profiles of the selected hospitals -...

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APPENDIX – I

PROFILES OF THE SELECTED HOSPITALS

1. APOLLO HOSPITALS ENTERPRISE LIMITED

Hospital Overview

Apollo Hospitals Enterprise Limited (AHEL) a part of Apollo Hospitals

Group, is a private sector healthcare provider. The company owns and

manages a network of specialty hospitals and clinics and a chain of pharmacy

retail outlets. It also provides consultancy services for commissioning and

managing the specialty hospitals. The company operates primarily in India. It

is headquartered in Chennai, India.

The company recorded revenues of INR 9,566 million (approximately

$212 million) during the fiscal year ended March 2007, an increase of 24.4%

over 2006. The operating profit of the company was INR 1,495 million

(approximately $33.1 million) during fiscal year 2007, an increase of 63% over

2006. The net profit was INR 954 million (approximately $21.1 million) in fiscal

year 2007, an increase of 83.5% over 2006.

Business Description

Apollo Hospitals Enterprise (AHEL) is the private sector healthcare

provider in Asia. AHEL operates through two business divisions: chain of

owned and managed hospitals and management consultancy services.

Through the chain of owned and managed hospitals division, the group

operates over 26 hospitals of which 14 are client hospitals, managed by

professionals deputed from Apollo Hospitals group.

The group’s consultancy division provides management consultancy

services. The division offers project and operations management consultancy

services to clients varying from conceptualization to commissioning of a range

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of healthcare models. The group is also engaged in providing hospital care

and healthcare delivery services. It provides nursing and hospital

management colleges, pharmacies, diagnostic clinics, medical transcription

services, third-party administration and telemedicine.

AHEL provides healthcare services and programs including, health

checkup, complementary and alternative medicine, corporate health

programmes, Apollo life magazine, disease management, understanding

medical investigations and Apollo clinics. Apollo Hospitals operates hospitals

in Chennai, Delhi, Hyderabad, Kolkata, Ahmedabad, Bangalore, Bilaspur,

Madurai, Visakhapatnam and Kakinada. AHEL has international operations in

Srilanka, Muscat, Dubai, India, Nepal, Tanzania, and Bangladesh.

History

Apollo Hospitals Enterprise Limited was incorporated as a public

limited company in 1979. The group negotiated with British American

Investment for association in a joint venture for setting up a multi-specialty

hospital on a state land provided by Government of Mauritius, in August 2007.

Major Products & Services

Apollo Hospitals is an Indian-based healthcare company. The

company’s key services include Chain of owned and managed hospitals and

Management consultancy services.

Apollo Hospitals is a leading player in the high-growth healthcare

sector. It currently has a network of 18 owned hospitals and 8 hospitals

through subsidiaries / JV / associates totaling to more than 4,000 beds. The

company also has 12 hospitals under management contracts which increases

its spread and raises its total bed count to more than 6,800. Apollo has

presence across the healthcare delivery value chain with 420 pharmacy

outlets. Its integrated business model, scale, national footprint and presence

across multiple disease and delivery segments make it one of the best plays

on the sector.

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Hospital Background

Apollo Hospitals Enterprises Ltd (AHEL) was incorporated as a public

limited company in 1979. Promoted by Dr Prathap C Reddy, it is the first

group of hospitals that pioneered the concept of corporate healthcare delivery

in India. AHEL today is the leading private sector healthcare provider in Asia

and owns and manages a network of specialty hospitals and clinics, a chain of

pharmacy retail outlets across the country, and provides consultancy services

for commissioning and managing hospitals. With nursing and hospital

management colleges, pharmacies, diagnostic clinics, medical transcription

services, third-party administration and telemedicine, Apollo's leadership

extends to all aspects of the healthcare spectrum.

The consultancy division of AHEL offers project and operations

management consultancy services to clients varying from to commissioning of

a wide range of healthcare models. Over the years, Apollo Hospitals has

founded various group companies to empower its flagship company, Apollo

Hospitals Enterprise Ltd, to create a healthcare powerhouse that has a

leadership position in every sphere of healthcare.

Medical Specialties offered

Apollo has established centers of excellence in a variety of medical

disciplines – cardiology, oncology, orthopaedics, cosmetic and plastic surgery,

critical care medicine and emergency and trauma care through their multi-

specialty and super-specialty tertiary care hospitals which offer highly

specialized and sophisticated medical care and surgical procedures in a

primarily inpatient setting. CRIS-INFAC estimates that expenditure on tertiary

care hospitals comprised approximately 15-20% of the total Rs 125,300 crore

spending for healthcare delivery in India in 2006.

According to CRIS-INFAC, this segment is expected to grow faster

than the primary or secondary care segments because of an expected rise in

complex lifestyles. Apollo hospitals have around 3800 super-specialty and

multi-specialty beds owned by self or subsidiary/associate/ JV, which are

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spread in metros, tier-I and tier-II cities, stand to gain the most with the

expected increased demand in healthcare delivery market in India.

2. CARE HOSPITAL

Care Hospitals is one of the fastest growing chains of hospitals in India,

engaged in providing primary as well as tertiary healthcare services, with a

difference. It is a hospital chain that is founded and managed by professionals

with a mission and a passion for providing healthcare for the needy. At CARE,

the growth has been phenomenal. From a 100-bed single specialty Heart

Institute facility focusing on cardiac care in Nampally (Hyderabad), CARE has

become a multi-specialty hospital chain comprising of 1400 beds across 12

hospitals.

Care’s reputation for its humanitarian and selfless service has ranked

this esteemed institution as the fourth largest healthcare provider in India

(CRIS-INFAC report, 2006). The effort to provide quality health care with

compassion has rewarded with the honor of being the top healthcare provider

in Andhra Pradesh. With the service-oriented Healthcare delivery model,

CARE is geared to provide cost effective and user friendly medication.

Despite the intense competition and intense marketing tactics employed by

multiple commercial corporate organizations, CARE has carved a niche for

itself by garnering the best reputation amongst the local masses. Armed with

the best of the facilities in areas of Education, Research, patient care and

highly qualified professionals, CARE endeavors to match global benchmarks

and conquer healthcare market in the second decade of its establishment.

CARE aims at providing a holistic approach to healthcare. The logo

has been crafted with this thought in mind. Through the explanation of the

logo and identity, endeavor to help partners, branch organizations,

shareholders and esteemed patients understand CARE and its entity better.

Brand Identity and Name are largely dependent on the Logo. People identify

an organization with its Logo. It is a Logo that states in part the organizations

ethics and values.

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History

A movement called ‘CARE’ took birth in the year 1997, when

Padmashri

Dr. B. Soma Raju led a team of medical professionals to set up the first CARE

Hospital. It opened a new chapter in the history of health care. The driving

force of Compassion, Concern, Care, coupled with single minded objective -

the recovery of the patient is been the fountainhead of inspiration. Today,

within a span of 13 years, CARE has emerged as the leading name in health

care and has earned a reputation for humanitarian and self less service. But,

most importantly, CARE has the undivided faith of millions.

The origins of CARE can be traced to 1983 when a team of

cardiologists, under the leadership of Padmashri Dr. B Soma Raju, set up a

synergy for professional excellence in the cardiology department of the

Nizam’s Institute of Medical Sciences (NIMS) in Hyderabad. The idea was to

propel the cardiology department into one of the top centers in the country.

The synergy gave momentum to the purpose and accelerated the birth of

CARE 13 years later. The team collaborated with scientists to make

healthcare affordable through the development of indigenous medical

technologies. It was the development of India’s first coronary stent (Kalam-

Raju stent) that inspired the creation of CARE Hospital in 1997 to nurture a

model that makes quality medical care affordable and accessible.

• At the outset, CARE earned accolades and appreciation from one and

all for its expertise in heart care. It continues to set new benchmarks

not only in heart care, but also expanded its horizons by becoming a

leading Multi-specialty Health Care Provider.

Accreditations

The following shows the accreditations CARE has enjoyed from reputable

sources.

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• CARE laboratories at CARE (Banjara) enjoy the accreditation from the

National Accreditation Board for Testing and Calibration Laboratories

and are awaiting inspection for ISO certification.

• CARE Foundation’s courses are accredited by National Accreditation

Boards like the Indira Gandhi National Open University (IGNOU), Netaji

Subhash Open University (NSOU), and the National Board of

Examination.

• A Physician Assistants (PA) program that commenced in 2003

received an accreditation from the NSOU

Management

Governance & Leadership

Every organization or Group’s growth and prosperity is largely

dependent on the leadership of the organization. It is an indisputable

fact that CARE Group of Hospitals has grown in reputation and profits

primarily because of the governance and leadership. Care’s

governance and leadership team has been undoubtedly responsible for

the growth of CARE as a Hospital Group. The following are the team of

people responsible for CARE governance and leadership:

Operations

CARE has accomplished growth in many facets but it’s the growth in

the number of patients that stands testimony to widening network of

operations. The trust the people have placed has further motivated in

furthering contribution to the patient care.

� 18% growth in OP registration to 31523 lakh in 2005-06

� 11% growth in IP admissions to 3486 lakh in 2005-06

� 11.09% increase in the number of surgeries performed in 2005-06.

� A 500 basis point increase in the average occupancy to about 70% in

2005-06.

� Specialists’ number increased from 20 to 100.

� Clinical and procedural outcomes on par with US Norms.

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� Control the cost components of patient care such as drugs disposables

and consumables account for nearly 50% of the total expenses, the

highest cost element in a hospital – to provide a superior value to

patients.

� Providing qualitative medical care has resulted in increase in patients

preferring CARE. This fact is reflected in the consistent growth in the

bypass surgeries, growing at a CAGR of 30% over the last nine year

3. NIZAM’S INSTITUTE OF MEDICAL SCIENCES

About NIMS

Nizam’s Institute of Medical Science was established (NIMS) in 1964

and has grown into a University in Hyderabad A.P. India and is one of the

pioneer and major referral medical center with about 100 beds with staff

around 2000. In 2005 bed occupancy rate was 83%, total admissions 30,481,

total hospital days 2,88,002, total operations are 18, 111 and average length

of stay 9.5 days.

NIZAM’S INSTITUTE OF MEDICAL SCIENCES (NIMS), Hyderabad, is

a University established under the Act of Andhra Pradesh State Legislature.

Inspired by the objectives, the Medical and Management professionals

of NIMS are striving for excellence. As part of it, several courses have been

organized under different disciplines. NIMS is recognized by University Grants

Commission and Medical Council of India.

The administration of NIMS is carried out under the supervision of

Governing Council, Executive Board, Director and other statutory bodies.

NIMS is located at the prime centre of the twin cities of Hyderabad and

Secunderabad, and spread over an area of about 23 acres. It has the

constructed area of more than six lakh sq.ft. The recently constructed giant

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structure, i.e., Millennium Block, itself has added an area of about one sixth of

the total space. This Institute extends its services through 28 Departments.

Out of them, 16 are super and Broad Specialties and others are Supporting

Departments.

The Institute has bed strength of 985 beds, out of which 684 are in

General Wards, 117 in private rooms and 184 in emergency and post

operative care. The average number of out-patients visiting the hospital per

day is about 1275, and the number of in-patients admitted per day is about

80. The average bed occupancy is over 89%.

Subsequently this University has raised to a cadre strength of about

2219 staff members, which includes Faculty-139, Residents (students)-172,

Junior and Senior Residents-43, Medical Officers & Senior Medical Officers-

14, College of Nursing & School of Nursing-6, College of Physiotheraphy-6,

Offcers-14, Ministerial-149, Paramedical-304, Nursing-426, Class IV-115,

Consolidated Staff-21, other workers about 810 and the remaining for other

categories. Interestingly NIMS has been consistently maintaining a very good

patient doctor ratio of about 3:1.

The Origin of NIMS

The Genesis of NIMS dates back to the year 1961. The Nizam's

Charitable Trust thought of starting a specialty Hospital for orthopedic patients

with an initial investment of Rs.55 Lakhs. The foundation stone was laid on

16.07.1961 by Sri Morarji Desai, Minister for Finance, in the cabinet of Sri

Jawaharlal Nehru, the first Prime Minister of India.

As per the Act, NIMS has a Governing Council as its supreme

authority. The Chief Minister of Andhra Pradesh is the President and the

Health Minister, the Vice President. This helps to have close contacts with the

authorities in developing NIMS. For a close supervision of the activities

during shorter spells, NIMS has an Executive Board with seven members

presided by Health Minister of Andhra Pradesh. In addition NIMS has an

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Academic Council with strength of 35 members for advising and approving the

Academic Programmes of this Institute.

Departments

Clinical Departments

1. Anaesthesiology and Intensive Care

2. Cardiology

3. Cardio Thoracic Surgery

4. Clinical Pharmacology & Therapeutics

5. Chest Clinic

6. Dental

7. Dermatology

8. Endocrinology and Metabolism

9. Gastroenterology

10. General Medicine

11. Gynaecology

12. Medical Oncology

13. Nephrology

14. Neurology

15. Neuro Surgery

16. Orthopaedics

17. Paediatrics

18. Physio Therapy

19. Plastic Surgery

20. Radiation Oncology

21. Rheumatology

22. Surgical Gastroenterology

23. Surgical Oncology

24. Urology

25. Vascular Surgery

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Diagnostic Departments

1. Biochemistry

2. Microbiology

3. Nuclear Medicine

4. Pathology

5. Radiology & Imageology

6. Transfusion Medicine

Supporting Departments

1. Biomedical Engineering

2. Civil

3. Computer Division

4. Electrical

5. Hospital Administration

6. Medical Records

7. College of Nursing

Other Departments

In an addition to the above, departments the Gas Room, Stores

(Medical, Surgical, Stationary, Linen) extend their services for

Maintenance of the Institute.

Academic Courses

On the Academic front the Institute conducts several courses

recognized by Medical Council of India. It offers about 40 disciplines. NIMS

conducts 8 super specialty courses in DM and M.Ch. in the Departments like

Cardiology, Cardiothoracic Surgery, Neurology, Neurosurgery, Nephrology,

Plastic Surgery, Urology and CP&T.

Similarly NIMS conducts 6 broad specialty courses of MD, MS and

DMRD in the Departments like General Medicine, Pathology, Orthopaedics,

Anesthesiology, Radiology and Hospital Administration. College of Nursing

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started on 2nd October 1991 and 209 students have completed B.Sc

(Nursing) till 2004. This is recognized by Indian Nursing Council.

Hospital Services

The performance of the Institute as a hospital is measured with the

parameters of number of beds, number of Out-patients, number of In-

patients, number of Surgeries, bed occupancy rate, average length of stay,

mortality rate and revenue generation.

Presently the hospital has 985 beds compared to 246 beds of 1986.

Out of these 985 beds, 684 are in general wards, 117 in private rooms and

184 in emergency and post operative care. The average number of out

patients visiting the hospital per month is about 32,000 and the number of in-

patients admitted per month is about 2,600.

It is gratifying to note that NIMS is a referral Hospital with a clientele of

more than 250 organizations. During the year 2008, the number of out-

patients has recorded a figure of 4.12 lakhs, which may be compared with

1.09 lakhs in 1986. Similarly the number of in-patients has increased from

about 6,758 to 31,295 during the same period. Presently the average bed

occupancy is about 89%.

While the average length of stay is 11 days during the year 2008, the

mortality rate is about 2% leaving the well being at 98%. Interestingly NIMS is

consistently maintaining a very good ratio of about 3:1 for the patient to the

Doctors. All these figures under different heads speak out ultimately the

services rendered by NIMS to the patients, quantitatively.

The number of surgeries is almost maintained at about 27,767 in the

year 2008. Out of them 8,701 are major operations, 16,248 are minor

operations and 2,818 are emergency operations.

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5. GANDHI HOSPITAL

History

Gandhi Medical College came into operations on 14th September 1954

AD. This was the second medical college in the erstwhile state of Hyderabad.

The Osmania Medical College was the first medical college in the Hyderabad

state having started as a medical school in 1846 and made a college in 1926.

Gandhi Medical College was the second in Hyderabad State, fourth in

Andhra Pradesh and 29th in the country. Average annual outpatient

consultations are about 80000 and there were about 42000 inpatient

admissions.11000 major operations and about 15000 minor operations are

performed each year at Gandhi hospital. Hospital has 27 departments

namely: general medicine, general surgery, pediatrics, orthopedics,

anesthesia, dermatology, leprosy, sexually transmitted disease,

ophthalmology, E.N.T., radiology, Casuality, blood bank, cardiology,

neurology, nephrology, gastroenterology, endocrinology, Cardio-thoracic

surgery, neurosurgery, pediatric surgery, plastic surgery, urology, TB clinic,

dental, obgyn, psychiatry and hospital administration.

During the 50 years i.e. 1954-2003 a total of 6090 students were

admitted to the MBBS course. The number of students admitted ranged

between a minimum of 42 in 1954 to a maximum of 224 in 1968. In one-year

i.e. 1970 there were no admissions. In recent years the admissions are

around 150 per year. There are some students who may have been

transferred from other medical colleges to Gandhi and very few left medical

studies to pursue other avenues in life.

As of now, the Rs 100-crore, 1600-bed Gandhi Hospital and Medical

College buildings complex, located in a 30-acre site, was created in a record

time. The 152-year-old hospital has about a million sq ft of built-up space,

hosting some 29 specialties. This hospital was created in 1851 to look after

the British residents of Secunderabad hosting a general, maternity and a ward

for paupers.

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The hospital project was executed by the Andhra Pradesh Health and

Medical Housing and Infrastructure Development Corporation. The Gandhi

Hospital lacks proper equipment in many departments, including neurology,

nephrology, cardiology and gastroenterology as most of them need

replacement and are out-dated. As a result, patients coming for routine check-

ups have to be referred to other hospitals.

Moreover, the hospital that has 1,012 beds and caters to over 900 out-

patients daily, has not more than Rs 30 lakh in the Hospital Development

Society Funds for replacement of equipment and has to depend on

government support that is not forthcoming.

The cardiology, neurology, nephrology and gastroenterology

departments are the wings that need urgent replacement of equipment.

However, the heads of department (HOD) have requested the government to

sanction Rs 40 crore to buy new machinery.

According to doctors at the hospital, though many patients come for

simple tests and scans, they have to be referred private hospitals where

charges are higher and to other better equipped government hospitals like

Osmania General Hospital due to lack of equipment.

The hospital also needs dialysis machines, as most of the machines

are very old. Even ventilators also need to be replaced. Moreover, the hospital

does not have a CT scan machine that is essential for investigations in most

departments. Among the list that has been forwarded by the hospital

management for replacement are half-a-dozen ventilators, 16 fully equipped

surgical operation theatres, six dialysis machines and video endoscopes and

a CT scan machine.

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6. OSMANIA GENERAL HOSPITAL

Osmania General Hospital is a multi specialty quaternary care hospital

with advanced training in every sub-specialty of Medicine, Surgery, Radiology,

Anesthesiology, Orthopedic surgery, Neurosurgery, Neurology. This hospital

has approximately 3800 beds, with patients overfilling the beds and wards. It

has one of the busiest Out-Patient clinics in all specialties in India, particularly

on Monday mornings.

By the end of the year 2008, Osmania General Hospital has become a

multi-specialty quaternary care hospital in Hyderabad, offering 3800 beds with

all necessary facilities & amenities. It has one of the busiest Out-Patient

clinics in all specialties in India.

Osmania Medical College is a medical school in Hyderabad, Andhra

Pradesh, India. It was founded in 1846 as the Hyderabad Medical School

making it one of the oldest medical schools in the world. It is presently

affiliated to the NTR University of Health Sciences. The College was originally

affiliated to the Osmania University of Hyderabad.

The Main Undergraduate course offered at the School is an MBBS

(Bachelor of Medicine, Bachelor of Surgery) course. In addition the college

also offers other undergraduate courses and many Postgraduate (graduate)

courses. It also offers many Super specialty courses.

The College campus is situated in Koti, which is at the heart of the city

of Hyderabad. Osmania Medical College has long been a government

institution in Andhra Pradesh. It is the oldest medical school in India and

perhaps Asia. Osmania has a rich history of pioneering medical innovations.

For the first time, chloroform was used as an anesthetic in Osmania. The

causative agent of malaria was elucidated by Sir Ronald Ross who has been

immortalized by the Sir Ronald Ross Institute of Tropical and Communicable

Diseases (popular by name Fever Hospital) affiliated to Osmania.

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OGH is the only medical college in India (and perhaps the world),

where each medical specialty has a separate training hospital. It is also the

only medical college in south India to offer a postgraduate course in

endocrinology.

Conclusion on Profiles of Hospitals

All these five hospitals though vary in the intensity of level of

implementation, varies in usage of management techniques in bringing the

quality for patient satisfaction or the implementation of quality initiatives but

comparably comes close in the efforts to strive towards providing better

healthcare deliverables to patients.

There are few areas present in all most all these 5 hospitals which

show significant efforts to avoid patient injury occurring in hospitals, reduce

the risk of adverse outcomes and lower costs. They all know that poor health

service quality wastes resources that could be used to treat more patients,

and the public is becoming more critical of the quality of hospital care. Most of

them quite aware that ensuring safety for patients and personnel and

improving quality are national objectives for health systems in both developed

and developing countries, in response to research highlighting poor quality,

increasing patient expectations, media coverage, and a belief that there are

effective methods to improve quality and safety. Further, it is an open thought

that health care organizations are increasingly expected by governments and

funders to introduce quality systems and strategies. Some health care

managers and practitioners also believe that action can and should be taken,

irrespective of external pressures.

While having a discussion with the administrators, doctors etc of these

five hospitals during collection of completed survey, it is interested to note that

some of them shared their thoughts which include proposal of multiple

approaches to ensuring safety and improving quality. Some think money

should be invested in more personnel; others think that doing more of the

same would not improve quality. Which strategies are most appropriate and

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cost effective for a particular hospital in a specific situation? Which approach

should a government promote?

This may not be a complete review of available research on multiple

quality topics but an attempt in synthesizing many types of research into

hospital quality strategies. The aim of this study is to come out of few

constructive thoughts enabling the decision makers to better formulate,

implement and evaluate strategies. Research puts competing claims made by

proponents of each approach into perspective and can help avoid costly

mistakes from choosing the wrong strategy or implementing it incorrectly.

There is no strong scientific evidence of which strategies are effective. It is

difficult to make valid comparisons among strategies. But there is useful

research that gives partial assessments of results, describing different types

of strategy, and suggesting means of implementation.

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APPENDIX – II

QUESTIONNAIRES USED FOR THE STUDY

1. QUESTIONNAIRE – FOR PATIENTS This survey is to successfully complete my doctoral research in management education related to hospitals in Hydera bad and their service quality. It is extremely critical having t he below information and your help is greatly appreciated. We assure the con fidentiality by keeping your identity unrevealed.

This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer – all we are interested in is a mark that best shows your expectations about firms offering health services.

1. The hospital has upto date equipment. 1 2 3 4 5 6 7 2. The hospital physical facilities are visually

appealing. 1 2 3 4 5 6 7

3. The staff (doctors, nurses etc) is well dressed and appears neat.

1 2 3 4 5 6 7

4. The appearance of the physical facilities of the hospital is excellent, keeping in view of the type of services required.

1 2 3 4 5 6 7

5. When the hospital promises to do a treatment (operation/diagnosis etc) by a certain time, it did so.

1 2 3 4 5 6 7

6. When you have problems, the staff (doctors, nurses etc) was sympathetic and reassuring.

1 2 3 4 5 6 7

7. The hospital is dependable 1 2 3 4 5 6 7 8. They have provided their services at the time they

promised to do so 1 2 3 4 5 6 7

9. They have maintained all the records accurately. 1 2 3 4 5 6 7 10. The hospital did not tell patients exactly when

services will be performed 1 2 3 4 5 6 7

11. You did not receive prompt service from the hospital staff (doctors, nurses etc)

1 2 3 4 5 6 7

12. Staff (doctors, nurses etc) of the hospital not always willing to help patients

1 2 3 4 5 6 7

13. Staff (doctors, nurses etc) of the hospital are too busy to respond to patient request promptly

1 2 3 4 5 6 7

xviii

14. You can trust the staff (doctors, nurses etc) of the hospital.

1 2 3 4 5 6 7

15. You feel safe in their transactions with the hospital staff (doctors, nurses etc).

1 2 3 4 5 6 7

16. The staff (doctors, nurses etc) of the hospital is always polite.

1 2 3 4 5 6 7

17. The staff (doctors, nurses etc) get adequate support from the hospital to do their jobs well

1 2 3 4 5 6 7

18. The hospital did not give you individual attention 1 2 3 4 5 6 7 19. Staff (doctors, nurses etc) of the hospital did not

give you personal attention 1 2 3 4 5 6 7

20. Staff (doctors, nurses etc) of the hospital do not know what your needs are

1 2 3 4 5 6 7

21. The hospital did not have your interests at heart 1 2 3 4 5 6 7 22. The hospital did not have operating hours

convenient to all their patients 1 2 3 4 5 6 7

Personal Information Gender :

Male Female

Age (Years) :

Below 30 30-60 Above 60

Income per annum (Rs) :

Below 1 Lakh

1 – 3 Lakhs

Above 3 Lakhs

Residing in:

Urban Rural

Education:

Illiterate School College

No. of visits:

First time Second time

More times

Category of treatment:

ICU Surgical Medical

I sincerely thank you for spending your valuable ti me and kindly return the filled-in form to the investigator who handed o ver this to you.

xix

2. QUESTIONNAIRE – FOR ADMINISTRATORS

This survey is to successfully complete my doctoral research in management education related to hospitals in Hydera bad and their service quality. It is extremely critical having t he below information and your help is greatly appreciated. We assure the con fidentiality by keeping your identity unrevealed.

This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. Do this by picking one of the seven numbers next to each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer – all we are interested in is a number that best shows your expectations about firms offering health services. 1. The hospital has upto date equipment. 1 2 3 4 5 6 7 2. The hospital physical facilities are visually

appealing. 1 2 3 4 5 6 7

3. The administrative staff is well dressed and appears neat.

1 2 3 4 5 6 7


1 2 3 4 5 6 7


1 2 3 4 5 6 7

6. When patients have problems, the administrative staff is sympathetic and reassuring.

1 2 3 4 5 6 7

7. The hospital is dependable 1 2 3 4 5 6 7 8. You have provided services at the time you


9. You have maintained all the records accurately. 1 2 3 4 5 6 7 10. The hospital did not tell patients exactly when


11. Patients did not receive prompt service from the administrative staff

1 2 3 4 5 6 7

12. Administrative staff of the hospital not always willing to help patients

1 2 3 4 5 6 7

13. Administrative staff of the hospital are too busy to respond to patient request promptly

1 2 3 4 5 6 7

14. Patients can trust the administrative staff of the hospital.

1 2 3 4 5 6 7

15. Patients feel safe in their transactions with the Administrative staff.

1 2 3 4 5 6 7

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16. The administrative staff of the hospital is always polite.

1 2 3 4 5 6 7

17. The administrative staff get adequate support from the hospital to do their jobs well

1 2 3 4 5 6 7

18. The hospital did not give individual attention to patients

1 2 3 4 5 6 7

19. Administrative staff of the hospital did not give personal attention to patients

1 2 3 4 5 6 7

20. Administrative staff of the hospital do not know what patients needs are

1 2 3 4 5 6 7

21. The hospital did not have patients interests at heart

1 2 3 4 5 6 7

22. The hospital did not have operating hours convenient to all their patients

1 2 3 4 5 6 7

I sincerely thank you for spending your valuable ti me and kindly return

the filled-in form to the investigator

xxi

3. QUESTIONNAIRE – FOR DOCTORS This survey is to successfully complete my doctoral research in management education related to hospitals in Hydera bad and their service quality. It is extremely critical having t he below information and your help is greatly appreciated. We assure the con fidentiality by keeping your identity unrevealed.


appealing. 1 2 3 4 5 6 7

3. The doctors are well dressed and appear neat. 1 2 3 4 5 6 7 4. The appearance of the physical facilities of the

hospital is excellent, keeping in view of the type of services required.

1 2 3 4 5 6 7


1 2 3 4 5 6 7

6. When patients have problems, the doctors were sympathetic and reassuring.

1 2 3 4 5 6 7





11. Patients did not receive prompt service from the doctors

1 2 3 4 5 6 7

12. Doctors of the hospital not always willing to help patients

1 2 3 4 5 6 7

13. Doctors of the hospital are too busy to respond to patient request promptly

1 2 3 4 5 6 7

14. Patients can trust the doctors of the hospital. 1 2 3 4 5 6 7 15. Patients feel safe in their transactions with the

doctors. 1 2 3 4 5 6 7

16. The doctors of the hospital are always polite. 1 2 3 4 5 6 7 17. The doctors get adequate support from the

hospital to do their jobs well 1 2 3 4 5 6 7

xxii


1 2 3 4 5 6 7

19. Doctors of the hospital did not give personal attention to patients

1 2 3 4 5 6 7

20. Doctors of the hospital do not know what patients needs are

1 2 3 4 5 6 7


1 2 3 4 5 6 7


1 2 3 4 5 6 7

I sincerely thank you for spending your valuable ti me and kindly return

the filled-in form to the investigator

xxiii

4. QUESTIONNAIRE – FOR NURSES This survey is to successfully complete my doctoral research in management education related to hospitals in Hydera bad and their service quality. It is extremely critical having t he below information and your help is greatly appreciated. We assure the con fidentiality by keeping your identity unrevealed.


appealing. 1 2 3 4 5 6 7

3. The nurses are well dressed and appear neat. 1 2 3 4 5 6 7 4. The appearance of the physical facilities of the

hospital is excellent, keeping in view of the type of services required.

1 2 3 4 5 6 7


1 2 3 4 5 6 7

6. When patients have problems, the nurses were sympathetic and reassuring.

1 2 3 4 5 6 7





11. Your patients did not receive prompt service from the nurses

1 2 3 4 5 6 7

12. Nurses of the hospital not always willing to help patients

1 2 3 4 5 6 7

13. Nurses of the hospital are too busy to respond to patient request promptly

1 2 3 4 5 6 7

14. Patients can trust the nurses of the hospital. 1 2 3 4 5 6 7 15. Patients feel safe in their transactions with the

nurses. 1 2 3 4 5 6 7

16. The nurses of the hospital are always polite. 1 2 3 4 5 6 7 17. The nurses get adequate support from the


xxiv


1 2 3 4 5 6 7

19. Nurses of the hospital did not give personal attention to patients

1 2 3 4 5 6 7

20. Nurses of the hospital do not know what patients needs are

1 2 3 4 5 6 7


1 2 3 4 5 6 7


1 2 3 4 5 6 7

I sincerely thank you for spending your valuable ti me and kindly return the filled-in form to the investigator who handed over this to you.

xxv

5. QUESTIONNAIRE – FOR PARAMEDICAL STAFF This survey is to successfully complete my doctoral research in management education related to hospitals in Hydera bad and their service quality. It is extremely critical having t he below information and your help is greatly appreciated. We assure the con fidentiality by keeping your identity unrevealed.


appealing. 1 2 3 4 5 6 7

3. The Paramedical Staff are well dressed and appear neat.

1 2 3 4 5 6 7


1 2 3 4 5 6 7


1 2 3 4 5 6 7

6. When patients have problems, the Paramedical Staff were sympathetic and reassuring.

1 2 3 4 5 6 7





11. Your patients did not receive prompt service from the Paramedical Staff

1 2 3 4 5 6 7

12. Paramedical Staff of the hospital not always willing to help patients

1 2 3 4 5 6 7

13. Paramedical Staff of the hospital are too busy to respond to patient request promptly

1 2 3 4 5 6 7


Paramedical Staff. 1 2 3 4 5 6 7

16. The Paramedical Staff of the hospital are always polite.

1 2 3 4 5 6 7

17. The Paramedical Staff get adequate support from 1 2 3 4 5 6 7

xxvi

the hospital to do their jobs well 18. The hospital did not give individual attention to

patients 1 2 3 4 5 6 7

19. Paramedical Staff of the hospital did not give personal attention to patients

1 2 3 4 5 6 7

20. Paramedical Staff of the hospital do not know what patients needs are

1 2 3 4 5 6 7


1 2 3 4 5 6 7


1 2 3 4 5 6 7


xxvii

6. QUESTIONNAIRE – FOR SUPPORT SERVICE STAFF This survey is to successfully complete my doctoral research in management education related to hospitals in Hydera bad and their service quality. It is extremely critical having t he below information and your help is greatly appreciated. We assure the con fidentiality by keeping your identity unrevealed.


appealing. 1 2 3 4 5 6 7

3. The Support Staff are well dressed and appear neat.

1 2 3 4 5 6 7


1 2 3 4 5 6 7


1 2 3 4 5 6 7

6. When patients have problems, the Support Staff were sympathetic and reassuring.

1 2 3 4 5 6 7





11. Your patients did not receive prompt service from the Support Staff

1 2 3 4 5 6 7

12. Support Staff of the hospital not always willing to help patients

1 2 3 4 5 6 7

13. Support Staff of the hospital are too busy to respond to patient request promptly

1 2 3 4 5 6 7


Support Staff. 1 2 3 4 5 6 7

16. The Support Staff of the hospital are always polite. 1 2 3 4 5 6 7 17. The Support Staff get adequate support from the


xxviii


1 2 3 4 5 6 7

19. Support Staff of the hospital did not give personal attention to patients

1 2 3 4 5 6 7

20. Support Staff of the hospital do not know what patients needs are

1 2 3 4 5 6 7


1 2 3 4 5 6 7


1 2 3 4 5 6 7


xxix

APPENDIX – III

LIST OF TABLES

Table no. Title Page no.

CHAPTER 1

1.1 Key Indicators 6

1.2 Establishment of Primary Health Centers, sub centers and Community Health Centers in India – As per different Five Year Plans

9

1.3 Percentage of Private Hospitals with different bed sizes 10

1.4 Classification of Hospitals 20

1.5 Types of Ailment Complexities 23

1.6 Total Number of Hospitals in India, 2007 27

1.7 Health care Accreditation in various countries 41

1.8 Goals specified in the National Health Policy 2002 46

1.9 Chronology of Service Quality Research 53

CHAPTER 2

2.1 List of some prominent hospitals in Hyderabad 83

2.2 Sample selection of hospitals 85

2.3 Sample Selection of Respondents – Staff 86

2.4 Sample Selection of Respondents – Patients 86

2.5 Variables / Parameters / Characteristics identified 88

CHAPTER 3

3.1 Definition of Original Ten SERVQUAL Dimensions 122

3.2 Definition of Modified SERVQUAL Dimensions 124

3.3 Comparative Analysis of Quality Implementation Issues in the Selected Hospitals

146

3.4 Comparative Analysis of Product Information in the Selected Hospitals

152

3.5 Comparative Analysis of Pricing Information in the Selected Hospitals

155

3.6 Comparative Analysis of Promotion Information in the Selected Hospitals

158

3.7 Comparative Analysis of Placing Information in the Selected Hospitals

159

xxx

3.8 Comparative Analysis of People Information in the Selected Hospitals

161

3.9 Comparative Analysis of Process Information in the Selected Hospitals

164

3.10 Comparative Analysis of Physical Evidence Information in the Selected Hospitals

166

CHAPTER 4

4.1 Perceptions of Administrative Staff on “Tangibles” Dimension

180

4.2 Perception of Doctors on “Tangibles” Dimension 181

4.3 Perception of Nurses on “Tangibles” Dimension 182

4.4 Perception of Paramedical Staff on “Tangibles” Dimension 183

4.5 Perception of Support Staff on “Tangibles” Dimension 185

4.6 Perceptions of Administrative Staff on “Reliability” Dimension

188

4.7 Perception of Doctors on “Reliability” Dimension 189

4.8 Perception of Nurses on “Reliability” Dimension 190

4.9 Perception of Paramedical Staff on “Reliability” Dimension 192

4.10 Perception of Support Staff on “Reliability” Dimension 193

4.11 Perceptions of Administrative Staff on “Responsiveness” Dimension

196

4.12 Perception of Doctors on “Responsiveness” Dimension 198

4.13 Perception of Nurses on “Responsiveness” Dimension 199

4.14 Perception of Paramedical Staff on “Responsiveness” Dimension

200

4.15 Perception of Support Staff on “Responsiveness” Dimension

202

4.16 Perceptions of Administrative Staff on “Assurance” Dimension

205

4.17 Perception of Doctors on “Assurance” Dimension 206

4.18 Perception of Nurses on “Assurance” Dimension 208

4.19 Perception of Paramedical Staff on “Assurance” Dimension

209

4.20 Perception of Support Staff on “Assurance” Dimension 210

4.21 Perceptions of Administrative Staff on “Empathy” Dimension

214

4.22 Perception of Doctors on “Empathy” Dimension 215

4.23 Perception of Nurses on “Empathy” Dimension 217

4.24 Perception of Paramedical Staff on “Empathy” Dimension 219

xxxi

4.25 Perception of Support Staff on “Empathy” Dimension 220

4.26 Two Way ANOVA test between Hospitals and Tangibles (Administrative Staff)

223

4.27 Two Way ANOVA test between Hospitals and Tangibles (Doctors)

225

4.28 Two Way ANOVA test between Hospitals and Tangibles (Nurses)

226

4.29 Two Way ANOVA test between Hospitals and Tangibles (Paramedical Staff)

227

4.30 Two Way ANOVA test between Hospitals and Tangibles (Support Staff)

228

4.31 Two Way ANOVA test between Hospitals and Reliability (Administrative Staff)

229

4.32 Two Way ANOVA test between Hospitals and Reliability (Doctors)

230

4.33 Two Way ANOVA test between Hospitals and Reliability (Nurses)

231

4.34 Two Way ANOVA test between Hospitals and Reliability (Paramedical Staff)

233

4.35 Two Way ANOVA test between Hospitals and Reliability (Support Staff)

234

4.36 Two Way ANOVA test between Hospitals and Responsiveness (Administrative Staff)

235

4.37 Two Way ANOVA test between Hospitals and Responsiveness (Doctors)

236

4.38 Two Way ANOVA test between Hospitals and Responsiveness (Nurses)

237

4.39 Two Way ANOVA test between Hospitals and Responsiveness (Paramedical Staff)

238

4.40 Two Way ANOVA test between Hospitals and Responsiveness (Support Staff)

239

4.41 Two Way ANOVA test between Hospitals and Assurance (Administrative Staff)

240

4.42 Two Way ANOVA test between Hospitals and Assurance (Doctors)

242

4.43 Two Way ANOVA test between Hospitals and Assurance (Nurses)

243

4.44 Two Way ANOVA test between Hospitals and Assurance (Paramedical Staff)

244

4.45 Two Way ANOVA test between Hospitals and Assurance (Support Staff)

245

4.46 Two Way ANOVA test between Hospitals and Empathy (Administrative Staff)

246

4.47 Two Way ANOVA test between Hospitals and Empathy (Doctors)

247

4.48 Two Way ANOVA test between Hospitals and Empathy (Nurses)

249

xxxii

4.49 Two Way ANOVA test between Hospitals and Empathy (Paramedical Staff)

250

4.50 Two Way ANOVA test between Hospitals and Empathy (Support Staff)

251

CHAPTER 5

5.1 Summary of hospital service quality dimensions 261 5.2

Gender distribution of Patients 265

5.3 Age distribution of Patients 266 5.4

Income Distribution of Patients 267

5.5 Residence distribution of Patients

268

5.6 Education distribution of Patients

269

5.7 “No. of visits distribution” of Patients

270

5.8 “Category of treatment” distribution of Patients

272

5.9 Case Processing Summary of Hospital * Gender Cross Tabulation

273

5.10 Case Processing Summary of Gender * Hospital Cross Tabulation

274

5.11 Chi-Square values of Hospital * Gender Cross Tabulation 275 5.12 Chi-Square values of Gender * Hospital Cross Tabulation 275 5.13 Case Processing Summary of Hospital * Age Cross

Tabulation 276

5.14 Chi-Square values of Hospital * Age Cross Tabulation 277 5.15 Case Processing Summary of Hospital * Income Cross

Tabulation 278

5.16 Chi-Square values of Hospital * Income Cross Tabulation 279 5.17 Case Processing Summary of Hospital * Residence Cross

Tabulation 280

5.18 Case Processing Summary of Residence * Hospital Cross Tabulation

280

5.19 Chi-Square values of Hospital * Residence Cross Tabulation

281

5.20 Chi-Square values of Residence * Hospital Cross Tabulation

282

5.21 Case Processing Summary of Hospital * Education Cross Tabulation

282

5.22 Chi-Square values of Hospital * Education Cross Tabulation

283

5.23 Case Processing Summary of Hospital * Number of Visits Cross Tabulation

284

5.24 Chi-Square values of Hospital * Education Cross Tabulation

285

xxxiii

5.25 Case Processing Summary of Hospital * Category of Treatment Cross Tabulation

286

5.26 Chi-Square values of Hospital * Category of Treatment Cross Tabulation

287

5.27 Two Way ANOVA test between Hospitals and Tangibles 288 5.28 Two Way ANOVA test between Hospitals and Reliability 289 5.29 Two Way ANOVA test between Hospitals and

Responsiveness 290

5.30 Two Way ANOVA test between Hospitals and Assurance 291 5.31 Two Way ANOVA test between Hospitals and Empathy 292 5.32 Description of Service Quality Gaps 297 5.33 Gap Scores of Apollo Hospital – Tangibles 298 5.34 Gap Scores of Care Hospital – Tangibles 300 5.35 Gap Scores of NIMS – Tangibles 301 5.36 Gap Scores of Gandhi Hospital – Tangibles 303 5.37 Gap Scores of OGH – Tangibles 304 5.38 Average Overall Scores – Tangibles 306 5.39 Gap Scores of Apollo Hospital – Reliability 307 5.40 Gap Scores of Care Hospital – Reliability 308 5.41 Gap Scores of NIMS – Reliability 310 5.42 Gap Scores of Gandhi Hospital – Reliability 311 5.43 Gap Scores of OGH – Reliability 313 5.44 Average Overall Scores – Reliability 314 5.45 Gap Scores of Apollo Hospital – Responsiveness 315 5.46 Gap Scores of Care Hospital – Responsiveness 317 5.47 Gap Scores of NIMS – Responsiveness 319 5.48 Gap Scores of Gandhi Hospital – Responsiveness 321 5.49 Gap Scores of OGH – Responsiveness 323 5.50 Average Overall Scores – Responsiveness 325 5.51 Gap Scores of Apollo Hospital – Assurance 327 5.52 Gap Scores of Care Hospital – Assurance 328 5.53 Gap Scores of NIMS – Assurance 330 5.54 Gap Scores of Gandhi Hospital – Assurance 331 5.55 Gap Scores of OGH – Assurance 333 5.56 Average Overall Scores – Assurance 334 5.57 Gap Scores of Apollo Hospital – Empathy 336 5.58 Gap Scores of Care Hospital – Empathy 338 5.59 Gap Scores of NIMS – Empathy 340 5.60 Gap Scores of Gandhi Hospital – Empathy 341 5.61 Gap Scores of OGH – Empathy 343 5.62 Average Overall Scores – Empathy 345 5.63 Average Scores on Expectations, Perceptions and

Difference between Expectation and Perception: Gap-5 347

5.64 Aggregated dimensional scores and overall Service Quality Index (SQI): Gap 5

350

5.65 Average scores of average dimensions 351 5.66 SERVQUAL Scores by Dimensions and by Hospitals 353

xxxiv

LIST OF CHARTS

Chart No. Title Page No.

CHAPTER 1

1.1 Number of hospitals and number of beds 9 1.2 Comparative expenditures between public and private

sectors in India 11

1.3 Health Expenditure as per cent of GDP 2003 16

CHAPTER 4

4.1 Perceptions of Administrative Staff on “Tangibles” Dimension

180

4.2 Perception of Doctors on “Tangibles” Dimension 181

4.3 Perception of Nurses on “Tangibles” Dimension 182

4.4 Perception of Paramedical Staff on “Tangibles” Dimension 184

4.5 Perception of Support Staff on “Tangibles” Dimension 185

4.6 Staff Perception on “Tangibles” Dimension 187

4.7 Perceptions of Administrative Staff on “Reliability” Dimension

188

4.8 Perception of Doctors on “Reliability” Dimension 189

4.9 Perception of Nurses on “Reliability” Dimension 191

4.10 Perception of Paramedical Staff on “Reliability” Dimension 192

4.11 Perception of Support Staff on “Reliability” Dimension 193

4.12 Staff Perception on “Reliability” Dimension 195

4.13 Perceptions of Administrative Staff on “Responsiveness” Dimension

197

4.14 Perception of Doctors on “Responsiveness” Dimension 198

4.15 Perception of Nurses on “Responsiveness” Dimension 199

4.16 Perception of Paramedical Staff on “Responsiveness” Dimension

201

4.17 Perception of Support Staff on “Responsiveness” Dimension

202

4.18 Staff Perception on “Responsiveness” Dimension 204

4.19 Perceptions of Administrative Staff on “Assurance” Dimension

205

4.20 Perception of Doctors on “Assurance” Dimension 207

4.21 Perception of Nurses on “Assurance” Dimension 208

xxxv

4.22 Perception of Paramedical Staff on “Assurance” Dimension

209

4.23 Perception of Support Staff on “Assurance” Dimension 211

4.24 Staff Perception on “Assurance” Dimension 213

4.25 Perceptions of Administrative Staff on “Empathy” Dimension

214

4.26 Perception of Doctors on “Empathy” Dimension 216

4.27 Perception of Nurses on “Empathy” Dimension 217

4.28 Perception of Paramedical Staff on “Empathy” Dimension 219

4.29 Perception of Support Staff on “Empathy” Dimension 220

4.30 Staff Perception on “Empathy” Dimension 222

CHAPTER 5

5.1 Gender Distribution of Patients

265

5.2 Age distribution of Patients

266

5.3 Income Distribution of Patients

267

5.4 Residence Distribution of Patients

268

5.5 Education Distribution of Patients

269

5.6 “Number of Visits” Distribution of Patients

271

5.7 “Category of Treatment” Distribution of Patients

272

5.8 Gap Scores of Apollo Hospital – Tangibles 299 5.9 Gap Scores of Care Hospital – Tangibles 301 5.10 Gap Scores of NIMS – Tangibles 302 5.11 Gap Scores of Gandhi Hospital – Tangibles 304 5.12 Gap Scores of OGH – Tangibles 305 5.13

Average Overall Scores – Tangibles 306

5.14 Gap Scores of Apollo Hospital – Reliability 308 5.15 Gap Scores of Care Hospital – Reliability 309 5.16 Gap Scores of NIMS – Reliability 311 5.17 Gap Scores of Gandhi Hospital – Reliability 312 5.18 Gap Scores of OGH – Reliability 314 5.19

Average Overall Scores – Reliability 315

5.20 Gap Scores of Apollo Hospital – Responsiveness 317 5.21 Gap Scores of Care Hospital – Responsiveness 319 5.22 Gap Scores of NIMS – Responsiveness 321 5.23 Gap Scores of Gandhi Hospital – Responsiveness 323

xxxvi

5.24 Gap Scores of OGH – Responsiveness 325 5.25

Average Overall Scores – Responsiveness 326

5.26 Gap Scores of Apollo Hospital – Assurance 328 5.27 Gap Scores of Care Hospital – Assurance 329 5.28 Gap Scores of NIMS – Assurance 331 5.29 Gap Scores of Gandhi Hospital – Assurance 332 5.30 Gap Scores of OGH – Assurance 334 5.31

Average Overall Scores – Assurance 335

5.32 Gap Scores of Apollo Hospital – Empathy 337 5.33 Gap Scores of Care Hospital – Empathy 339 5.34 Gap Scores of NIMS – Empathy 341 5.35 Gap Scores of Gandhi Hospital – Empathy 343 5.36 Gap Scores of OGH – Empathy 345 5.37

Average Overall Scores – Empathy 346

5.38 Overall Service Quality Index 350 5.39 Average scores of average dimensions 352 5.40 SERVQUAL Scores by Dimensions and by Hospitals 353

LIST OF FIGURES

Figure No. Title Page No.

CHAPTER 1

1.1 Flow of relationship within Health Sector operators 32

CHAPTER 3

3.1 Correlation between Modified SERVQUAL Dimensions and Original Ten

125

3.2 Service Quality Gap Model by Zeithaml et al. 130

3.3 Key Factors Contributing to Gap 1 132




CHAPTER 5

5.1 The Gap Model (Reproduced from Parasuraman, Zeithaml and Berry, 1985)

295

5.2 Extension of the Gap Model 296

profiles of the selected hospitals -...

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