A STUDY ON PATIENT SATISFACTION AND

QUALITY EVALUATION OF HEALTH CARE

SERVICES

(With reference to Private Multi – Specialty Hospitals

In Coimbatore District)

This is submitted to the Bharathiyar University for the

award of the Degree of Doctor of PHILOSPHY IN

COMMERCE

By
ANUSHIYA

Under the supervision of

Dr.M.ARUMUGAM, M.Com., Ph.D., DIM.,

Reader, Department of Commerce,

PSG College of Arts and Science,

Coimbatore.

PSG

Since 1947

For Graduate and Research Department of Commerce

PSG College of Arts & Science

 An Autonomous College Affiliated to Bharathiyar University
Coimbatore.

CONTENTS

CHAPTER TITLE PAGE No

I Introduction and Design of The Study
II Review of Literature
III Health Care and Services in India
IV Analysis and Interpretation
V Summery of Findings, Suggestions
and Conclusions.
Bibliography, Appendices.

CHAPTER – I

Introduction and Design of Study

In todays global environment, services occupy a key role

in every economy. Almost all the developed countries and the
majority of developing countries are science economies. All
human beings are service provides as well as consumers.
Transportation, education, communication, health care,
hospitality, encashment, information Technology and host of
service have become a part of human life.

Aging population, increased leisure time, time pressure,

more female workforce participation, changing social and
cultural values and advances in technology have led to
considerable changes in the nature of many sciences. The
services are growing not only in volume by also in sophistication
and complexity.

The world is no longer dominated by goods and

manufacturing sector. It has been replaced by a recover and more
dynamic sector, the service sector. Two out of every three
persons are now employed in a service firm.

The service sector has significant contribution especially

for income generation and employment creations. It accounts for
58 percent of world Gross National product and nearly 60% of
total employment in US. In India the rate of growth of service
sector share picked up dramatically from 1980 and peaked during
the last decade of the twenties century. It over took agriculture as
the highest earning sector around 1985 and at present it accounts
for 47.9 percent of Gross Domestic Product. The service sector
today is nearly as big as primary and secondary sectors put
together.

In the last ten years (1994 – 2004), the services sector has
grown on an average by 7.9 % per annum ahead of agriculture
sector wit the growth of 3% per annum and manufacturing sector
with the growth of 5.2% per annum.

In the service sector, the most significant trend

representing both a threat and an opportunity is the increasing
competition nature of the market palace. This necessitates the
service products to have a more professional approach in
marketing their service, if they are to be successful.

Marketing is a process of perceiving, understanding,

stimulating and falsifying the needs of the specialty selected
target markets by chanellising an organization’s resources.

It is a process of matching an organization’s resources to

the needs of the market. Marketing is concerned with the
dynamic interrelationships b/w company’s product and services,
the customer’s wants and needs and the activated of the
competitors. Just like manufacturing businesses goods services
firms use marketing to position themselves in chosen target
market.

A service provides, unlike a manufacturing firm does not

manufacture but rather performs something for the customers.
The delivers and experience that is intangible, heterogeneous,
inseparable and perishable in nature. These unique features
processed by the services have a significant impact on the
marketing of service that are the often result in marketing of
services that are substantially different from the marketing of the
product.

Service marketing function is much broader than the

activities and o/p of the traditional marketing department
requiring close cooperation b/w marketers and those responsible
for operations and human resources. To attract new customers
and to retain the existing customers the service providers must
find ways to face the challenges created by the special features of
the services. The challenges revolve around understanding. The
customer needs and expectations tangiblising the service
offering, dealing with people and delivery issued and keeping
promises made to the customers.

The marketing of the services requires an extended

marketing mix comprising production, pricing, promotion, place,
people, physical evidence and process. The marketers have to lay
greater stress on the last three elements of the marketing strategy
and combine them wit the first four to achieve harmonious blend
which fulfils customer’s wants and satisfaction. The service
product must be tailored to meet customer’s needs priced,
realistically, actively promoted to customers and distributed
through convenient channels.

A customers sees a service providers through the

employees, customers often judge the performance of service
providers by associating them with the behavior and attitude of
their service personal. So they must be well unformed and
provide the king of service that wins customer’s approach. A
service organization can be only as good as its people.
 Service providers also try to demonstrate their service
quality through physical evidence and presentation. By creating
tangible attributes of something, service providers facilitate
customer’s evaluation of the service quality and create a service
experience.

Process an element of the extended marketing mix of

services marketing plays an important role in determining the
quality of service design, production and delivery. A well
designed and well executed process increases customers, reduces
the cost of offering services and improves the efficiency of
service delivery. It helps in achieving the goal of customer
satisfaction.

The key marketing issues that are faced any service

provider relate to managing differentiation, managing
productivity and managing quality. To succeed service marketers
must create competition differentiation, offer high service quality
and find ways to increase service productivity. Service providers
should strive to enhance the quality of their service to exceed
customer expectations, so as to stay ahead of competitors.
Improving service quality enable the providers to coin credibility,
enhance customer satisfaction obtain repeat customers and even
charge a premium price. The rapid changes in technology and the
business environment have served to provide new avenues for
service marketer to market and differentiate their quality services.
 The health care industry is the world’s largest industry and
is undergoing a rapid transformation to meet the ever increasing
needs and demands of the patient populations.

The hospitals have been functioning in a very competitive

environment. Hospitals that are dynamic, growth oriented and
which survive are the ones that give priority to the quality of
services provided. Corporate hospitals are trying to attract
customers by offering value added services. On the other hand
more and more corporate and trust hospitals are entering the
market further increasing the competition. Hospitals have to
design and redesign their marketing strategies for providing
quality health care and ensuring their own survival. Using the
right balance of marketing elements, marketers of hospital
service and can ensure that their marketing efforts provide them
the expected results.

The hospitals offer medical services line services,

supportive services and auxiliary services. They also offer
educational and tracing facilities and promote medical research.
Modern hospitals offer perheral services to add additional
attractions to the services product such as pay – phone,
restaurants, health care education etc.

INTERVIEW SCHEDULE FOR PATIENTS

I. PERSONAL PEOPLE
1.1. Name and address :

1.2. Age : a) up to 20 years b) 21 –

30 years
c) 31 – 40 years d) 41 –
50 years
e) 51 – 60 years f) 61 years
& above

1.3. Sex : a) Male b) Female

1.4. Educational Qualification : a) Illiterate b)

Primary Level
c) HSC Level d)
Graduation Level
e) Diplomo Level f) Post
Graduation Level
g) Professional Level.

1.5. Occupation Status : a) Agriculturist b)

Business
c) Employees d)
Professional
e) House Wife f)
Student
f) Retired Person.
1.6. Monthly Family Income : a) Up to Rs.5,000/- b) Rs.5000 -
10,000/- b) Rs.10,000 – 15,000/- d)
Rs.15,000 – 20,000/-
e) Rs.20,000 – 25,000/- f) Rs.25,000
and above.

1.7. Area of residence : a) Urban b) Rural

1.8. Nature of treatment :

II. AWARNESS:

2.1 a) Are you aware of the following medical and surgical

service offered by the hospital? Yes / No
b) If yes, tick the service that you are aware of

S.No Medical S.No Surgical

1 General 1 General
2 Cancer 2 Cardiac Surgery
3 Cardiology 3 Dental
4 Dermatology 4 ENT
5 Diabetes 5 Gynecology & Obstetrics
6 Gastro Eterology 6 Neuro Surgery
7 Heamatology 7 Orthopedics
8 Nephrology / Urology 8 Ophthalmology
9 Neurology 9 Plastic/Cosmetic Surgery
10 Paediatrics
11 Psychiatry
12 Pulmonology
13 Rheumatology
2.2 a) Are you aware of the supportive services offered by the
hospital?
Yes / No
b) If yes, specify the services offered by the hospital which you
are aware of
S.No Service S.No Service
1 Ambulance 7 Laboratory
2 Blood Bank 8 Nursing
3 Canteen 9 Operation Theater
4 Dietary 10 Pharmacy
5 House Keeping 11 Radiology
6 ICU 12 Registration

2.3 a) Are you aware of the following Hospital Charges? Yes /

No
b) If yes specify the charges that you are aware of
S.No Charges S.No Charges
1 Physician Charges 6 Parking Charges
2 Radiology / Laboratory 7 Nursing Charges
3 Registration 8 Room Rent
4 Medicines 9 ICU Charges
5 Canteen Rates 10 Dietary Charges

2.4. How did you come to know about this hospital, its service and
charges?
a) Advertisement b) Employees of the Hospital
c) Private Practitioners d) Other Patients
e) Share Holders f) Prime Location
 g) Health Camps h) Friends and Relatives.

2.5. If through advertisement, which media

a) Newspaper and magazines b) Radio and TV
c) Banners, Posters etc. d) Web

2.6. Reasons for selection of this Hospital

(If more than one factor, rank them)
S.No Reasons for selection Rank
1 Private Physician’s advice
2 Reputation of the Physician concerned in the hospital
3 Reputation of the hospital
4 Nearness of the hospital to the patients residence
5 Lower charges compared to the other hospital
6 Facilities and care available in the hospital
7 Concessions offered by the hospital
8 Recognition of the central and state government for
their employees and health fund schemes.
9 Emergency situations
10 Other patients who have taken treatment earlier
11 Friends and relatives
12 Health insurance schemes
13 Employees of the hospital

III. LEVEL OF SATISFACTION

Tick the following which you feel will be appropriate with the
help of the abbreviations.
HS – Highly satisfied S – Satisfied
JS – Just Satisfied DS – Dissatisfied
HDS – Highly dissatisfied
3.1. a) Level of satisfaction about the registration service
S.No Factors HS S JS DS HDS
1 Reception Service
2 Availability of Information
3 Waiting time for admission
4 Procedure for admission

b) In case of dissatisfied / highly dissatisfied state the reason

3.2 a) Level of satisfaction about the physical competence & medical

care
S.No Factors HS S JS DS HDS
1 Professional competence of Doctors
2 Time spent by the doctor for
diagnosis
3 Explanation about the health and
Treatment
4 Attitude and Behavior
5 Willingness to listen/answer
patient’s questions
6 Psychological support
7 Health education provided
8 Visit
9 Professional appearance

b) In case of dissatisfied/highly dissatisfied state the reason

3.3 a)Level of satisfaction about the nursing center care

S.No Factors HS S JS DS HDS
1 Nursing skills
2 Attitude and behavior
3 Promptness in meeting needs
4 Mediation at regular intervals is in
time
5 Psychological support
6 Professional appearance

b) In case of dissatisfied / highly dissatisfied state the reason

3.4 a) Level of satisfaction about Room Environment

S.No Factors HS S JS DS HDS
1 Calm & Quietness in room
2 Bed size and quality
3 Facilities (Fan, water, sanitation etc)
4 Cleanliness
5 Appearance
6 Ventilation

b) In case of dissatisfied / highly dissatisfied state the reason

3.5. a) Level of satisfaction about dietary services.

S.No Factors HS S JS DS HDS
1 Timeliness of food served
2 Diet
3
4 Taste
5 Temperature of food served
6 containers

b) In case of dissatisfied/highly dissatisfied sate the reasons

3.6 a) Level of satisfaction with regard to discharge process and billing

S.No Factors HS S JS DS HDS
1 Presenting explanation of the bill
2 Discharge instruction
3 Discharge summary
4 Time taken for the patient to leave
the hospital

b) In case of dissatisfied / highly dissatisfied state the reason

3.7. a) Level of Satisfaction about the quality of the supportive staff.

S.No Factors HS S JS DS HDS
1 Skill & Knowledge of the
supportive sataff
2 Promptness in meeting staff needs
3 Care & Concern
4 Appearance

b) In case of dissatisfied / highly dissatisfied state the reasons

3.8. Your option about hospital charges that you are aware of
Tick the following which you feel will be appropriate with
the help of the abbreviations
VH – Very High H – High
N – Normal L – Low
VL – very cow
S.No Charges VH H N L VL
1 Physicians charges
2 Radiology / Lab Charges
3 Registration Charges
4 Medicines
5 Canteen rates
6 Parking charges
7 Nursing Charges
8 Room Charges
9 ICU Charges
10 Dietary Charges

3.9 a) Did you face any problem in the hospital? Yes / No

b) If yes, kindly specify it.

3.10. Give your suggestion to improve the service to patients.

INTERVIEW SCHEDULE FOR OUT PATIENTS

From personal profile to Awareness
I. PERSONAL PEOPLE

1.1. Name and address :

1.2. Age : a) up to 20 years b) 21 –

30 years
c) 31 – 40 years d) 41 –
50 years
e) 51 – 60 years f) 61 years
& above

1.3. Sex : a) Male b) Female

1.4. Educational Qualification : a) Illiterate b)

Primary Level
c) HSC Level d)
Graduation Level
 e) Diplomo Level f) Post
Graduation Level
g) Professional Level.

1.5. Occupation Status : a) Agriculturist b)

Business
c) Employees d)
Professional
e) House Wife f)
Student
f) Retired Person.

1.6. Monthly Family Income : a) Up to Rs.5,000/- b) Rs.5000 -

10,000/- b) Rs.10,000 – 15,000/- d)
Rs.15,000 – 20,000/-
e) Rs.20,000 – 25,000/- f) Rs.25,000
and above.

1.7. Area of residence : a) Urban b) Rural

1.8. Nature of treatment :

II. AWARNESS :

2.1 a) Are you aware of the following medical and surgical service
offered by the hospital? Yes / No
b) If yes, tick the service that you are aware of
S.No Medical S.No Surgical
1 General 1 General
2 Cancer 2 Cardiac Surgery
3 Cardiology 3 Dental
4 Dermatology 4 ENT
5 Diabetes 5 Gynecology & Obstetrics
6 Gastro Eterology 6 Neuro Surgery
7 Heamatology 7 Orthopedics
8 Nephrology / Urology 8 Ophthalmology
9 Neurology 9 Plastic/Cosmetic Surgery
10 Paediatrics
11 Psychiatry
12 Pulmonology
13 Rheumatology

2.2 a) Are you aware of the supportive services offered by the

hospital?
Yes / No
b) If yes, specify the services offered by the hospital which
you are aware of

S.No Service S.No Service

1 Ambulance 7 Laboratory
2 Blood Bank 8 Nursing
3 Canteen 9 Operation Theater
4 Dietary 10 Pharmacy
5 House Keeping 11 Radiology
6 ICU 12 Registration

2.3. a) Are you aware of the following Hospital Charges? Yes /

No
 b) If yes specify the charges that you are aware of

S.No Charges S.No Charges

1 Physician Charges 5 Canteen rates
2 Radiology / Laboratory 6 Parking Charges
3 Registration 7 Dressing and Injection
4 Medicines

2.4. How did you come to know about this hospital, its service and
charges?
a) Advertisement b) Employees of the Hospital
c) Private Practitioners d) Other Patients
e) Share Holders f) Prime Location
g) Health Camps h) Friends and Relatives.

2.5. If through advertisement, which media

a) Newspaper and magazines b) Radio and TV
c) Banners, Posters etc. d) Web

2.6. Reasons for selection of this Hospital

(If more than one factor, rank them)
S.No Reasons for selection Rank
1 Private Physician’s advice
2 Reputation of the Physician concerned in the hospital
3 Reputation of the hospital
4 Nearness of the hospital to the patients residence
5 Lower charges compared to the other hospital
6 Facilities and care available in the hospital
7 Concessions offered by the hospital
8 Recognition of the central and state government for
their employees and health fund schemes.
9 Emergency situations
10 Other patients who have taken treatment earlier
11 Friends and relatives
12 Health insurance schemes
13 Employees of the hospital

III. LEVEL OF SATISFACTION

Tick the following which you feel will be appropriate with
the help of the abbreviations.
HS – Highly satisfied S – Satisfied
JS – Just Satisfied DS – Dissatisfied
HDS – Highly dissatisfied

3.1. a) Level of satisfaction about the registration service

S.No Factors HS S JS DS HDS
1 Reception Service
2 Availability of Information
3 Waiting time for admission
4 Procedure for admission

b) In case of dissatisfied / highly dissatisfied state the reason

3.2 a) Level of satisfaction about the physical competence & medical care
S.No Factors HS S JS DS HDS
1 Professional competence of Doctors
2 Time spent by the doctor for
diagnosis
3 Explanation about the health and
Treatment
4 Attitude and Behavior
5 Willingness to listen/answer
 patient’s questions
6 Psychological support
7 Health education provided
8 Daily Visit
9 Professional appearance

b) In case of dissatisfied/highly dissatisfied state the reason

3.3 a) Level of satisfaction about outpatient department

S.No Factors HS S JS DS HDS
1 Location of OPD in the hospital
2 Space in the OPD department
3 Facilities (Seating, Fan, Water,
Sanitation etc.
4 Consulting time of OPD department

b) In case of dissatisfied/highly dissatisfied state the reason

3.4. a) Level of Satisfaction about the quality of the supportive staff.

S.No Factors HS S JS DS HDS
1 Skill & Knowledge of the
supportive
staff
2 Promptness in meeting staff needs
3 Care & Concern
4 Appearance

b) In case of dissatisfied / highly dissatisfied state the reason.

3.5. Your option about hospital charges that you are aware of
Tick the following which you feel will be appropriate with
the help of the abbreviations
 VH – Very High H – High
N – Normal L – Low
VL – very cow
S.No Charges VH H N L VL
1 Physicians charges
2 Radiology / Lab Charges
3 Registration Charges
4 Medicines
5 Canteen rates
6 Parking charges
7 Dressing and Injection Charges

3.6 a) Did you face any problem in the hospital? Yes / No

b) If yes, kindly specify it.

3.7. Give your suggestions to improve the service to patients.

EXPECTATIONS OF THE PATIENTS

Based on your experience as a patient, pleased think that

the kind of hospital that would deliver high quality of services.
Show the extent to which you think such a hospital would
possess the features described by the each statement with the help
of the numbers next to each statement.

If you strongly agree that such hospital should possess a

feature tick the number 7; if you strongly disagree then tick the
number 1. If your feelings are not strong tick the appropriate
number in the middle.
 Statements 1
234567
1. Hospital should have up to date Equipment

2. The physical facilities of the hospital should be visually

appearing

3. The hospital staff should be clean and well groomed

4. The appearance of the physical facilities of the hospital

should be in keeping with the type of service provided

5. when hospital promises to do something by a certain time,

they should do so

6. when patient / attendants have a problem the hospital

should take every problem the hospital should take every

step to solve it

7. The hospital should be dependable

8. The hospital should provide its services at the time it

promises to do so

9. Hospital should keep its records accurately

10.The hospital staff should tell patients / attendants exactly

when service will be performed.

11.The hospital staff should give prompt service to patients /

attendants

12.The hospital staff should always be willing to help

patients/attendants

13.The hospital staff should not be too busy to respond to

patients / attendants request

14.The hospital staff should always be honest and genuine

15.The patients / attendants should feel safe in their dealings

wit the hospital staff

16.The hospital staff should be consistently courteous with

patients/attendants

17.The hospital staff should have sufficient knowledge to

answer the questions of patients / attendants

18.The hospital should give patients / attendants individual

attention

19.The hospital staff should respect patients own value system

20.The hospital should have working hours convenient to all

patients / attendants

21.The hospital staff should understand the needs of their

patients / attendants
 PERCEPTIONS OF THE PATIENTS

The following statements relates to your feelings about

their hospital. Please show the extent to which you believe that
this hospital possesses the features described by each statement
wit the help of the numbers next to each statement.

If you strongly agree that such hospitals should posses a

feature tick the number 7; if you strongly disagree then tick the
number 11. If your feelings are not strong tick the appropriate
number in the middle.

Statements 1
234567
1. Hospital should have up to date Equipment

2. The physical facilities of the hospital should be visually

appearing

3. The hospital staff should be clean and well groomed

4. The appearance of the physical facilities of the hospital is

in keeping with the type of services provided

5. The hospital promises to do something by a certain time, it

does so
6. When patient / attendants have a problem the hospital

takes every step to solve it.

7. The hospital is dependable

8. The hospital should provides services at the time it promises

to do so

9. Hospital should keep its records accurately

10.The hospital staffs should tell you exactly when services

will be performed.

11.The hospital staff give you prompt services

12.The hospital staff are always be willing to help you

13.The hospital staffs are not be too busy to respond to your

request.

14.The hospital staffs are always honest and genuine.

15.You feel safe in your dealings with the hospital staff

16.The hospital staffs are consistently courteous with you.

17.The hospital staffs have sufficient knowledge to answer your

questions.

18.The hospital staff give you individual attention

19.The hospital has working hours convenient to you

20.The hospital staff respect patients own value system

21.The hospital staff understand your specific needs

THE END