. As mentioned earlier, EMERALD 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. We also have a patient education service, wherein brochers regarding Diabetes, what the various Diabetes symptoms are, what the various treatments are involved, how diabetes can be avoided by way of healthy eating and exercise etc.Along with this we even have a website with necessary information for the patients.

SERVICE SECTOR MANAGEMENT

48

5.

PEOPLE

Service personnel play an important role in an organization. For satisfying the users, it is only not essential that they are made available the best possible medical aids. In addition to the medical aids, the behavioral aspect is also found impact generating, especially when we consider marketing a customer satisfaction-engineering tool. It is natural that the expectations of all groups can’t be uniform. 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 is trained to provide quality patient care using state of the art technology. The objective of EMERALD is providing quality service to patients and this can be achieved by: 1. Motivating employees to be efficient, dedicated and loyal to the organization. 2. Providing regular on-the-job training of employees to ensure continuous improvement in health care 3. Utilizing services of professionally competent medical consultants. 4. Use of the latest technology. Motivation is not necessarily by giving high salaries. There are many other ways to motivate employees – concessions should be given to the employee’s near ones and there should be active participation of the employees in the activities of the hospital.

SERVICE SECTOR MANAGEMENT

49

6.

PROCESS:

Process is a set of activities that take an input, convert it and add value to the input and finally, create an output. Blueprints design processes, which sets a standard for action to take place and to implement the service. A process is divided into the following phases in a hospital. At EMERALD the patient has to go through the following phases: 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.

SERVICE SECTOR MANAGEMENT

50

7. PHYSICAL EVIDENCE: Physical evidence makes a huge impact on the customer. Physical evidence provides customers means of evaluating the service. Corporate image plays an important role in terms of physical evidence. The physical evidence has a good and favorable influence on the mindsets of the patients and their relatives who visit the hospital. This helps patients to come again to our hospitals and also do favourable publicity by the most effective weapon the “word of mouth”. We have the following aspects which help in enhancing physical evidence there by creating good first impressions. •

The hospital is structured as per the hospital planning decided by the Bombay hospital association.

•

Emerald Hospitals has a good ambience. This ambience plays an important role because when a patient walks into a hospital, he immediately forms an opinion about the hospital.

•

The staff follows a dress code to show professionalism and maintain discipline. The staff is trained to understand; be warm and comforting because the patients that goes to the hospital is usually disturbed or unhappy. •

The hospital is centrally air – conditioned.

•

The signage is put at regular intervals so that people can have easy

accessibility. •

The reception and help desk are on the ground floor, for easy access to

information and other departments. •

Our hospital is well organized and segregated into different departments.

•

The departments are well planned and equipped with the state-of-the-art

technology. •

All the doctors are provided with a well – equipped cabin.

SERVICE SECTOR MANAGEMENT

51

•

Professional hospital interior designers plan the operation theater; also the

blood bank and the intensive care units are on the same floor in proper spacing and alignment of the OT. •

There is wooden flooring in the hospital and in the wards, it is marble

•

Good lighting and ventilation is taken care of.

•

There are different bathrooms for women and men, two on every floor.

•

There are six lifts in total: two for patients, one for doctors only, one for

staff, two for visitors which is used only from 10am -11am in the morning and 4pm to 6pm in the evening. The rest of the times one remains for visitors the other are for the catering department, which has to serve meals. •

The kitchen is extremely hygienic and the food prepared as per required.

Also the kitchen has a glass door so that the process of cooking is visible. The cooks are well trained and use sterilized crockery. Also they have were gloves, masks, lab coats and no footwear allowed. •

Water coolers are placed at regular intervals having hot and cold drinking

water facility. •

There phone booths in the visiting lounge.

•

There are two cyber cafes: one for the doctors and staff and one for

visitors in the visiting lounge. •

Special care is taken to maintain hygiene; cleanliness and the whole

hospital is well – lit. This is generally taken care of by the housekeeping department. •

Keeping the hospital clean and dirt free is every ones responsibility and

because of which the dustbins are kept at regular intervals. •

The hospital is kept odor free by spraying air fresheners and

neutralizers. •

Our hospital has kept in mind both the aspects of physical evidence that is

essential and peripheral evidence. Physical evidence plays an important role in a hospital where the patients are already depressed or traumatized and a good atmosphere could make all the difference.

SERVICE SECTOR MANAGEMENT

52

Every aspect of our hospitals has to meet the hygiene and cleanliness standards set by the board. We ensure care, convenience and comfort at all times.

8. PRODUCTIVITY AND QUALITY: Productivity in services is how we transform the inputs into outputs, which are valued by the customer. Quality is the degree to which the service satisfies a customer by meeting their wants and expectations.

INNOVATION Hospitals will soon go hi-tech, not so much in terms of sophisticated medical equipment, but in that a patient’s kith and kin can virtually visit him/her from any part of the world and the patient too can communicate with them and relieve their undue anxiety. Bangalore has emerged as a pioneer in the design of an interactive website used in making virtual visits to hospitals, thus introducing a human element hitherto, unthought of. This breakthrough in the usage of information technology for patients was achieved by the Bangalore based ‘Think Ahead Incorporated’, in designing he website for a hospital. The primary advantage of this technology is the mitigation of undue anxiety of relatives particularly, sons and daughters, children of patients who are settled abroad – who cannot be at the bedside of the patient undergoing treatment for a heart ailment or a major surgery. The ‘Virtual Family Visit’ allows relatives to see real time images of patients through audio – visual files which can be downloaded on their computer by entering the hospital website through the Internet. These files of the patient are shot by the hospital using a webcam to show the convalescing patient and his message for his family members. The files are then uploaded in the hospital website. The family members can also communicate with the patient by way of sending online get well card to patients.

SERVICE SECTOR MANAGEMENT

53

Besides, they can also get reports of the patient’ condition from the doctor in-charge, if the relatives so desire. Wockhardt Hospital, where the virtual family visit is in use, the relatives are physically able to see their near and dear ones recuperating from the treatment which avoid emotional trauma. This facility in hospitals is particularly useful when a relative is unable to rush to the hospital to be physically present due to various reasons. Besides, the patient himself is to be on the road to faster recovery when he communicates with his loved ones.

SERVICE SECTOR MANAGEMENT

54

THE SERVICE MARKETING TRIANGLE – BY GRONROSS Company –EMERALD DIABETES HOSPITAL CENTER

Internal Marketing Enabling the Promises

Employees – doctors, nurses, etc.

External Marketing Making the Promises

Customers - Patients

Interactive Marketing Keeping the Promises

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 •

The company here is the hospital which dreams up the idea of a service offering by way of treatment, which will satisfy the customers i.e. patient’s expectations of getting cured.

•

The patient who seeks to get cured is the customer for the hospital as he is the one who avails of the service and pays for it.

SERVICE SECTOR MANAGEMENT

55

•

The employees comprise of all the people who are involved in providing the service, namely doctors, nurses, technicians, attendants, administrative personnel etc.

From the triangle we see that three kinds of marketing activities take place in a hospital. EXTERNAL MARKETING The hospital undertakes external marketing as to promote the service i.e. treatments and facilities to the patients. This has been explained in detail under the promotion mix and the hospital marketing.

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. 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.

SERVICE SECTOR MANAGEMENT

56

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 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. 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

INTERNAL MARKETING AT EMERALD •

Continuous medical education programs are held periodically so as to make doctors aware of how new/rare diseases, latest technology etc.

•

Training programmes are held every fifteen days for nurses who come into most direst and frequent contact with patients, so as to educate them on how to handle various temperaments/patients.

•

They also collect feedback from customers which will help them continuously in improving the service delivery.

SERVICE SECTOR MANAGEMENT

57

CRITICAL INCIDENTS Here, critical incidents are the period prior and during the procedure, discharge and billing. During and prior the procedure, the relatives of the patients are likely to be most vulnerable. That is, they are worried about the well-being of the patient and as a result are likely to be less tolerant of mishaps. EMERALD handles this by ensuring that the relatives receive a host of conveniences at the time. For instance, •

A counselor gives frequent updates to relatives during the procedure. In the case of ICU patients, the counselor also arranges meetings between the ICU doctor and the relatives once a day.

•

Relatives are provided with comfortable cubicles with communication facilities in the waiting lounge.

•

Prayer rooms are also provided for the relatives. This is where they can pray while the patient is in surgery or ICU.

•

Sometimes there may be more than one consent form for a procedure. This may prove a complication that the patient/relatives don’t need at the time. Thus, the hospital ensures that the patient’s consultant or his assistant explain the details of the procedure to the patient/relatives.

All measures are also taken by the hospital to ensure that the patient receives the best care, a number of formalities have to be completed by the patient at the time of discharge. As this may prove confusing to the patients, the ward sister gives the patient a discharge summary at the time of discharge. After the procedure and recovery the patients are usually eager to get home. Therefore, they will not appreciate lengthy or complicated billing procedures. The hospital has a separate business centre for the efficient and quick processing and payment of bills. So as SERVICE SECTOR MANAGEMENT

58

to avoid any inconvenience to the patient, the final refund is made by cheque, and sent to the patient by courier

COMPLAINT MANAGEMENT/SERVICE RECOVERY 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. •

EMERALD has a distinct Customer Care department. It is the duty of this department to sort out problems associated with customer satisfaction, complaints etc.

•

The department takes a round of the hospital everyday between 9-12 every morning, collecting feedback and checking on the service that the patients and visitors receive.

•

Feedback forms are provided by the ward sister to the patient at the time of discharge. The patient is asked to fill it and put it in the suggestion boxes before leaving. The patient is assured of his/her identity being kept secret from the hospital staff.

•

Suggestion boxes are placed at the nurse’s station in each wing.

•

The department acts any problems discovered on. For example, if a patient complains that a particular doctor doesn’t arrive on time etc., the doctor is made aware of the situation/ discomfort caused due to his late arrival and asked to correct his behavior.

•

In the event that the patient leaves the hospital with a bad impression, a letter is seen to the patient, apologizing for the inconvenience and an assurance that it will be looked into and prevented from happening again.

The use of web technology for virtual hospital visit is said to be the first of its kind in the world. The claim may be true considering that family bonds in the country are very strong and even extends to close relatives. It may also be one of the reasons why such a facility had not been thought of in other parts of the world. Besides, scaled – down joint

SERVICE SECTOR MANAGEMENT

59

families are still prevalent where this technology would come in handy. The success of this facility is revealed by the fact that there were as many as 8,000 hits within two months after its introduction.

MEDIA PLAN All media promotions will begin six months before the commencement of the hospital in order to create some awareness before be become completely functional. The Ad spend will be maximum in the first year, as this will be when we are creating awareness about diabetes and also building a name in society among our target audience. Our plan will consist of the following activities along the various lines,

Personal Selling: It involves sending personnel out to schools, pharmacist, doctors and other hospitals etc. to talk to prospective customers (patients), especially parents of these children. So that nobody is ignorant about the seriousness of the disease. We will also have walk in seminars to achieve the same end.

Public Relation: Direct contact program: •

Nurse’s day celebration on 12th may every year.

•

Children’s day celebration on 14th November every year.

• Celebration of Independence and Republic day in order to shape the young minds as they will be molding the future. Education/Awareness: • Magazines newsletter where children will share their experience. • Sponsorship incase of school sports day. • Pharmacist and doctors.

SERVICE SECTOR MANAGEMENT

60

Corporate Social Responsibility: • Free check-ups done at school and other places. • Diabetic week • Beautification of the surrounding • Out reach camps incase of epidemics, communicable diseases • Provide medicines to orphanages and old age homes. Internal assessment: • Seminars held on a monthly basis for doctors in the auditorium. • Get together and informal meetings for staff. • Continuous training provided to staff on different issues such as behavior, personality, etc. • CMEs (continuous Medical educational Programmes) • Committees for grievances and accepting constructive criticism. . Advertising: Television commercial media plan Channels

Program

Days Mon, Tue, Wed, Thur

Star plus

Kaun Banega Crorepati 2 Kyunki saas bhi kabhi bahu thi Kasautii zindagii kay

Sony

C.I.D.

Aaj Tak

News around the clock

CNBC

Health and Fitness

History

Biography

Star world

Opra Winfrey Show

Zee Café

Full House

SERVICE SECTOR MANAGEMENT

1 1

Total Fri, Sat,Sun 11 1 1

1 1 1

1

1 1 1 1 1

#### 3

Budget (Rs.) week 39,00,000

2 2

17,00,000 12,00,000

1

12,00,000

2

39,000

1

12,000

1

9,000

1

25,000

1

5,000

61

Total

2

2

2

2

2

2

2

14

80,90,000

The total budget for the TVC for the week is Rs. 80,90,000 and hence for the month Rs. 32,360,000 and the difference in the rate is due to the various categories.

News paper media plan Name Of The Paper Times of India + Wellness Hindu Economic Times Dainik Bhaskar(Regional paper) Gujrat Samachar(Regional paper) TOTAL

No. Of times in a week 3 2 3 2 1 11

Weekly Budget (Rs.) 6,00,000 1,00,000 3,00,000 2,50,000 50,000 13,00,000

Magazine: Name of the magazine Health and Nutrition Health Screen Reader’s Digest India Today TOTAL

Weekly Budget 67,500 55,000 2,50,000 4,00,000 7,72,500

The print budget for the month is Rs.82,90,000

Outdoor: Place Worli Mahim (Bombay Scottish) Juhu ( Maneckji cooper school) Bandra ( A.V.M. school) TOTAL

SERVICE SECTOR MANAGEMENT

Weekly Budget 3,50,000 1,00,000 1,00,000 3,00,000 8,50,000

62

The monthly budget for outdoor advertisements is 34, 00,000

Direct Marketing: As for direct marketing, we will be sending out brochures/pamphlets on a selective basis to doctors, hospitals and schools. They can even visit our website for the same. We also have customer service departments, which will be entertaining all the calls and queries of the customers.

SERVICE SECTOR MANAGEMENT

63

THE ROAD AHEAD… It is very important to have a clear cut vision of what the organization wants to achieve in the following years as competition gets intense and delighting customers gets difficult. Hence we at EDH have set a benchmark for ourselves regarding the future perspective and we will achieve this within five years from now. The list on our agenda includes: •

We plan to open a medical institution (diabetes education) in our campus which would help the young minds get first hand information with practical exposure.

•

We would have our own Research and Development facilities.

•

Continuous improvement in Human Resource.

•

We plan to expand ourselves into a multi-specialized hospital.

•

Open branches in metropolitans.

•

Emerging as one of the main market players in the field of health care.

•

Finding new ways to delight our patients and help them to stay fit for a better tomorrow.

•

Air ambulance facility will be provided in near future.

•

‘The diet store’ which is one of a kind now, will have franchising given to different places and cities.

SERVICE SECTOR MANAGEMENT

64

AIR AMBULANCE CONCEPT Transfer from military evacuation to today’s sophisticated EMS (Emergency Medical Services) programs for all concerned did not occur overnight. Australia, a land of vast distances and scattered population, probably deserves the credit for being the leader in integrating the airplane into the health care delivery system. “Get the patient to the best medical care available as rapidly and as safely as possible, a rewarding goal with proven medicalbenefits.” In India this service was only available in the military, but none in civil due to lack of finances and non-availability of suitable aircrafts. With the onset of liberalisation in our country during the early years of the last decade, it became possible to commence a dedicated Air Ambulance Service, leading to reduced morbidity and mortality during evacuation. An air ambulance is specifically designed to accommodate the aero medical needs of person’s who are ill, wounded, injured or otherwise mentally or physically incapacitated or helpless, who may require emergency medical care in-flight, and who, in a physician’s opinion, cannot be safely transported on a standard commercial flight.

SERVICE SECTOR MANAGEMENT

65

BIBILOGRAPHY 1) S. L. Raheja Hospital

Name of fellow

A) Books Philip kotler……..Marketing Management Christopher Lovelock…….Service sector Management Understanding diabetes (Simple guide for patients)….Anil Kapur, Kamla Kapur B) Magazines / Brochures Health screen….. Volume 2, No.7, July 2005 (diabetes clinical management ……cover story pg 10 – 17) Granosinithline ( nd, sheetal booklet) S. L. Raheja pampletes Healthcare Websites C) websites

D)Nespaper Bombay times…….30th August , 2005 Mumbai Mirror ……29th August, 2005 SERVICE SECTOR MANAGEMENT

66