service sector management final
TRANSCRIPT
St. Andrew’s College
Of Arts, Science and Commerce
St.Domnic Road, Bandra (W)
Mumbai 400050
Certificate
This is to certify that the above mentioned students have done the project on 18
September 2009 as a part of Service sector management Subject.
This study has been carried out by the students under my guidance and
supervision during the period of 2009-10. The project work is original and
authentic to best of knowledge.
Place: Mumbai
Date:
Signature of the guide
TABLE OF CONTENTS Page No.
1. Introduction to Service Sector
2. Concept of Service Marketing
3. Hospitals in India
4. History of Hospitals
5. PEST Analysis
6. Unique Characteristics of Hospitals
7. Classification of Hospitals
8. 7 P’s of Hospital Sector
9. Market sementation
10.Quality Dimension
11.Conclusion
INTRODUCTION- SERVICE SECTOR
The service sector has been growing significantly for more than fifty years to the
extent that in the developed world, more people earn their living from producing
services than making manufactured goods. In fact around three quarters of the
population in the United States and the European Union are employed in service
industries. Services therefore have a major impact on national economies. The
subject of Services Marketing has grown in response to this. Latterly however,
manufacturing and technology industries have also recognised the need to
provide services not only as a means of adding value to the physical products
which they market but also as the basis for a different orientation to the
management of their businesses. This module will address the key issues,
concepts and models which form the core of Services Marketing theory, focusing,
as far as possible, on the service industries of relevance to students taking the
module.
What is a Service?
Services include all economic activities whose output is not a physical product or
construction, is generally consumed at the time it is produced and provides added
value in forms (such as convenience, timeliness, comfort or health). That is
essentially intangible concerns of its first purchaser.
Concept of ‘Service Marketing’
The perception of service marketing focuses on selling the services in the best
interest of users/ customers. Marketing a service is meant marketing something
intangible. It is marketing a promise. In the marketing of services, we go through a
number of problems directly or indirectly influencing the business index. The
problems like market segmentation, marketing information system, behavioral
management are studied minutely which simplify the task of formulating a sound
mix for marketing, such as Product mix, Promotion mix, Price mix and the Place
mix. It is important to mention that we find “People” an important mix of
marketing services. If we market the services in a right direction, the available
opportunities can be capitalized on optimally and also it contributes substantially
to the process of development. In view of the above, we observe the following
key points regarding the concept or perception of services marketing:
It is a managerial process of managing the services.
It is an organized effort for providing a sound foundation for the
development of an organization.
It is a social process helping an organization to understand the emerging
social problem and to take part in the social transformation process to
justify its existence in the society.
THE HOSPITAL INDUSTRY
Service Management is:
1) To understand the utility the customers receive by consuming or using the service
offering of the organization
2) To understand how the organization (personnel, technology, physical resources,
systems and customers) will be able to produce and deliver this utility
3) To understand how the organization should be developed and managed so that the
intended quality can be achieved
4) To make the organization function so that this quality can be delivered on a
continuous basis.
Today the hospital is a place for diagnosis and treatment of human ailments and
restoration of health and well being. The basic function of a hospital is to give
proper treatment to the injured and sick without having any social, economic and
racial discrimination.
Some of the other important functions and services of modern hospitals are
training of the doctors and nurses, support to medical research and assistance to
all activities carried out by public health and voluntary agencies to prevent
diseases. It is also a center for training of health workers and bio-social research.
Today it also acts as an institution that provides accommodation to patients for
medical nursing and care. Medical services are primarily provided by the central
and state governments.
Hospitals are not for profit making, they are social institutions that make the
required medical services available to society. With time the classes and quality of
hospitals have changed a lot . Most hospitals today are trying to provide all ultra
facilities and are in the process of making state of the art hospitals. Hospitals
provide the infrastructure facility to healthcare
The last two decades have seen the mushrooming of corporate and privately run
hospitals. Most large trust and corporate hospitals have invested in modern
equipment and focus on super-specialties.
The private sector accounts for 70% of primary medical care and 40% of all
hospital care in India. They employ 80% of the country’s medical personnel.
The corporate hospital sector is most evolved in the south while charitable/trust
hospitals proliferate in the west. However, the north and east are also showing a
growing trend in private hospital expansion. Key therapeutic areas are cardiology,
nephrology, oncology, orthopedics, geriatrics, maternity and trauma/critical care.
Hospitals are not for profit making, they are social institution to make available to
society the required Medicare services. However this may not be true for private
hospitals. Today hospitals are a place of diagnosis and treatment of human ills, for
the training research, promoting health care activities and to some extent a
center helping biosocial research. WHO states that hospitals are socio-medical
organization whose functions are: Curative, preventive, patient services and
training of health workers in biosocial research.
With time the classes and quality of hospitals have changed a lot today. Most
hospitals today are trying to provide all ultra facilities and are in the process of
making state of the art hospitals. Hospitals provide the infrastructure facility to
healthcare.
Hospitals in India
By the late 1980s, there were approximately 128 medical colleges--roughly three
times more than in 1950. Data for 1987 shows that there were 320,000 registered
medical practitioners and 219,300 registered nurses. Various studies have shown
that in both urban and rural areas people preferred to pay and seek the more
sophisticated services provided by private physicians rather than use free
treatment at public health centres.
The fast pace of development of the private medical sector and the burgeoning
middle class in the 1990s have led to the emergence of the new concept in India
of establishing hospitals and health care facilities on a for-profit basis.
Current Scenario
India, the growing economic power in Asia is witnessing frenetic growth of its
health care sector. India’s much-noted economic growth is rapidly improving
living standards and the healthcare industry will be a major beneficiary of the
overall increase in incomes. Recent major regulatory reforms have improved the
growth prospects for health insurance and, as a result, a large section of middle
income families will be able to afford healthcare services leading to high demand.
The report of the National Commission on Macroeconomics and Health had
estimated the size of private healthcare sector in India to be worth Rs 69,000
crore and projected that size to double to Rs 156,000 crore by 2012,besides an
additional Rs 39,000 crore if health insurance picks up. With the current pace, the
corporate segment in the private medical service sector is likely to absorb a good
share of this business.
Large domestic market is well complemented by inflow of overseas Medical
tourists. The number of Medical tourists has increased ten-fold from 10,000 in
2000-01 to about 100,000 in 2004-05.
HISTORY OF HOSPITALS
Etymology
During the Middle Ages the hospital could serve other functions, such as
almshouse for the poor, or hostel for pilgrims. The name comes from German
“hospes” (host), which is also the root for the English words hotel, hostel, and
hospitality.
Early history
In ancient cultures, religion and medicine were linked. The earliest known
institutions aiming to provide cure were Egyptian temples. Greek temples
dedicated to the healer-god Asclepius might admit the sick, who would wait for
guidance from the god in a dream. The Romans adopted his worship.
The Sinhalese (Sri Lankans) are perhaps responsible for introducing the concept of
dedicated hospitals to the world.
Institutions created specifically to care for the ill also appeared early in India. King
Asoka founded 18 hospitals in 230 BC. There were physicians and nursing staff,
and the expense was borne by the royal treasury. State-supported hospitals later
appeared in China during the first millennium A.D.
StatisticsNumber of Hospitals:
States Government Private TotalPunjab 174 39 217Haryana 58 20 78Maharashtra 445 2583 3115Gujarat 263 2031 2370Rajasthan 218 0 218H.P 46 6 57Karnataka 209 56 293W. Bengal 242 129 392Kerala 141 1899 2040Assam 141 80 268A.P 141 1722 1863U.P 534 139 652Tamilnadu 282 119 408M.P 363 0 363Bihar 237 90 328Orissa 250 29 284
PEST ANALYSIS
In India even after 60 years of independence we all have to accept that the
government has failed to provide the basic health care facilities in many areas.
Health care sector is one of the most neglected which is only meant for slogans by
most of our politicians. Following are the list of factors that affect the health care
sector:
POLITICAL FACTORS
There are non- merit quotas in medical institutions which is adversely
affecting the quality & perhaps, the availability of trained and skilled
medical professionals. It is said that because of these reservations the
quality of the future Indian doctors will be very poor.
It is mandatory for the hospitals to keep 20% of the beds free for those
from the lower classes who cannot afford costly treatments.
Providing subsidized land and equipment to Hospitals will help them cater
to their poorer patients better.
Reduction in Import duties will help Hospitals acquire new, modern and
more sophisticated medical equipment and technologies.
ECONOMIC FACTORS
Because of the increase in the per capita income amongst the higher and
middle classes of the society there has been an increase in the spending
from these classes in the health care sector.
Service Tax on Hospital services @ 12.24% has increased the costs of
services provided by the Hospitals. In addition, the cost of input services
(electricity, cleaning, maintenance, laboratory, laundry, patient care,
transportation, ancillary services etc.) has increased due to imposition of
service tax and a hike in Tax rate from 10% to 12%.
Cost advantage in healthcare that India offers coupled with technologically
advanced medical treatment system has helped in the growth of medical
tourism.
The cost of making and maintaining a hospital is extremely high.
Introduction of Private Medical insurers has increased the reach of medical
insurance amongst the Indian public. This is helping the hospitals service
more patients.
Third Party Administrators (TPA’s) has increased the claims settlement rate
at increased cost of medical insurance.
SOCIAL FACTORS
Certain percentages of beds have to be kept for poor people. For example
in Bombay 20% of the beds have to be kept reserved for poor people
whether it is a private or a public hospital.
Look after the needs of local poor people.
Open counseling and relief centres.
Safe disposal of hospital wastes like used injection needles, waste blood etc
& taking care of the environment is to be given high priority.
Campaigns and free medical checkups have to be conducted whenever
necessary.
In brief the social aspect of the hospital industry is to see that latest
treatment and medicines are available to people at large at concessional
rates or free of cost and that its activities are not only restricted to rich
people.
TECHNOLOGICAL FACTORS
A large number of technically qualified professionals have made it possible
to expand the medical services.
Computerization and telecommunication services have made remote area
treatment a reality.
Use of new age equipments is making the delivery of medical treatment
better.
Stem cell research has opened up a whole new arena of Hospital services,
wherein, a new body part can be grown to replace a dead or a diseased
organ within the body of the patient.
Robotics micro-surgery: - a greater degree of robotics technology in
operating room to provide precise and less traumatic as well as less
destructive surgery.
Laser technology
Employment of information technology tools for networking of
examination rooms, treatment rooms, operating rooms and diagnostic
reporting rooms.
Deployment of information technology tools for generation of specific
disease related databases, classified by a number of variables.
UNIQUE CHARACTERISTICS OF SERVICES With Respect To
Hospitals
There are four commonly cited characteristics of services that make them
different to market from goods: Intangibility, Inseparability, Variability and
Perishability.
INTANGIBILITY:
Intangible means that which cannot be seen or touched. Intangible services
are difficult to sell because they cannot be produced and displayed ahead of time.
They are therefore harder to communicate to prospective customers.
Example – A services of a surgeon cannot be seen, it can only be felt and the
difference in the patient can be noticed when he recovers, hence the doctor
charges a premium for the services offered by him.
INSEPARABILITY:
This characteristic is interpreted differently by different service marketing
marketers, but all interpretations point out that special operation problems exist
for the firm's managers. One interpretation of this term is the inseparability of
customers from the service delivery process. In particular, many services require
the participation of the customer in the production process.
In case of the hospital industry, patient has to present for experiencing the
services being offered. Only then can he be treated. In case if he is not present in
person he would have to communicate with the doctor to get some feedback, the
doctors can work only when there are patients, A Hospital Industry will not work
if there are only patients and no doctors.
VARIABILITY :
The fact that service quality is difficult to control compounds the marketer's task.
Intangibility alone would not be such a problem in customers could be sure that
the services they were to receive would be just like the successful experiences
their neighbors were so pleased with. But in fact, customers know that services
can vary greatly. Even the same service provider has good days and bad days or
may be less focused at different times of day. Services are performances, often
involving the cooperation and skill of several individuals, and are therefore
unlikely to be same every time. This potential variability of service quality raises
the risk faced by the consumer.
In the hospital industry, the services offered by one doctor cannot be indentical
to the services of another doctor as it may vary due to several reasons such as
experience, degree , knowledge etc. Also the services provided by one doctor to
one patient cannot be the same when he operates the same patient again as all
these things are even situational.
PERISHABILITY:
The fourth characteristic distinguishing services from goods is their time
dependence. Services cannot be inventoried, since they are performed in real
time. And time periods during which service delivery capacity sits idle represent
revenue-earning potential that is lost forever. Periods of peak demand cannot be
prepared for in advance by producing and storing services, nor can they be made
up for after the fact. A service opportunity occurs at a point in time, and when it is
gone, it is gone forever. This can present great difficulty in facilities planning
In the hospital industry, the injection used for one Patient cannot be used for the
other patient, there has to be a new set up for the other patient, hence the other
items used by one patient cannot be inventoried by the others.
CLASSIFICATION OF HOSPITALS
There are different types of hospitals established with the motto of offering the
medcare services and educational and training facilities. In a natural way, we find
distinction in their structure, function and performance. The classification is found
based on different criteria as mentioned below.
Classification on the basis of objective
On the basis of the objective, there are three types of hospitals, Teaching-cum-
research for developing medicos and promoting research to improve the quality
of medical aid. General hospitals are for treating general ailments and Special
hospitals for specialized services in one or a few selected areas.
This shows what is the main intention or motive of setting up the hospital
On the basis of the OBJECTIVE there are three types:
Classification of Hospitals on the basis of objective
Teaching cum research
This is for developing and promoting research to improve the medical aid. These
hospitals are affiliated with universities for medical research and the training of
medical personnel. Large teaching/ research hospitals have a variety of goals. In
addition to treating patients, they are training sites for physicians and other
health professionals. Teaching institutions are almost always affiliated with a
medical school, which means patients have access to highly skilled specialists who
teach at the school and are familiar with up-to-the-minute technology.
E.g. Pravara Medical Hospital & College, Pravara is a Teaching-cum-research
hospital.
General
The best-known type of hospital is the general hospital which is set up to deal
with many kinds of disease and injury, and typically has an emergency ward to
deal with immediate threats to health and the capacity to dispatch emergency
medical services. A general hospital is typically the major health care facility in its
region, with large numbers of beds for intensive care and long-term care; and
specialized facilities for surgery, plastic surgery, childbirth, bioassay laboratories,
and so forth. General hospitals minister to all types of illness.
Special
This is for treating specialized ailments or providing specialized services in one or
a few selected areas. Types of specialized hospitals include trauma centers,
children's hospitals, seniors' hospitals, and hospitals for dealing with specific
medical needs such as psychiatric problems. Special hospitals are concerned with
only one disease or group of diseases.
VIMHANS is known for gamma-knife therapy and is a preferred centre for brain
and spinal surgery. Every year this hospital gets 60-70 patients, half of them from
Mauritius with neurological disorders requiring micro-brain surgery.
Classification on the basis of ownership
On the basis of ownership, there are four types of hospitals. This shows who owns
a hospital or in other words who are the owners or have possession of the
hospital. It can be divided in the following ways:
On the basis of the OWNERSHIP , there are four types:
Classification of Hospitals on the basis of ownership
Government
This is owned managed and controlled by government. Government hospitals are
operated and maintained wholly by the national, provincial, city or municipal
government, or other political unit; or by any department, division, board or
agency thereof.
E.g. Nair Hospital and St. George are Government Hospitals.
Semi-Government
This is partially shared by the government. Semi-Government hospitals are
operated and maintained partially by the national, provincial, city or municipal
government, or other political unit; or by any department, division, board or
agency thereof.
Private
Private hospitals are privately owned, established and operated with funds
through donation, principal, investment, or other means, by any individual,
corporation, association, or organization. They are profit-making institutions.
Proprietary hospitals are owned by corporations or, less often, by individuals such
as doctors who practice at the hospital. Hospital corporations usually own a chain
of institutions located in several states, and they often own nursing homes or
other types of health care facilities as well.
Voluntary Agencies
These agencies are the ones that run hospitals. Hospitals run by voluntary
organizations. Many hospitals have hospital volunteer programs where people
(usually students and senior citizens) can volunteer and provide various ancillary
services. A voluntary hospital is a nonprofit community facility operating under
religious or other voluntary auspices. Ultimate responsibility for all that takes
place at the hospital rests with its board of trustees, generally selected from the
community's business and professional people, who serve without pay. To
manage the hospital the trustees appoint a paid administrator.
Classification on the basis of path
On the basis of path of treatment, we find allopath, the system which is promoted
under the English system. This shows the path or trail of treatment. Ayurved is
based on Indian system where herbals are used for preparing the medicine. Like
this we find Unani and others
On the basis of PATH OF TREATMENT , there are:
Classification of Hospitals on the basis of Path of Treatment
Allopath
This term is generally used to describe the conventional approach to medicine or
"Western" medicine. It is the system that is promoted under the English system. It
is the method of treating disease by the use of agents that produce effects
different from those of the disease treated. It’s the system of medical practice
which treats disease by the use of remedies which produce effects different from
those produced by the disease under treatment. A system, which treats a disease
with drugs having opposite effects to existing symptoms, each successive
discovery and development in Allopathy, is the result of extensive research. Each
new remedy has helped alleviate pain and suffering and increased the life span of
people.
Ayurveda
It is based on the Indian system where herbal are used for preparing medicines. It
is India's traditional, natural system of medicine that has been practiced for more
than 5,000 years. Ayurveda provides an integrated approach to preventing and
treating illness through lifestyle interventions and natural therapies. Published
studies have documented reductions in cardiovascular disease risk factors,
including blood pressure, cholesterol, and reaction to stress, in individuals who
practice Ayurvedic methods.
Homeopath
A system of therapy based on the concept that disease can be treated with drugs
(in minute doses) thought capable of producing the same symptoms in healthy
people as the disease itself. According to homeopathy, symptoms are the body's
way of fighting disease. It is a system of alternative medicine that strives to treat
"like with like". Homeopathy rests on the premise of treating sick persons with
therapeutic agents [drugs, remedies] that are deemed to produce similar
symptoms in a healthy individual.
Unani
It is a comprehensive system encompassing virtually all of the known healing
systems of the world. As an alternative medicine, Unani has found favor in Asia
especially India. In India, Unani practitioners can practice as qualified doctors, as
the Indian government approves their practice. Unani medicine is very close to
Ayurveda.
Others
Many hospitals are maintained solely for the treatment of military personnel and
veterans. Some hospitals are placed on special high priority segments of the
public works or utilities infrastructure to ensure continuity of care during a state
of emergency.
Classification on the basis of size
On the basis of size, we find variation in the size of hospitals.
On the basis of the SIZE, there are:
Classification of Hospitals on the basis of size
Teaching
These hospitals have 500 beds and differ according to the tune of students.
District
They have 200 beds which can be raised to 300 beds according to the changing
requirements.
Taluka
These generally have 50 beds that can be raised to 100 depending on the needs.
Primary Health Centers
They consist of beds from the range of 6-10.
SEVEN P’S
PRODUCT
A product is a set of attributes assembled in an identifiable form. The product is
the central component of any marketing mix. The product component of the
marketing mix deals with a variety of issues relating to development, presentation
and management of the product which is to be offered to the market palce. It
covers issues such as service package, core services and peripherals, managing
service offering and developing service offering.
Hospitals today offer the following services:
1. Emergency services
2. Ambulance services
3. Diagnostic services
4. Pharmacy services
5. Casualty services
Emergency Services: Emergency services and care at most hospitals is unique
and advanced. The hospitals have state of the art ambulances. The CCU’s on
wheels under supervision by medical and para-medical staff. There is hi tech
telecommunication available to a patient in an emergency at any given time.
Ambulance Services: Hi Tech ambulances linked by state of the art
telecommunications are fully equipped with doctors that are available to render
medical attention and assistance in case of emergencies at the patient’s doorstep.
Diagnostic Services: Modern hospitals are muti-speciality and muti-
disciplinary, that can handle any kind of ailment, they offer a wide range of
facilities for e.g : orthopaedics, Oncology, Neurology, plastic surgery etc.
Pharmacy Services: Most hospitals also have a pharmacy which is open 24
hrs. It caters to the needs not only of the inpatients and out patients, but also
patients from the other hospitals who require emergency drugs.
Casualty services: Includes a 24 hrs casualty department, which attends to the
accident or emergency cases.
Apart from the above services, hospital also offer “Health diagnosis
programme” which is a comprehensive, complete, periodic health check up
provided for busy executives, professional businessmen.
The health diagnosis programme consists of the following:
1. Master health check up.
2. Executive health check up.
3. Diabetic’s health check up.
PRODUCT LEVELS
Core product:
The core product of the service is the service the customer is really getting or the
reason why the customer wants the service. In the hospitals the core service is the
cure that the customer is expecting. For example, a person who is suffering from
“appendicitis” expects relief from the pain and surgical removal of the appendix.
Every hospital provides a core service.
Basic service:
The basic product is what is necessary to satisfy the core benefit or need. In the
hospital sector, the basic product is the bed that is provided, the various qualified
doctors and the nurses that are there in the hospital to look after the patients. The
basic product in the hospitals sector also includes the advanced equipment required
for diagnosing, operating and curing the patient. This basic service also includes
the ward boys who are required for keeping clean and hygienic conditions that are
necessary for the patients.
Expected service or benefits:
The expected benefits refer to the standard of the services the customer expects.
These are the types of services that the hospitals have to provide, if such services
are not provided then the customer may not opt for the service.
Here the expected benefits are that the beds should be hygienic and the services
provided by the doctors and the nurses should be according to the industry norms.
The hospital premises should also be clean. The equipments should be in proper
working conditions and there should be a pleasing environment for the patients to
rest and get cured quickly.
Augmented benefits or additions:
These refer to the various additions to the services over and above the consumer
expectations. These benefits play an important role in attracting patients to the
hospital. In India most of the hospitals have tried to adapt the marketing strategies
of the western countries. Most of the hospitals provide private air-conditioned
rooms for their patients. A few private hospitals also provide maternity wards
wherein the babies and their mothers are taken care of. The children’s ward is a
special section in which hospitals provide special treatment and care for the
children. They are given toys and various other games to play with.
Some hospitals have nurses and doctors that provide exceptional services that
exceed the customer expectations. They provide the patients with pathology
services, a blood bank, there are also the radiology departments. They also have
pharmacies within the hospital building itself.
PRICE
Price is one of the prominent elements in the marketing mix. Price charged must
be acceptable to target customers and it should co ordinate with other elements
of the marketing mix.
According to Philip Kotler, one should try to “Sell Value, Not Price”. Price is a
major determinant of a buyer’s choice, as a person must have the need,
willingness and ability or financial backing to buy the product. In hospital & health
care sector services involve the use of expensive and complex machinery, which
involve huge investments. Apart from that, the cost of maintaining them and cost
of running the hospital is in no terms cheap.
Public sector pricing
In the public sector hospitals the subsidies received from the government are
significant sources of income. The public hospitals provide free treatment to
those who hail from the poor sections of the society. These costs are incurred by
the government. The customers who are above the poverty line have to pay
nominal charges to the public hospitals for their treatment. The rest of the
amount is acquired from the respective governments.
Private sector hospitals
The private sector hospitals have a distinctive pricing strategy. They charge low or
no price to the poor people. This depends on the subsidy programs offered by the
government. Some private hospitals charge a very high price as compared to the
cost of the services provided. Most of the private hospitals have extremely good
quality services and this justifies their pricing strategies. Now-a-days there are the
facilities like medi-claim available that help attract customers to the superior and
expensive services.
Private Charity hospital
In private charity hospitals the pricing strategy adopted is different from that of
the public hospitals. What the private charity hospitals do is that they provide
free treatment to the people from the poor strata of the society; they charge a
minimal rate or subsidized rate to the low and middle income groups who can
afford to pay and lastly they charge high fares to those belonging to the upper-
middle class and high class.
PLACE
This is an important element of the marketing mix which is known as place mix,
which focuses on the location of the service factory. It refers to the contact point
between the service provider and the customer.
It is very important to form the place mix properly in case of hospitals because of
the very fact that the customer himself comes to the service factory, also herein
quiet a number of factors and limitations come into play like the cost of the place
and the area required. Certain hospitals require a lot of space for the building and
all the facilities that are necessary for the treatment of the patient; hence they
may have to locate the hospital at a place where there is lot of space available
and at a cheaper.
Some of the essential features which may be taken into consideration are as easy
and convenient accessibility, safety or protection availability of the infrastructural
facilities, attractive and healthy surroundings.
The selection of place is very important in order to avoid the inconveniences to
the users in reaching to the hospital in time. Adequate transport and
communication facilities should be available where the hospitals are located.
Hospitals should be located at easily accessible places i.e. areas which have an
easy access to all modes of transport. Every hospital must provide transport by
way of properly equipped ambulances to deal with emergencies.
The service product is closely linked to its delivery and nature of the delivery
system also has a powerful impact on the patient experience. Example: Tata
memorial hospital specializes in cancer treatment and is located at a center place
unlike other normal hospitals, which you can find all over other places
PROMOTION
Promotion is an element in an organization’s marketing mix that serves to
inform, persuade and/or remind people about an organization’s or
individual’s goods, services, image, ideas, community involvement or
impact on society. Promotion is used in hopes of influencing the recipient’s
feeling, beliefs, or Behaviour through any form of communication.
In Hospital Sector, it is considered to be extremely “UNETHICAL” to
advertise or promote one’s medical services. This is so because, it is not a
good thing to say that you can save someone’s life better than somebody
else. Also it is very bad to say that you are profiteering from people’s
misery.
Hospitals conduct camps in rural areas to give medical check ups at a
reasonable price so that the rural people approach the hospital again in the
future. Hospitals generally advertise in health and fitness magazines.
Promotional Strategies
Word of Mouth
This strategy is considered to be the godfather of promotional strategies in
Hospital sector. A patient who has been successfully treated in a hospital
will always suggest this to another customer. This is also used to create
customer loyalty among potential customers before any actual service has
been rendered to them. This is why most of the hospitals have to be very
efficient in the service delivery.
Periodicals
Several Medical Magazines, newspapers and Journals are printed in order
to create awareness about the hospitals among the general public. This
system is also used by specialists to make a great doctor referral network of
specialists in other fields.
e-Promotions
Websites of several hospitals are coming up as a means of promoting
oneself without breaking the “ethical code”. The websites serve as
information medium to those people who seek treatment for a particular
problem. Also they can be used to provide some tangible evidence about
the facilities.
Mail Campaigns
These can be called as post service techniques used to enhance one’s image
in eye of the patient. In this technique the doctor’s send a review mail
inquiring about the patients’ health and also asks for a feedback regarding
the facilities. This is also being started by the hospitals in order to spread
good word of mouth among potential customers.
Education of Customers
In this system hospitals inform the general public about a particular disease
i.e. they create awareness about a particular disease and inform these
people about all the necessary symptoms of the disease. This serves in
creating customers and a trust among the two as well as this serves as
increasing ones market access, this happens as these people who have
been informed will further spread the word out thus, increasing coverage.
This is termed as “MISSIONARY PROMOTION”.
Referrals
Doctors who operate from clinics, polyclinics give referrals of Hospitals to
get the treatment of their patients done. For the service provided by the
referrer the Hospital gives an acknowledgement in the form of a
commission also called as a referrer fee. This leads to internal promotion of
both the hospital as well as the doctor.
PEOPLE
People refer to both the people inside the organization (employees) as well as
outside the organization (customers). People in Service Sector Marketing
represent both the employees of the company as well as the customers of the
company. However, in case of hospital sector the customer cannot be relied on as
this is an extremely high knowledge driven sector where it is difficult to filter
down the complex information in simpler forms for the customers. The people
have to be trained properly in order to keep the customer satisfied. The
employees have to be trained properly so that they interact well with the
customer. Employee here does not only mean the high level ones but also the
lower level ones. Employees are the Human Face to the service delivery provided
by a service provider.
Clinical Employees
Doctors
Nurses
Medical Assistants
Paramedics: Provide Physiotherapeutic treatment to recovering patients
Pharmacists
Non – Clinical Employees
Ward Boys: Aids to nurses who run errands for them
Cleaners: Sweepers, toiletry maintenance etc…
Laundry Department: Replacing and Washing linens
Sterilizers: Sterilizing Equipment and Facilities
Equipment Handlers: X-Ray Machine Operators etc…
Administrative Staff: Accountants, Cashiers, Bills Collection etc…
Catering & Dietetics: Provide for nutritional needs of the patients
PHYSICAL EVIDENCE
The physical evidence is defined as the environment in which the service is
delivered and where the firm and the customers interact; and any tangible
commodities that facilitate performance or communicate the service. It plays a
role in enhancing customer’s perception of the service quality. The acceptance of
services is communicated through the physical evidence; therefore, it is of great
significance to the service marketers.
How important is the physical evidence of “Wockhardt” or “Lilavati”. In a city like
Mumbai where the income of people is higher as compared to the other parts of
India, one is ready to spend on one’s health and hence the look of a hospital too
would matter.
The environment in which the service is delivered and where the customers and
firm interact, and any tangible components that facilitate performance or
communication of the service.
The physical evidence of services includes all of the tangible representations of the services such as brochures, letterhead, business cards, report formats, signage and equipment. Physical evidence makes a huge impact on the customer. Physical evidence provides customers means of evaluating the service
Elements of Physical Evidence
Often customer evaluates the services on the tangible clues of physical evidence,
before its purchase. The general elements of physical evidence are:
EXTERIOR ELEMENTS OF HOSPITALS
Exterior elements include the outer look of the place of delivery of service. The
exterior gives a formal introduction to the customer as to the kind of service he/
she is to receive. In the case of hospitals, the physical evidence is a very crucial
element as one is seeking medical help relating to one’s health and no one would
take chances in such cases. Hence, exterior as well as interior factors should be
kept in mind.
Some of the exterior factors essential in Hospitals are as follows:
Exteriors Design
Entrance
Signage
Parking
Surrounding Environment
Security
INTERIOR ELEMENTS OF HOSPITALS
In case of hospitals, the interiors play a very vital and important role. If the
hospital is not hygienic, does not look up to the standard as it promises to be and
the equipment used is not of good quality, patients would hesitate coming for any
treatment to such a hospital.
Given below are some interior elements in context of hospitals:
Interior Design
Safety Signs
Rooms
Washrooms
Equipment
OTHER TANGIBLES
Along with the exterior and interior elements in hospitals, other tangibles also help
in putting up a good impression of the hospital in the eyes of the customer.
Sometimes, small elements too may make a big difference. This section refers to
those small elements. The other tangibles are as follows:
Uniforms.
Staff
Equipment
Visiting Card
ATM Centers
Telephone service
Ambulances
Service sector management
PROCESS
Process is a set of activities that take an input, convert it and add value to the
input and finally, create an output. Process has only recently been given much
attention in the service sector although it has been the subject to study in
manufacturing for many years. Blueprints design processes, which sets a standard
for action to take place and to implement the service.
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Joining Phase
The Intensive Consumption Phase
Detachment Phase
Feedback
Service sector management
1. The joining phase – which includes
The arrival of the patient
Registration – where a patient has to make an initial deposit at the
inpatient billing counter after which a file is opened in the patient’s name
to know the patient’s medical history.
2. Intensive consumption phase – which includes
Diagnosis – where the consultant diagnoses the illness by making the
patient undergo various tests
Treatment – where the illness is treated with proper medication or surgery
Information about further actions – the consultant will instruct the patient
regarding the diet to be followed, the medication to be taken etc.
3. Detachment phase – which includes
Discharge of the patient
Payment – after the patient is discharged, the bill will be paid at the billing
counter.
4. Feedback – at this stage, the patient is requested to fill an evaluation
form, which helps the hospital authorities to know the level of satisfaction
derived by the patient. Patient’s suggestions are always considered for
improving the hospital services.
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General Process Organization in a Hospital
Within the hospital, if we look at each individual department, we notice that each department serves the needs of another department, for instance, the purchase department serves the need of the stores, the billing department serves of the finance department etc. So in each way, each department is a customer to another department, while at the same time it might be a supplier to another department. Each department is an ‘internal customer’ or the other departments.
Only when each unit of the hospital understands who their customers are and what their needs are, will the hospital develop basis for giving the best service in the most efficient way to the patient.
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Finance Dept Billing
Purchase Dept Stores Doctors
Nurses
Patient ( External customer)
Service sector management
Market Segmentation
Market segmentation is a useful business tool to identify new and expanded ways
to improve services and enhance revenues. This tool identifies unique subsets of
the population to target for specialized services and marketing initiatives.
SEGMENTING
Segmenting variables such as geographic, demographic, Psychographic and
behavioral segmentation helps in knowing consumer wants needs and responses
of various services and products. It is very essential to know which segment would
be right for setting up our hospital as only after studying the diseases and the
people who are diseased or at high risk of getting those diseases form our
segment.
Geographic Segment
It calls for dividing the market into different geographical units such as nations,
states, regions, countries, cities or neighborhood. One can operate in few
geographic areas, or operate in all but pay attention to local variations. It is
advisable to target all sections of people, by and large the entire mass by
delivering varied services to a specific disease.
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Service sector management
Demographic Segment
The market is divided into groups on the basis of variable such as age, family size,
family lifecycle, gender, income, occupation, education, religion, race, generation,
nationality and social class. With these variables of segmentation we get to know
the preferences and the usage rates associated with different consumers
Psychographic Segment:
This segmentation is done as per the lifestyle, personality of the people. Different
people have different lifestyles and different personality, so for them the
expectation of service also differs, so keeping all such points in mind the hospitals
provide services.
People living with very high level of sophisticated lifestyle prefer hospitals which
provide best quality service.
On the other hand people having very simple lifestyle may also go to public
hospital.
Behavioral Segmentation
In this the segmentation is done as per the following variables i.e. knowledge of,
attitude towards, use of, or response to a product or a service. These behavioral
variables – occasions, benefits, user status, user rate, loyalty status, buyer
readiness stage and attitude- are the best starting points for constructing market
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Service sector management
segments. For e.g person having diabetes would go to the hospital after knowing
the facilities that they offer and the care, comfort they provide. This would help in
creating loyal patients and create goodwill for our hospital.
Quality dimensions
Quality refers to the inherent or distinctive characteristics or properties of a
person, object, process or other thing. Such characteristics or properties may set
a person or thing apart from other persons or things, or may denote some degree
of achievement or excellence. When used in relation to people, the term may also
signify a personal character or trait.
For example, hospitals have to decide what quality of food to buy for their
patients. The buying objective here is not profit, because the food is provided to
the patients as part of the total service package. Nor is cost minimization the sole
objective, because poor food will cause patients to complain and hurt the
hospital’s reputation. The hospital purchasing agent has to search for institutional
food vendors whose quality meets or exceeds a certain minimum standard and
whose prices are low. Knowing this, many food vendors set up a separate division
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Service sector management
to respond to the special needs of institutional buyers. Thus, Heinz, for example,
will produce, package, and price its ketchup differently to meet the different
requirements of hospitals, colleges, and prisons.
Quality dimensions by Parasuraman
The quality customer service is the foundation for long run businesses. This
quality dimensions will regulate the business process, solutions and services.
Quality of service is the most important and the most critical component for a
customer. These are five quality dimensions, which can be taken into account for
the assessment of service quality.
BY Parasuraman et al – Parasuraman, Valerie Zeithaml and Leonard Berry
identified five dimensions with which consumers judge services.
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Service sector management
RELIABILITY
It shows the ability of the service provider to perform the promised service
accurately and dependably. It means that the service provider should be able to
identify and provide business solutions to their customers to achieve their goals
and objectives. Reliability assures performing the promise given to the customers
in the most effective and efficient manner.
In the case of hospital industry it is consistently shown to be the most important
determinant of service quality because this is the main reason why the customer
i.e. patient comes to a hospital for his treatment and as soon as he enters in a
hospital, it becomes an implied promise of the management of the particular
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hospital that they will try their level best to treat him properly. A person should
be assured of the acute physical and mental disorders also. So this is the most
vital promise which a hospital gives to its customers and if it is broken then it will
cause a great problem to its customer as well as it affects the reputation of the
hospital but as such there is no hard and fast rule in any of the hospital that a
patient will be cured.
Basically the main service, which a hospital gives, is cure and treatment only and
they shouldn’t compromise a bit in this criteria. Hospitals should hire the best
doctors affordable and available to them in the industry, which can provide the
best of the services. Hospitals should also provide all the other services like the
accommodation, medicines, timely appointments, appropriate diagnosis, and etc.
to their level best to the patients.
ASSURANCE
Assurance is all about trust and confidence. It comes with the brand equity, trust
and loyalty towards consumers. Consumers should be assured about the service
and they should have trust on the brand. This dimension is particularly important
for hospital industry because it involves a high risk and there is a great
uncertainty of the outcomes. Trust and confidence may be embodied in the
person who links the customers directly to the company for example securities
brokers, insurance agents, etc. but in the hospital industry the customer is not
directly linked to the whole organization but with only a part of it in the way of
some particular doctors and attendants.
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Service sector management
So in the early stages customer may use the tangible evidence to assess the
assurance dimension like the degrees, honors, awards, and special certifications in
this type of professional services. So if the hospital is rated 5 star, than the patient
may be assured that at least they are getting treated by the best professionals in
the industry and the probability of they getting cured is high in a critical disease
with such hospital other than low graded hospitals. So here the knowledge, skills,
credentials and reputation of hospital and its employees is of immense
importance to assure the customers about the service.
TANGIBILITY
Tangibility means representing the service physically. It stands for the appearance
of facilities, equipments, personnel and communication material. Making
customers happy with business environment is the motto of service providers. All
of these provide physical representations or images of the service that customers,
particularly new customers, will use to evaluate quality.
Hospital is a type of service in which the customer himself comes to the service
factory hence there is more interaction with the tangible cues. In a hospital the
tangibles are the waiting rooms, examination rooms, surgical and operational
tools, and facilities inside the rooms, modern infrastructure, essential drugs,
equipments for investigations, etc. on which a patient can make out the service
quality of a particular hospital.
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Service sector management
Hospitals should also take good care of their kitchen and canteens. They should
be kept absolutely clean and clear to insure hygiene. This is the main aim for a
hospital to attract more and more customers. As there is no particular tangible
service like in real estate industry or in catering industry in which you can actually
try a product and then can approve it. But in this case a patient can’t just try the
service of the doctors in the hospital so he will have to rely on these type of
tangible goods and the profile of the surgeons and doctors to take a decision to
get admitted in a particular hospital.
EMPATHY
Empathy means the individualized attention and customized service given to the
customers by the organization. Understanding the customer’s needs, goals, and
objectives and providing solutions with good quality and helping them to
overcome their problems. A hospital should acknowledge patient as a person,
should remember his previous problems and should than hear to him with
patience to treat him in the best possible manner. This industry is all about giving
customized service to everyone because every patient has different problems so
he should be treated with a great empathy.
More than the treatment, what a patient wants is care and comfort. A patient
gets distressed when he is alone, when there is no one to hear him and there is
nothing to pass his time on. So staff and doctors should always be friendly and
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Service sector management
there should be a friendly environment in the hospital because it relieves the
mental pressure of the patient and so he can be recovered soon. He should be
given the best of the food and best of the services, which he demands taking care
of his treatment so that he feels good.
A patient is the customer of the hospital but not a regular customer so whatever
he is experiencing and getting will be his perception throughout his lifetime and
this is the only time when a customer can be satisfied and there will be no second
chance. This will also create the word of mouth publicity when he is discharged
from the hospital and he will tell about his experiences to others.
RESPONSIVENESS
Responsiveness reveals the service providers awareness in problem solving with
viable business solutions. It can be defined as the way the service provider
responds to the customers and his willingness to help. The foremost thing is that
the service provider must be accessible to solve the problem whenever it occurs
and there the service provider should see through it that there should be no
waiting after that. Than the service provider should be willing to listen to the
problem and solve it as soon as possible.
Attentiveness and promptness is something on which a hospital should emphasis
on while dealing with them at the time of their treatment, problems and
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Service sector management
complaints. To excel in this dimension the hospital must view the process of
service delivery and handling the requests from the patient’s point of view and
should try to minimize the time taken to respond to the patient problems. Speed
and the promptness are the two main criteria, on which a hospital’s
responsiveness dimension can be evaluated.
In the case of any emergency or critical matter the responsiveness of doctors and
staff are very important so they should be alert for such situations at any time of
the day. So responsiveness of a hospital is communicated to the patient by the
length of time taken to assist them, answer their questions or giving attention to
their problems. Training is the most vital tool given to the employees i.e. doctors
and the staffs to deal with even the worst conditions during emergency and they
should be responsible enough to deal with it then and there.
BY David A. Garvin eight dimensions of quality were identified by Garvin:
1. Performance: every product is supposed to deliver benefits and the
measure of its quality is performance of the offer. A dish scourer, which can
clean plates completely and quickly, would be a performance.
2. Features: these are in addition to the core product, which does not come as
standard ‘features’, like add-ons.
3. Reliability: this is a measure of the degree of probability of the product
delivery what had been promised.
4. Conformance: delivery quality meeting design standards.
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5. Durability: this is a measure of the length of time that a product can deliver
benefits, without deterioration.
6. Serviceability: if the product can be repaired with ease and speed than it is
a measure of quality. It could include the behavioural dimension of service
of personnel like their politeness
7. Aesthetics: this is a measure of the product’s looks, design, touch and feel.
8. Perceived Quality: consumers develop a perception due to company –
controlled stimuli like advertising, publicity and brand promotion, and
social effects like word-of-mouth.
Quality
Some matters which influence perception of quality of service in a hospital are
While making inquiries or giving instruction, nurses and other staff refer to
patients by bed numbers or by the disease he suffered from. It makes a lot
of difference if the patient is identified by his name.
Letting patients know what they are suffering from, what is being done to
them, why particular tests are being conducted, what they can expect in
terms of discomfort, caused by a particular medical procedure, etc. Open
communication is very satisfying.
Letting patient having an option regarding their treatment or continued
hospitalization, because of high costs involved. Hospitals tend to treat
patient like captives or hostages, who cannot escape, and on whom any
treatment, at any cost, can be forced, without their consent.
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Service sector management
Letting accompanying relatives know what is being done to the patient and
about options.
Patients being escorted by someone senior when they have to be taken
else where, for X-rays, Scanning, etc. instead of their being left alone in
corridors on wheel chairs or stretchers, waiting for their turn.
Removing particular serious cases from general ward. Patients get
depressed when they see other patient in acute distress, or in a terminal
condition with a lot of anxious relatives moving around and medical staff
rushing about.
A primary nurse being assigned, as an aid to every patient to take care of
his need throughout his stay in the hospital.
3-room Intraoperative MRI Suite (IMRIS)
This is India's first 3-room intra operative diagnostic and imaging solution where
the patient is never moved. IMRIS brings MRI surgical imaging to patients
undergoing surgery and enables surgeons to leverage the unique ability to
provide better outcomes for their patients. It is the world's most patient-safe
intra-operative imaging solution that allows the surgeon to accurately depict
changes in brain position and anatomy during surgery. IMRIS provides complete
360° surgical access to the patient and can service multiple operating rooms. At
Kokilaben hospital, a 1.5 Tesla ceiling-mounted MRI is stationed in a diagnostic
bay with two adjacent operating rooms on either side.
Orthopedic, ENT and Neuro Navigation Systems
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Service sector management
World over, navigation systems are redefining the way surgeries are performed.
They enable surgeons to achieve greater precision by providing electronic
guidance using computers, infrared cameras and wireless instruments. Surgeons
can effectively make data-driven decisions in the operating room by incorporating
the three technological innovations that provide a data-rich, visual surgical
environment that helps reduce procedure invasiveness, risk and operative times.
Radiation Oncology Linac Suites
The Trilogy stereotactic system is the most advanced, sophisticated machine of its
kind in the world. As the leading image-guided radiotherapy (IGRT) system,
Trilogy marks the beginning of a new generation of cancer care. The versatile
system combines imaging and treatment technologies, and can be used to deliver
the widest range of external beam radiotherapies: 3D conformal radiotherapy,
IMRT, fractionated stereotactic radiation therapy and intensity-modulated
radiosurgery for cancer and neurosurgical treatments. Advanced imaging
capabilities built into the system allow therapists to position patients for
treatment with sub-millimetre accuracy. A respiratory gating system compensates
for any tumour movement that occurs as a patient breathes. The system at
Kokilaben hospital is powerful and can deliver radiotherapy doses at least 60 per
cent faster than conventional accelerators. This shortens the length of time
patients need to spend undergoing treatment. In addition, the radiation beam is
highly precise, allowing clinicians to deliver treatments with unprecedented
accuracy.
Stereotactic Radiosurgery
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Service sector management
The Novalis Tx at Kokilaben hospital is among the world's first whole radiosurgery
systems for indications in the brain, liver, pancreas, prostate and lung. It enables
small, deep-seated tumours to be treated by radiation without open surgery and
offers a versatile combination of advanced technologies for the treatment of
tumours and other anatomical targets. With this platform, the Kokilaben hospital
offers state-of-the-art, non-invasive treatment for a wide range of cancers and
other potentially debilitating conditions, without harming nearby healthy tissue
and without involving traditional surgery.
3 Tesla MRI
Patients today demand the highest quality of care, including a comfortable exam
experience and the assurance that the diagnosis is the most accurate possible.
When you combine 3T with a 70 cm open bore, you give them just that. More
space limits claustrophobic rejections, fewer patients need to be sedated, and
sharper images are captured thanks to less anxiety-related movement. The 3T
system at Kokilaben hospital accommodates patients with special needs and
conditions including spinal deformities, respiratory problems and those with pain
and mobility issues. It also allows us to expand care to a wider range of patients
including obese, paediatric, elderly, ICU patients or those dependent upon
medical equipment. The 3T broadens clinical possibilities with easy access in
interventional MRI and opportunities to perform more functional studies (using
the functional MRI tool).
40-slice PET/CT
India's first, Positron EmissionTomography - Computed Tomography (PET-CT) is a
medical imaging device that combines both a Positron Emission Tomography and
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Service sector management
an x-ray Computed Tomography, so that images acquired from both devices can
be taken sequentially, in the same session, from the patient and combined into a
single superimposed image. PET-CT has revolutionised medical diagnosis by
adding precision of anatomic localisation to functional imaging, which was
previously lacking. For example, in cancers, surgical planning, radiation therapy
and cancer staging have been changing rapidly under the influence of PET-CT.
Dual Source Cardiac CT (DSCT)
The latest revolution in CT is the new Dual Source CT technology that pioneers
new clinical opportunities. Our DSCT is faster than every beating heart, c an
obtain full cardiac detail at half the dose of radiation, serves as a one-stop
diagnosis in emergencies, and goes beyond visualisation with dual energy. Twice
as fast as other cardiac CT scanners and less influenced by irregular heart
rhythms, it eliminates the need for beta-blockers to slow down the heart rate
prior to cardiac scanning. The DSCT at Kokilaben hospital opens the door to a new
world of characterisation, visualising the chemical composition of the human
body. The result: two spiral data sets acquired in a single scan providing diverse
information, which allows us to differentiate, characterise, isolate, and distinguish
the imaged tissue and material composition.
SPECT
Single photon emission computed tomography (SPECT) is a nuclear medicine
imaging technique using gamma rays. SPECT can be used to complement any
imaging study where a true 3D representation is needed, such as tumour,
infection, thyroid or bone imaging. As SPECT permits accurate localisation in 3D
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space, it is used to provide information about localised functioning of internal
organs; for instance, functional cardiac or brain imaging.
CONCLUSION
The nature of surgical operations has changed considerably. Alternate
procedures, without resorting to conventional surgery, are becoming available,
thanks to new technology, using lasers, micro instruments, etc. therefore, there is
little post surgical care. Patients can return home the same day, with verry little
discomfort, and hardly any possibility of complications.
Patients, the world over, are finding it cheaper to arrange for nurses and
equipment at home, because of the heavy cost of hospitalization. Equipments can
be hired. Care provided at home is more comforting.
For these reasons, the occupancy of hospital beds is going down. Similar trends
are expected in India. The data on patients, given earlier, points to the need of
restructuring hospitals, to meet new usage patterns.
Speciality hospitals are being connected to similar hospitals in other parts of the
world, through satellite communication networks. Through data exchanges and
teleconferences, doctors in one place can confer and consult with colleagues
anywhere in the world.
Doctors from one city, visit hospitals in other cities, other countries, for short
durations, to demonstrate their skills, to teach, and to learn.
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Service sector management
A good hospital is a place for learning, if the experience gained in the case of a
patient is properly recorded and stored in a library. Doctors enhance their
knowledge and skills by accessing such records. The quality of both the doctor
and the hospital can be enhanced in this way.
Bibliography
Websites
www.expresshealthcaremgmt.com
www.ficci.com
www.dogpile.com
http://en.wikipedia.org/wiki/Hospital
http://en.wikipedia.org/wiki/Healthcare
http://en.wikipedia.org/wiki/Tertiary_sector_of_the_economy
http://www.economywatch.com/world-industries/services-sector/
http://www.economywatch.com/world-industries/health-care/
http://www.economywatch.com/world-industries/health-care/india.html
http://www.himpub.com/frontend/home.asp?UserId=319903243
Reference Books:
Christopher Lovelock and Jochen Wirtz, Service Marketing, Pearson Education
publication house, Fifth edition
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Service sector management
Zeithmal & Bitner, Services Marketing, 3rd edition
C. Bhattacharjee, Service Sector Management- An Indian perspective, Second Edition.
Arun Kumar, Hospital Mangemnt, Second Edition.
Talluru Sreenivas, Service sector in Indian Economy, 2nd Edition.
Vasanti Venugopal and Raghu V.N, Services Marketing, First Edition
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