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ANU-A Study on Marketing of Hospital Services'

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 A Study on Marketing of Hospital Services

Abstract : Hospital marketing is becoming increasingly competitive all

over the world and India is no exception. The gradual shift from the selling to

marketing vis-a-vis the customer orientation is quiet evident in present day hospital

services. Hospitals become consumer centered and are expecting high medical care

and demanding quality services at reasonable prices. Under these circumstances,

age-old methods may not give us long run results. The application of modern

marketing principles would pave avenues for rationalizing and standardizing the

services. Thus marketing has become a new ‘mantra’ for the service

providers in a hospital setting. Article evaluates the innovative marketing

strategies adopted by corporate hospitals to sell their services and tries to

explore the Marketing process explained with the help of 7P’s i.e.

Product, Price, Place, Promotion, People, Physical evidence and Process in

sample hospitals which run under different corporate managements. For this purpose

it is proposed to elicit the perceptions from the doctors, nursing staff and

administrative staff on marketing mix of hospitals. The data was analyzed by

applying different statistical tools to know whether the perceptions of

respondents are indistinguishable or not.

 Introduction

The health care market has become consumer centered and expecting
high quality care at a reasonable price. The mushroomed development of
corporate hospitals in India, competition is also bringing massive changes in
industry structure.

At present, the competitor is large national or multinational organizations with vast

economic resources at their disposal. In this context, hospital services marketing
is slowly and surely coming of age and is being woven into the fabric of hospitals
planning and public relations programmes.

There is an in built tendency to think that services will be sold out automatically,
hospitals will overflow if a doctor has a degree and money will flow if an
equipment is brought. But unfortunately, marketing, which is very essential for
survival of any hospital, is being almost ignored. Many of the corporate hospitals
over the last two decades, have developed marketing culture in their set – up
which has enabled them to scale new heights in their ventures. In advanced
countries, the marketing has taken deep routes where as in the developing countries
the need is being felt just now. Many of us still prefer to be victims of established rules,
ethical codes, social constraints and spiritual laws. Thus the concept of hospital today
is differed from what is used to be in the past. As we are moving to service economy,
the customers are more critical and keen towards quality services and high standards.
As every one of us know patient is the local person in this changed environment,
the hospitals must strive for maximum patient satisfaction. In deriving patient
satisfaction, hospital marketing is playing csrucial role. It is now recognized
as a necessary management function in a highly competitive, resource
constrained environment. A growing number of hospitals now havefull - fledged

marketing departments which have brought into operation with result oriented
2
marketing plans and strategies.
The marketing process consists of hundreds of variables or ingredients which are
involved marketing planning, marketing decision making and formulation of
marketing mix strategies. All these can be conventionally classified into seven
major strategies namely product/service,

price, place promotion, people, physical evidence and process. The product
element of the hospitals includes diagnosis, treatment provided, the education
training provided to nursing and medical students and research. Services like
facilities for attendants, ambulance, and pharmacy services etc., augment the core
service. The pricing of services should take into consideration the operational
costs and the paying ability of the patient, apart from the value provide to the
customer. People play a very important role in marketing of hospital services.
Processes add value to customer and also improve the efficiency of the operations
of the hospitals. Physical evidence can be provided using a good layout and
maintain hygiene. Supplementary services also help in providing physical
evidence to customer

Hospitals have distinct marketing concerns. The health care arena is in a constant
state of transition and recent years have witnessed numerous developments with
implications for marketing activities. Virtually every aspect of health care has
undergone significant change over past few years, and virtually all of these changes
have implications for marketing. The demand for health care services is influenced by
numerous factors both inside and outside health care. Some observers have
predicted that the first decade of the twenty first century will be the decade of the
consumer in health care and ample evidence supports this environment is
emerging in which healthcare organizations will be required to cater to the
needs and wants of a more demanding set of customers. Regardless of other trends
developing in healthcare, the industry will continue to be technologically oriented.
 Hospitals are increasingly competing on the basis of price, and
healthcare marketers must be in a position to support this marketing angle.
Marketers may be required to defend adverse mortality outcomes or,
conversely, be presented with the opportunity to capitalize on favorable surgical
outcomes. Marketers will be increasingly called on to moderate the outcomes issue,
and outcome measures will become an inherent component of marketing evaluation.
In keeping with a broader definition of health and illness, the healthcare
industry is experiencing a shift away from disease management toward patient
management. Despite the weak labor market of the early twenty-first century,
healthcare providers continue to face shortage of key personnel. The current shortfall
is more extreme than previous ones, and little chance for short-term amelioration of
the problem is recognized. Reports of unethical behavior, negligence, and
greed have served to sully the reputations of most of the players in healthcare in one
way or another. All of these developments have major implications for healthcare
marketing. The future healthcare environment is likely to be
characterized by more competition; tighter margins; more diverse, better
informed, and more demanding consumers; demands for accountability; and
growing labor shortages. Marketing may not be a panacea for this laundry list of
challenges, but the judicial use of marketing resources can certainly contribute to
their amelioration.

2
Objectives of the Study
Specific objectives of this research are :
• To analyze and compare the Marketing process (Product, Price, Place,
Promotion, People, Physical Evidence and Process) in two selected
corporate hospitals.
• To study and compare the perceptions of Administrative staff, Doctors and
Nursing staff towards marketing process.
• To suggest suitable measures for effective marketing of hospital Services in
general and the selected hospitals in particular.
 Selection of Sample Hospitals
The researchers have selected two corporate hospitals in Hyderabad, Andhra
Pradesh. They are APOLLO HOSPITAL, Jubleehills and CARE
HOSPITAL, Banjarahills which are having similar and almost identical
facilities.
1. The select two hospitals under study are providing tertiary care and they are high-tech
hospitals.
2. The two sample hospitals are located in the advanced locality of the city with in the
distance of 6 km from one another.
3. The two hospitals have almost similar physical area, comprehensive
equipment, skilled medical specialists and nursing staff with common set of policies
and proposals.
4. Two hospitals run on modern scientific and high tech lines, under the control of
private management.
Selection of Sample Size and its Justification.
A detailed study of two super- specialty hospitals (Apollo and Care) was taken for
study. In each hospital, the sample is taken from three categories after giving
adequate representation to all classes. The three classes include 1. Doctors 2. Nurses 3.
Administrative Personnel. Following table showing the population of two selected
super specialty hospitals and sample size of selected hospitals.

5
 Pertaining to the questionnaire to doctors in Apollo, out of 156 doctors, the
questionnaire was distributed to 85 and only 75 response sheets were taken for final
analysis. Out of 127 doctors in Care hospital, the questionnaire was distributed to 90
and 75 response sheets were selected for final analysis. In the case of questionnaire
relating to nursing staff, in Apollo hospital, out of 560 nurses, 340 nurses are
working on permanent basis and 220 are working on contract basis. The
questionnaires were distributed to 170 nurses who are working on permanent basis and
finally 150 questionnaires were selected for analysis. In the case of Care hospital,
out of 510 nurses, 320 nurses are working on permanent basis and remaining
190 are working on temporary basis. The questionnaires were distributed to 180
respondents who are working on permanent basis and 150 response sheets were
taken for final analysis. The questionnaires developed for administrative personnel
was distributed to 45 numbers in Apollo, and 35 were selected as sample for final
analysis. Out of 40 administrative personnel in Care hospital, 35 persons are selected
for final analysis.

Collection of Data

For collection of data efforts were made to elicit the opinions through
personal interviews and by distributing questionnaires. The instrument was
tested for its reliability and validity. A five degree scale (Summated Scale)
was used. It contains the columns of strongly agree, agree, can’t say,
disagree and
strongly disagree of the respondents with the given statement. In this aspect
researchers have taken help from the different eminent people in the concern
area. Observation method is also used while collecting the data
7
Methodology for Data Analysis

The data is analyzed with statistical tools like percentages, Mean, Standard
Deviation, ANOVA to know whether the perceptions of respondents are
indistinguishable or not with reference to Marketing Process of sample
hospitals.

Review of related Literature

Product : An article ‘New service development: From Panoramas to
Precision’ by Anne M. Smith, Moira Fischbacher, Francis A. Wilson
argues
that a panoramic, or holistic, approach to new service development and a high level of
precision at the micro level, will combine to provide a more successful service
design and new service development process. ‘Developing New
Services For Hospitals: A Suggested Model’ written by Michael R. Bowers
proposes that hospitals’ should facilitate market-driven service
development. “Is product-line management appropriate for your health
care activity?”

G.M.Naidu; Kl emenhager; Pillari; George.D examines the result of the study

on product-line management (PLM) as management tool on health care
industry. “Product line management in hospitals; an exploratory
study of managing change” by Burger, Philip C; Malhotra, Naresh.K.
presents an abstract ofproduct line management in hospitals. According to this
article product line management is a system in which one manger is responsible for
all aspects of marketing and delivery of one particular product or service bundle.
 Price: “Case mix specialization in the market for hospital
services” byDean E. Farley and Christopher Hogan opine that Hospitals
may be able to reduce their costs by limiting the breadth of services
they provide. “Isthere a link between hospital profit and quality?” by

Zallocco Ronald.L. In this article the author discussed relationship

between quality and profitability. The authors studied each hospital to
determine the relationship between quality and profit levels on one hand and
price, occupancy levels, and costs per patient on the other. Conclusions
include: First, low quality hospitals have much lower levels of profitability
than high quality hospitals. Second, low profit and quality does not result in
lower demand. Third, poor quality hospitals are understaffed and have
inadequate investments in capital assets.

Place: “Identifying market Segments within A health care delivery

System by Wilbur W.Stanton, James M. Daley applied a two stage methodology for
identifying healthcare market segments. The paper “Modeling the
impact of internet atmospherics on surfer behavior” by Marie-Odile
Richard examines the role of Internet atmospherics cues on the behavior of
surfers and their impact on variables such as site attitudes, site involvement,
exploratory behavior, pre-purchase and purchase intentions.

Promotion: ‘Building a strong services brand: lessons from Mayo

Clinic’ by Leonard L. Berry, Kent D. Seltman explains the services branding
model by showing how one organization has created, extended, and protected a
powerful brand through an unwavering commitment to the well being of its
customers.
‘Brand equity in hospital marketing’ Kyung HoonKim,Kang Sik
9 Suk Hou Kang identifies five factors that
Kim, Dong Yul Kim, Jong Ho Kim,
influence the creation of Brand equity through successful customer
 relationships.‘Assessing advertising Content in a Hospital Advertising
Campaign by Menon, Mohan K.Goodnight, Janelle M. Wayne, Robin J.
have designed a measure advertising content based on the cognitive and affective
elements of informational (i.e., information processing) and transformational
(i.e., experiential)

People: “The role of the Internet in physician—patient

relationships byS. Altan Erdem, L. Jean Harrison- Walker explains the
importance of Internet in building physician-patient relationship in their marketing
activities of health care units. “The exploration of consumers’
behavior in choosing hospital by the application of neural network” by
Wan-I Lee, Bih-YawShih,Yi-Shun Chung explains the application of
neural network to classify consumers’ behavior inchoosing
hospitals. “Concepts in service marketing for healthcare
professionals” by Christopher L. Corbina, Scott W. Kelley, Richard
W.

Collection of Data
For collection of data efforts were made to elicit the opinions through personal
interviews and by distributing questionnaires. The instrument was tested for its reliability
and validity. A five degree scale (Summated Scale) was used. It contains the columns of
strongly agree, agree, can’t say, disagree and
strongly disagree of the respondents with the given statement. In this aspect researchers
have taken help from the different eminent people in the concern area. Observation method
is also used while collecting the data.
Methodology for Data Analysis

The data is analyzed with statistical tools like percentages, Mean, Standard
Deviation, ANOVA to know whether the perceptions of respondents

1
1
 Discussion: From the above table it can be observed that both the selected hospitals
services can be divided into core, tangible, augmented services. The product – mix in
Apollo hospital include
medical and surgical services, ICU services, pain relief services, emergency services,
supporting services and special services like health check up services, diagnostic services
etc. As explained in the above chart Apollo corporate services and blood bank
services are the augmented services. On the other hand the product – mix in care
hospital
include medical and surgical services, laboratory services, online services, blood
bank services, emergency services etc. When we look into the services of both the
hospitals it can be said that Apollo hospital is concentrating on generating the core
services and tangible services, where as the care hospital is concentrating on core
services and augmented services. After observing the length, width and depth of both
the hospitals one can say that both the hospitals are striving for quality health care to the
needy.

Pricing in Hospitals
Pricing is the most often used to describe the actual charge made by an
organization. In hospital prices go by various names. Health insurance companies
charge premium and in turn
they pay billed amounts. They are often reimbursed on the basis of costs. Pricing in hospital
services is generally done by keeping in view the cost of running the hospital, the overheads,
salaries of the doctors, nurses and administrative staff, cost of infrastructure, bed occupancy,
quality of service etc. The following is the information related to price in select hospitals.
Price in Apollo Hospital: In Apollo hospital the pricing is described in three heads:
1.Fees 2.Inpatient charges 3.Third party reimbursement. These three heads are based on the
costs of producing different services. In addition in Apollo the prices includes subsidiary
elements, and the price may be greater or smaller, depending up on the discounts. The discounts
are offering to the special groups such as employer groups and senior citizens etc. While
fixing the prices of the services, the management of Apollo considering the actual charges
made by the hospital. Hospital is considering effort costs, psychic costs and waiting costs.
While finalizing pricing it is observed that in Apollo hospital, there are heavy fixed costs.
These costs are charged who are utilizing by the third party payment. Some of these services
are charged in Apollo with a view to maximizing short- run benefits. Apart from this certain
heart related services are charged

1
independently by the Apollo without considering the market forces. Apollo is providing
different categories of rooms for patients depending up on their
paying capacity. Following table reveals the pricing structure for different categories of
rooms, with facilities in Apollo hospital.
 
      
     
   
  
    
 
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   
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       

           
  
         
           
        
          
           
        

              
         

            
  

           

         


Pricing in Care Hospital: Pricing in Care hospital largely based on costs, which are
broadly divided in to direct and indirect costs. Before finalizing pricing for services
Care hospital is trying to know the cost for providing those services. Before fixing
prices, Care hospital is considering all the related components for calculating total

1
cost of service. It is taking fixed and variable costs to determine final price. After fixing the
prices scientifically, the management decides how much subsidy is to be extended. For
inpatients the hospital is charging on the basis of variable costs and based on the category of
bed he is opting.
 
    
   
     
        
        
      
      
       
       
       
 Discussion: In Apollo hospitals, the prices are made by the estimating demand of
the service and its supply by the other producers. Especially this is happening when the
hospital is going to launch new services. Most of the services are based on costs and
it is observed that nearly forty percent of the patients are having third – party
reimbursement. The authorities of Apollo hospitals differentiating the pricing
structure based on different categories of rooms and facilities that are being
provided by them. For maximizing the service utilization Apollo authorities are
fixing lower prices for certain services. Sometimes they are offering the services at free
of cost. Pricing in Care hospital largely based on costs which are divided into direct,
indirect and graduated costs. Before fixing the prices the hospital is trying to know the
exact cost of services and it is inquiring the prevailing costs in other hospitals of that
region. Most of the services for inpatients in Care hospital are based on variable
pricing structure and on the basis of the category of bed the patient occupies. As
mentioned above there are three categories of beds like general ward beds, semi
private rooms and private rooms.

1
Place or Distribution Channels in Hospitals
Place is one of the key elements for hospital. Hospital should be easily accessible to the
patients and it should be adequately protected from pollution. Every hospital will try to make
services available and accessible to its target consumers. It has two aspects. The first is
availability of service and place convenience to the patient. The second aspect is the entire
health care system. While distributing health care we need accessibility with physicians,
hospital administrators, donors, government, insurance companies, employers and others.
Thus hospitals in general will have three major distribution decisions. They include physical
access (channels, location, and facilities), time access and promotional access.

Distribution Channels of Apollo Hospital: In Apollo, physical access comprises the

channels which the hospital using for distributing the health services. Location of the Apollo
hospital includes the branches or outlets to operate, size, locations and the availability
of specializations at each branch etc, and designing of the facilities. Apollo is utilizing
different channels for delivery of health services
to the needy. In Apollo, the patients now can get the surgery on an inpatient or out-
patient basis or in free- standing one-day surgery in centers. Apollo, offering house
visits in some areas where more no. of physicians available. Apollo changed the
channels of

2
distribution in obstetrics, and moved the birth process out of traditional labor and delivery
rooms in to hospital-based alternative birth centers and on occasion in to the home. Following
table shows the Tele-medicine service of the Apollo hospital.
Table - 4 : Apollo Tele-medicine services
  

  

        


      
       


         

 
           

 
            

      
            
             
            
        
            
          
            
           

 
   

One important trend noticed by researchers in Apollo hospital, is using new

channels to bring health services to the consumer, rather than forcing the consumer to
come to the hospital. For this, Apollo is arranging mobile vans for delivering medical care
and health screening tests at shopping malls,
schools and worksites. The main campus of Apollo hospital is located at film nagar,
heart of the city spread over a campus area of 35 acres, within built-up area of 190,000 sft
with a patient serving capacity of 1, 00,000 per year. The other outlets located at various areas
are shown in the table.

2
 Table - 5
Other outlets of Apollo Hospital
  
  
  
    
    
    
    
    
    
    
    
    
    
      
    
    
    
    
    
    
    
    

Distribution Channels in Care Hospital

The distribution channels of Care hospital are explained in terms of two aspects. The
first one is location of the hospital and the second aspect includes the facilities, branches
located in the same city and over the country with its bed capacity and
specializations, community outreach programmes, satellite clinics which deliver
health
services at the people’s doorstep. Care hospital located at Banjarahills Road No: 10
Hyderabad, spread over 10 acres with 55,000 Sft. of built up area. At present, Care hospital
having 430 beds,
including 120 critical care beds with annual inflow of 1, 80,000 patients for consultations and
16,000 patients for admission. The hospital have good transportation facility from all the
corners of the city.

2
 Table - 6
Outlets of Care Hospital
    
   
  
   
  
 
  
  
 
 

   
   

       


     

      

     

  
   
 
      
      
      

Discussion: Place element in the

market – mix leads to the identification of the suitable location. The two main issues
considered regarding the decision
of place is accessibility and availability
of service. Accessibility refers to ease and convenience with which a service can be
purchased. Apollo and Care hospitals are having place convenience as they are located at
central location it is accessible with different transportation systems. It is observed
that outpatient department timings are not convenient in CARE and patients are feeling
comfortable with the OP timings of APOLLO. In conclusion it
may be stated that the two hospitals are enjoying satisfactory distribution network of
their services.having good place - mix in marketing their services.

Sales Promotion activities in Hospitals

Promotion is the hot topic in marketing of hospital services. In broader sense,
five tools of the marketing mix – service, price, place,
promotion, and people are communication tools. Messages are carried to the market
by the service’s styling and features, its offering price
and the places and times through

2
promotion function. The promotional tools are numerous and varied. These tools fall
into four groups - Advertising, sales promotion, personal selling, and publicity.
Sales Promotion in Apollo Hospital
The promotion mix of Apollo hospital based on advertisement, promotion of
services, publicity of service, personal selling and public relations. It is observed that
the Apollo hospital is using Print & Electronic media such as magazines, news papers,
television and posters, skywriting, calendars, cards, catalogs, directories, programmes,
circulars, internet etc, for the promotion of their services. It is observed that APOLLO is
trying to build up brand image for their services. It is successfully built up brand image for
some of their services like bypass surgeries, diagnosis, pharmacy etc.

In a view to increasing reputation, Apollo is participating several social service

programmes. Following table represents some of such activities.

Table - 7
Apollo Hospital Social Service Programmes
  
 

           
         

          

 
               
 
   
           
  
         
         
 
  

As a part of promotional activities, Apollo started a separate public relation

department for delivering functions of developing media relations, publications, and
community relations. This department is planning important

2
role in implementing the strategic plans of the hospital. Apollo public relation department
working with objectives of developing their hospital as a leader in patient care, research and
education.
Promotion activities of Care Hospital
Care hospital giving equal importance to the image advertising and product
advertising in their promotional campaign. For this purpose Care hospital is
preferring electronic media, and web based advertisements. Along with, Care hospital is
advertising through news papers, magazines and bill boards, displays, posters,
traveling displays, station posters, direct mail advertising etc. Apart from the above
methods Care hospital is following other methods like distributing souvenirs, brief
presentations by the surgeons on kidney transplantation and other critical surgeries on
the screen, etc. Hospital is providing medical insurance, immunization and other
health records, health facts, health related articles, up-to-date papers for distribution.

Discussion
Promotion function of any service organization involves the transmission of
message to past, present, and potential customers. Customers need to be made aware
of the existence of the service provided. Promotion includes advertising, sales
promotion, personal and publicity. Hospitals do not normally undertake aggressive
promotion, they

3
rely a lot on a favorable word of mouth. To increase the cliental, the sample hospitals are
continuously introducing different health services a like the acupressure clinic, master
health programmes, and diabetic health checkups apart from annual health checkups.
Two hospitals are conducting camps in rural areas to give medical checkups at a reasonable
price. They are sponsoring frequent visits to the spastic society, old age homes etc. These
hospitals are advertising in health and fitness magazines. The promotional activities of Apollo
are gaining attention of the patients. Care is also giving different campaigns like heart
checkups, dental checkups at concessional rates. Care is using audio visual aids for
advertising. On the whole one can say that Apollo is paying attention towards the services at
concessional rates and Care is advertising through Media.

People Mix in Hospitals

Being knowledge based industry, people play key role in hospitals. Here the people include
patients and the staff. Apart from the technical expertise the services of supporting staff is
important. In order to provide quality treatment many hospitals running their own medical
and nursing schools to train the
staff according to their requirements. Patients also play a key role in hospital service
delivery. Apart from maintaining quality staff hospitals also conducting Customer
Education Programmes to enable patients and attendants to appreciate the value and
quality of services, to build a patient oriented, service minded workforce. The hospital
must hire the right people, develop service quality, provide the needed support systems.

People Mix in Apollo Hospital

The people mix of Apollo consists of Doctors, nurses, paramedical staff,
supporting staff and front office

3
executives. Apollo is managing personnel, by developing and enhancing a systematic
service culture. Hospital is having a human resource department with eminent people in the
concern field. This department is attending different functions likes man power planning,
training, motivation, evaluating, and rewarding etc, for building competent personnel. In
order to get the right people. Apollo is following traditional recruitment methods
like advertising for posts, calling applications and other recruitment methods such as
conducting campus interviews at reputed institutions.
Table - 8
Employee Strength in Apollo Hospital
  
 
  
   
       

People Mix in Care Hospital

The people in Care hospital classified as high contact people and low
contact people. High contact service people include doctors and nursing staff who
are engaged in providing the services to the patients round the clock. The
administrative people, supportive service people come
under low contact service people. Care hospital is trying to attract and retain doctors with
knowledge and skills. Care is giving importance to the attitude of the employees. In this
regard Care hospital has adopted certain strategies to retain the competent people for the
organization. Care hospital is maintaining a team of Cardiologists and

3
Cardiac Surgeons, neurologists, critical care specialists etc, in the hospital and they are
made available in the hospital
whenever need arises. Total number of employees in Care can be summarized in the following
table.
Table - 9

 
  
       
    

Employee Strength in Care Hospital

Discussion
The people component is an important element in the Marketing – mix. It is
observed that in two sample hospitals the people are recruited on
merit basis. Knowledge and skills are
given the top priority. It is observed that Apollo is giving importance to the reputation
of the doctors in the medical field and the care hospital is giving importance to the
attitude of the people. The employee motivation is satisfactory in two hospitals.

Physical Evidence in Hospitals

The physical evidence of hospitals includes hospital physical facilities as well as
the other forms of tangible communications. The physical evidence essentially
wraps the service and conveys an external image what is inside to consumers.
The physical setting of a service in hospital does the

3
interaction of many stimuli. The physical evidence is the outward appearance of the
hospital and thus can be critical in forming initial impressions or setting up patient and their
attendants expectations. There is exhaustive list of physical factors that influence internal as well
as external customers for hospital. They include lighting, color, signage, textures, quality of
materials, style of furnishing, layout, wall décor, temperature composite dimensions i.e. ambient
conditions, special layout and functionality and signs, symbols etc.

Physical Evidence in Apollo Hospital

The physical evidence mix of Apollo hospital can be described in terms of admission
office, signs, patient care room, medical equipment, recovery room, building exterior, employee
uniforms, reports and stationary, billing
statements, website etc. Apollo designed the above elements of evidence for
each service and it is communicating something about the service. Apollo hospital is
located in 35 acre site, the hospital houses 178 hospital rooms on three floors. This
hospital is taking tremendous care that was taken in its design to serve the needs of
patients, doctors, staff and visitors.

Physical Evidence inCare Hospital

The importance given to the physical evidence in Care hospital can be witnessed
through entrance, lobby area, parking area, waiting area, public toilet facilities, signage
system, gift, book and florist’s shops, coffee shop-
cum-snack bar, interior decoration, lighting and ventilation, uninterrupted power supply,
drinking water facilities, sewerage, telephone and communication facilities,
transportation facilities, security and display of awards and certificates won by doctors
and hospital etc. Care has recognized that the public areas of a hospital serve as an
important reference point in the context of space and traffic in the facility. Therefore
attention is paid while designing the facilities. In Care the main lobby is designed to
serve as a convenient access route to the medical and other staff proceeding to

3
administrative and other areas of the hospital.

Discussion
Physical evidence is the environment in which the service is delivered with physical
or tangible commodities and where the firm and the customer interact. Modern hospitals
need to create good ambience. Write from the reception ambience plays very important role
because when a patient walks into the hospital he forms an opinion about the hospital.
It is considered to be important as the patients and their relatives will already in depressed or
traumatized state. It is observed that in two sample hospitals from reception onwards they
are maintain right ambience that is creating a positive feeling in the minds of patients and
attendants. The interior decoration in Apollo is better compare to the Care. Ventilation, drinking
water and sewerage facilities are good in both select hospitals. For uninterrupted power
supply, sample hospitals are maintaining latest power generators and maintenance is good.
Apollo and Care hospitals are rightly placing the awards and certificates won by the doctors and
hospitals for building confidence in the minds of the patients.
Process element in Hospitals
‘Process’ is termed as ‘Interactive Marketing’ in services marketing. It is
one of the important seven components
of services marketing. Interactive marketing may be defined as the
‘managerial process through which a series of interactions between service provider
and consumer are organized to
facilitate efficient participation in
service production and consumption that satisfies the needs and wants of the consumers
and create positive perceived quality’. Process is an essential
ingredient in the production and delivery of service. Since the inseparable
nature of services does not allow any differences in the production and delivery of a
service, process becomes an all-inclusive ‘P’ for service
marketers. Hospitals must pay as much attention to proper planning, designing,
organizing and functioning of the various departments (specialties). The patient is
examined and given treatment in the out-patient department up to the time he/she is
hospitalized. He/she is then admitted and cared for as an inpatient until he/she is
discharged and the patient gets treated again in the out- patient department. Besides these
the other services like investigative procedures and counseling services are to be
done in the out-patient department.

4
Process in Apollo Hospital

The Apollo hospital has paid special attention in simplifying the procedure for
admission in to the hospital for treatment. It has taken all measures to extend medical
treatment in single premises, which creates easy accessibility to all patients to avail the services
of various specialized doctors. Keeping in view different types of patients that approach
Apollo hospital, the hospital management has instituted several registration centers at different
places in the state. The patients, who want to take appointment may consult these centers and
can get appointments for the consultation. Apollo encourages prior appointments to avoid
unnecessary waiting time to the patients in the hospital. For the patients who come to the
hospital directly without prior appointments, the Apollo management has opened
four registration centers to avoid congestion and for arranging time bound appointments
with the doctors.

Process element in Care Hospital

The process followed in extending medical services to the patients and visitors at Care
hospital is simple, patient friendly and time saving. The out patients who want to take
treatment in
care hospital have to take prior permission or appointment from registration
department in consultation with the doctor concerned. To avoid congestion and to save
the time of patients/visitors, the care hospital has made arrangements to get appointment
through e-mail, phone or in person. The outpatients, who go to the care hospital directly,
have to contact department of registrations and get the serial number for the stipulated
time to consult the doctor. They may wait in the waiting halls till their chance comes.
For this care hospital is providing spacious waiting halls with all the facilities like
comfortable seating, televisions, magazines, news papers and clean water supply,
telephone and toilet facilities to make the patients feel comfortable and homely.
Discussion
Process is an essential ingredient in the production and delivery of service. It is
essentially the procedures and patterns in the delivery of a service. Since the inseparable
nature of services does not allow any differences in the production and delivery of a
service, process becomes an all-inclusive ‘P’ for
service marketers. Two sample hospitals are not creating any complications when the
patient is discharging on emergency situations. Further it is observed that the

4
patients are waiting more time at service counters in Care hospital. In the case of patient waiting
time at doctors, Apollo is better than the Care hospital. The process for discharging the
patient is feeling comfortable at Apollo than Care hospital. In emergency conditions patients
are feeling difficult for their procedure in Care hospital. But in Care majority of respondents are
not satisfied with the number of service counters. In Apollo patients and their relatives feeling
comfortable for the procedure to discharge the patients in emergency situations. But in normal
conditions the process to discharge the patients is good in the two hospitals. It is observed that
two hospitals having simple bill payment procedures. On overall two hospitals are
having good process element.

So far the researchers tried to give blue print about the working of 7Ps in practice. Now in
the next part, it is proposed to relate above observations with the data given by hospital
staff through their perceptions on marketing process.

Following tables indicating the Grand Mean and S.D of perceptions of Doctors, Nurses
and Administrative Personnel on marketing mix of sample hospitals.
 Table - 10
Perceptions of Doctors on the Marketing Process of Sample Hospitals
(Grand Mean and S.D.)
(N=75)

 
 
   
     
     
     
     
     
      
     
     
Table - 11
Perceptions of Nurses on the Marketing Mix of Sample Hospitals
(Grand Mean and S.D.)
(N=150)
 
 
   
     
     
     
     
     
      
     

Table - 12      

Perceptions of Administrative Perso

nnel on the Marketing Mix of Sample Hospitals
(Grand Mean and S.D.)
(N=35)

 
 
   
     
     
     
     
     
      
     
     

4
 Table 10 shows the perceptions of doctors on marketing process, are positively
opinioned in two sample hospitals. The mean scores are in the range of 2.25 to 3.10
and 2.12 to 3.32 in Apollo and Care hospitals respectively; on a 5 point scale
indicating marketing mix of the sample hospitals is agreeable to the respondents.

Table 11 indicating the perceptions of nurses on marketing process, are positively

opinioned in two sample hospitals. The mean scores are in the range of 2.13 to 3.08
and 1.94 to 3.02 in Apollo and Care hospitals respectively; on a 5 point
scale
indicating marketing mix of the sample hospitals is agreeable to the respondents.
Table 12 indicating the perceptions of administrative personnel on marketing
process, are positively opinioned in two sample hospitals. The mean scores are in the range of
1.92 to
2.55 and 2.01 to 2.33 in Apollo and Care hospitals respectively, on a 5 point scale indicating
marketing mix of the sample hospitals is agreeable to the respondents.

Following tables present the statistical analysis of data collected from doctors,
nurses, administrative personnel of Apollo and Care hospitals.
Table - 13
Mean Values of Doctor's Opinion on 7P's in Apollo Hospital
In order to find whether the perceptions of the doctors are indistinguishable
the null hypothesis is framed as -
      
 
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       

4
 The perceptions of the doctors are indistinguishable with respect to the 7P's
of Apollo Hospital.
Table - 14
A NOVA of Doctor's Opinion on 7P's in Apollo Hospital
values
       
      
    
  
Table representing ANOVA of doctor’s opinion on 7P’s in Apollo hospital
showing the level of significance or risk probability is less than .05 so the
hypothesis is rejected. Therefore it can be said that, the perception of doctors are
distinguishable
i.e. the perception of the doctors are differ from one another.
Table - 15
Mean Values of Nurse's Opinion on 7P's in Apollo Hospital
       


     
 
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
 In order to find whether the perceptions of the nurses are indistinguishable
the null hypothesis is framed as-
“The perceptions of the nurse are indistinguishable with respect to the
7P’s of Apollo hospital”
Table 16
ANOVA of Nurse’s Opinion on 7P’s in Apollo Hospital
       
      
    
  

Table representing ANOVA of nurses’ opinion on 7P’s in Apollo hospital

showing the level of significance or risk probability is less than the .05 so the
hypothesis is rejected. Therefore it can be said that, the perceptions of nurses are
distinguishable i.e. the perceptions of the nurses are differ from one another.
Table 17
Mean Values of Administrative personnel’s Opinion
on 7P’s in Apollo Hospital
      
 
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       

4
 In order to find whether the perceptions of the administrative personnel are
indistinguishable, the null hypothesis is framed as-
“The perceptions of the administrative personnel are indistinguishable
with respect to the 7P’s of Apollo hospital”
Table 18
ANOVA of administrative personnel Opinion on
7P’s in Apollo Hospital
       
      
    
  

Table representing the ANOVA of administrative personnel’s opinion on

7P’s in Apollo hospital showing the level of significance or risk probability is
greater than the .05 so the hypothesis is accepted. Therefore it can be said
that, the perceptions of administrative personnel are indistinguishable i.e. the
perceptions of the administrative personnel are not differing much one another in
the 7P’s.
Table 19
Mean Values of Doctor's Opinion on 7P’s in Care Hospital
      
 
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
 In order to find whether the perceptions of the doctor’s are indistinguishable,
the null hypothesis is framed as-
“The perceptions of the doctors are indistinguishable with respect to the
P’s of Care hospital”
Table 20
A NOVA of Doctor's Opinion on 7P's in Care Hospital
       
      
    
  

 
              

           

 

      

 
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       

5
 In order to find whether the perceptions of the nurse’s are indistinguishable,
the null hypothesis is framed as-
“The perceptions of the nurses are indistinguishable with respect to the 7P’s
of Care hospital”
 
 
       
      
    
  

 
               

         

 

      


      
 
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       

      

   

 

       
      
    
  

 
             
              
 
      

 
  
 

    

    

     
    
      
    
      
    
      
    
      
    
      
     
      
    
      

     

          

            
      
     

5
 In the above table the 7P’s differ significantly among themselves with respect to
the average scores of the
responses provided by the staff.
● The ANOVA gave significant difference between the means of the 7P’s
(Product, Price, Place, Promotion, People, Physical
Evidence and Process).
● The figures in the brackets parenthesis indicate the rank of the corresponding
mean in the
ascending order.
● The column with no-star represents, the average respondents of administrative
personnel in Apollo hospital are not differing much in the 7P’s i.e. the respondents
have rated them as equally strong with out
much distinction of one from the
remaining. As none of them is more than 3, there is no evidence of any disagreement.
At the same time no neutrality also.

● The average P (People) with rank 1 is strongly agreeable from the respondents
point of view namely doctors of the Apollo hospital
followed by rank 2,3,4,5,6 and 7 respectively.
● The average P (product) with rank 1
is strongly agreeable from the
 respondents point of view namely nurses of the Apollo hospital followed by rank
2,3,4,5,6 and 7 respectively.

● The average P (physical evidence) with rank 1 is strongly agreeable from the respondents
point of view namely doctors of the Care hospital
followed by rank 2,3,4,5,6 and 7 respectively.
● The average P (product) with rank 1 is strongly agreeable from the respondents point
of view namely
nurses of the Care hospital followed
by rank 2,3,4,5,6 and 7 respectively.
● The average P (physical evidence) with rank 1 is strongly agreeable from the respondents’
point of view namely administrative personnel
followed by rank 2, 3,4,5,6 and 7
respectively.

Discussion
Product, Price, Place, Promotion (First 4 Ps)

The perceptions of doctors on the

process (first 4 P’s) The P’s entire are positively opinioned by the respondents in two sample
hospitals. The mean
scores are in the range of 2.34 to 3.10
and 2.42 to 3.01 in Apollo and Care hospitals respectively, on a 5 point scale

5
indicating marketing mix (first 4 P’s) of the sample hospitals is agreeable to the
respondents.

The perceptions of nurses on marketing mix (first 4 P’s) The P’s entire are
positively opinioned by the respondents in two sample hospitals.
The mean scores are in the range of 2.13
to 3.08 and 1.94 to 3.02 in Apollo and Care hospitals respectively, on a 5 point scale
indicating marketing mix (first 4 P’s) of the sample hospitals is agreeable
to the respondents.

The perceptions of administrative

personnel on marketing mix (first 4 P’s) The P’s entire are positively opinioned
by the respondents in two sample
hospitals. The mean scores are in the range of 1.92 to 2.55 and 1.88 to 2.01 in Apollo
and Care hospitals respectively, on a 5 point scale indicating marketing mix
(first 4 P’s)
of the sample hospitals is agreeable to the respondents.

People, Physical Evidence, Process (Last 3 Ps)

The perceptions of doctors on marketing mix (last 3 P’s) The P’s entire are
positively opinioned by the respondents in two sample hospitals. The mean scores
are in the range of 2.24
to 2.50 and 2.12 to 2.61 in Apollo and Care hospitals respectively, on a 5 point scale indicating
marketing mix (last 3P’s) of the sample hospitals is
agreeable to the respondents.

The perceptions of nurses on marketing mix (last 3 P’s) The P’s entire are positively
opinioned by the respondents in two sample hospitals. The mean scores are in the range of
2.17 to 2.66 and 2.02 to 2.67 in Apollo and
Care hospitals respectively, on a 5 point scale indicating marketing mix (last
3P’s) of the sample hospitals is
agreeable to the respondents.

The perceptions of administrative personnel on marketing mix (last 3P’s) The P’s entire
are positively opinioned
by the respondents in two sample hospitals. The mean scores are in the range of 2.03 to
2.34 and 1.81 to 2.42 in Apollo and Care hospitals respectively, on a 5 point scale
indicating marketing mix (last 3P’s) of
the sample hospitals is agreeable to the respondents.

The statistical analysis (ANOVA) and the conclusions revealed that the 7P’s from the
hospitals people side, the
responses have given a relative rating
of the 7P’s in five out of six cases leading to a particular ‘P’ being strongly

5
agreeable, a particular ‘P’ is just agreeable. Therefore respondents with a long
term attachment with an
organization can better distinguish the
organization aspects than those who just stay for short while and leave.
Inference
The statistical analysis and the conclusions revealed that the 7P’s from the
hospitals people side, the responses have given a relative rating of the 7P’s in five out of
six cases leading to a particular ‘P’ being strongly agreeable,
a particular ‘P’ is just agreeable. Therefore respondents with a long term attachment
with an organization can better distinguish the organization
aspects than those who just stay for short while and leave.
Suggestions for Better Marketing of Hospital Services
The following are some of the suggestions made to the marketing managers
and policy makers of hospitals. If they are implemented, the present problems in the
hospitals may be overcome to a great extent. Hospitals have to understand what they
want to communicate or what it is or what it is want their target audience to know or
remember, or what the hospital stands. This is the most important part of the
marketing plan. It provides the
necessary directions to marketing efforts and has far reaching consequences.
Hospitals should not be out of touch With Society
Hospital managements convert hospitals into consumer-oriented marketing
enterprises. Hospitals will have to adopt the marketing concept with a philosophy that all
planning is to be done with the patient needs considered first and foremost.

Marketing through Public Relations

There are alternate marketing programmes that maintain image and not require
advertising while still reaching large number of people. These programmes are a blend of
public relations and guest relations activities implemented by well trained, motivated and
dedicated staff that provides friendly, courteous service to patients. In almost every area
of the hospital where staff comes into direct contact with the patients, the human relations
and patient relations are of utmost importance. This is where public relations and
marketing work at their best. Depending on how the staff practices public relations will
make or mar the hospital. All other outside marketing activities are secondary, even

5
superfluous and irrelevant. Hospitals have failed to pay attention to this fact which is a
key to their success.

Service Costs are to be Regulated

Medicine is not mere business. It is an honorable profession with its code of ethics
and a statutory body called medical council of India to uphold the dignity of the medical
profession. But unfortunately these bodies are inactive and ineffective in curbing
irrational practices and malpractices. Somehow, the prevailing high treatment costs are to
be brought under control. For this reason, common man is not in a position to go to
these corporate hospitals. Some of the strategies to curb the high treatment costs
include.

Establishing Norms for Treatment

Unnecessary surgeries and unnecessary laboratory tests to be eliminated.
This is possible by establishing norms for treatment. Guidelines are to be
created to curb these nefarious practices. These hospitals should be made
answerable to a medical audit committee.

Establishment of Media Relations Policy

Every hospital, regardless of its size, location and whether or not it has
a public relations department, must develop and enforce an official policy for dealing with
the press and the kinds of information that may be released. The policy should specifically
state who speaks for the hospital, whether the chief executive officer or the public relations
director, or any other, and in their absence as during the night when quite often accident
victims are admitted, who may be called to make a statement to the press. All those who are
required to make statements to the media should be familiar with the official policy and the
procedure laid down therein.

Customer Relationship Marketing

The most important aspects of a true CRM initiative lie in how the organization as a
whole defines its customers, identifies and segments their needs, and organizes around serving
them in the most efficient and effective manner possible. Hospital services marketers should
first identify what goals are most important to the organization, and these should guide the
internal planning and implementation efforts. Some of the more common goals and
objectives for developing and implementing technology-driven customer relationship
programs include

6
● Improving customer service and
satisfaction;
● Increasing profitability;
● Reducing the number of negative
customer experience;
● Allocating resources more efficiently’
● Reducing the cost of managing
customer interactions;
● Attracting and retaining customers
and prospects;
● Staying in front of customers and building stronger relationships over time; and
● Improving clinical outcomes.

Conclusion
Of late, the hospital management has gained prominence the world over. The
management of a hospital is found significant to deliver services to the society. For a
successful marketing of services, it is essential that the concerned
organization is professionally sound. This helps the hospital in many ways, such
as an increase in the organizational potentials to show excellence, a strong base for
serving the poorer sections and a favorable nexus for making it an on- going
process.The first and foremost task before a marketer is to satisfy the users by making
available to them the
quality services. We cannot deny the fact that in the Medicare services in addition to the
medical aid, a number of other factors also play a significant role. If the doctors and nurses
are found soft, sympathetic, and decent to the patients, the time-lag for curing a patient is
minimized fantastically. Of course the medical aid play a pivotal role but the supportive
services also play an incremental role without which the duration of treatment is
increased considerably. In the Indian perspective, the core medical personnel lack this
dimension. By marketing Medicare services, we engineer a strong foundation for both
i.e. the best possible medical aid and a personal touch-in- service. By marketing medical
services we mean making available the Medicare services to the users in such a way that they
get quality services at the reasonable fee structure. The marketing principles focus on
making available the services even to those segments of the society who are not in a position to
pay for the services.

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6
 Annexure
Questionnaire for Doctors/Nurses/Administrative Personnel
(1) Strongly agree (2) Agree (3) can’t say (4) Disagree (5) strongly disagree
Product
               
                  

             
               

              
            
              

           
                

             
               
              
              
                
           

             
                
            
                
                   

                
             

                  
                 
                

               
       
                   
        
               

             
      
       
               
                 
   
 A Study on Marketing of Hospital Services

                
                
  
     
  
                
     
 
                  
 
              

                 

       

      
       
      
      
                  
           


                  

            
                
               
             
                 

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