Chapter 1 Executive Summary: With the growth of Indian markets and the reduction in the government duties on the

business of the firms, there is a lot of opportunity and competition in the Indian market. To be successful in the present market scenario and have an edge over the existing competition, the healthcare service providers (hospitals) need to adopt a market based learning approach where they can assess their marketing principles and techniques in accordance to the needs to the customers. With so much competition and so much growth opportunities, the customer relationship marketing principles become all the more important. This research has been carried out with the view of critically analyzing the relationship marketing techniques used by Kokilaben DhirubhaiAmbani Hospital in Andheri, Mumbai. The researcher has also taken into account the competition that exists for Kokilaben DhirubhaiAmbani Hospital in Mumbai and how it is able to sustain because of its relationship marketing strategies. The conclusion has been formed on the basis of the analysis of the data collected in the form of filled questionnaires. The researcher has concluded through the research that most of the customers at Kokilaben DhirubhaiAmbani hospital are satisfied with the services provided at the hospital and the researcher also concluded that the hospital has sound relationship marketing techniques in place with a few areas of improvements which have been suggested by the researcher in the latter part of the research.

The whole research has been segmented into different sections. They are as follows: INTRODUCTION: This section of the research is the most basic part of the research. Here the research will give a brief summary what the research is all about. The researcher will discuss the topic of her research and will also discuss why this particular topic was chosen. The researcher will also give a brief idea about the organization on which the research has been conducted and will put forward the aims and objectives of the research. This researcher will also justify the purpose of the research and also highlight some of the limitations that can exist in the research. LITERATURE REVIEW: In this section, the researcher will apply all the theories and practices that are related to the research. The researcher will discuss the different theories and processes mentioned by various scholars and professionals which relate to this research. In this research, the literature review first begins with a brief introduction on what is relationship marketing and what is healthcare industry. The researcher specifically describes the healthcare industry in India as the organization of the research is based in India. The researcher describes various trends in the Indian healthcare market and how relationship marketing play a role in the healthcare industry. The researcher also discusses all the different tools and techniques that have been employed in relationship marketing in healthcare industry. The researcher has also discussed the 7 Ps of marketing applicable to the hospitals which is a part of healthcare industry. The researcher also
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discusses how relationship marketing has an impact on the business of hospitals and also discussed what lies in the near future when it comes to relationship marketing in the hospitals. RESEARCH METHODOLOGY: In this section of the research, the researcher has discusses various methods that can be used to collect and analyse data. The researcher has discussed the qualitative research and the quantitative research and has also discussed which research method has been used for this research. The researcher has also discussed about the primary and the secondary data and the methods used for the collection and the analysis of the data. FINDINGS: In this section of the research, the researcher has discussed the data collected. The researcher has put together all the data collected from the sources and made a comprehensive analysis. The data has been collected in the form of questionnaire. DISCUSSIONS: After going through all the data and analysing it, the researcher generates some figures. Based on the figures, the researcher has discussed the findings from the data. CONCLUSIONS: Once the data has been analysed, the researcher has made conclusions based on the returned questionnaires and the data collected from them. The conclusions are based on this research only.
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 RECOMMENDATIONS AND JUSTIFICATIONS: After the conclusions are derived, the researcher makes a few suggestions to the chosen organization on how better results can be achieved in the future. Looking at the data from the returned questionnaires, the researcher has a general idea of the working of the organization and what the customers expect out of the firm. Based on these things, the researcher has suggested a few changes in the working of the organization.

Chapter 2 Introduction: 2.1 A brief Introduction The healthcare industry in India has been the topic of discussion for many of the management scholars in the recent years. The topic has been in the limelight as healthcare industry in India has been developing by leaps and bounds and reaching new heights (Namazi). In 2011 Dr. Prathap C. Reddy, Apollo Hospitals group founder-chairman mentioned in Bangalore that the entire industry will grow speedily as there will be more life expectancy, greater incomes, better health facilities, diseases which will relate to advanced lifestyle will be more prevalent. As a matter of fact, it is already a million-dollar industry that is presently going through a speedy expansion phase with 12 percent CGPA (cumulative growth per annum) since 2008 (Namazi). By 2020, the sector will accumulate Rs.1.3 trillion (Rs.12,60,000 crore) in revenues. With so much of growth opportunities in this sector, the business practices are also changing. New marketing principles are being followed by the business in all the sectors. In the present market, satisfaction of customers has become
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the key objective of many firms. Even the hospitals and the healthcare sectors are feeling the pressure to cope with the strong competition specially those which are private. In a country with enormous population and geography, it becomes even more difficult to serve all with satisfactory results. As a result of this, different sectors are trying to focus on a particular segment of customers. Private firms like private hospitals specially target the customers who fall in the higher income category of customers from both domestic and international markets. The government is under constant pressure and it advices the private sectors to improve the quality and the efficiency. Thus new opportunities and threats will be created in the market in front of the relaxing market players. There is a vast middle class and upper middle class in the Indian society. The private insurance companies have also played a key role in the growth of healthcare industry. All these factors have increased the demand for better customer satisfaction techniques and assessing the ways of providing customer satisfaction. 2.2 Kokilabem Dhirubhai Ambani Hospital: Kokilaben DhirubhaiAmbani Hospital is one of the few hospitals chains across India which has a very good brand reputation and brand image. Kokilaben DhirubhaiHospital in Mumbai has emerged as one of the best healthcare institutes to provide healthcare services to the customers. The hospital believes in the best treatment and services to all its customer who look to seek treatment from the hospital. The hospital practices a good and effective way of delivering high quality services to its patients and also providing high quality training to its staff to create and maintain a good brand image. The hospital is equipped with the modern technology and a high quality staff to live up to the expectations and the demands of the customers. The primary focus of the
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hospital is to provide the best healthcare services to the customers and also in a way similar to the Indian culture. Kokilaben DhirubhaiAmbani hospital also has seminars and conducts camps to create awareness about the healthcare issues and also discuss preventive measures relating to certain diseases. This hospital is based in Andheri Mumbai where a vast population is of rich and higher middle class and it is equipped with all the latest technologies. The hospital provides diagnostic services enable accurate and quick diagnosis to give treatment with high quality by the doctors of Kokilaben DhirubhaiAmbani hospitals. It is equipped with the modern functional facilities twenty four hours to everybody entailing T.M.T, Cath Lab, X-Ray, Ultrasound, CT Scan, MRL, PFT, ECG, Laboratory and other operation theatres. It has an advantage of being located centrally as well as easily accessible to each and everyone. It offers round the clock emergency care through specialized doctors with their particular proficiency entailing trauma care (Kokilaben DhirubhaiAmbani, 2011). 2.3 Relationship Marketing in Kokilaben DhirubhaiAmbani Hospital Kokilaben DhirubhaiAmbani Hospital practices good relationship marketing techniques specifically to increase the customer satisfaction. As the customers have become more knowledgeable about the options available in the market and also the choosy nature of the customers, Kokilaben DhirubhaiAmabani Hospital has realised that relationship marketing has become even more important to increase the customer satisfaction, customer loyalty and increase the reputation of the brand. The relationship marketing of Kokilaben Dhirubhi Ambani Hopital is mainly based on the following aspects :

Patients: Since there is so much information available online as well as through the media, the customers have become more informed about the healthcare trends and the healthcare market. Kokilaben DhirubhaiAmbani Hospital has a very informative and interactive website in place which offers the customers bundles of information. The hospital takes utmost care to provide the best services to the patients and maximize customer satisfaction. Physician Benefits: With the help of data offered by HSMD (Healthcare Strategy and Market Development) of hospitals like Kokilaben DhirubhaiAmbani Hospitals, it is found out that private hospitals like Kokilben Dhirbhai Ambani Hospital benefit a lot with a good relationship with the physicians. Many patients are referred by the physicians to such hospitals to avail complicated treatments. 2.3 Need of present study :Hence taking into account the competition and growth opportunities in the healthcare industry in India, the research was carried out keeping in mind the marketing strategies used by the hospitals, which enables them hold an edge in the existing competition. There have been numerous studies being conducted on hospitals. However it is very important to know how the hospitals can maximize profitability as the profitability seems to be the main objective of the firms in the present market. If the factors leading to maximum profitability are identified, the staff of the hospital can channelize the energy on the factors that increase profitability and the management can work on the policies and procedures with the purpose of increasing profitability as well. Relationship marketing is one of the most important factors in increasing profitability. Hence relationship marketing in the hospitals has become an
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important feature these days as it increase the customer loyalty and customer retention. It appears that the profitability does not depend much upon the market trends and current scenarios in the markets, but it depends more upon the marketing techniques used by the hospitals and also the policies and procedures followed by the hospitals (Gapenski, 2004).

2.4 Aims and Objectives:The aim of the research is to study and assess critically the role of relationship marketing in healthcare industry. The research has been carried out on Kokilaben DhirubhaiAmbani Hospital in Andheri, Mumbai. The objectives of the research are as follows: -To assess critically the research in accordance to relationship marketing. -To critically evaluate the significance of relationship marketing in healthcare industry. -To critically assess the relationship marketing strategies employed by Kokilaben DhirubhaiAmbani Hospital in Andheri, Mumbai. -To offer suggestions for further improvements in the relationship marketing strategies adopted by the hospital.

2.5 Limitations of the research:

This research is non-experimental survey that studies the hypotheses relating to the influence of relationship marketing in healthcare industry. The opinions
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and views of a particular segment of customers have been taken into consideration and the general conclusions have been drawn. The opinions and views have been largely influenced by the local culture and practices. The researcher found it difficult to find suitable references for the research. The researcher found it difficult to collect the data with the limited time in hand. The research was carried out on a hospital which is a part of healthcare industry and hence the findings and conclusions may not necessary apply to the entire healthcare industry in general. Chapter 3 Literature Review: 3.1 Introduction:In the recent years, many management scholars and philosophers like Peter Ducker were of the opinion that the main objective of the business is to satisfy the customers. They believed that it is not the profit but the reward is the objective of running a successful business (S.Shajahan, 2004). This belief was formed under the basis that a satisfied customer will be willing to buy products and services from the organization if the customer feels that he is getting true value from the products or services. The value will be formed for the shareholder as profit, when the customer pays the organization a price which is more than the cost that the organization had to bear to deliver the entire product or service. Hence the value is created in the market if the customers feel that they get best value. Before the marketing concept was developed, the main purpose of marketing was to increase the sales volume. Profitability was not the major priority then as it was believed that more sales can result into increased profitability. In the current times, the marketing concept is completely different from what it used
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to be. Customers are now very aware of the products they are buying and the cost they are spending to buy a product or service. The customers will only buy products or services from the organizations they can trust upon. This is where relationship marketing comes into play. Relationship marketing can be defined as the marketing techniques that are directed towards developing and maintaining trust and long term relationships with the consumers (http://www.businessdictionary.com). The fact that relationship marketing has a vital role to play in healthcare industry has been globally accepted(Cassidy 1993). 3.2 Relationship Marketing- The concept:Relationship marketing is the business discipline that is focused on increasing the business efficiency by building trust and long term relationship with the customers (Philip Kotler, 2008). Various researchers and scholars have tried to define and explain the philosophy that surrounds relationship marketing. Although there is no universal definition of the term relationship marketing, there have been attempts made to understand relationship marketing the business context. (Grnroos, 1994) has termed relationship marketing as marketing to create, maintain and increase and commercialise customer relationship in order to achieve the firms objectives. He mentions that apart from commercial interest, the stakeholders look at the mutual benefits in such relations. According to Shani and Sujana (Shani, 1992) , relationship marketing is an integrated effort to identify, maintain, and build up a channel with each stakeholder and endlessly create enhance the strength of the channel for the mutual gain of both the sides, through communication, personalised and value-added contacts over an extended period of time. They believe that by
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creating a long term relationship with the customers, an added value is offered to the customers in the products or services which they buy. (Gummesson, 1996) defines relationship marketing as relationships, channels and communications. He points out that the relationship can be strengthened through the channels that can be developed by the firm. (Morgan, 1994) defines relationship marketing as those exercises which are meant to establish, develop and maintain successful relational exchanges. They try to point out the essentialities of trust, mutual co-operation and shared values in maintaining a successful relationship. 3.3 The healthcare market:In layman terms, marketing is concerned with the identification of the needs of the customers and the creation or the implementations of programs and services that are made to satisfy those needs of the customers. The role of the marketer is to analyse the demographics and other related information and data and then find out the specific products and services that the customers are looking for. The marketer will then formulate the services and the products that can satisfy the consumers needs. The marketing process in the healthcare industry is very complicated due to the wide range of divergence of the consumers in healthcare services like patient, the employer, the staff, the physician and to satisfy the personal needs of each of these stakeholders. Despite the fact that the healthcare industry has been considered as an imperfect market, marketing has developed as an inevitable feature in the present healthcare industry. The firms in the healthcare industry like hospitals spend a lot of money in marketing and there

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is a constant in the marketing techniques followed with the continuously changing healthcare market (Kumar, 2003). In the present times, the healthcare market is not just about advertising, but it has now become a more relationship building process. Relationship marketing has become even more important in the private hospitals in India as there have been a lot of discussions and findings about the hospitals trying to fool or cheat the consumers by charging enormous amount of money and indulging in false practices. The media in India has become very active in highlighting such practices of the hospitals and this hampers the trust of the consumer which will also hamper the chances of the consumer buying services from that particular firm. The consumers have become more aware of the things going around and the consumer will only go the firm which he/she can rely upon. Through relationship marketing, the trust of the consumer can be won. Through relationship marketing, the consumer can be assured that he/she will get the best products or services and the best value out of the money that he/she has invested in getting the services or products. Once the relationship has been established, it proceeds with a continuous communication and feedback process. 3.4 Government and Private Hospitals in India:It is a very common known fact that the planet that the human beings reside on these days is never disease free. Due to the changing lifestyles, it is inevitable that almost every person has to sort to the healthcare industry. On a very regular basis, the people have to look for the health services which can be found in the terms of doctors providing treatments in clinics or hospitals (http://vspages.com). The increase and continuous demand of and continuous
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of capitalism had evolved the practices in healthcare industry and thus there are two types of hospitals which exit in the Indian healthcare market today; they are private hospitals and public hospitals(government hospitals). It is evident that both private and public hospitals can offer the same services; however there exists unique differences which can be characterised both in terms of services and technology. The main difference between the two types of hospitals is that the private hospitals are managed and run by an individual or a group who look after all the processes including the financial aspects of the hospital. The working of a private hospital is such that all the staff of the hospital including then nurses and the doctors are obliged to work for an individual or a group who can be termed as the owner of the hospital. These days people prefer private hospitals on the general notion that private hospitals are more cleaner and are better equipped both in terms of staff and technology. However, along with the fact that the patients get better treatment and facilities in the private hospital, it is also true that the cost of treatment for such hospitals is also high. So the people who can afford the services of the private hospitals will always prefer the services from private hospitals. Public hospitals are different to the private hospitals in a way that the public hospitals are entirely funded by the tax payers on aspects such as constructions, medicines, technology and the wages of the doctors and the staff. The public hospitals, in general are more popular among the group of people who cannot afford the prices of the private hospitals. The sad fact of the public hospitals is that the concerned governments are not able to provide high quality services that are being provided in the private hospitals in terms of cleanliness, staff and the technology as well.
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Thus the basic difference between the private and the public hospitals is that the private hospitals are entirely funded by the private owners and the public hospitals are government funded. The quality of services in private hospitals is much better than the public hospitals, and as a result the prices are also much higher in the private hospitals. In India, especially there is a vast difference in the price and quality as the government fails to invest money on the welfare of people. If given a choice, an individual will always prefer the services from a private hospital. 3.5 Relationship marketing, service quality and general practice The tradition of marketing has been that it is focused only on the marketing mix, with a focus which is short term and is transaction based (Kotler, 1991). Although, marketing mix is a very important tool, the current business scenario demands that the marketing techniques cannot just rely on the marketing mix. There have been a lot of criticism on the marketing mix and some of these criticisms include the scarce conceptual basis (Van Waterschoot, 1992) focus on production rather than market orientation (Moller, 1992), difficulties with implementation. As a result of such criticisms, it has been noted that the marketing processes cannot solely rely on the marketing mix for the achievement of the organizations goals and objectives and a new paradigm is what is called for (Gro nroos, 1994). The new paradigm is called as relationship marketing which can also described as marketing which is related to the communications with the networks of relationships (Gummesson E. , 2002). (Conway, 2000)have mentioned that relationship marketing is also applicable to non-profit organizations for the achievement of the organizations goals and
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objectives. The key objectives behind relationship marketing strategies are to render the best quality services, create and extent the trust between the provider and the customer, retention of the customers to build a greater customer network etc. It is difficult to measure the quality of the services specially in the healthcare industry as there is difference in the definitions of qualities when it comes to patients and professionals offering the services. General practice may justify focus on doing the right things, for the right people, at the right time, and doing them right first time (Donaldson, 1998). Due to the shortage of technical expertise, the professional service clients find it impossible to judge the quality in services. The patients, in particular do not feel qualified to make a judgement on the technical quality they assess their healthcare by other dimensions which reflect what they personally value (Kenagy, 1999). As a result of the difference between the perceptions of quality among the patients and the professionals, there exists a difference between the quality of treatment that the patient expects and the quality of treatment that is eventually provided to the customer. On the basis of the most common factor, the patients perceive in their minds of what to expect in terms of general practice. As a result of these expectations and perceptions, the customer lay the foundation of the expected service of quality that should be assessed and developed. Service quality has been defined as the extent of discrepancy between customersexpectations and their perception (Parasuraman, 1988). The rendering of high quality services according to the requirements of the patients can only by achieved by understanding the expectation and the perceptions of the patients and then creating strategies which perfectly match these requirements.

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The concept of relationship marketing lays the foundation for the understanding of the practice patient relationship. By inculcating a relational perspective, a much more clear picture and understanding can be generated of how relationships included in general practice exchange, impact the service quality and elucidate the different reasons that can affect the practice-patient relationship. In contrast to the transaction marketing of consumer goods, where the tangible product is itself the solution, relationship market is revolved around the fact that the relationship itself is a solution and how the healthy relationships with the customers plays a vital role in the customer satisfaction eventually. There are three important processes involved in relationship marketing: (i) interaction (ii) dialogue (iii) value Fig 1: The triplet of relationship marketing

Core

Interaction

Value

Dialogue

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Output Source: (Grnroos, 1994)

Communication

The interaction process is the most essential feature of relationship marketing (Haimowitz, 2011). It is the process in which the interaction between the consumer and the supplier takes place. The communication aspect of relationship marketing is covered in the interaction process. A dialogue which works two ways is required to create, sustain and enhance the process of interaction. The value process in relationship marketing is required to show how the consumer perception acts to the establishment and the exchange of value over a period of time. As soon as the establishment of the relationship has taken place, it carried on with the interaction process. There have been suggestions that in the services where there is high more interactions, the interactive feature of rendering of service has an important role in the assessment of the entire service quality (Kotler, 1991). 3.6 Relationship marketing in Hospitals: It is the prime concern of the hospitals to make the patients feels that they will be getting the best treatment. This demands the hospitals to have a proper relationship marketing team and practices in place. The relationship marketing in hospitals demands the hospitals to market itself in such a way that the patient would choose the particular hospital only. Relationship marketing in hospital should also make sure that the patient is satisfied while getting the treatment in hospital and also try to maintain the relationship with the
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patients when they are discharged from the hospital after the treatment. The customer relationship for the patient during the treatment phase demands concern in two major things. One is the staff aspect and the second is the procedures that the patients in the hospital have to undergo while getting the treatment (Haimowitz, 2011). Similarly once the patient is discharged, the after treatment relationship concerns two things. One is maintaining the records of each patient in the database and the other would be a regular communication with the patient after the discharge. Both these things are related to one another and complement one another. 3.6.1 The Hospital customers:The customers can be defined as the individuals who buy and receive the products or services from a particular firm. The customers in the hospitals can be characterized as follows:Patients- patients are those people who approach the hospital to get the treatment for the disease and hope to get a cure after the treatment. Attendants- attendants are the people who are related to the patient or the people who are accompanying the patient during the treatment of the patient at the hospital. Clients- clients may be the workers of a particular firm who would refer people to get the treatments in the particular hospitals in case of emergency. Clients can also be doctors working in clinics who would refer the patients approaching them to get the treatment done in the particular hospital.

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Customers- they are the people who are in healthy state and they would offer the patients some useful schemes in terms of insurances and health packages etc. 3.7 Hospital Marketing Mix:The seven Ps of marketing can be applied to the hospital marketing mix in the following ways:3.7.1 Product The products offered in terms of services have a commercial purpose and it may have both tangible and intangible assets which seek to live up to the needs and demands of the customers and hence satisfy the customer (Haimowitz, 2011). In the hospital industry, there is much more customer interactions. The services offered at the hospitals can categorized as follows: Level of Quality The supporting services in place in the hospitals have a vital role to play in delivering high quality performance in the hospitals. Services such as laboratory with latest technology, blood banks, good canteens, laundries and radiology determine the extent to which the customer would find the hospital attractive. Accessories The segmentation of the customers can be achieved through this. These days many hospitals in India provide facilities such as yoga sessions, good canteens and cafeterias etc. for the customers who can afford to pay more for their luxuries and comforts. There are different rooms in the hospitals like the
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general rooms and the special rooms in the hospitals according to the luxuries in the rooms. Certain hospitals also provide good accommodation to the attendants of the patients who do not reside in the same town or city. Packaging Packaging is the integration of different services put together as one bundle. For example, at the Kokilaben DhirubhaiAmbani Hopital, there is a full health check up package available to the customers. Product line There is wide range of services that a hospital can offer to its customer and satisfy the needs of the customers. For example, Kokilaben DhirubhaiAmbani Hospital has dental department, X-ray department etc and within the dental department, it has services like root canal, dental surgery etc. Brand Name There is a lot of competition in the present healthcare market in India and due to the tough competition, the hospitals try to establish a brand name by being different from its competitors. In the current times, the hospitals offer the following services: -Emergency Services These days emergency services at a majority of hospitals are modern and unique. There are ambulances with the state-of-the-art technology. The ambulances are run with para-medical staff being on board. There is advanced technology available in terms of communication when patient needs in emergency services.
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-Ambulance Services Ambulances with latest technology are run these days with doctors available who can give the necessary medical treatments and attention if there is an emergency wherever the patient needs it. -Diagnostic services In the modern hospitals, there are various departments that can give treatment in wide areas such as plastic surgeries, orthopaedics etc. -Pharmacy services There are pharmacy services available in hospitals which are open 24 hours that offers assistance to the needs of the patients both inside and outside of the hospital and also provide assistance to the patients of other hospitals in case they need emergency drugs.

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3.7.2 Price

Figure 2Pricing in hospital: Image source-( http://well.blogs.nytimes.com/2012/04/23/the-confusion-of-hospital-pricing/ accessed on 16th of May 2012) Price is one of the most essential aspects in the marketing mix. The price of a product or service should be formed keeping in mind the target customers and also the other elements of the marketing mix should be taken into consideration while deciding the price. The price in the hospitals will depend mainly upon the treatment offered and also the services that are availed to the patient. Due to the intangibility feature of a service, it makes it harder to create a price for a particular service that is offered. The deciding factor of price does not depend upon the prices offered by the competitors, but it mainly depends on the prices suggested by the departmental heads. The prices may vary continuously with the change in technology. Before deciding the

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price, the factors relating to the governmental controls are also taken an account of. Pricing in government/public hospitals In the Indian economy, where there are many people who are below poverty line, it becomes even more difficult to set a proper price which can render the needs of the people and also generate profits at the same time. In order to get the latest equipments and technology to improve the medical facilities, the hospitals have to invest a lot. The sections of the societies which are middle class or upper middle class also expect very good treatment at a cheaper cost. As a result of this, most of the public hospitals are in difficult situations as they are not able to formulate appropriate prices which can render customer satisfaction as well as high profit margins. This ultimately affects the society, specially the poor sections of the society. The marketing team in such cases should formulate marketing strategies which can support the public interests. It does not imply that the prices should be uniform; however the pricing can be different to different sections of the society. In government hospitals, there is a different fee structure as there is a need to make the services available to the poor sections of the society. Pricing in Private Hospitals -Cost based pricing Price is generally decided by adding up the direct costs, overhead costs and the preferred margin of profit. Such pricing technique is difficult to follow in the hospitals as the costs are difficult to identify. This pricing technique is followed by very few hospitals in the private sector.
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-Competition based pricing Deciding the price of a service or product, keeping in mind the prices offered by the competitors, is a complicated affair as the competitors working environment and financial management may not be similar, -Demand based pricing The previous two pricing strategies are complicated and are not totally favourable for pricing followed in hospitals. With the help of the demand based pricing , the price is decided keeping in mind the value that the customers seek. The prices will be relevant to the quality of the service provided. The prices for the same services may vary in different hospitals due to the difference in the qualities of the services provided. Sometimes there will be different prices in the same hospital itself for similar treatments. For example, there are different prices in the same hospital for the general ward and the special ward. Ideally prices should be fixed taking into consideration the time and cost of the staff the urgency of the treatment and the level of service provided. There are many occasions specially in the private sectors that the prices are too high for the treatment received. The customers may feel that they are cheated and are charged much more than they should be charged. This is where relationship marketing is so vital. Through a proper relation marketing strategy, the customer can assured that the prices that are being charged are worth for the level of treatment and the level of service rendered.

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3.7.3 Promotion The promotion process in the marketing mix is related to spreading the message to the previous, current and the potential customers (Haimowitz, 2011). Through promotion, the customers can be made aware of the products and the services offered by the organization. The different processes that can be involved in promotion are advertising, publicity and sometimes even a mouth of word can be termed as promotion. In order to promote their products and services, the hospitals sometimes conduct camps in the villages and the rural areas where the people do not have access to the best medical facilities. These camps are meant for promotion purposes and they provide services at a much cheaper rate than usual. In doing so, the hospitals encourage the rural public to visit their hospitals in the future if they need any treatment or services. Hospitals also make it a point to frequently visit centres like old age homes and care centres. Usually the hospitals would advertise themselves in healthcare magazines and healthcare websites. Despite the fact that there is no specific strategy for marketing in hospitals, there has been a kind systematic process that has been developed in the past few years. The marketing is different from the previous years in a way that the corporate now look to build sound and long term relationship with its clients. Promotion in hospitals is not exactly similar to a lot other organizations in the corporate world; but the promotion in the hospitals depend on a lot on trust and brand image. The word of mouth also has a huge impact on the promotion process in the hospitals. Promotion in the hospitals can be divided into three phases: Potential customers
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The hospitals need to use proper advertising channels and processes to advertise their products and services. They hospitals need to create an awareness in the people about how they are different from the other hospitals and how they offer better services and facilities. Through proper advertising, the hospitals can create a trust in the customers that they will be getting the best treatment at the hospital. There are a lot of customers around who would be suffering some kind of disease and all such customers are the potential customers for the hospitals and they need to make sure that these customers choose their hospital to get their treatment done. This can be achieved by proper marketing techniques. The treatment phase The hospitals need to make sure that the customer satisfaction is of prime importance. When the customer enters the hospital for treatment, he/she should be made feel very comfortable and should be given the best treatment. Along with the cure of the disease, the customer would expect to have a proper ambience in the hospital. The customer satisfaction during the treatment phase depends on the following things:-Cleanliness Hospitals are the places which people visit to get some kind of treatment. It is very important that the hospitals spread the message that the health of the customer is the foremost priority. In India , specially the public hospitals are not that clean which creates a very negative brand image. It is very important to stress in cleanliness as it is very important from health as well as promotion point of view. -Know how of staff
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The staff that has been employed in the hospital should be well trained and equipped. It is very important that the staff knows the role and responsibilities while performing the respective duties. The nurses should be properly trained in a way that the customer satisfaction should be the prime importance. The clerks, the cleaner etc should be made aware of their importance too in delivering the right message to the customers. The hospitals should try to get the best doctors as the members of their staff. -Paper works There are a lot of procedures and paper works while getting treatment at the hospitals. The staff at the hospital should make sure that these processes are smooth and they do not irritate the customers. These things play a vital role in the customer satisfaction and if all these things are put into place properly, the hospital has done its part in promoting itself. After treatment phase The hospitals need to have a record in their database of each customer that gets treated in the hospital. this record should include all the details of the customer as to for what the customer was treated etc. Once the customer leaves the hospital after the treatment, the hospital needs to make sure that it creates a bond with the customer. A long term relation with the customer plays a vital role in the promotion of the hospitals. The hospital needs to make sure that when the customer visits the hospital after the treatment for checkups, he/she will still get the best services. The hospitals can regularly update the previous customers about the new schemes and technologies that have been installed in the hospital through posts, sms, email etc. By doing so, the
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hospitals will create a long term relation with the customers it will never lose its customers. Programs which are held indoors and outdoors have a vital role to play in the marketing strategies of the hospitals (Gummesson E. , 2002). Some of the processes that can be listed are continuous medical awareness programs for the general people, check up camps for the people, events being held on the different health days, having interviews in place from specialists on media channels, a user friendly and informative web sites etc. Hospitals also undertake different events like Liver Day, Blood Donation day etc. which creates awareness among the general public and also assists in business purposes. Hospitals can also associate themselves in co branding which assists them in promotion through other brands. The most important factor that is going to affect the healthcare market in the near future is the growing stature of the hospitals chains such as Apollo, Birla Health centres etc. There are many organizations like these which invest a lot in corporate branding and advertising. 3.7.4 People The people aspect in the marketing mix also plays a vital role in the relationship marketing of the hospital. The people aspect refers to the roles that are played by the individuals in the offering of services. In the hospital industry, these people will include all the professionals like the nurses, doctors, cleaners, clerks etc. It is in the best interest of the hospitals to employ people who are qualified and can perform their roles and responsibilities in the best possible way. People factor plays a very critical role in the hospitals as in the hospitals even a small mistake or event can be a question of life or death. It
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makes it all the more important that the staff at the hospital is well trained and are made fully aware of the roles and responsibilities. There should be regular meetings of the staff to provide motivation and also continuous training should be given to the staff with the evolving technology. Apart from being highly professional, the staff should also be trained in such a way that they also provide a personal touch in offering the services as the patients at the hospitals would also require some emotional support sometimes. The goal of providing the best quality services to the patients can be achieved by: Encouraging the staff to be efficient, hard working and loyal to the firm. Rendering continuous on-job training of staff to make sure that there are regular improvements in the services offered. The utilization of the latest technology Using the competitors professional medical consultants services. It is not necessary that the motivation can be offered in terms of money only. Motivation can also be given to the staff by having policies like discount to the employees closed ones. It is very important to identify the needs of the staff too as the staff will be determining the extent to which the goals and objectives of the organization are met. 3.7.5 Process Process is a collection of activities that modify the inputs by adding value and assist in creating a better output (Haimowitz, 2011). It is just in the recent years that process has been given much importance in the service sector whereas it has been an internal part of the manufacturing sector for several years.
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The process is differentiated into three phase when it comes to the working of hospital.
Joining Phase

Intensive Consumption Phase

Detachment Phase

Feedback

Figure 3: Hospital Process

Source: (Haimowitz, 2011)

The joining phase This phase is concerned with the patients arrival and the registration of the patients. The patient needs to pay an upfront deposit at the billing department. Once the patient has done that, a new file will be made for the patient which will include all the medical information that is needed concerning the patient. Intensive Consumption Phase The intensive consumption phase involves processes like diagnosis, treatment and directions for further actions. The diagnosis process involves the patient to undergo various medical tests concerning the illness. The treatment process involves the patient getting treated for the illness with surgery or other
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medical processes. After the treatment is done, the doctor will inform the patient about the care that needs to be taken in terms of diets or the daily activities etc. The medications will be prescribed if needed and also the doctor may ask the patient to visit the hospital a few times to keep an eye on the healing of the disease and so on. The detachment Phase The detachment phase includes the process in which the patient is being discharged from the hospital after getting treated and making the necessary payments. The patient is discharged from the hospital if the doctor or the consultant feel that the patient no longer needs the hospital supervision and can go home. Once the patient is ready to be discharged, the payment is done at the billing counter. Feedback Phase The feedback phase is very important to know whether the patient was satisfied with the services provided by the hospital. When the patient is getting discharged, he/she is provided with a questionnaire to fill up which is related to the customer satisfaction. There is also a space if the patient would like to mention which is not included in the questionnaire. Through these feedback forms, the hospital can assess the strategies and make necessary changes if needed. Fig 4: The common processes in a hospital:Source: (Haimowitz, 2011)

Finance Department

Billing 31

Purchase Department

Stores

Doctors

Patients

Nurses

Within a hospital, all the departments are looked upon individually and are interrelated to another. One department will serve the requirements for the other department. As it is shown in the figure that the purchase department will fulfil the needs of the finance department and the chain continues. Hence, it may be implied that each department acts as a customer to another department, but it may be a supplier to the other department and the same time. It is very important for each department to understand and identify its customers and try to fulfil their needs. This is very important in providing the most efficient and the best service to the customer. Every department should look upon itself as a different sector trying to serve customers in the best possible way and hence satisfy the needs of the customers. In doing so, it may occur that each department may look separated and may not look like a team. However, it has been found that in most of the organizations which use such process, the customers have been served very well and there is a much better customer- supplier relationship (Shani, 1992).
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3.7.6 Physical Evidence The physical evidence part of the marketing mix is related to the customer having an opinion about the organization or judging the organization. This is also a very important feature of the marketing mix. The customers can presume and assume based on what they see of the services and the perception which is created in the customers mind will effect the marketing of the organization. Hospitals in the modern era inevitably need to have a very good ambience in place. As soon as the customer enters the hospital, he/she can easily form an opinion about the hospital by looking at the ambience and the surroundings. The uniform of the staff, the etiquette of staff etc also play a very role in forming a positive image in the mind of the customer. Physical evidence plays an important role in marketing as the customer can easily have perception by the way things appear. Sometimes good physical appearance can hide the flaws in the organization if they exist. 3.7.7 Place The place of the hospital should be deciding in such a way that it is easily accessible to majority of the customers (Gro nroos, 1994). The hospitals should not be located at places which are far away from the main town. These days, there are hospital chains like Kokilaben DhirubhaiAmbani Hospital which are present in different cities of India. Before setting up a hospital in a new town or city, the hospitals need to assess which would be the best possible place both for the patient point of view and the business point of view.

3.8 Tools and Techniques for relationship marketing in hospitals:

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It is very important to utilize the proper medium for the marketing of a hospital. Tools play an inevitable role in the formation of strategy of the marketing plan, analysis of the market and assessing the results. There are a variety of statistical tools that are available to assess the data available from the market. There is always surge for marketers to get an insight from the customers, know how they percept the services, their assessment of the brand image, and how far they stand toe to toe or above their competitors. In order to create meaningful and accurate conclusions, the reliance on statistical tools and the technological resources becomes handy. There are many different kinds of communication and media networks available keeping in mid the marketing techniques that have been put into action by the hospitals: (http://www.expresshealthcare.in)

- Mass Communication: advertising in magazines, newspapers, brochure, multi media etc. - Personalised Communication: text or multimedia messages, emails, etc. - Public Relation Activities: Community development events, achievement etc. - Brand Building Activities: Brand recall activities, brand perception improvement activities etc. -Incentive based Sales: Direct to consumer approach, special packaging / rates etc. - Social network or digital media

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3.8.1 Insurance There a lot of people in India who bear the expenses for their medical needs on their own, but there also a large amount of people these days who seek insurance or are supported by their companies while clearing out their medical expenditures. It thus becomes important for the hospitals these days to relate to health insurance companies and the organizations in the corporate world. In a similar way, there is also a need to inculcate foreign insurers and foreign patient facilitators. 3.8.2 General Physician or the Clinic Doctors The attachment to the general physicians is a very important aspect for the marketing of the hospitals. The patients in India have a general tendency to visit their regular physicians when the need arises. If the patients then feel the need to visit a hospital, they seek the advice of the physician. It thus becomes very important that the hospital tries to convince such physicians about the capabilities of the hospital in delivering the best services and providing treatment for complicated diseases. Having a good relationship in place with the physicians is an important part of the business of the hospital but the industry needs to eradicate the kick back system. The hospitals need make sure that they do not follow the unethical business ways of the kick back system and that it is necessary to avoid it or stop it if it exists. In addition to this, the development of relationship with the general physicians can be enhanced by holding conferences, updating them about the changes in the hospitals, and by providing information to them through their web-sites or journals etc.

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3.8.3 Internal Referrals The strategy of internal referral can also bring about great profits for the hospitals. Generally diabetics (endochrinology department) is a good catchment for patients for other specialities. Taking care of diabetic patients on most occasions develops an all win situation for both the patient and hospital. 3.8.4 Customer Relationship Management(CRM) Customer relationship management is a modern concept that came into existence due to the positive change in marketing and also the social exercises. Despite the fact that this concept emerged mainly from the western world, it has achieved rapid recognition in the modern Indian market as well. The concept is formed on the basis of strategic positioning and marketing tools that incorporate the collective efforts of a for profit business and a non-profit organisation for mutual benefit. The marketing experts believe that CRM concept is advantageous to both the groups since such processes hospital business to create and better the image of the brand, increase the customer loyalty and increase the sales whereas charity institutes benefit from the fact that through CRM, funds are collected for charity to provide assistance to a particular cause. 3.8.5 Marketing Team The techniques and the processes which have been mentioned above will only be successful if there is dedicated and motivated team working with the same objectives. A marketing plan can only be successful if the hospital has a good marketing team working solely to achieve the goals and objectives set by the organization. Although in the previous days hardcore marketing in hospitals
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did not relate as being a good social idea in Indian market, these days it has become quite common and inevitable. 3.9 Impact of relationship marketing on the business of hospitals: There have been arguments on the fact the through relationship marketing, the performance and the productivity of the organizations improves (Sheth Jagdish N., 1992). This implies that as a result of relationship marketing, there should be a much better result in achieving the organizations goals and objectives. If the relationship marketing does not assist in the achievement of the targets set out by the organization, the concept will virtually fade away in the coming years. In the current times, where the markets are declining, the core challenge faced by the hospitals is the efficient use of the bed size capacity. There are many days in the hospitals where there are many beds lying empty. The reasons for such lower numbers of patients admissions in the hospitals are improved procedures, more stress on out patient services and pressure to maintain a proper cost. This scenario can be considered as good for the patients, but on the other hand, it is not an ideal situation for hospitals. The hospitals have to bear the additional costs of the under utilization of space and resources due to lower number of patients in the hospitals. Having said that,if the hospitals have a relationship marketing techniques which are based on customer retention and groping in potential customers, then such hospitals will find themselves in much better situation from the business point of view. The occupancy rates in such hospitals will also be higher than most other hospitals and there will also be a wider customer network for such hospitals

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given the customer satisfaction they offered to the previous customers and the publicity that the previous customers will spread. The other thing similar to occupancy rate which should be considered is the admissions per bed. Proper relationship marketing with the stakeholders like the patients, physicians, corporate etc. can really increase the customer loyalty and the probabilities of the customer coming back to buy the services. These stakeholders will not only refer the hospital services to the patients, more customers will be attracted to buy the services as a consequence of the brand image created by the previous customers. There is a common policy that is being practiced by the hospitals about the time lag in the payment and the patients have the privilege to pay after a certain point of time once they receive the services. As a result of this practice, there is a possibility that the ratio of uncollected funds will increase which will hamper the financial progress of the hospitals. These ratios will be comparatively lower in the hospitals which practice good relationship marketing techniques. The customers who are having a sound and healthy relationships with the hospital will be more motivated to clear the financial deals between themselves and the hospital. The customers will act more responsibly towards payments to their favourite healthcare service provider to keep receiving services in the future. Relationship marketing will also increase the gross revenue of the hospitals when the selective targeting according to the patients is followed. By providing the perfect service as demanded by a profitable customer, the revenue per day of the hospital will also increase. 3.10 The future of relationship marketing in healthcare:
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 Healthcare information available all the time:It is expected that as the years pass, the customers will start expecting an access to their personal healthcare information whenever they wish to. There will be a continuous increase in the demand of the information that the customers will seek to make decisions, both in terms of volume and availability. These days customer can carry out a simple search on the internet and can get bundle of information about any particular disease or treatment. The customers can also get all the information about any hospital and how effective the hospital is. (Philip Kotler, 2008) The customers can get access to the working of the hospital and also get the information about the costs of the hospital. In the near future, it can be expected that the ways of finding out such information will increase considerably and also the customer do not necessarily have to be at home to avail such information. The increase use of internet on the mobile phones will make it possible for the customers to seek whatever information they need no matter where they are. There will be mobile applications on the mobiles which will make the availability of such information very easy to the customers. The popularity of smart phones like iphones is just a mere indication of how far the mobile technology is changing the information exchange. The healthcare industry will also have to accept this change in the market and make the information easily available to the customers according to their preferences (Philip Kotler, 2008). The Physician role of consumers It will be very common in most of the industries that the consumer will produce even more available content. As a result of the stupendous increase in the number of bloggers, user generated media and social networking sites, the
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customers are generating and controlling even more contents which are available online. This trend will also increase more in the healthcare industry in the coming years. Such an increase of this aspect in the healthcare industry can prove to be advantageous as well as disadvantageous to the healthcare industry (S.Shajahan, 2004). The main benefit will be that the healthcare industry can reach out to its customers much easily and with much cheaper costs with the vast online networks and hence the message will be spread out much quicker as well. Apart from the positive change, such a phenomenon can also prove to be very critical in the healthcare industry. In the case of healthcare industry, even a single piece of incorrect information can prove to be very critical to the patients health. In the healthcare industry, the health of the patient is the prime concern and any misleading information or wrong practice by the patient can be a matter of life or death. This can hamper the brand image and reputation in the worst way. The companies will have to be very careful while sharing any information and be very careful in protecting the lives if the customers. Internet The use of internet to seek healthcare information is already becoming more and more in India. This usage will become more in the coming years and most of the other media will fall behind internet as the source of information. The Internet will become the primary and, potentially, most trusted source for healthcare information for the vast majority of consumers. The most trusted sources are friends and relatives; however with the vast resources available online, the internet will become the most trusted source for healthcare decisions. (Haimowitz, 2011) With the great assistance also available online and with the social media networking also increasing, the customer will take
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the advice from the online experts. The physicians will still remain as one of the most trusted sources of information but it can be assumed that before taking the advice of the physician, the customer would have done an online research just to confirm the viability of the physicians advice. Healthcare institutes will have to be aware of the growing trends of online community and they will have to take proper actions to create a very good online resource which the customers can trust and which also assist them in the marketing. Healthcare data With the continuously evolving technology and the changing demands of customers, it will be possible for the customers to access and monitor their healthcare information which will be stored in just one place and can be accessed whenever and wherever the customer wants to. In some countries, there have already been practices like the electronic card in which the medical records of the patient for several years has been stored. Such technologies will also enter into the Indian market and will be of high demand (Wood, 2008). In the present times, such data is available only to the doctors, the hospitals, the physicians etc and is not available to the customer easily. In the coming years, the customers will have a much easier access to such data. For example, the patient can easily find about the things that he/she is allergic to by accessing such data. There have already been websites like Google Health where a patient can keep a track of all the medical records and also write down notes after an appointment with the doctor and similar things. By the utilization of such web-sites, the patients do not necessarily have to see the doctor or the medical advisor to get information about their medical records. Instead, they
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can easily access such web sites and collect information they need whenever and wherever they want to. This will also help them to get the information easily in case if emergencies. Such concepts have been discussed since many years, but to the disappointment of the customers, there have not been proper implementations yet. The healthcare institutes should realise that this change can really serve as the driving force in the healthcare industry and should take proper steps to implement such things and make it easier for the customers to track their medical records. This will save a lot of time and energy for the customers and will ultimately lead to more customer satisfaction. Social Networking Knowing groups of people online who they can relate to, the customers will start to develop networks taking advice of such online groups rather than taking advice from their physicians (Gummesson E. , 2002). As a result of so many people using the internet, it becomes more probable to know people having similar experiences and it is applicable for even rarest experiences. People start utilizing such networks to discuss medical issues, offer medical advices, refer physicians and hospitals, share difficulties and support each other. Gaining huge numbers, the online community will pressurize the healthcare institutes much more. The healthcare institutes must realise the threat and the opportunities of such online communities for if they do not recognize these communities, they are in danger of negative brand image formation. Care and Contact

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The doctors and the patients will be in continuous contact as a result of the health-monitoring technologies. In the current scenario, there are few technologies to monitor the patients health; however, these technologies are just in the initial stages and are not so authentic and so they are not accepted positively by the customers. But in the coming years, these technologies will spread more across the public. With the help of these technologies, it will be easy to check procedures after surgery, drug compliance events etc and the patient can be updated all the time about the health status through the internet. This will reduce the gap of communication between the patient and the doctor and thus enable them to be connected more closely. The patient will no longer have to visit the doctors for little changes in the health. The doctors can check the patients health information online and can make suitable changes in the medications by sending out a massage to the pharmacy. The patients will appreciate such technologies and will not hesitate to share the personal information if they are getting a much better healthcare facility (Haimowitz, 2011). Those healthcare institutes which will adopt such techniques first, will have a much greater competitive advantage than its competitors and will have a much larger group of satisfied customers. They will have much deeper and more lasting bonds with their customers.

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 CHAPTE 4 RESEARCH METHODOLOGY: 4.1 Research Ethics Marketing Research benefits both the organisation and to the consumers (Armstrong et al, 2009) Marketing research is considered because it helps to learn the need and wants of the market and also provides the necessary attributes to the market to help the organisation to satisfy the needs and wants of the organisation (Yang & El-Haik, 2009). However, it has been argued by (Jobber, 2009) as, if the research has been not utilised properly the research could harm the undertaking organisation as well as the benefit of the customers. The research literature reveals prime two types of misuse of the research (Babbie & Benaquisto, 2010) which includes: Intrusions of consumer privacy and Misuse of research findings (Kotler et al, 2010a) Many customers find the marketing research useful since it has a specific purpose. Most of the customers participated on the research and spent time on giving their valuable opinion. But they also fear that the researcher might use their feelings of knowledge and might manipulate their buying. On the other hand, research findings can be powerful persuasive tools. Organisation frequently uses results from researches and claims in their advertising and promotional campaign. However, there are few advertisers openly manipulate their research designs or blatantly misrepresent the findings; most abuse tends to be subtle stretches (Kotler & Armstrong, 2010b)

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 4.2 Research Approach 4.2.1 Deductive Approach Theories and hypotheses are expanded by deductive approach and they are examined through experimental study. In fact, it is known as a kind of methods to apply theories in the real world of relationship marketing. This is because the validity of theories may need to be tested and considered. Deductive approach is mainly preferable in the natural sciences. Deductive research is not related to observations or experiences, it is only material of sense (Fisher, 2010a). 4.2.2 Inductive Approach The validity of inductive research gathers from its analysis and this analysis gained by eliminating predictions and considering hypotheses. According to today inductive research includes experiments, group projects and individual projects. (Fisher, 2010b) defined induction as a research which is from past experience or experiment. It is also claimed that the inductive consideration is less strong than deductive. 4.3 Justification of Research Approach In comparison, philosophical observation of methodology is different than the meaning through the research subject (Saunders, 2009). The comparison between deductive and inductive approaches is explained below. The contrast between Deductive and Inductive approaches are explained below Deductive approach -Collects quantitative data

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-Flows from theory to data -Investigational design approach -Independent researcher for presentation -Scientific principles -Generalises investigative findings -Can be quicker than inductive approach Inductive approach Collects qualitative data Close consideration of research Flexible design structure The researcher is a part of the research Look for rival hypotheses and unmeasured factors Begins construct individual cases Source: Adapted from Saunders et al. (2009) and Jones III and Gomez (2010) Overall, after many considerations and comparisons of deductive and inductive approaches, the author decided that deductive approach is the most suitable approach for this study. Deductive approach is also considered because to ensure that there is critical analysis in this research which enhances this research to focus more on enhancements which has to be made in the hospital to ensure there is a good relationship marketing strategy is carried on in the environment
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 4.4 Methodology: Research methodology is supported as it is not only the method to understand results but it also the study of a method and the values for choosing a specific method of study. The term research in marketing is often used for collecting the data for analyzing and interpreting to get the necessary information for making future strategy. The future strategy must ensure that it should be complying with the corporate objective to gain the competitive advantage. It is the evidence in measuring the performance by the company in which the organisation operates (Kotabe & Helsen, 2009) The research process involves identifying and defining the research problem and analysing the found problems and back log in the research and analyse the data to reach conclusion. Setting the research objectives requires selecting the mode of data collection. Data can be collected in two ways. Primary Research conducted where data collected from the original source specifically for the current research purpose. A primary research source includes questionnaires, interview, survey and experiments. Secondary Research is also called as desk research which refers to historic data, the research conducted earlier and published for further usage. Source includes the published information from books, journals, newspapers, market research reports, government statistics, and directories etc. It is sensible to conduct the secondary research because the researcher find it cheaper (Blythe, 2008), easy to collect, and flexible for decision making. The drawbacks with the secondary research are that it appears most of the time back dated and lacks accuracy. But it helps the researcher in possible design of the primary research

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because secondary research indicates the gap between the research and help to choose the appropriate method of the research. (Rossman, 2010) Before examining the types of research design it is important in ensuring the role and purpose of the research design (Creswell, 2009). The researcher should ensure that the research design fits into the whole research process from farming a question to finally analyzing and reporting data. Selecting the research problem cautiously will lead to the objectives of the research (Kotler P , 2008). The marketing research design could be is of three types. 4.4.1 Explorative Research It is conducted for the purpose of gathering initial data and suggesting theory. In explorative research, organisational problems are calculated and the method is therefore flexible and emerges the study progresses. Exploratory study consists of getting information from research literature, secondary sources and from knowhow of the persons. Descriptive Research tries to describe the market the potential outcomes and study the attitude of the customers in a descriptive manner. (Krishnaswamy et al, 2009) 4.4.2 Descriptive research The collection of a wide range of social indicators and economic information such as household expenditure patterns, studies for usage of time and analysis, employment, and crime statistics are termed as descriptive research. Descriptions can be concrete or abstract. A relative concrete description might describe the ethnic mix of a community, the changing age of a population or the gender mix of a workplace.
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 4.4.3Causal Research This research is conducted to test the cause-and-effect relationship of the suggested hypothesis (Babbie, 2010). Research instruments are used to collect the data from the market (Kotler et al, 2008). Marketing research instruments are of two types. The Questionnaire is a set of relevant questions (Brace, 2008) to the research objectives and the answers provide possible data to test the hypothesis. To be an appropriate questionnaire the questions should not be too long and unambiguous (Cohen, 2007). A research method or design provides a framework for collecting and analysing data. A Choice of research design reflects decisions about the priority being given to a range of dimensions of the research process (Bryman & Bell 2007). Choosing the research methods is one of the primary tasks for any research in an organisation. Research methods are of two types: Qualitative Research Qualitative Research entrenched firmly from various aspects of the social science (Baker & Hart, 2008). It has been described as both art and science (Cateora & Graham, 2009). Qualitative research is an overall term to describe the work researches do in formulating their interpretations of the subjects of their studies and giving representations of theses interpretations in order to add to a body of knowledge. The term itself is self explanatory which deals with the non-numeric data collection by probing. Qualitative research involves content analysis (Silverman, 2010). In qualitative research techniques which generally used are focus group, exploratory groups,

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teleconferencing, video conferencing, depth interview techniques and method of observation. Quantitative Research Quantitative research deals with the numbers and involves statistical analysis of the data (Henning et al, 2009). Commonly used techniques included in quantitative method of researching are all types of survey. Quantitative research outlined as a distinctive research strategy (Gill & Johnson, 2010) but in broader terms it is described as analysing the collective numerical data (Groves et al, 2009). It exhibits the relationship between the theory and deductive research (Engel & Schutt, 2010). It has a distinctive epistemological and ontological position (Alvesson & Skoldberg, 2009) which suggests that there is good deal more to it than the mere presence of numbers. The process of Quantitative Research (Creswell, 2009) outlines the main steps involved in quantitative research. This is very much an ideal-typical account of the process and it is probably never or rarely found in this pure form, but it represents a useful starting point for getting to grips with the main ingredients of the approach and the links between them (Bryman & Bell, 2007). Quantitative Research Quantitative research is a data collection method that is described on a numerical degree (Jonker and Pennink, 2010). The essence of the quantitative research is to divide things simply in order that the researcher can plan statistically. Quantitative researchers should make pilot-test their findings in order to guarantee the gathered data targets criteria of both authority and trustworthiness. Quantitative methods are traditional type of researches (Cottrell and McKenzie, 2011).
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Quantitative research is a method examining the relationship between variables to test objective theories, and these variables can be measured and analysed with statistical methods. Quantitative study takes the existing literature on the studied topic, derive suggestions, and test these suggestions rather than taking concepts and facts from those existing literature to see your statements and observations in their context as done by quantitative study. The difference between qualitative and quantitative methods is that qualitative methods involve a research describing people and events characteristics without comparing events in terms of measurements or amounts, on the other hand, quantitative methods focus on measurement and amounts larger and smaller facts, similar and different data, more and less of the characteristics displayed by the people and events that the research studies (Thomas, 2003). For the effectiveness of research methodology a critical discussion of both qualitative and quantitative method of research is been conducted. Quantitative researchers sometimes criticise qualitative research as, qualitative method of research is too subjective and imprecise. By this the critical thinkers means that research which are made by qualitative tools relies upon researchers unsystematic analysis. The factors which are significant and relationship with the people who have been utilised for research are also not properly systemised. However, quantitative research is criticised as a natural science model is not suitable for measuring a social world such as business, economy and organisational factors (Bryman A and Bell E, 2007) It has been mentioned as quantitative research is associated with positivism and positivist approach but it has been argued as now the business systems
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are working in the post-positivist world. Moreover, quantitative researchers are believed as positivists who assume that there is objectivity in the data collection during the research whereas post-positivists argue that it is not possible for a researcher to be objective. Post-positivists further argue that much research carried out by positivist tradition researchers who are termed as quantitative researchers was complicit with colonialism/imperialism this means that the researcher assumed a superior position to the people or culture studied (VanderStoep W S and Johnston D, 2009b) Quantitative method of research is described as wide and thin whereas it is contradicted as qualitative method is narrow and much deeper into the concept of topic of the research. It is mentioned as quantitative research methods are wide and thin because it will analyse widely in numbers and statistics which gives a result of broader ideology from larger participants in a research (Mannel R, Martens J P, Walker M, 2008) Parahoo notes that quantitative research has a limitation that it cannot understand and measure human phenomenon and emotions such as stress, beliefs, emotion and anxiety. He also condemns that quantitative research cannot always understand inner meanings that attach to concepts which asks questions that require a fixed responses which cannot termed in a different manner (cited in Cowan D, 2009) It has criticised as the data collected by the quantitative researchers occasionally will not understand the appropriateness of conducting research. It is also added that the assumptions made will have a number of faults. The following critics emphasizes that experiments, statistics, datas from surveys might be inappropriate in some of social researches. Qualitative researchers
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criticises as it should not be assumed that quantitative research method techniques are the only way of analysing the validity of research findings. By this they point out that some of the results provided from the quantitative research might be inappropriate to qualitative analysis (Silverman D, 2006) The quantitative survey method is use to collect data. The justification about data and its collection are mentioned below 4.5 Data collection Data collection methods are dividing into primary and secondary data collection. 4.5.1 Primary data collection Primary data collection is by survey, questionnaire interview, group interview, observations, and case studies or by critical incidents. This in a unique in every research as it is researchers most common method use for data collection. The main aspects analysed for survey research are -Selection of communication method, -Maximise response to survey, -Questionnaires design, -Question phrasing (Lancaster et al 2005)

Thus, primary data is use in manual analysis for surveys and gathering statics. The data input sheets contain different manual formats for assessment of qualitative and quantitative research method. The method is select depending upon the aim and objective of research.

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 4.5.2 Secondary data collection Secondary data defined, as data collected by someone, other than user, in this research number of secondary data will use. This is done to save time spend to collect data. In case of quantitative data collection, previous database use by researcher will help to capture past change or development and gives steps to start answering research question (Saunders 2007). Data analysis in regards with secondary research has following characteristics (Encyclopaedia 2008) : -Researcher goal with promotion mix and antismoking drug sales data -The methodology used to collect primary data. -Time and type of collected data -Research method use with questionnaires -Success and consistency of data collection and source -The layout of the questionnaire should be precise and clearly define (Groebner et al, 2008). Questionnaires are two types. Close-End Question -includes all possible answers of the questions (Donsbach & Traugott, 2008). On the other hand, the Open-End Question does not allow the respondent to answer (Kotler & Armstrong, 2010) from the multiple choices rather they have to answer in their own words. Research respondents are the subject of the research (Saunders et al, 2009), whose behaviour and interest will be tested for the research. Selection of respondent might vary based on the type of the research (Monsen & Horn, 2008). The most widely used techniques to choose the respondent are: population and sampling (Rubin & Babbie, 2010). A Population could best be
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described as the aggregate set who usually shares the common characteristics and value (Burns, 2000). A Sample is a representation of the sub-group (Pole & Lampard, 2002). The sampling frame provides the list of the possible respondent (Royse et al, 2010) from whom the researcher draw the sample needed to conduct the research. Recently there has been a move away from probability sampling towards quota sampling (Blythe, 2008) and a growing use of databases for sampling. The reasons for this are that quota sampling is easier and more reliable (Buckingham & Saunders, 2004), and databases provide a quick and easy way of sampling for postal questionnaires. To collect data from large group of people questionnaires are the best way. Questions can be open end or closed end to get a statistical report although close end question is always good to design research. Questionnaires are time and cost effective. People are more likely to say the truth as researchers have no record of individual says as there is no face-to-face interaction between respondents and interviewer, this method has great anonymity. On the other hand, side questionnaires also have some draws backs as design problem, low response rate and in complete information. In spite of few disadvantages it is best method to collect data from large geographical area and easy to analysis. In this research questionnaire designed by researcher and it has been justified for choosing the questionnaire. Suitable well-designed questionnaire used to collect data from hospital. The questionnaires designed had the specification as detail information, clarification of questions, sequential questions, easily understandable wordings and pleasant layout. Questionnaire

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The cross-sectional form of this research necessitated self-completion questionnaires as the research instrument. A well designed self-completion questionnaires has the advantage of been administered over a shorter period of time (Saunders et al, 2009). This is of particular importance when aiming the questionnaire at three sample subsets discussed in section The questionnaires contained questions specific to each sample group. The staff questionnaires consisted of closed-ended (quantitative) while questionnaires aimed at the Managers and HR Representative consisted of closed-ended and open-ended (qualitative) questions to achieve the mixed research strategy. The closed-ended questions were standardised and common to the three subsets while the open-ended questions elicited responses to further understanding relationships between the variables (Bryman and Bell, 2007, Saunders et al, 2009). To elicit qualitative data, the questionnaires employed a rating scale to restricted questions requiring graded responses. Varying degrees of a Likert scale was used in which participants were required to indicate degrees of agreement to a series of statements to form a multiple indicator or item indicator (Bryman and Bell, 2007). To elicit qualitative data respondents were requested to elaborate on responses. The responses allowed the researcher to understand the relationship between the variables though emerging themes and categories. 4.6 Questionnaire Design When choosing a questionnaire the researcher should answer some questions; these are listed by (Marshall and Rossman 2010)
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Before using it in collecting survey data, the questionnaire needs to be tested (Groves et al., 2009). The researcher tested questionnaire on randomly chosen 10 people and according to results the researcher changed income groups as it was found slightly higher than predicted. Questionnaire was planned to contain 14 questions; the first five questions aim collecting general information on respondents buying behaviours and preferences on air travel and the last seven questions were designed to gain demographical information of the population. CHAPTER 5 FINDINGS: The views collected from about 30 users of customer service from Kokilaben DhirubhaiAmbani hospital are critically analysed and discussed below.

poor fair satisfactory good excellent

Fig: Extracted from questionnaire about customer service

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According to questionnaire provided in appendix 1 the pie diagram comprises views for 7 questions in the questionnaire. Views can be analysed according to different factors such as -Long term relationship -Customer service -Knowhow of staff -Environment of hospital Longer term relationship: Primary marketing technique used by each and every organisation is to maintain their existing customers. For the maintenance of customers; organisation has many facilities to attract the customers by providing and ensuring good services. If relationship marketing has to be successful in an organisation there should be an effective marketing strategy to make it happen. The marketing strategy has to be completely taken care of by the senior staff in the management of an organisation. The most important factor to be considered while making a marketing strategy is that it has to be considered as a long term strategy. The management should also ensure that the relationship marketing strategy should not be a short term perspective to the organisations customers. Considering the longer term relationship between the customers in the questionnaire customers also meant that hospital should not only frame rules from the management but it also should ensure that all the staffs are following it. So, customers for getting satisfaction with the staffs so that there will be a longer term relation with the hospital, management must ensure effective communication for the
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awareness of staff. Finally the internal management must ensure that employees should be trained about the method of marketing and also should be managed periodically all the staffs are updated or not.

Long term relationship

Poor Fair Satisfactory Good Excellent

Customers of about 30% replied satisfactory about the longer term relationship. They are asked about the credibility of the hospital and also about the pricing which are considered by customers in large scale for longer term relation with the hospital. Customers also considered about the customer services provided by the staff and also about the knowledge they possess. Customers about 19% given good for the longer term beneficial of this hospital. They also mentioned about the brand name and the credibility of the part of organisation this hospital belongs to. Customers revealed that they have faith in the operation of the hospital because of the persons who handles the management of this hospital. Of about 13 % customers gave fair in terms of considering all the above mentioned important factors. One of the customer
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specifically mentioned that his family would prefer this hospital just for the reason of affordable quality health care delivered by the hospital. A family mentioned that the customer handling is well and good enough in terms of higher quality treatment. About 4% customers felt that the longer term relationship with the hospital is possible for the entire family because of the staff morale is constantly strong. One of the customer mentioned about the long duration with this hospital is possible only because there is a good management in this hospital which can solve and can make customers always happy and ensure higher standard in delivering quality service. Only about 2% of customers felt the longer term relation with the hospital will be poor because of the needs to get advanced in the way the hospital operates. Customers specified that staff needs co operation and knowledge sharing among themselves. Customers felt that there is no proper communication between each staff. Customers also complained about the knowhow of one staff are higher whereas the other staff is not even aware of hospitals policies. Customers also made a clear point about the period of service of each staff and the importance of their presence in this hospital. One of the customer complained that new staffs need more training so that if the senior staff relieves from the hospital the recent staff can organise the hospital so that there will be a proper care will be given to the customers in future. Concluding the various views about the customers in terms of long term relation of customers it is felt overall satisfied as the result of hospitals credibility. It is believed in this research that if the hospital considers all the grey areas which knowingly or unknowingly exists in this hospital if considered and corrected there will be smooth flow of customer service and also will be higher credibility for the hospital among the market.
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Customer service: The major factor to be considered in relationship marketing is the ways in which customer service plays a major role in relationship marketing which has been revealed by customers participated in research. It is also believed as customer relation encourages the long term orientation, shift in emphasizing from manipulating the level of satisfaction of the customers to genuinely involving customers in to the products of the organisation. It also improves the importance to staffs to work towards common goals which has been propounded by the management of any organisation. It also emphasizes the need to attract, maintain, and enhance customer relationships (Berry, 1983). The importance of customer service in relationship marketing is also supported as the need for all marketing activities to be directed towards establishing, developing, and maintaining successful relationships (Cited in Fyall A, 2003). Considering the above thoughts analysing the customer relationship in a hospital like Kokilaben DhirubhaiAmbani hospital has been considered important for relationship marketing. In the questionnaire there are questions such as customer care and professionalism, initiatives by staff, responding promptly to phone enquiries and requesting customers to comment on best factor about customer services are raised to analyse about the level of customer service in the hospital. The responses are categorised into poor, fair, satisfactory, good and excellent. These categories are then calculated in excel by pie formulas and found that among the total of 30 respondents from different background about 12 revealed satisfactory as a result which is in higher level than other categories which comprises 41% of total respondents.
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Customer Service

Poor Fair Satisfactory Good Excellent

About 24% revealed customer service was fair in the questionnaire. Over 17% responded customer service is good and 54% said its satisfactory. About 3% said excellent service in hospital whereas only 2% said poor about customer service. Customers mentioned poor and commented about the particular staff about hospital. So, from customers point of view customer relationship in health care depends upon persons as well not only with hospital and its atmosphere. Overall only a few respondents revealed that customer service was poor. Overall customer service was accepted as average. In relationship marketing customer service plays a major role in analysing the effect of relation between staffs and customers of an organisation. Relationship marketing is based on number of factors by which that hospital can affiliate customers to use their products. This hospital took customer service to attract children, adults and senior citizens in the betterment of delivering customer services. In relationship marketing among various schemes such as online advertising, branding your products, making an advert by differentiating different cultures and ethics to advertise; consumer psychology plays a much
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important role for relationship marketing in hospital (Black K, 2011). Consumer psychology is all about understanding why there is a need of consumer engagement with an organisation and how individuals and groups are getting engaged into activities of staffs. Taking this into account in the questionnaire customers provided thoughts such as improvising the customer relation by giving better training to staff that lack knowhow about the services of that organisation. In conclusion about customer service impact on relationship marketing customers are brought forward to provide their suggestions in improvising the hospital. A customer revealed that allowing us to give our suggestions is a greater part of relationship marketing with customers.

Knowhow of staff: Usually management ideas for enhancing the knowhow of the staffs are seen as a immediate solution for ensuring the smooth flow of relationship marketing of the organisation. The importance of knowledge management to the staffs by which it impacts on relationship marketing has been supported as organisational know how to the staffs have always been a scale for measuring the success of any organisation, success creating fortunes in organisation and also a critical factor for deciding the success of an organisation (Sallis E 2002). Knowledge of staffs in relationship marketing is the next needed factor which has to be considered in the part of relationship marketing by each and every organisation. For rendering a customer service a staff should be fully aware of that particular product of that organisation. In Kokilaben DhirubhaiAmbani hospitals all the staffs are trained periodically about the advancements of
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technology and about the customer relationship. The importance of customer relationship is given much importance in order to ensure there is a delivery of proper service to consumers of hospital. In the questionnaire knowhow of staffs are analysed by asking the customers about both the knowhow and the service of the customers. Customers about 3% answered poor about the knowhow of staffs. They have identified that the lack of training to the new starters in the hospital have made them to respond negatively. About 20% customers revealed fair about the knowhow of staffs and 47% answered as satisfactory. They also added that staffs are aware about the different services provided by the hospital and guided them according to their needs. Customers also added that communication by staffs and morale of the staffs was also good to guide them. Over 15% of customers said that staffs are good at their knowhow by training. Few customers mentioned about the effectiveness of training to the staffs made them really approachable.

Knowhow of staff

Poor Fair Satisfactory Good Excellent

Communication skills about the staffs are also appreciated by the customers. The customers from different background have also mentioned good; since
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they have not had any difficulties in understanding the guidance given by the staffs in hospital. Customers also mentioned that they responded good for staffs especially for the way of handling them was felt well and good by them in the hospital. About 5% customers responded as excellent about the knowhow of customers they mentioned as excellent because they revealed that service provided by the staffs was exceptionally good in various stages of their treatment in the hospital. Few customers who felt excellent also suggested about the staff excellence to the management of the hospital. The importance of knowhow in relationship marketing is discussed because relationship marketing is based on business marketing from the point of view of the interactions between stakeholders, the network-oriented approach, distribution channels, the marketing of services, and direct and database marketing (Moller and Halinen 2000). In order to interact customers know how of staffs are considered for this research. Majority of customers addressed knowhow of staffs as fair and good for customer relationship marketing. Environment of hospital: One of the important factors to be considered in relationship marketing and interacting customers is considering the atmosphere and infrastructure of the organisation. In this research infrastructure and atmosphere of the hospital is considered in a major level because customers first attraction will be about the environment of the hospital starting from factors such as cleanliness of the hospital, equipments in the hospital, availability of new and advanced facilities to the customers under one roof.

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Environment

Poor Fair Satisfactory Good Excellent

The importance of environment is considered because there is a proven evidence of for infrastructure and impact on policy of an organisation it is said as environment of the organisation will improve understanding the range variability of infrastructure across different countries. This research also provides factors which constitute effective infrastructures, policy and practice and improve training for staffs for understanding the importance of infrastructural factors that inuences the impact of health promotion for the customers to the hospital (Claudia, Konig 2011). The customers commented in the questionnaire that environment of the hospital includes all factors such as infrastructure, equipments, availability of pharmaceuticals inside the hospital, availability of appointments fixtures for meeting various surgeons and also about the qualifications of the doctors in the hospital.

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In the questionnaire about 28% customers revealed fair for the environment of the hospital in which they mentioned about the cleanliness of the hospital is appealing and neat. Few customers mentioned about the periodic cleaning is also done properly. About 19% customers responded atmosphere of the hospital as good and 46% as satisfactory. Few customers told about the cleaning staffs are approachable to make suggestions if any in the hospital for cleaning. Only few customers which 2% told that the quality of cleaning and the infrastructure of the hospital is poor and bad. They also commented in the questionnaire that the staffs are hurrying with their cleaning work and are not proper due to hastiness. Few customers even suggested that those staffs needed training on cleaning areas. About 5% of customers replied excellent in the questionnaire for maintaining the environment of hospital. Few customers told that infrastructure is at its best when comparing to other hospitals in Mumbai. Over 33% of the respondents to the questionnaire accepted satisfactory as their feedback to this hospital. The customers mentioned that the recent infrastructure and the equipments are affordable to their budget. This satisfactory level given by the customers made the hospital relationship management to the overall of good level for the environment in the hospital. CHAPTER 6 DISCUSSIONS: Overall in discussing about the feedback from the questionnaire. The various factors which support the relationship marketing in the hospital are classified into three major factors. Considering all the three factors overall customers revealed as fair for the relationship marketing in this hospital. When customers views are gathered together who are commented about these three major factors majority of the customers accepted that hospital quality and the customers relations are fair for them. The familiarity of the hospital
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also paves way for the new customers to approach the hospital with the trust of getting cured to their diseases. When discussing about Kokilaben DhirubhaiAmbani hospital comparatively, other hospitals in Mumbai are taken into consideration. The other hospitals such as Tata memorial hospital, Lilavati hospital and research centre, Dr. Balabhai nanavati hospital, Saifee hospital, Kohinoor hospital and Fortis kalian hospital are considered for comparatively discussing with Kokilaben Dhirubhai Ambani hospital. Primarily, Tata memorial hospital which has been initially commissioned and took over by ministry of health in the year 1967 and has departments for cancer research and education institute which has about 43000 patients every year visits the hospital. Tata memorial hospital also has similar facilities like Kokilaben DhirubhaiAmbani hospital. The advancements such as technological equipments and communication facilities. Tata memorial hospital has computerisation of medical reports with widening of communication facilities with customers whereas Kokilaben DhirubhaiAmbani hospital has a facility of an enquiry submission as a 24 hours service for its customers. This facility in this hospital has been appreciated by many customers which enhances the customer relationship between customers and the hospital. So, comparatively Tata memorial hospital has scored about a grade of 5 out of 10 according to a survey. (www.consumerdaddy.com, 2012a) When compared to other hospitals such as with Lilavati hospital and research centre the only difference between this hospital and Lilavati hospital is; it is a non-profit and managed by charitable trusts. But there are differences in the
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operations of management between these hospitals. But in comparatively to the survey Kokilaben hospital is at the rating of 4.95 which now makes the need to enhance Kokilaben hospitals grey areas where some of the customers revealed in the questionnaire about the lack of training to their staff in the hospital. (www.consumerdaddy.com, 2012b) When considering the next traditional competitive hospital such as Dr. Balabhai nanavati hospital; it has been opened by Dr. Jawaharlal Nehru during 1951 and has been serving for 60 years in India. It has more similarities in the operation of team of staff, research institute and principles with this hospital. Dr. Balabhai Nanavati hospital and Kokilaben hospital shares the same average in the survey as well. (www.nanavatihospital.org) In comparing to a private hospital which has close competitive edge in customer service is SAIFEE multi speciality hospital which has its various speciality services comparatively more than Kokilaben DhirubhaiAmbani hospital. The only advantage Kokilaben hospital has is it is an older organisation than SAIFEE hospital because it has been opened in the year of 2005. Comparing the similarity of each hospitals both the hospital serves for the patients of all age groups and considers in providing more professional services by employing highly qualified team of staff in their hospital in order to ensure the relationship marketing between the hospital and the customers are always fair. (www.saifeehospital.com, 2012) Comparing with the next best private hospital which is kohinoor hospital. It is centrally located in mumbai which has a pride of worlds second LEED Platinum certifed and Asias first hospital to be certified in this category. It has similar advanced specialised technologies with Kokilaben hospital but in comparitive
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study with both these hospitals the only contradicting factor is number of years of operation. Kohinoor hospital has been opened by the year of 2009. So, concludingly relationship marketing plays a vital role depending on the number of years an organisation is in the market as well. (www.kohinoorhospitals.in) The next private sector hospital which has been profounded by fortis group in Mumbai. Fortis kalyan hospitals which has wide spread branches in mumabi in four areas. It has over forty years of operation in healthcare industry. Comparing Kokilaben DhirubhaiAmbani hospital with this fortis kalyan hospital there are much more similar factors such as number of year of medical service and equipments used for the treatment of patients. The only difference between Kokilben hospital and fortis kalyan is the innovative operation. Fortis kalyan hospital has a feature of creating innovative ideas to solve the medical issues of the patients throught its various network of hospitals around the world. Concluding this discussion Kokilben hospital has to ensure there is innovation in their treatment process which makes Kokilaben hospitals relationship marketing looks high among the customers (www.fortishospitals.com) In concluding this discussion by comparing Kolilaben DhirubhaiAmbani hospital with all other few hospitals around mumbai. Several factors such as raising the standards of hospital for better marketing, training to staffs for betterment in customer relation, raising staff activities to think innovative ideas in their treatment and also to ensure above average in the customer services. In discussing about the hospital and its service to them customers also revealed about the credibility and how far the hospital is trust worthy for their future. Most of the customers felt good about the current service of Kokilaben
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DhirubhaiAmbani hospital by comparing to other hospitals in and around Mumbai. Few customers said new hospitals with advanced technology and newly equipped hospitals would be competetive for this hospital. They mentioned in the discussion in the questionnaire about the marketing capacity of how other hospitals market their brand. Customers revealed that only for the goodness of renowned history of this hospital customers are still opting Kokilaben DhirubhaiAmbani hospital. Empirical evidence on the profitability of firms engaging in relationship marketing is uncertain. As over 25 % customers suggests, and this study reaffirms, relationship marketing may not be appropriate for all service providers. To achieve relationship marketing success, both the customer and the service provider must perceive the service offering to be mutually beneficial (Berry, 1995). As such, some service firms are beginning to experience a certain amount of backlash from relationship marketing efforts, as consumers may feel burdened when service firms request personal information, such as area codes, zip codes and other demographic information. In addition, relationship marketing efforts must be affordable and practical to implement for the service firm. Due to levels of standardization and customer contact that influence consumers perception of relational benefits, providers may not be accruing financial rewards worth justifying the costs of engaging in relational activities (De Wulf et al., 2001). Therefore, relationship marketing should not be a universal philosophy for all service firms, particularly those that are more standardized. The results of this study suggest that a service firm providing a more standardized service offering is better served by hiring and training competent and trustworthy employees rather than adopting relational benefit programs. While benefit
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programs, such as frequent dining cards at fast food restaurants may not generate the expected benefits (i.e. loyalty, word-of-mouth, and satisfaction), other options for developing relationships with customers are available. In lieu of benefit programs, management is encouraged to practice relationship marketing aimed at employees so that they, in turn, perform well for customers. Additionally, management should focus on maintaining systems for monitoring service performance and customer complaints, as well as an emphasis on overall employee satisfaction. On the other hand, high contact customized service providers are encouraged to engage in relationship marketing activities with highly involved consumers, specifically those related to confidence benefits. As suggested by the present study, service providers should measure the product category involvement of their clientele. Customers highly involved with the service offering (i.e. haircut) should be the focus of the service provider due totheir enhanced perception of relational benefits and increased likelihood of relational response behaviors. Perhaps including questions pertaining to involvement issues should be added to comment cards already in use at many service locations. Mere willingness by consumers to complete such surveys may indicate higher levels of consumer involvement with a particular service type, and thus could be a useful starting point for service providers in segmenting customers Finally customers concluded discussing the above mentioned factors which has been spotted as grey areas in which Kokilaben DhirubhaiAmbani hopital. These grey areas are will now be taken into consideration in this research to suggest and strongly recommend hospital the ways in whcih they have to work in order
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to ensure relationship marketing is higher in their hospital to have satisfied customers. CHAPTER 7 CONCLUSION: Primarily this research was propounded by the researcher in the context of analysing about the customer relationship marketing critically by conducting a research in Kokilaben DhirubhaiAmbani hospital, Mumbai, India. In this research customer relationship marketing has major part in analysing all the parts of market. In this research history of the hospital, advancements in the market from traditional marketing strategies and movement from old method to new method has been discussed. Secondly, findings in this research has been made by using quantitative method of questionnaire about the Kokilaben DhirubhaiAmbani hospital and its quality of customer services. In this research concepts such as seven Ps of marketing which are considered as more important chain relationship marketing, customer service relationship in longer term to the hospital, hospital pricing policy and effects on customer relationship marketing are also discussed in the research. Thirdly, future of customer relationship marketing is also included which will enhance customer relationship management in this hospital. In order to ensure relationship marketing tin the hospital is critically analysed general process of cutomer relationship management is discussed in order to differentiate the and suggests the mangement the best practice of relationship marketing management in Kokilaben DhirubhaiAmbani hospital. The impact of customer relationship management in the current situation and also impact among the customers of Kokilaben DhirubhaiAmbani hospital is given in detail. A
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comparitive study through dicussion about both the government hospitals in and around mumbai with the private hospitals in also mentioned in this research. The comparitive study is taken into account by the findings from about 30 customers of different background and all customers in this hospital are considered for research. The views from the customers about this hospital is compared with the other hospitals operation in order to ensure the customer service strength of this hospital. Finally this research has justified about for the reasons why it has took quantitative research and not qualitative as well. This research will now concluded by following the above discussions and findings which is analysed by the author with the views from the different authors will now recommend and suggest the following to Kokilaben DhirubhaiAmbani hospital. CHAPTER 8 RECOMMENDATIONS AND JUSTIFICATIONS: Relationship between customer satisfaction and customer loyalty. customer satisfaction has been the issue of attention in the past ten years. Nonetheless, the old method in evaluating customer satisfaction have not been sufficient to ascertain the important of satisfaction because of its narrow scope. The scale of customers opinion was too wide , most measuring implements ,therefore, were not appropriate to be applied in this case. (Oliver, 1980) Furthermore, by evaluating customer satisfaction the range of perceptions could not be measured by traditional methods because these methods did not provide a broad way to evaluate the perceptions which may have an effect on customer's subsequent behaviour. Consequently, the relationship between customer satisfaction and its impact on increasing loyal customer and
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companies operational performance has been acknowledged by business studies (Dick and Basu 1994) The reviewed literature proposed that customer loyalty is an attitudinal concept reflecting value, trust, and commitment within the company-customer relationship. Satisfaction was thought to be one of the antecedents of customer loyalty. Nonetheless, customers with satisfaction may not necessarily have a loyalty to a particular company. It is also argued that "loyal customers will go to the mat for their solution of choice (Buttle and Burton 2002). This statement implied that the loyal customers could make a positive word of mouth which would refer to their preferred companies. (Strategies 1999) also stated that there might be an emotional relationship connected between company and its loyal customers.The individual-level model of customer satisfaction proposed by many researchers have been discussed and observed about a strong relationship between customer satisfaction and customer loyalty (Anderson and Sullivan 1993 p.125-43). Other researchers concluded that a primary factor leading to determine loyalty was a satisfaction. (Oliver and Linda 1981 p.88-93). These researches aimed to support (1993p.64-73) argument that even though there is a close connection between customer satisfaction and customer loyalty , the customer satisfaction is not a surrogate for customer loyalty. To sum up, the companies need to satisfy their customers beforehand in order to establish customer loyalty to product, service and company. Recommendations by this research is completely analysed according to the research conducted and discussed above. It is all about the customer relationship marketing and it s vital role as a key to the success of an
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organisation. The customer service recommendations are now suggested by customer to Kokilaben DhirubhaiAmbani hospital. They are Advancements in equipments It is strongly recommended to the management of the hospital that they should ensure that there are newly equipped and recently advanced technological medical device are used in the hospital. As discussed earlier in the research Kokilaben DhirubhaiAmbani hospital has to ensure that it is giving the competitive edge with the new hospitals compared in this research. Moreover the advance equipments must be handled and given training to the new staffs for handling it. So, that there will be smooth flow of usage of new technologies. The advanced equipments are in the hospital even though there is a need for the latest technologies as suggested by the customers for enhancing the relationship between the hospital and the customers. Making customer aware Awareness of the services to the customers is considered as the most vital part of the customer relationship research by any organisation. Awareness is the primary concept of marketing (Reichheld, 2008).it is believed from this recommendation ensuring customers aware about the services in the hospital, customers will ensure the usage of all services in the hospital which will enhacne the customer relationship between them. Customer awareness can be made thorugh in-hospital advertisements such as issuing brochures, leaflets, references about hospital services by physicians and posters inside hospitals. Health care system
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Health care system of maintaining customer medical records in an IT database is recommended to the hospital in this research in order to ensure that there is long and reliable relation with the existing and new customers in the hospital. The health care system is also welcomed by customers in the suggestions asked to the customers in the questionnaire. Health care system can be enabled as a popular relationship marketing technique for customers by creating notification mails and appointment bookings of customers as an email or newsletter to create a relationship between the hospital and the customers. Health care system also will be an advanced tool of hospital operation which is believed that it will benefit both the customers and the hospital as well. Health care system will cover all customers from new ones to existing customers. If health care system taken into consideration from this research it is believed as it will motivate the existing customers to spread about the enhancements and about the historic achievements of this hospital which will ensure new customers for the hospital. Enhancing longer term relationship Longer term relation and its effectiveness is discussed earlier in the research which is considered as the vital part which is believed as it will ensure that longer relation will enhance the relationship marketing of an organisation. Longer term enhancement is suggested as the prime concern in recommendation. Recommending customers to attend health check workshops in a monthly basis which should be recommended by surgeons is the major part in maintaining the longer relation between the customer and the hospital. In this method of making the customers to attend the workshops and health check up. Good will of the hospital and the reputation of hospital will increase in conducting workshops about dental health, yoga classes and
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conduction of free eye check up in the hospital is also recommended. This research also suggests hospital to conduct diabetes and heart health care campaigns to ensure the customers are not affected by this common kind of diseases which will ensure a feel good factor for the customers about the hospital. Training Training to the new proposed structure is strongly recommended. During data collection among 30 customers 9 customers indicated that staffs are unaware about which departments are supervised by which surgeon in Kokilaben DhirubhaiAmbani hospital. All department employees felt in the training session which was conducted in the month of August, until now employees are only revealed about head counts in the department who will be working in the department and the management will reveal in few days about the in charge surgeon. All department employees reported they were really concerned about the responsible duties of each and every employee in the hospital. So, it is strongly recommended to management to provide role plays in training among employees. In this training (Rees D and Porter C, 2004) suggests process of action learning. It is explained as employees from multi-disciplinary departments when made to work together this process will make each and every employee to learn from each others mistake. The introduction of training might also reveal to the management about is there any necessity to provide training for senior surgeons and team of doctors to develop the performance of their team and team members in Kokilaben DhirubhaiAmbani hospital.

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It is believed as training motivates employees towards the new techniques in relationship marketing because previously in this research it is mentioned as few staffs were not motivated towards the new structure noticed and revealed by the customers during collecting data for this research. Employees revealed that unawareness about responsibilities is one of the reasons for lack of motivation. Training provides employees a clear vision about the new roles and the importance in adopting it. Colquitt, Lepine, & Noe criticises that a research has proven that willingness of employees to attend a training programme is related with possessing skills in an increased level, self-interest, commitment to the organisation, involvement with performing the work and career progression (cited in Van den Broeck A & Vansteenkiste M, 2010) Training employees with the new roles and responsibilities will motivate employees in adopting the proposed new techniques as recommendations in this research. Studies about training and transferring the knowledge to work have proven that training employees motivates to adapt to change. It also adds that Learning and motivation are both essential for training transfer. Without learning, nothing can be transferred from training to the workplace. Without motivation, nothing will be transferred from training to the workplace (Gegenfurtner et al, 2009) So, it is recommended as before implementing change after the acceptance of all employees about the new structure training should be provided to all employees to perform within the hospital. In this approach employees who are unclear about the service provided to the customers would be in a position to perform well and to produce a good customer service as aimed by the management after implementation of these recommended changes.
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 Pilot system or Trial run Pilot system is a form of testing the newly proposed techniques and its effectiveness within the organisation which has been specified by most of the customers in the questionnaire. Trialling within departments or conducting a trial period before complete implementation will reveal to management about the effectiveness of particular schemes. Trial run has been explained as some of the systems might not work properly as it has been planned and expected to be performing. It is therefore supportive by conducting a test before it is implemented. This could be in the form of dummy run in which the scheme is run into two or three departments within the organisation or in a smaller organisations first one year is considered as trial period. In both cases this would involve going through each stage of the process. Managers and the staffs will have to be carefully briefed on the purpose of the test and persuaded that it is everyones interest, including their own, that the test should take place (Armstrong M and Cummins A, 2011a)

The pilot scheme is aimed at reviewing future errors if any, in the proposed system within the organisation. The main aims of pilot scheme are reported as follows

The process and effectiveness of new techniques

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The utility of information given to customers The effectiveness of the training given to the staff The quality of ratings and assessments made The effectiveness of the procedures used, including records of

recommendations and decision made for longer relation maintenance of customers. Pilot scheme has been implemented in NHS National Health Services by the government which is a similar public sector organisation like Kokilaben DhirubhaiAmbani hospital. Pilot system has been undertaken for one year for similarly proposed new techniques in which GPs has more responsibilities of maintaining funds and allocating funds to different sectors. It has been described in one of the reports that there was better understanding of roles by doctors and nurses due to pilot system and it has increased the efficiency and performance of employees. (Moore A, 2010) However, pilot scheme possess above mentioned aims there are several contradictions reported by an organisation. It is reported as in the beginning of implementation it was accepted by employees to undertake proposed role plays, but in operating pilot systems trade unions were not pleased about the role allocations in pilot system. Trade union denounces pilot system and also organisation has withdrawn from operating the system (Lawler JJ and Hundley G, 2008) Positive reinforcement It is termed as reinforcement is a tool which encourages the positive behaviour of employees and positive results and to utilise in the success of the relationship marketing between the customers and the hospital (Palmer B,
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2003) In the concept of reinforcement it is suggested to the management to utilise the positive behaviour of employees within hospital to encourage other team members who are not motivated about the new techniques for marketing. In the questionnaire customers has been revealed that 2 staffs out of 10 and out of 6 management representatives 4 representatives in the team were interested towards the new techniques and enhancing the relationship marketing. Few customers revealed that the way of communication from those motivated staffs to the customers are much appreciated. Reinforcement in this context it is recommended as by conducting pilot run and considering employees concerns and by responding to the feedback of customers, management can reinforce the proposed recommendations as a new techniques (Vance M et al, 2011) It is believed by recommending reinforcement which will motivate employees towards the structure of relationship marketing and able to deliver good performance to the organisation. It is also emphasized as strengthening proposed new marketing techniques by formalising the rules, decision making and policies in the new system and supporting the change will enhance the relationship marketing between the customers and the hospital (Meehan J and Simonetto M et al, 2011) Self Reinforcement Self-reinforcement is defined as an internal system which outcomes related to a particular behaviour produce or lead to more of that behaviour (James. S.L. Matrecia and Sepehri M, 2011b) In this research self-reinforcement is primarily insisted to the management to adopt self-reinforcement as a process of
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motivating employees about the customer relationship marketing. The major reason behind this recommendation is to ensure each and every employee is motivated before implementing the relationship marketing. The recommendation of employee motivation is emphasised in this research because among 16 interviewees 10 interviewees unfortunately revealed staff are not motivated due to various reasons such as no motivational factor in the hospital, fear of unknown about the methods, job cuts and often government policy changes within hospital. In self-reinforcement process a positive behaviour which is within an employee will make other employees within the department to act accordingly towards delivering a good performance. It is said as a fundamental and primary step is identifying factors and situations which make employees feel motivated. Belle et al states that in order to find the positive behaviour within each employee, they must be critical about their own performance. He also emphasizes through the process of learning to recognise mistakes in their method of working, they can obtain increased knowledge about their performance. Thus, recognition creates appropriate behaviour about success (cited in James. S.L. Matrecia and Sepehri M, 2011c) It has been proven that team based organisations are benefited by selfreinforcement. It has been initiated by Glassop, Morgeson and Mumford et al., as team based organisations expects to its employees to self manage their activities. Self-reinforcement is also supported as the process is motivating the team members to achieve the success by co-ordinating as a team. The selfreinforcement process not only makes team members to execute the targets but it also co-ordinates mutually as a team to achieve established goals. It
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explains that improved self management skills are likely to enhance working as a team. (Cited in Rousseau V and Aube C, 2010) However, in some cases self-reinforcement leads to negative outcomes such as lack of honest self-evaluation and the presence of personal and situational rationalization might lead to continued negative behaviour. Recently in 2010 other researchers namely Hershberger, Ziyd, Rodes and Stolfi recognized in the process of self-reinforcement, competency is a major factor of human behaviour and interpersonal interaction is not easy to measure and understand. (Cited in James S.L. Matrecia and Sepehri M, 2011d) The above mentioned recommendations are strongly recommended to the management according to the need of various employees. These recommendations may or may not be applicable if the employees are not interested to adopt towards the new structure. But it is believed in this research the recommendations which are proposed addresses the issues of motivation, engaging employees towards the relationship marketing as a strategy to achieve new satisfaction within customers and necessity in training and complete awareness about the proposed new recommendations. Implementing proposed new structure in smaller groups (Trialling) Over 4 customers of 10 suggested about trialling the method of customer service in a smaller group before implementing in the hospital. They also felt that when the system has been implemented in smaller groups. It will enable to locate the inaccuracy if any in the proposed recommendations. Trialling the new system will assure then to the management about any unpredictable errors if any between the staff. Trialling of new system will always ensure if there are any errors in the new system. Trialling also minimises the amount of
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risk by implementing in the smaller group within the department which has less employees. Trialling is supported as pilot run which means Use this tool to eliminate any unforeseen problems with the implementation of the project and to begin implementation on a smaller, less risky scale (Palmer B, 2003a) Creating mission and vision statement One of the employee suggested creating a mission and vision statement will engage all employees to work towards the goals of hospital and the customer satisfaction. One of the representative in the management also felt the same which has been discussed earlier in this research. So this research strongly recommends to the management to consider this recommendation before implementing the ideas for enhancing the relationship marketing in the hospital management. This should create awareness about the goals of proposed new techniques. Vision and mission statement is suggested in this research to engage all employees towards a specified goal of hospital. (Chenoweth D, 2011) explains vision statement as An organisations vision statement is a brief and motivating statement about what an organisation intends to do and achieve in future. The mission statement is the statement which is more specific and action related. Mission statement should be derived from vision statement and vision statement should be supported with mission statement. It is also emphasized as mission statement is more expressive than the vision statement. It is also insisted that mission and vision statement should have articulate goals to which are achievable by an organisation (McCann P, 2000)

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Lansdell states that creation of mission and vision statements attracts criticisms such as it many times becomes a collection of business technical terminologies (cited in Gill R, 2006a) it is criticised by Scott Adams in The Dilbert principle as mission and vision statement as a long awkward statement that demonstrates managements inability to think clearly (cited in Gill R, 2006b) REFERENCES: 2008, R., 2008. Measuring Customer Satisfaction and Loyalty: Survey Design, use and statistical design. s.l.:Quality press. al, K. e., 2009. Management research methodology. s.l.:Pearson education. Anon., n.d. [Online] Available at: http://www.businessdictionary.com/definition/relationshipmarketing.html [Accessed 13 May 2012]. Anon., n.d. [Online] Available at: http://vspages.com/private-hospitals-vs-public-hospitals-1590/ [Accessed 15 May 2012]. Anon., n.d. [Online] Available at: http://www.expresshealthcare.in/201107/market01.shtml [Accessed 25 MAY 2012]. Anon., n.d. [Online] Available at: www.nanavatihospital.org [Accessed June 05 2012]. Anon., n.d. [Online] Available at: www.nanavatihospital.org [Accessed 05 June 2012].

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Appendix : Customer service questionnaire

This questionnaire aims to investigate literature on patients behaviours and the importance of customer service at KOKILABEN DHIRUBHAIAMBANI HOSPITAL, MUMBAI. The survey is part of my MBA dissertation in the University of Wales.

Thank you very much for your help

Section 1 Research Questions

1.1

Have you ever been to this HOSPITAL?

Yes____ / No_____

1.2

Was the environment clean and comfortable? Yes____ / No____

PLEASE EVALUATE YOUR VISIT BY RATING YOUR EXPERIENCE

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1.3 Poor 1

Customer care and professionalism of staff Fair 2 Satisfactory 3 Good 4 Excellent 5

1.4 Poor 1

Knowhow and service of staff Fair 2 Satisfactory 3 Good 4 Excellent 5

1.6 Poor 1

Initiatives by staff to solve problems if any Fair 2 Satisfactory 3 Good 4 Excellent 5

1.7

Attention to detail and efficiency of staff

Poor 1

Fair 2

Satisfactory 3

Good 4

Excellent 5

1.8

Response to phone enquiries or complaint

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Poor 1

Fair 2

Satisfactory 3

Good 4

Excellent 5

1.9

Interest to serve and enthusiasm of staff

Poor 1

Fair 2

Satisfactory 3

Good 4

Excellent 5

1.10

Overall, how would you rate our customer service?

Poor 1

Fair 2

Satisfactory 3

Good 4

Excellent 5

1.10

Which factor did you like best about our customer service and

will you keep longer term relation with hospital when it is needed? ________________________________________________________________ ________________________________________________________________ ____________________________
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Section 2 Background Information I need to finish this questionnaire by collecting some personal information about you forresearch purposes.

2.1

What is your gender? [ ] Male [ ] Female

2.2

What age were you on your last birthday? [ ] 20 30 [ ] 41 - 50 [ ] Over 60

[ ] Under 20 [ ] 31 40 [ ] 51 60

2.3 [ ] Single

What is your marital status? [ ] Married [ ] Divorced [ ] Living with a partner.

[ ] Separated [ ] Widowed

2.4

What is your ethnic origin? * + Asian * + Oriental..

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* + African. [ ] African American

* + South American [ + European

* + other (please state)

2.5

What is your occupation? [ ] academics [ ] building/contracting [ ] business [ ] artist * + other (please state)

[ ] student [ ] finance/accounting [ ] law/legal [ ] health care service [ ] pensioner

2.6

What is your level of education? [ ] College Degree [ ] Post Graduate Degree

[ ] High School [ ] Under Graduate Degree

* + other (please state) ..

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2.7

How could we improve our customer service?

________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________

2.8

Feel free to make additional remarks

________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________
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Thank you for taking the time to complete this questionnaire

Please be assured that your responses will be treated as strictly confidential and used by the researcher for academic purpose only.

Yours Faithfully,

Name of the Student : DR.NIDHI PATEL Wales ID: :15212AI131 University of Wales

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