Redesigning Healthcare services

Group 4

The Indian Healthcare Industry-An Overview

India's healthcare sector has been growing rapidly and estimated to be worth US$ 40 billion by 2012 Revenues from the healthcare sector account for 5.2 per cent of the GDP, making it the third largest growth segment in India. The sector's growth will be driven by the country's growing middle class, which can afford quality healthcare.

Indian Healthcare Industry to Double in Value by 2012 Rising income levels Changing demographics Shift in disease profile from chronic to lifestyle diseases to propel the growth The health infrastructure across Indian states is projected to grow by an average of 5.8 percent per annum between 2009-2013, taking the total expenditure in 2013 to USD 14.2 billion Of the 32 Indian states that the report considered, the six states of Maharashtra, Rajasthan, West Bengal, Uttar Pradesh, Tamil Nadu and Andhra Pradesh are forecasted to represent approximately 50 percent of the expenditure for 2009-2013 period. While the Indian healthcare system has grown manifold over the past few years, it has yet not been able to keep pace with the rapid rise in the population. One example of that is the availability of hospital beds in our country against a world average of four beds per 1,000 population, India lags behind at just over 0.7 presently. There is a growing need to deal with the issues of urban healthcare infrastructure as rural to urban migration has significantly increased the demand for these services.

The Indian healthcare industry is estimated to double in value by 2012 and more than quadruple by 2017. The main factors propelling this growth are rising income levels, changing demographics and illness profiles, with a shift from chronic to lifestyle diseases. This is likely to result in considerable infrastructure. The healthcare sector in India is undergoing a phase of reform propelled by rapid economic growth. Apart from the healthcare providers, emerging markets such as diagnostic chains and medical device manufacturers are attracting increasing amounts of investment. In comparison to all 32 states, Maharashtra forecasted to maintain its dominance as the state with highest cumulative healthcare infrastructure expenditure, with spend of $ 7.3 billion between 2009 and 2010.

Growth drivers Medical Tourism Telemedicine Healthcare services outsourcing Diagnostic services Increasing awareness Medical insurance Aging population Growing urbanization Low cost treatment

Need For Multi-Speciality Hospitals All facilities under one roof Most advanced facilities. Provides Basic Facilities at a rock bottom price with the same quality They can attract talent Indian Healthcare Industry-Growing and Innovation in High Tech Area Change in attitude towards healthcare

Concept for Designing:

The idea for the redesign of the service is to open a hospital with following facilities:

Therapeutic Specialties
1) 2) 3) 4) Ortho Cardiology Gynecology Pediatrics

5) 6) 7) 8) 9)

ENT Sex clinic/ counselling center Rehabilitation center Psychiatry Dental

10) Wellness center 11) Ophthalmology 12) Medicine 13) Surgery

Super Specialty
1) Liver Transplant and Digestive Diseases 2) Joint Replacement 3) Women and Child Care 4) Trans Nasal Brain Tumor Surgery 5) PELD Minimal Access Slipped Disk Surgery 6) Urology and Andrology 7) Obesity Surgery

Diagnostic Services
Radiology: CT scan, MRI, bone mineral densitometry, mammo graphy, ultrasound, x-ray Laboratory: biochemistry hematology, serology, microbiology, clinical pathology, histopathology Other support services: Endoscopy, blood bank and blood components, dialysis, non -invasive cardiology such as echo, stress testing, holter, and ECG IT Driven tools and services: Hospital management system Billing Inventory Accounts management

Records management

The city selected for the hospital is Pune, Maharashtra due to the following factors: Positive Factors: 81% Literate population Densely Populated 7,214/ Km2 Majority of High and Middle income group Good Sewerage system Huge scope for further development Population of Pune city (2009) excluding suburbs is around 33 Lacs (approx.). Total bed stren gths (which includes Private and Government Hospitals) is 6000 approx. So number of beds per 1000 population is 1.8, but according to WHO standards it should be 3. So we are short of 4000 beds in Pune. And this shortage will increase in future. IT Services sector remains a major driver of the economy and jobs created here, Pune's NRI Diaspora and first-generation of successful technology entrepreneurs are encoura g ing a renaissance of entrepreneurial activity. Pune is emerging as a prominent location for IT and manufacturing companies to expand. 25% of income of Pune comes from IT sector. Pune has the sixth largest metropolitan economy and the highest per capita income in the country. Additional 2,500 additional beds in 2016

Negative Factors Reputed hospitals like Ruby Hall, Apollo Jehangir, Aditya Birla Market penetration difficult for newcomer High Real estate razes Scarcity of Trained Doctors, Specialist, Nursing staff (common problem of whole India) Congested space around hospital premises

SWOT Analysis for hospital

Strength Location ,Pune Capacity- Large no. of beds A lot of medical and surgical sub-specialties Availability of library and training classrooms and equipment and enable scientific research Skilled and expertise medical staffs On site testing equipment-- CT/MRI/LABS High standards of quality, cost-effectiveness and patient satisfaction

Weaknesses High priced service May be perceived

Opportunities Location of hospital serves large population, more available connections, and resources. Ease of the public transportation to the hospital Well known hospital with good relationships and form collaboration with primary care facilities (referrals?) Ability to expand in hospital departments and health care Ability to work a variety of jobs with relative ease, both between institutions, states, and countries, without losing step or grade (Veterans Administration) Advance practice nursing is greatly encouraged and promoted with tuition reimbursement

Threats Presence of highly qualified competitors near the hospital (Rush, Univ of Chicago, Advocate Healthcare Network) Insurance changes and Medicaid/Medicare cut (not a large portion of payments, but still substantial at ~20%)

Law suits and penalties by the Department of Health ( found this online as a general threat for all hospitals, we don't have to use it) Major national healthcare reform will affect all aspects of organization Unable to capture best candidate due to lengthy wait time Innovation and originality difficult due to institutional protocols Other competitors

SWOT ANALYSIS FOR HEALTHCARE SECTOR IN PUNE

Strengths: Pune called Oxford of East, has huge student base. Also it is hub of IT industry, thus we expect high employer base utilization of insurance and hospital services. Weaknesses: Acute shortage of skilled doctors and trained Para-medical staff and investments required to uplift the current status of the healthcare. Opportunities: Changes in demography and socio -economic mix are altering the population's disease profile and increasing the incidence of lifestyle diseases thus increasing the demand for beds. Threats: Steep population growth with lack of proper healthcare policies. Infrastructure and accessibility to the healthcare for all is challenge in the coming days.

COMPETITOR ANALYSIS- DEENANATH MANGESHKAR HOSPITAL

It has all the ultra-modern facilities including Blood Bank, Cancer research centre etc. The hospital has more than 65 ICU beds with a central monitoring system. The hospital has a well-equipped auditorium of the capacity of 3000 people with air conditioner, advanced sound system and a sophisticated video projection system too. The hospital conducts lot of awareness programs and makes films for the people and society like the films on diabetes etc. It offers following facilities: Department of medical genetics o Clinical Genetics o Cytogenetics o Molecular Genetics o Metabolic Genetics Ayurveda Panchkarma Homeopathy Dentistry Clear vision clinic Voice clinic Obesity clinic Cardiology Neurology Kidney transplant Cancer treatment

IVF centre Neuro-Trauma Unit

The 7Ps in Service Marketing Mix

Service Marketing Mix is an extended marketing mix and is an integral part of service blueprint design. The service marketing mix consists of 4Ps as part of marketing mix and adds 3Ps as part of optimum service delivery. Understanding the service marketing mix is fundamental to help you design service is better manner about consumer behaviour and enhancing quality of service. This is not exception case for any services; special is healthcare industry where quality of service is oriented factor to take care of patient health. Improving access, coverage and quality of health services depends on the way you design service in terms of incentives influencing providers and users. The paper will present the 7Ps in service marketing mix for a blueprint service design of multi-speciality hospital in India.

Product

Promotion

Price

Process

MultiSpeciality Hospital

Place

Physical Evidence

People

Product In case of services, product is intangible, heterogeneous and perishable, seeks to satisfy needs of consumers. Service product can be defined as quality level, accessories, packaging, warranties, and product lines, branding, technical and functional. Multi-Speciality hospital requires providing not only quality, reliable services but also convenience services. It should be designed fully equipped with various facilities as the following Accommodation facilities: AC* Suites

AC Deluxe class AC deluxe AC general Common Class:

The specialties in care facilities include cardiology, cardio-thoracic surgery, gastroenterology, orthopaedics & joint replacement surgery, neurology, critical care medicine, nephrology, oncology, hand & micro surgery, urology critical care, adult fitness & health promotion program, physiotherapy, laboratory medicine, reproductive medicine and complete health plans Accessories services: Emergency services with state of the art ambulances, tech telecommunication 24/7 available to a patient in an emergency at any given time; Ambulance services with hi-tech ambulances linked with fully equipped with doctors, available to render medical attention, assistance to patient at the door step; Diagnostic services to handle any kind of ailment and offer a wide range of facility, for instance, oncology, neurology, orthopaedics, plastic surgery, etc.; Pharmacy services offer services 24/7 which will cater the needs of inpatients and outpatients; Causality services include a 24 hours causality department which attends to the emergency cases. Price Pricing is the most important factor for patients to decide a hospital for a particular treatment. For a particular product or service you have to pay certain price for consuming that service. Service Pricing follows principles and practices of pricing of goods and therefore it may be profit oriented, government oriented, competitive or customer oriented. In the case of multispeciality hospitals, the price should consider as premium price as it can afford for the multi service and quality offer by the hospital. The availability of treatment facilities is very important for taking care of patients because in case of general diseases it may not be a required element since its treatment is easily available but when treatment of complex patient opt for premium price is very important factors. Price in multi-specialty hospital depends on the cost of treatment (include doctors fee, the nature treatment of the treatment, various medicines and surgical items to be used, nurse service fees, etc.) Plus the charges of different types of accommodations facilities available. Facilities AC Suites AC Deluxe Class Price (INR) per day 6000 4000

AC Deluxe AC general Common Class

2500 1300 400

Promotion Since a service offering can be easily replicated promotion becomes crucial in differentiating a service offering in the mind of the consumer. In cases of multi-specialty hospitals offers high premium price. Thus, multi-specialty hospital should invest heavily in advertising their services. Customers need to be made aware of the brand and services offer. Impersonal promotion such as Press release Promotion, Bill boards Promotion Personal promotion: rely on word of mouth as experience of this customer is very important to attract another customer. Can be promoted through community initiatives Hospitals hold seminars and conferences relating to specific diseases, where they invite the doctors from all round the country even foreign specialist, for detailed discussion. This makes the hospital well known amongst the doctors, who could in future refer complicated cases to the hospital. Place Service delivery is concurrent with its production and cannot be stored or transported; the location of the service product assumes importance. Factors affect to the placing decision are number competitors in the area, market size, geographical regions, location that attract customer the most, local infrastructure, accessibility place, public transportation network, etc. A hospital should be located in place which is easy to accessibility. In India, multi-specialty hospital should present all states of India. The ideally location is nearby public transportation. People People are a defining factor in a service delivery process, since a service is inseparable from the person providing it. Consequently, customer service training for staff has become a top priority for many organizations today. In hospital, the facilities, the quality and availability of doctors, nurses, supporting staff are very important. The behaviour and attitude of the personnel offering service will influence the customer's overall perception of the service. Customers are a source of influencing other customers by word of mouth. Be sponsor for healthcare programs on TV. Other ways of promotion can be medical camp, medical tourism, social networking

Resource Allocation should be designed by computer assisted Human resources requirement planning as the following benchmarks Front line: 3 employee each shift, 3 shifts per day, each shift 8 hours. Back line: HR Staff requirement Allocation Working hours nurse Special arrangement: 1 nurse per 8 hours per shift patient for 24/7 AC suits and 1 nurse for two patients for AC deluxe. Normal arrangement: the ratio will be 5:1 Nursing supervisor 1 person for one team of 10 nurses 8 hours per shift Physician 60% for patient; 40% for 8 hours per shift documentation job support 2 nurse teams 2-5 senior doctors for each 8 hours per shift specialty 5-10 junior doctors for each specialty Shift 3

3 3

Doctors

Physical Evidence Services are intangible in nature most service providers strive to incorporate certain tangible elements into their offering to enhance customer experience. Physical evidence is the environment in which the service is delivered with physical or tangible commodities and where the hospital and the customer interact. Multi-specialty hospital may be designed following the hospital counter, common ward, single room, emergency room, common room, dress code, certificates and awards. Three Aspects of Physical Evidence are: Ambient Factors: Smell in the hospital, Effect of Colours used on walls Design Factors: Design of the rooms, plush interiors, ICU location, etc. Social Factors: Type of Patients that come to the Hospital

Process The process of service delivery is crucial since it ensures that the same standard of service is repeatedly delivered to the customers. The different tasks performed by the hospital involves two different type of process for: Outpatient & Inpatient Outpatient basically meets doctor at appointed time for simple medication Diagnosis Treatment and takes advice from doctor. They dont require staying in hospital for period of time.

Impatient is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extremely ill or are have severe physical trauma. Since service is inseparable, it is the process through which consumers get into interaction with the service provider. Process generally forms the different tasks that are performed by the hospital. The process factor is mainly dependent on the size of the hospital and kind of service it is offering.

STP analysis

SegmentationThe basis for segmentation may be basically demographic. The service being a multi-speciality hospital, cannot be segmented on the basis of age, sex or other psychographic or behavioural factors. The hospital is going to be a world class facility, with all modern equipments and state of the art infrastructure. So income will be the appropriate basis for segmentation. The segmentation may also be done based on the geography. TargetingThe hospital will provide world class health care facility and state of the art technology to its patients. The nursing staff will also be specially trained to serve the patients better. Thus the higher middle to higher income group will be the target group for this hospital. Also being located in the city of Pune, the target group is expected to be from around central and western part of the country, Maharashtra, Gujarat and Karnataka.

Positioning

Quality healthcare services with state of the an medical facilities under one roof Well qualified staff Excellent customer patients services Easily accessible and competitively priced Customized designs to suit the varying needs of different customers (patients) Constant interaction with the patients and strong bonding with them Promoting healthy India

MARKETING STRATEGIES
Communication mix The aim of this exercise is to establish the brand in the minds of the customers so well that it becomes the first name that customers recall whenever discussing or thinking abouthealthcare. The product would be heavily advertised before launching and then we wouldinvolve in extensive sales promotion. The communication strategy of promoting andadvertising the brand is as follows: 1. Magazines Health General Lifestyle 2. Newspaper ads 3.Hoardings across various places in cities 4.Advertisements in local television shows 5.Sponsoring and .organising awareness camps and visiting schools 6. Mobile marketing

Public Relations and Publicity We have chosen newspapers and magazines because of wide range of our target audience.Magazines and newspapers are always in the eye amongst public. Magazines are read for a period of a month, which brings more attention to an advertisement. We plan to advertise in National and local newspapers Health MagazinesWe further plan to utilise the non personal communications such as photographs, films andtapes showcasing the facilities of our hospital and the advantages that the local populationwill have by getting themselves treated at a world class hospital as compared to the localnursing homes. Promotion activities 1.Hoardings: Visual hoardings to be placed on prime locations of the city to increasevisibility among masses. Also we would place hoardings in high density residentialareas, industrial areas and on city outskirts. 2.Camps: Blood donation camps and free check up camps would be arranged in schoolsand colleges.

3.Event Sponsorships: We would try to grab attention of the prospects by sponsoringevents such as cultural events, sports events etc. We can even organize marathons.4.Advertisements to be placed on local and short route buses. Sales Promotion 1.Tie up with Insurance companies for devising various insurance cover plans. 2.Tie ups with corporate and educational institutions for annual health contracts. Special packages for economically backward patients, senior citizens, maternity package,annual health check up package, package for diabetic patients, physiotherapy package etc. Future Plan We have devised a plan which would be followed in case of future expansions. We are planning to implement a Hub and Spoke model which will help us in expanding our servicesto areas where we cannot currently reach due to infrastructure related issues. Issues liketransportation, electricity, public sanitation facilities available in smaller towns and villagescurrently dont allow us to open our super speciality hospitals in these areas. Even if theseare ignored, there would be problems finding good doctors and other hospital staff whowould be willingly ready to work in such areas. To circumvent these issues, we have comeup with this model.

Service Blueprint
Service blueprinting is defined as a tool for simultaneously depicting the service process, the points of customer contact and the evidence of the service from the customer's point of view. The proposed blueprint allows for a quantitative description of critical service elements, such as time, logical sequences of actions and processes, also specifying both activities and events that happen in the time and place of the interaction (front office and back office that are out of the line of visibility for the users but are fundamental for the service).

1. Patient goes to the main Reception desk and gets and OPD (Out Patient Department) card. 2. Depending on the complaint, Patient is referred to the specialty department. 3. Patient meets the receptionist of the specialty department and specialty department OPD is made. 4. Patient is sent to' a Consulting room. 5. (In a non-teaching Hospital) patient is sent to a consultant (In a teaching hospital) Intern or Post Graduate attend to the patient.

6. Complaints are noted down and patient is sent to. Examination Room. 7. PG and consultant discuss on the .complaints mentioned and probable examinations to be made is decided. 8. Patients total body examination is done by specific priority to area of complaint and vital signs are also noted down. 9. PG and doctor make a provisional diagnosis. 10. Required investigation are prescribed. 11. If patient is not willing to continue then his provisional diagnosis becomes his final diagnosis for the hospital. 12. If the Patient agrees for the treatment then patient is directed to concerned laboratory. 13. At Lab a staff collects the OPD card from patients and conducts the test mentioned. 14. The test results are directly sent to the consultant. 15. Final diagnosis is done arid treatment is prescribed. 16. Patient is given up a follow date (Usually 5 days, depending on the issue and asked to come on a particular day to meet the same. consultant). 17. Patient comes on specified date and meets the particular consultant. 18. Consultant again checks the patient and if any other tests then it is noted on the OPD. If patient has recovered then it is again noted on the OPD.

Service BluePrint for Multi-Speciality Hospital