Service operation systems and strategies of Hospitals

SUBMITTED BY: ARPAN KHURDELIA DIPALI BANGAR MOHIT ASSUDANI NEHA PATHAK (20) (33) (51) (54)

National Rural Health Mission

Reduction in IMR and MMR
Universal access to essentials like women and child health, water, sanitation, immunisation

Prevention and control of communicable and non-communicable diseases

Integrated primary care Population stabilisation incl. gender balance Revitalise local health traditions
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SMALL STEP TOWARDS A BIG REVOLUTION

1983 First super-specialty corporate hospital in India Apollo Hospitals, Chennai Started with 150 Beds; today has 700+ beds

20 Owned hospitals, 20 Associate hospitals and over 30 clinics Over 6800 beds, 14 Cardiac Institutes, 6 Oncology Institutes
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Medical Tourism to India

4 Medical tourism can be broadly defined as provision of 'cost effective' private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. Low Cost Rich Cultural Heritag e

A bone-marrow transplant which would cost you around $250,000 in the US and 150,000 in UK will cost you a mere $26,000 in India. A patient can successfully get a gastric bypass surgery in India by paying just $9,500 as against a $65,000 price tag for the same in the US
The Medical Tourism Industry alone which was worth $333 million in 2005 has grown up to a $2 billion industry in 2012

Why INDIA?

Less Waiting Time

Personal ized Services

World Class Quality

Doctor, do you think I need an MRI?

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Self-reported assessment of medical practices

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Aspects of Practice Fee-splitting practices Over-prescription of drugs Over-prescription of diagnostics Inadequate sterilization of medical equipment Inadequate measures of disposal of waste Inadequate fulfilment of standards Inappropriate use of medical technology Breakdown of trust in doctor-patient relationship Inadequate information given to patients Lack of accessibility during emergencies

Prevelance High 24 25 14 12 31 5 4 14 15 12

Health Care in India: summary assessment

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Safety Timeliness Effectiveness

Efficiency
Equitable Patient Centeredness

Basic health care is a privilege not a right

Service Quality in Bangalore Hospital

9 CASE 1

Introduction:
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Conducted in 5 Bangalore based hospitals Used the multidimensional, generic, internationally

used market research instrument called SERVQUAL SERVQUAL instrument has been widely used in many service industries (hotels, dentistry, travel, higher education, etc)

About SERVQUAL
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SERVQUAL has following advantages Standard for assessing different dimensions of service quality Valid for a number of service situations Reliable Has limited number of items; customers and employers can fill it out quickly standardized analysis procedure

Research objectives:
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Determine how well the hospitals in Bangalore city were meeting the patients' expectations on the service quality dimensions. Determine service quality scores by dimensions and overall service quality index

Determine the relative importance of the five dimensions to the customers

Determine management's perceptions of patients' expectations

Hypothesis:
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Patient Perceptions of Service Quality

H0: There is no difference in patients' perception of service quality among the five hospitals. H1: There is a difference in patients' perception of service quality among the five hospitals.

Managements' Perceptions about Patients' Expectations.

H0: There is no difference in managements' perception of patients' expectations of service quality among the five hospitals. H1: There is a difference in managements' perception of patients' expectations of service quality among the five hospitals.

Survey Findings:
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Tangibles
Most of the patients were happy with neat and clean house keeping Disturbance due to the noise from the adjacent buildings Felt the need for a spacious visitor lounge

Reliability
Satisfaction regarding the correct diagnosis Not very happy about the fast retrieval of documents, communication with the security personnel, follow up checks etc

Responsiveness
Dissatisfaction as to not getting information on the type of service facilities that are provided for the costs incurred at the time of admission

Survey Findings:
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Assurance
Patients were happy about the excellent nursing care, assistance in the reception Very cordial and empathetic staff, ever smiling - ever ready helpers and the attitude of the physicians

Empathy
Some patients expressed their dissatisfaction regarding discrimination in treatment by ward boys and some nursing staff between the general and private ward patients accounting for larger negative scores for empathy

Conclusion:
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Patients define health care quality in terms of

tangibles, reliability, responsiveness, assurance and empathy Results pinpoint areas for attention to improve upon health care service quality Focus more on training the paramedical staff in order to build confidence in the patients' mind regarding the service delivery Physicians should be involved in continuous learning programmes to further improve their knowledge in professional subject matters

Factors Affecting In-patient Satisfaction in Hospital

17 CASE 2

INTRODUCTION :
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Hospital services are professional service. Services delivered by a provider with the skills acquired by

lengthy training to apply in practice, competence in a field

of knowledge.
The consumptions are made in the belief that by using an

experienced professional, the client is buying confidence and reducing risk.

Customers act like detectives in the manner in which they

process and organize experience clues.

Satisfaction:
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The long-term survival of hospitals depends on loyal patients

who come back or recommend the hospital to others.

Health care is dissimilar from most other services. Patients as laypeople cant evaluate the technical aspects of

medical services.
Satisfaction will be during their interaction within the system

in different phase of services such as front office, food and beverage services.

Present Situation :
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In India and many developing countries, emphasis is on

service coverage and inputs in the provision of health services.

Ignored the needs of the very people for whom these health

services exist.
Incorporating patient views make health services more

responsive to peoples needs.

The present patients are better educated and have access to

more information via the internet.

Factors determining satisfaction among patients :

Front Office Services: Ease of getting admitted Waiting time for admission Counseling process Query handling and courtesy Housekeeping Services: Cleanliness and maintenance Timely response of additional services Medical Services: Care and concern by doctors Time spent by doctors Explanation of treatment and diagnosis Regular visits during stay Nursing Services: Care and concern by nurses Timely medication Explained treatment in simple terms Promptness in managing pain Response to calls Discharge Services: Speed of discharge Billing accuracy Handling of billing queries

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Services with high priority :

Promptness in managing pain and Explained treatment in simple terms Time spent by doctors and Care and concerns by doctors Timely medication and Billing accuracy.

Services with low priority:

Facilities for attendants Speed of discharge Timely delivery of food Food quality

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Conclusion:
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Performance makes consumers return to the same

provider and spread more word of mouth recommendations.

Continuously redesign process and understand the factors

that are highly associated with patient satisfaction.

A Study of Patient Satisfaction in Outdoor Services of Private Health Care Facilities

24 CASE 3

Introduction:
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Aimed at understanding the extent of patient

satisfaction with diagnostic services Captures the behaviour of doctors and medical assistants, quality of administration and atmospherics The role of demographic characteristics like gender, occupation, education, and income is also considered

Sample Design and Data Collection:

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Primary information collected through pretested

questionnaire from 220 randomly selected patients 300 out of 6670 patients were given the questionnaires (filled in personally) who visited these health care units The problem of incorrect judgement was taken care of in study as only regular and experienced patients were contacted The data so collected from different health care units were clubbed together for analysis after comparing similarity in attitude and perception of respondents with regard to out-patient services

Ranking of Selection Criteria:

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S.No. Attributes 1 2 3 4 5 6 7

Rank Efficiency 1 Prior Family Experience and Recommendations by Friends, Relatives etc. 2 Reputation 3 Own Physician 4 Time Factor 5 Location 6 Sanitation 7

Results
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Criteria for Selecting the Health Care Unit First preference to the efficiency of doctors Next was prior family experience and

recommendations by friends, relatives, etc Respondents preferred to avail services from private units because of time factor

Strategic Implication:
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The average degree of satisfaction secured by patients in

private health care sectors is far greater than that of government health care system Benefits sought by patients do not always provide high degree of satisfaction costly services do not appear to be highly valued by the potential patients It is found that overall satisfaction is a result of number of factors like performance of doctors, performance of medical assistants, good level of communication, promptness in delivering the services, responsiveness to customer needs

Changes in Hospital Competitive Strategy: A New Medical Arms Race?

30 CASE- 4

Objective:
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To describe changes in hospitals' competitive

strategies, specifically the relative emphasis placed on strategies for competing along price and non price dimensions

Methods:
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This study uses data gathered through the

Community Tracking Study site visits, a longitudinal study of a nationally representative sample of 12 U.S. communities Research teams visited each of these communities every two years since 1996 and conducted between 50 to 90 semi-structured interviews

Data and Methods:

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Gathered through the Community Tracking Study (CTS) Longitudinal study of a random, nationally representative

sample of 12 communities with more than 200,000 people Interviewed executives at three to four hospital systems and freestanding hospitals Respondent types included 140 hospital executives, including CEOs, planning and other senior executives, medical directors, and state hospital association executives Detailed questions about current policy, regulatory and market pressures, hospital strategy, changes in hospital strategy since 19981999 and the reasons for these changes

Principal Findings:
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Hospitals' strategic emphasis changed significantly

between 19961997 and 20002001 In the mid-1990s, hospitals primarily competed on price through wholesale strategies By 20002001, non-price competition was becoming increasingly important and hospitals were reviving retail strategies Three major factors explain this shift in hospital strategy:

less than anticipated selective contracting and capitated payment the freeing up of hospital resources previously devoted to horizontal and vertical integration strategies the emergence and growth of new competitors.

Conclusion:
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A new medical arms race is emerging Three major factors have stimulated changes in

hospital competitive strategies

Less than anticipated selective contracting and capitated payment due to the backlash against more restrictive managed care plans and products (i.e., HMOs) Freeing up of hospital resources previously devoted to horizontal and vertical integration strategies Inpatient and outpatient hospital competitors have emerged and grown, many of which are focused on high-tech, profitable service lines

Role of Value Chain Strategy in Healthcare Supply Chain Management: An Empirical Study in India
36 CASE 5

Introduction:
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Healthcare providers, payers, vendors have to adopt

right Information Technology(IT) solution to minimize costs and provide responsive service to patients Fundamental logic of value creation is also changing and in a way that makes clear strategic thinking to survive the global competitive environment Upstream suppliers provide inputs The firm then adds value to these inputs, before passing them downstream to the customer

Health Care scenario in India:

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Healthcare sector can be divided into the primary,

secondary, tertiary and the super-specialty level Primary level caters to the basic needs of the patient India spends Rupees 103,000 crore i.e. 5.2% of GDP on healthcare Yet a CII- McKinsey study (2002) shows that Indian healthcare sector is performing poorly on all key dimensions of coverage, purchasing and delivery Healthcare spending is expected to increase from Rs 86,000 crore in 2000-01 to an estimated Rs 86,000 crore-plus in real times by 2012

New Strategies in Supply chain:

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The main service parameters of hospital is primarily based on quality of healthcare delivery cost promptness safety effective and efficient diagnosis and treatment reduced process/procedure times Internal customer satisfaction Total Quality Management(TQM) methodology implementation technology and innovation patient relationship management supplier relationship management patient satisfaction speed of recovery, ability to provide efficient service

Conclusion:
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Healthcare organisations must strive for value

addition across entire supply chain by monitoring supply chain performance Indian hospitals need to strengthen each activity in the value chain by focusing on continuous improvement in the supply chain operations

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