Marketing Mix Hospital

Chapter - 4
Marketing Mix in Hospitals II

(3Ps)
The main aim of this chapter is to explore the last three Ps i.e. People mix, Physical evidence
mix, and the Process mix in hospitals along with the results of opinions elicited from doctors,
nurses and the administrative personnel.
People Mix In Hospitals

Being knowledge based industry, people play key role in marketing mix of hospital services.
Without people, hospital cannot exist or serve. Here people include patients, and the staff who
treat and take care of those patients. Doctors and technicians, who take care of the diagnosis and
treatment of patients,. So, it is important for corporate hospitals to attract and retain doctors who
have excellent knowledge, skills, and also the right attitude.
Apart from the technical qualifications, the supporting staff like nurses and housekeeping
personnel should be well-mannered, gentle, hygienic and meticulous. Because patients should be
provided utmost care as their recovery depends not just on the medical treatment but also on the
human touch provided by the support staff. In order to provided quality treatment and support
services many hospitals run their own medical and nursing schools to train staff according to
their requirements.
Patients also play a key role in hospital service delivery. For this, apart from maintaining
quality staff, many hospitals also conduct customer education programs to enable patients and
the attendants to appreciate the value and quality of services. Because it is not possible to have
an efficient delivery, if the patient is not confident and supportive.
The importance of staff in the marketing of hospital services is captured in the people element
of the services marketing mix. The people can be described as all of the human actors who play
a part in service delivery and thus influence the buyers perceptions namely the firms
personnel, the customer and other, and other customers in the service environment.10 People in
the hospital; doctors, nurses, supporting staff and others, are critical to the success of hospital
because
They are the service of the hospital
They are the hospital in the patients eye.
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They are the brand image of the hospital.
They are the promoters of the hospital services.
In many cases, the contact employee of the hospital is the service. The employee may be a
doctor, nurses, housekeeping staff or any other. Because the employee represents the
organization and can directly influence consumer satisfaction, they perform the role of
marketers. On the other hand service marketing is about promises, promises made and promises
kept to customers. A strategy framework known as the services triangle visually reinforces the
importance of people in the ability of firms to keep their promises and succeed in building
customers relationships.11 Fig no: 4.1 illustrates this.
Fig. No: 4.1

Service Triangle in Hospital
Hospital
Internal marketing External marketing

(Enabling promises) (Making promises)
Providers Interactive marketing customers

(Doctors, nurses etc,) (Keeping promises) (Patients)
The triangle shows the three interlinked groups that work together to develop, promote, and
deliver services. These key players are labeled on the points of the triangle: the company or
hospital or management; the customers; and the providers. Here the provides can be firms
employees i.e. doctors, nurses who actually deliver the companys services. Apart from this
between these three points on the triangle, three types of marketing must be successfully carried
out for a service to succeed: external marketing, interactive marketing and internal marketing.
External Marketing: The efforts that the firm engages in to set up its customers expectations
and make promises to customers regarding what is to be delivered. Anything or anyone that
communicates to the customers before service delivery can be viewed as part of this external
marketing function.
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Interactive Marketing: This is also called real-time marketing. Here is where promises are kept
or broken by the firms employees, subcontractors or agents. People are critical at this juncture.
If promises are not kept customers become dissatisfied and eventually reach.
Internal Marketing: These are the activities that management engages in to aid the providers in
their ability to deliver on the service promises: recruitment, training, motivating, rewarding, and
providing equipment and technology. Unless service employees are able and willing to deliver
on the promises made, the firm will not be successful, and the services triangle will collapse.
There is concrete evidence that satisfied employees make for satisfied customers and satisfied
customers can, in turn, reinforce employees sense of satisfaction in their jobs. Some have even
gone so far as to suggest that unless service employees are happy in their jobs, customer
satisfaction will be difficult to achieve.12 The under laying logic connecting employee
satisfaction and loyalty to customer satisfaction and loyalty and ultimate profits can be explained
with the following fig no: 4.2
Fig. No: 4.2
The service profit chain
Revenue
Employee Growth
Retention
External
Internal Service Customer Customer
Service Employee value Satisfaction Loyalty
Quality Satisfaction
Employee Profitability
Productivity
Source: An exhibition from J.L.Heskett, T.O.Jones, G.W.Loveman, W.E.Sasser, Jr., and L.A. Schlesinger, Putting the Service-Profit Chain to
Work Harvard business review; march-April 1994, p.166.
Service profit chain researchers are careful to point out that the model does not suggest
causality. That is, employee satisfaction does not cause patient satisfaction: rather than two are
interrelated and feed off each other.
Patients perceptions of service quality will be impacted by the customer-oriented behaviors
of employees.13 In fact, all of the five dimensions of service quality: reliability, responsiveness,
assurance, empathy and tangibles can be influenced directly by service employees. Delivering
the service as promised i.e. reliability is often totally within the control of front-line employees.
Front-line employees directly influence customer perceptions of responsiveness through their
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personal willingness to help and their promptness in serving customers. The assurance
dimension of service quality is highly dependent on employees ability to communicate their
credibility and to inspire trust and confidence. Credibility, trust, and confidence will be tied
totally to employee actions. Empathy implies that employees will pay attention, listen, adopt,
and be flexible in delivering what individual customers need.14 Employee appearance and dress
are important aspects of the tangibles dimension of quality, along with many other facts that are
independent of service employees: the service facility, dcor, broachers, signage, and so on.
The front-line service people are referred to as boundary spanners because they operate at
the organizations boundary. Boundary spanners provide a link between the external customer,
environment and the internal operations of the organization. What the level of skill or pay,
boundary-spanning positions are often high-stress jobs. In addition to mental and physical skills,
these positions extraordinary levels of emotional labor, frequently demand an ability to handle
interpersonal and inter- organizational conflict, and call on the employee to make real-time trade-
offs between quality and productivity on the job. These stresses and trade-offs can result in
failure to deliver services. Arlie Hochschild referred these people as emotional Labor that goes
beyond the physical or mental skills needed to deliver quality service.15 It means delivering
smiles, making eye contact, showing service interest, and engaging in friendly conversation with
people who are essentially, strangers and who may or may not ever be seen again emotional
labor draws on peoples feelings to be effective in their jobs.
Front-line people often face interpersonal and inter organizational conflicts on the job.
Because they represent the customer to the organization and often need to manage a number of
customers simultaneously. Their frustration and confusion can, if left unattended, lead to, job
dissatisfaction, a diminished ability to serve customers, and burnout.16
Boundary spanners feel conflicts between when they are asked to do and their own
personalities, orientations, or values. Some times there is a conflict between role requirements
and the self-image or self-esteem of the employee. Conflicts also arise when employees are
required to wear specific clothing or change some aspect of their appearance to confirm to the
job requirements.
A more common type of conflict for front-line service employees is the conflict between their
two bosses, the organization and the individual customers. Service employees are typically
rewarded for following certain standards, rules, and procedures. Ideally these rules and standards
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are customer based. When a customer makes excessive demands, the employee has to choose
whether to follow the rules or satisfy the demands. Then conflicts arise.
Some times conflict occurs for boundary spanners when there are incompatible expectations
and requirements from two or more customers. In the case of serving customers in turn, the
provider may satisfy one customer by spending additional time, customizing the service, and
being very flexible in meeting the customers needs. Meanwhile, waiting customers are
becoming dissatisfying because their needs are not being met in a timely way. In the case of
serving many customers at the same time, it is often difficult or impossible to serve the full range
of needs of a group of heterogeneous customers simultaneously.
Front-line service people are asked to be both effective and efficient: they are expected to
deliver satisfying service to customers and at the same time to be cost effective and productive in
what they do. A physician in a hospital is expected to deliver caring, quality, individualized
service to his patients but at the same time to serve a certain number of patients within a
specified time frame. This essential trade-offs between quality and quality, and between
maximum effectiveness and efficiency, place real-time demands and pressures on service
employees. Peter Drucker suggests that productive performance in all service job will combine
both quality and quality objectives17 Jagdip Singh, a noted service researcher, has studied
productivity and quality as two types of performance inherent in front line service jobs18
Research suggests that these trade-offs are more difficult for service business than for
manufacturing and packaged goods business and that pursuing goals of customer satisfaction and
productivity simultaneously is particularly challenging in situation in which service employees
are required to customize service offering to meet customer needs19
Strategies for Customer (Patient) Oriented Service Delivery in Hospitals
To build a patient-oriented service-minded workforce, the hospital must
Hire the right people
Develop to deliver service quality
Provide the needed support systems and,
Retain the best people
Within each of these basic strategies are a number of specific sub strategies for accomplishing
the goal.
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Hire the Right People
The first step starts with the right service delivery people from the beginning. This implies
that considerable attention should be focused on hiring and recruiting service personnel. There
are number of ways to improve service employee recruitment efforts to get the right people from
the beginning.
Compete for the Best People: To get the best people, hospital needs to identify them
and compete with other hospitals to hire them. This is referred as competing for talent
market share20 Here firms act as marketers in their pursuit of the best employees, just as
they use their marketing expertise to compete for customers. Thinking of recruiting as a
marketing activity results in addressing issues of market (employee) segmentation,
product (job) design, and promotion of job availability in ways that attract potential long-
term employees.
Hire Service Competencies and Service Inclination: It has been identified that service
employees need two complementary capacities: they need both service competencies and
service inclination21 Service competencies are the skills and knowledge necessary to do
the job. In many cases, competencies are validated by achieving particular degrees and
certifications such as MBBS, MS degrees and passing the relevant examinations required
of doctors and B.Sc nursing degree, training certification courses are required for nursing
staff etc, in the hospitals. In other cases, service competencies may not be degree related,
but may instead relate to basic intelligence or physical requirements. In hospitals for an
executive of cash counter, must possess basic math skills and the potential to operate a
cash register and computer system. Given the multidimensional nature of service quality,
service employees should be screened for more than their service competencies. They
must also be screened for service inclination i.e. their interest in doing service related
work, which is reflected in their attitudes toward service and orientation toward serving
customers and other on the job. Research has shown that service effectiveness is
correlated with having service-oriented personality characteristics such as helpfulness,
thoughtfulness and sociability22 An ideal selection process for service employees assesses
both service competencies and service inclination, resulting in employee hires who are
high on both dimensions23
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Be the Preferred Employer: The ability to attract the right people depends upon, among
other things, the image of the organization.24 therefore, to attract right people, hospitals
should develop a positive internal environment that ensures employee prosperity i.e.
providing extensive training, career and advancement opportunities, excellent internal
support, and attractive incentives and offering quality goods and services etc.
Develop People to Deliver Service Quality
Once hospital has hired the right employees it must train and work with these individuals to
ensure service performance. For this
Training: To provide quality service, employees need ongoing training in the
necessary technical skills and knowledge and in process or interactive skills.25 Gronors
has identified the following there kinds of training tasks.26
Developing a holistic view of how a service strategy works and what is the role
of each individual in relation to other individuals, functions within the firm and
relations with customers.
Developing and enhancing a favorable attitude towards a service strategy and
part-time marketing performance.
Developing and enhancing communication skills and service skills among
employees.
Therefore the training programme should aim at basically three important skills for
employees. They are
Technical Skills: Technical skills are taught through on-the-job training, as
when telephone service trainees listen in on the conversation of experienced
employees. Most of the hospitals are quit conscious of and relatively effective
at training employees in technical skills. These skills may think through formal
education. For example hospitals run their own nursing institutions.
Interactive Skills: Service employees also need training in interactive skills
that allow them to provide courteous, caring, responsive, and empathetic
service. It also includes communication, listening, problem-solving and
interpersonal skills etc.
Social Skills: These skills relating to building personal relationships and
recognizing and treating regular customers differently.
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Training in hospitals should not be limited only to new employees. It should be ongoing
process. The ever changing market environment necessitates change in hospitals and the need for
improved service skills, continuous training is important for employees to offer better quality
service.
Empowerment: According to Zeithaml and Bitner empowerment means giving
employees the desired skills, tools and authority to serve the customer employees need
the knowledge and tools to be able to make decisions on the customers behalf. And
also they need incentives that encourage them to make the right decisions. Research
suggests that there may indeed be positive benefits to empowering frontline service
workers. Some of these benefits include in reduction in job-related stress, improved job
satisfaction, greater adoptability, and better out comes for customers.27 Bowen and
lawler suggest that organization well suited to empowerment strategies is ones in which
The business strategy is one of differentiation and customization,
Customers are long-term relationship customers,
Technology is non -routine or complex,
The business environment is unpredictable, and
Managers and employees have high growth and social needs and strong
interpersonal skills.
Therefore, an empowered hospital is characterized by flexibility, quick decisions, and
authority given to front-line people.
Employees Work as Team: Patient satisfaction will be enhanced when employees work as
teams in the hospital. Patients often perceive better experiences when employees work together
as teams. Because service jobs are frequently frustraining demanding, and challenging, a team
work environment will help to alleviate some of the stresses and strains. An interactive
community of coworkers who help each other, commiserate, and achieve together is a powerful
antidote to service burnout28 By promoting teamwork hospitals can enhance the employees
abilities to deliver excellent service while the camaraderie and support enhance their inclination
to excellent service providers. Some of the tips for promoting team spirit in the hospitals are:
Encourage the attitude that every one has a customer

Rewarding based on individual achievements and performance.
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Restructuring the hospital to develop market-based groupings. Creating team and
supporting effective team work, especially cross functions.
People Require Internal Support System
Without customer-focused internal support and customer oriented systems, it is nearly
impossible for employees to deliver quality service. Therefore service employees need support
systems to be efficient and effective in their jobs. The quality of service provided will be greatly
dependent on the adequacy of support systems. A doctor in a hospital requires a system that
provides information relating to the patient, testing facilities, equipment to handle and support
services, to perform effectively. Following are the strategies for ensuring customer-oriented
internal support.
Measuring and Reward Internal Service: Internal customer service audits and internal service
guarantees are two strategies used to implement a culture of internal service quality. Steps in
conducting an internal customer service audit are
Defining patient.
Identify hospital contribution.
Define service quality.
Validate hospital criteria.
Measure service quality.
Develop a mission statement based on what the hospital contribute.
One risk of measuring and focusing on internal service quality and internal customers in that
people can sometimes get so wrapped up in meeting needs of internal customers that they forget
they are in business to serve ultimate, external customers29
Technical Support: The quality of the work by the employees enhanced with the support of
technology and equipment. When employees do not have the right equipment, they can be easily
frustrated in their desire to deliver quality service. Tools, machines, other tangibles and systems
provided to the employees not only increase and accuracy but also provide comfort and
convenience in service performance30
Internal Procedure Support: Internal procedures must support quality service performance. In
other words to support service personnel in their delivery of quality service on the front line,
hospitals internal process should be designed with patient value and satisfaction in mind. For
developing service-oriented internal processes, hospitals should avoid bureaucratic rules and
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procedures. For this hospitals need redesign of systems. This kind of wholesale redesign of
systems and processes has become known as process reengineering it involves rethinking and
redesigning of process.
Retain the Best Ones: Hospitals that hires the right people, trains and develops them to deliver
best service quality, and provides the needed support must also work to retain the best ones. Here
there are some strategies that are particularly aimed at this goal.
Motivation: Employees will be motivated to some extent by their pay checks and other benefits,
but the best employees will be attracted away to other opportunities if they are not committed to
the vision of hospital. This will happens, if the management of the hospital failed to
communicate the vision of the hospital to the employees. What this means in practice is that the
vision is communicated to employees frequently, and that it is communicated by top managers,
often by the CEO31
Treat Employees as Customers: When employees are considered important by the
management who understand their needs and wants and offer value satisfaction, employees are
more likely to stay with the hospital. Because many companies have adopted the idea that
employees are also customers of the organization, and that basic marketing strategies can be
directed at them.32 A hospital become the best place of to work by doing the following.
Treating employees as customers
Using employee input and a fact-based approach for decision making in the design and
implementation of human resources policies, programs, and processes
Measuring employee satisfaction and trying to continuously improve the work place
environment
Benchmarking and incorporating best practices of human resource management.
In order to design programs to satisfy the needs of employees, internal research and employee
segmentation are useful approaches. Advertising and other forms of communication directed at
employees can also increase their sense of value and enhance commitment to the organization.33
Evaluating and Rewarding Performance of the Employees
Evaluation of performance of the employees is vital in internal marketing. It is necessary to
develop systems that measure the performance of the employees i.e.
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Feed Back to Management: Hospital managers should collect employee performance
regularly for several purposes. It is helpful to identity areas for improvement, defects,
and deviations from the quality specifications and initiates appropriate corrective action.
Feedback to Employees: Hospital employees need to be provided support systems that
can help evaluate performance by themselves and also report such performance to the
top management. This leads to corrective action when something is not in the border. A
survey by internal employees, customer feedback surveys and so on are useful in
designing and evaluating the system.
Measuring Performance: Hospitals need to develop an acceptable methodology for
measuring the performance of employees. The performance measures help the
management to recognize the merit, to identify training needs and to develop plans for
motivating employees, if necessary.
Reward systems need to be linked to the organizations vision and to outcomes that are truly
important. If the hospital wants the strongest service performers to stay with the organization, it
must promote and reward the employees. The rewarding system primarily should contain the
following three dimensions to be effective in hospitals.
Competitive Compensation: Hospitals need to review their compensation package
periodically to motivate the employees and promote moral in them. Salaries, benefits in
whatever form compensation is offered to employees, it should be competitive.
Otherwise the other hospitals try to attract the employees.
Extended Benefits: Hospital managements should always innovative in providing
extended benefits to the employees, like employee welfare measures within the
organization, employee family welfare measures, employee children education, functions
and social interaction etc. such benefits promote the sense of belongingness among
employees and help build a strong morale.
Payment for Excellence: Hospital makes the employees to involve in developing the
measurement system and the related reward policy. Because the measure adopted to
identify the performers is often subjected to serve criticism by employees, it may
harmful to the hospital.
For developing new systems and structures to recognize patient focus and patient satisfaction,
hospitals must develop a variety type of rewards. Traditional approaches such as higher pay,
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promotions, and one-time monetary awards or prizes are linked with service performance. They
may implement other types of rewards like peer award (employees recognizing each other by
personally), special organizational and team celebrations for achieving improved patient
satisfaction etc.
Apart from above discussion, experts have suggested that a customer-oriented, service-
oriented organization will have at its heart a service culture, it is defined as a culture where an
appreciation for good service exists, and where giving good service to internal as well as
ultimate, external customers is considered a natural way of life and one of the most important
norms by everyone34 Therefore hospitals must remember two points here. First, the service
culture exists if there is an appreciation for good service. Second good service is given to
internal as well as external customers. For this hospitals have to remember two points.
First, Developing Service Culture: Hospitals can not develop service culture quickly,
and there is no magic. But the human resources and internal marketing strategies
support the development of service culture overtime. hundreds of little (but significant)
things, not just one or two big things, are required to build and sustain a service
culture35 If we observe some successful service oriented organization, they opinioned
that it takes years of consistent, concerted effort to build a service culture and to shift
the organization from its old patterns to new ways of service delivery.
Second, Transporting A Service Culture: Transporting a service culture from other
hospitals is also a very difficult task. Suppose it is from out side the country there are
some barriers like language, cultural etc.
Patients Role in Hospital Services Delivery

In hospital services delivery patients participation at some level is inevitable. Because
services are actions or performances, typically produced and consumed simultaneously. In many
situations employees, customers, and even others in the service environment interact to produce
the ultimate service outcome. Therefore, the concept of people in services marketing mix apart
from employees i.e. doctors, nurses, supporting staff, administrative personnel. Customers i.e.
patients and other hospital service utilisers play important role in marketing of hospital services.
Because they participate customers are indispensable to the production process of service
organizations, and they can actually control or contribute to their own satisfaction.36
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In hospitals customers play three major roles in service delivery i.e.
Customers as productive resources
Customers as contributors to quality and satisfaction and
Customers as competitors.
Patients as Productive Resources in Hospitals
Hospital customers have been referred to as partial employees of the organization-human
resources who contribute to the organizations productive capacity.37 Customer inputs can effect
the hospitals productivity through both the quality of what they contribute and the resulting
quality and quantity of output generated. In other words customer participation in service
production raises a number of issues for hospital. Because customers can influence the quality
and quantity of production, some expert believe the delivery system should be isolated as much
as possible from customer inputs in order to reduce the uncertainty they can bring into the
production process. So, hospitals always see customers as a major source of uncertainty i.e. the
timing of their demands, and the uncontrollability of their attitudes and actions etc. experts
believe that services can be delivered most efficiently if customers are truly viewed as particular
employees and their participative roles are designed to maximize their contributions to the
service creation process. This tells us, organizational productivity can be increased if customers
learn to perform service related activities they currently are not doing or are educated to perform
more effectively the tasks they are already doing.38
Patients are Contributors to their Own Satisfaction and the Ultimate Quality of the Service
they Receive In Hospitals
Services in hospitals which the service outcome is highly dependent on customer
participation. The desired service outcomes are not possible unless the customers perform their
roles effectively. In hospitals, where patient compliance in terms of taking prescribed medication
or changing diet or other habits can be critical to whether patients regain their health (the
delivered service out come).39 Researches on organization suggests that, customers who believe
they have done their part to be effective in service interactions are more satisfied with the
service.
Patients as Potential Competitors of Hospital
Customers are competitors of the hospital service, what it supplies. Because, customers not
need the provider or entire service for them selves. These customers can be viewed as resources
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of firm, or as partial employees. Therefore hospitals have to remember, that in many types of
services delivered by it, the customer can choose fully or partially for themselves. Thus, in
addition to recognize that customers can be productive resources and concreters of quality and
value hospitals also need to recognize the customers role as a potential competitor.
Enhancing Patient or Customer Satisfaction in Hospitals
Enhancing customer or patient participation is the key for effectiveness of service delivery in
the hospitals. Usually, customers in the participation of service production and consumption will
influenced by different factors like, customers goals, time variables, importance of the service
value of the service, other employees, co-customers, physical environment, impression formed
on contact employee, situation pressure, mood, etc. hospitals need to identify the factors
influencing the customer participation and develop appropriate strategies for encouraging
effective participation of customers. Fig. no: 4.3 explain the strategies for enhancing customer
participation.
Fig. No: 4.3

Strategies for Enhancing Customer (Patient) Participation
Effective Recruit,
Define Customer Educate and
Customer Jobs Participation Reward
Customers
Manage the
Customer Mix
Define the Process where Patient have to Perform

In developing strategies for addressing customer involvement in service delivery, the
organization first determines what type of participation it wants from customers, thus first
hospitals define the customer jobs. Because, it is essential to identify clearly the processes where
customer participation is vital for service quality. In hospitals, customers participation at the
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level of diagnosis and following the treatment by consuming medicines, as per the direction of
the doctor, are important for service quality.
Hospitals may decide that it is satisfied with the existing level of participation it requires from
customers but wants to make the participation more effective. Alternatively, the hospitals may
choose to increase the level of customer participation, which may reposition the service in the
customers eye. Experts have suggested that higher levels of customer participation are
strategically advisable when service production and delivery are inseparable; marketing benefits
(cross-selling, building loyalty) can be enhanced by one-site contact with the customer; and
customers can supplement for the labor and information provided by employees.40 In health care
researches and providers are working on ways to gain more active customer participation in
treatment decisions.
On the other hand, the description of customer job cannot be universalized. It varies with the
types of service and hospitals desired position within the industry. Some customer job may
require helping them selves, some jobs require helping others, and some customer jobs may be to
promote the hospital by providing word-of-mouth endorsements. Finally, once the desired level
of participation is clearly, the organization can define more specifically what the customers job
entails.41
Provide an Appropriate patient Mix
Here, compatibility management is critically important for hospitals. It is defined as a
process of first attracting homogeneous consumers to the service environment, then actively
managing both the physical environment and customer-to-customer encounter is such a way as to
enhance satisfying encounters and minimize dissatisfying encounters.42 In brief it means, the
process of managing multiple and sometimes conflicting segments. Therefore in hospitals,
customers interact often with other customers in the process of service production and
consumption. The status, culture and behavior of the other customers will influence the level of
participation of a customer significantly. Some patients do not want to take the treatment in the
presence of other known patients. Some like to mix with different age groups. Some may have
status barriers. The like and dislike of patients with respect to fellow patients vary. The hospitals
should study the feelings and dispositions of various categories of customers and schedule the
services, taking into consideration the compatibility of the customer mix.
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Recruit, Educate, and Reward Patients
Hospitals must remember that, the customer becomes a partial employee at some level, and
strategies for managing customer behavior in service production and delivery can mimic to some
degree the efforts aimed at service employees. As with employees, customers participation in
service production and delivery will be facilitated when
Customers understand their roles and how they are expected to perform
Customers are able to perform as expected, and
There are valued rewards for performing as expected.43
Recruit the Right Patient
Hospitals should seek to attract customers who will be comfortable with the roles, to do this,
it should clearly communicate the expected roles and responsibilities (i.e. hospital should explain
the treatment process to the patients before they are going to adopting, requirement etc.) in
advertising, and other hospital messages. By previewing their roles and what is required of them
in the service process, customers can self-select in to the relationship. Self-selection should result
in enhanced perceptions of service quality from the customers point of view and reduced
uncertainty for the hospital.
Educate and Train Patient to Perform Effectively
Hospital services utilisers need to be educated or socialized so they can perform better role.
Through the socialization process, it is possible for service customers to gain an appreciation of
specific organizational values, develop the abilities necessary to function within a specific
context, understand what is expected of them and acquire the skills and knowledge to interact
with employees and other customers.44 Many hospitals use formal training programs to educate
customers on how to utilize the services etc. customer education can also be partially
accomplished through written literature and customer hand books that describe customers role
and responsibilities. Hospitals may develop patient hand books, very similar in appearance to
employee handbooks to describe what the patient should do in preparation for arrival at the
hospital, what will happen when he or she arrives and policies regarding visiting hours and
billing procedures. The hand book may even describe the roles and responsibilities of family
members.
Even formal training and written information are usually provided in advance of the service
experience, other strategies can continue customer socialization during the experience it self. On
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site, customers require two kinds of orientation: place orientation (how does this organization
work? What am I supposed to do?).45 Customers are also socialized to their expected roles
through information provided by employees and by observing other customers.
Reward Patients
Rewards are likely to come in the form of increased control over the delivery process, time
savings, monetary savings, and psychological or physical benefits. In hospitals patients who
perform this role effectively are likely to be rewarded with better health or quicker recovery.
Customers may not realize the benefits or rewards of effective participation unless the
organization makes the benefits apparent to them. Therefore hospital needs to clarify the
performance-contingent benefits that can accrue to customers just as it defines these types of
benefits to employees. Hospitals also remember that not all customers are motivated by the same
types of rewards. Some other strategies for enhancing customer compatibility include, the code
of conduct for customers, training employees to observe customer-to-customer interactions and
to be sensitive to potential conflicts etc.
The challenge of managing customer in the process of service delivery is unique to hospitals.
Through understanding the importance of customers in service delivery and identifying the roles
played by the customer in a particular context, management can develop strategies to enhance
customer participation. Now we will take up the people mix in sample hospitals.
People Mix in Apollo Hospital
In Apollo hospital people mix consists of Doctors, nurses, paramedical staff, supporting staff
and front office executives etc,. Apollo is managing personnel, by developing and enhancing a
service culture systematically. For this the hospital having a human resource department with
eminent people in concern field. This department delivering different functions likes man power
planning, staffing, training, organizing, supporting, motivation, evaluating, and rewarding etc,
for building hospital with competent personnel. In order to get the right people Apollo hospital
finding best people, where they are available and how competing with other hospitals. For this
Apollo is following traditional recruitment methods like advertising for posts, calling
applications and other recruitment ideas such as campus interviews at reputed institutions. It is
observed that the Apollo is suffering with unavailability of trained people like nurses and
paramedical staff etc. Further Apollo is concentrating on finding qualified people but not
whether they have an inclination to the service or not. Because the attitude towards the service
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job and orientation to serve people are important criteria to test. In Apollo there are working for
providing services to the patients. Table no: 4.1 shows the employee strength of Apollo hospital.
Table No: 4.1
Employee Strength in Apollo Hospital
Employees Total Number

Professionals 156
Nursing Staff 560
Additional Support Staff 875
Total Number of Employees (Medical & Non Medical) 1591
Apollo is having training system and infrastructure for training the employees. Some times
Apollo is hire specialists for its training needs. Apollo is giving training to the employees
basically to meet the objective of: developing and enhancing communication skills and service
skills among employees. For this Apollo is conducting training programmes aim at three
important skills i.e. technical skills, interactive skills and social skills. But the researcher
observed that the training programmes are not continuously organizing by the Apollo hospital.
For utilizing people Apollo is assigning the jobs to the persons on the basis of their capability
as well as willingness. But this is not happening in the case of all the employees in Apollo.
Hospital is compromising in certain areas by considering the persons who are really to work at
low salaries. It is observed in Apollo the front line employees are getting high priority in service
production and delivery process. Apollo is giving training to the employees in assessing the
exact needs of the patients. In process of empowering the patients Apollo is giving required tools
to the frontline employees. But here the researcher has observed that there is no proper
delegation of authority to serve the customers. They are some times confusing in their work
process. Apollo trying to increase the team works in the hospital. For this it is restructuring the
hospital and developing market based groupings. Along with Apollo is creating teams and
supporting effective team work.
To increase the quality of service delivery, Apollo is arranging supporting system. For this
Apollo is providing complete patient history on computer system, the doctor can get immediately
whenever he need on his laptop. Complete testing facilities and equipment are available to the
270
diagnosing departments to handle and support services for performing effectively to the staff like
nurses, paramedical staff, supporting staff etc.
Along with the supporting system Apollo hospital is arranging management support in the
form of documents, information networking, communication system, scheduling, mobility etc.
for increasing the performance of employees and customers in the service process. As a part of
internal marketing Apollo is motivating employees by promotions, monitory benefits,
competitive compensation and payments for extraordinary performances. On the basis of
employee category the benefits are changing in Apollo. For doctors, nurses and paramedical
staff, on the basis of average level performance and experience Apollo is giving immediate
promotions and increments in the salary. In the case of supporting staff and administrative staff
who are working in office are getting promotions and salary increments on the basis of length of
service. Here the researcher observed that Apollo is not considering the motivational levels of
supporting staff and office staff. As a part of evaluation of performance of the employees Apollo
is following two types of feedbacks i.e. feedback to management and feedback to employees.
Apollo is taking feedback on employee performance on half yearly basis for identifying areas for
improvement, defects and deviations from the quality specifications and initiate appropriate
corrective action. Feedback to employee is taking on monthly basis, and the feedback is supplied
to the concern employee to know their level of performance.
It is observed in Apollo, the employee turnover is minimized by the competitive
compensation only. Besides direct compensation Apollo providing extended benefits to the
employees like employee measures with in the organization like children education, functions
and social interactions. Along with benefits Apollo is have rewarding system. They are
identifying the best performers and rewarding them to the level of their excellence. But it is
observed that there are some criticisms by the employees about the rewarding system in Apollo.
Further in Apollo the experienced and efficient personnel moving out of the hospital, it is
becoming a challenging task to the Apollo. Because retaining the right people in the organization
is the real essence of the human resource policy. Let us discuss the people mix in Care hospital.
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People Mix in Care Hospital
The people mix in Care hospital classified as high contact people and low contact people based
on the extent of patients contact required for the creation of a service. High contact service
people include doctors and nursing staff who are engaged in providing the services to the
patients all round the day. The administrative people, supportive service people etc come under
low contact service people. Care hospital is trying to attract and retain doctors with excellent
knowledge and skills. Here Care is giving importance to the attitude of the employees. In this
regard Care hospital has adopted certain strategies to retain the efficient people for the
organization. They are
Recruiting or hiring the best and the dedicated qualified doctors.
Recruiting the serene, service oriented and loyal nursing staff.
Follows a special procedure for recruitment of the staff.
Providing regular on-job training of employees.
Using latest technology.
Establishing nursing college with a view to provide excellent education along with
training in the hands of experienced people.
Prizing and rewarding the best performers.
Providing the needed support for its employees by way of welfare activities.
Promoting team work by motivating the staff and arranging regular outings make the
staff feel like a family to achieve the team spirit.
By following above strategies Care hospital is running with a team of Cardiologists and
Cardiac Surgeons in the country. Round the clock this hospital made availability of cardiologists,
cardiac surgeons, neurologists, critical care specialists, anaesthiologists etc, in the hospital. Total
number of employees in Care can be summarized in table no: 4.2
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Table No: 4.2
Employee Strength in Care Hospital
Employees Total Number

Professionals 127
Nursing Staff 510
Additional Support Staff (Medical & Non Medical) 850
Total Number of Employees 1487
Nearly 11.12% of all employees in Care comprises of doctors with nearly 4.72% of them
being specialists and 3.64% of non-medical staff.
Medical Staff Selection Process in Care Hospital
Following is the procedure for selection of medical staff in Care hospital.
Initial scrutiny by the credential committee.
Approval and acceptance by the medical staff or its executive committee.
Final approval by the governing board.
Initial evaluation of performance during the year against high standards.
Subsequent appointments for two-years period after careful evaluation which
encompasses all aspects of work including clinical responsibility for patient care and
accountability.
Continuing internal assessment through
o Departmental meetings
o Peer evaluation
o Continuing medical education and improvements in professional knowledge and
skills.
o Mandatory attendance at medical staff and committee meetings and
organizational activities of medical staff.
o Medical staff rules and regulations, standing orders, etc. by which all medical
staff are bound. Various standing committee such as credentials committee,
quality assurance committee, critical care and operating room committee,
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medical records committee, surgical case review (tissue) committee and infection
control committee ensure quality care.
It is observed that Care hospital is suffering with unavailability of trained medical
professionals including nurses, paramedical staff etc. For minimizing the employee turnover and
retain them, Care maintaining competitive compensation packages. Besides direct compensation
this hospital providing extended benefits to the employees like children education, special
monitory incentives for better performance etc. Every employee will get the promotion after
completion of minimum three years of service subject to the recommendations of the screening
committee.
Along with benefits Care hospital is have rewarding system for high contact people as well as
for low contact people. They are identifying the best performers and rewarding them to the level
of their excellence. Further in Care the experienced and efficient personnel moving out of the
hospital, it is becoming a challenging task to the Care hospital like Apollo.
In process of empowering the patients Care hospital arranging required tools to the frontline
employees. But here it is observed that, they are some times confusing in their work process. In
a view to encourage the team works in the hospital Care hospital restructuring and developing
market based groupings. To increase the quality of service delivery, Care is arranging supporting
system, for this Care is providing complete patient history on computer system, the doctor can
get immediately whenever he need on his laptop. Complete testing facilities to the diagnosing
departments, different equipments to handle and support services to perform effectively to the
people like nurses, paramedical staff, supporting staff etc.
Along with benefits Apollo is have rewarding system. They are identifying the best
performers and rewarding them to the level of their excellence. But it is observed that there are
some criticisms by the employees about the rewarding system in Apollo. Further in Apollo the
experienced and efficient personnel moving out of the hospital, it is becoming a challenging task
to the Apollo. Because retaining the right people in the organization is the real essence of the
human resource policy.
Now we will take up the perceptions of Doctors, nurses and administrative personnel about
the people mix of sample hospitals.
274
Perceptions of Doctors about the People Mix of Sample Hospitals
Table no: 4.3 representing perceptions of doctors about the people mix of the sample
hospitals
Table No: 4.3
Perceptions of Doctors about People Mix of the Sample Hospitals
Perception: ( 1 ) Strongly agree ( 2 ) Agree ( 3 ) cant say ( 4 ) Disagree ( 5 ) strongly disagree
(1) (2) (3) (4) (5)

S.L Statement Perception Apollo Care
NO % %
1 46.70 6.66
2 42.65 82.69
This hospital is having doctors with Excellent 3 6.66 6.66
1
knowledge. 4 1.33 1.33
5 1.33 1.33
Total 100.00 100.00
1 45.39 6.66
2 34.65 81.36
3 6.66 6.66
2 This hospital is having doctors with Excellent skills.
4 7.98 2.66
5 5.32 2.66
Total 100.00 100.00
1 34.65 13.30
2 32.06 57.41
3 6.66 11.97
3 This hospital is having doctors with right attitude.
4 11.97 14.66
5 14.66 2.66
Total 100.00 100.00
1 14.66 6.66
2 11.97 25.32
3 25.32 33.37
4 In this hospital, doctors deal with all the patients alike.
4 27.99 27.99
5 20.06 6.66
Total 100.00 100.00
1 41.35 33.32
2 38.66 49.39
In this hospital the supporting staff plays an important 3 17.33 13.30
5
role for better recovery of the patients. 4 1.33 1.33
5 1.33 1.33
Total 100.00 100.00
1 32.05 52.01
2 27.99 13.30
In this hospital the supporting staff and nurses are well 3 25.32 20.06
6
qualified. 4 7.98 13.30
5 6.66 1.33
Total 100.00 100.00
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(1) (2) (3) (4) (5)
1 20.06 13.30
2 32.09 33.32
The house keeping personnel in this hospital are well 3 27.90 31.99
7
mannered, gentle, hygienic and meticulous. 4 11.97 20.06
5 7.98 1.33
Total 100.00 100.00
1 27.99 33.29
2 45.35 38.66
Your customer awareness programs enables patients 3 14.66 20.06
8
in getting the value and quality healthcare. 4 6.66 6.66
5 5.34 1.33
Total 100.00 100.00
1 52.65 41.38
2 13.30 38.66
The staff at this hospital is sympathetic towards patient 3 26.06 11.97
9
problems pertaining to the facilities in the hospital. 4 1.33 6.66
5 6.66 1.33
Total 100.00 100.00
The opinion poll was conducted with a statement that the Hospital is having doctors with
excellent knowledge 75 respondents in each hospital involved in the poll, 38 respondents with
48.03% expressed strongly agree opinion in Apollo and 5 respondents with 6.66% in Care. 32
respondents with 42.65% in Apollo expressed agree opinion whereas in Care 65 respondents
with 84.02% expressed. The equal number of 5 respondents with 6.66% expressed neutral
opinion in both the Hospitals of Apollo and Care. Only 1.33% of respondents has come forward
to express disagree and strongly disagreed opinions in both the Hospitals of Apollo and Care.
From the analysis shown above, it can be noticed that the doctors in these Hospitals are having
excellent knowledge.
The survey turned on the aspect of the Hospital having doctors with excellent skills 34
respondents with 45.39% expressed strongly agree opinion in respect of Apollo and in Care 5
respondents with 6.66% expressed. 26 respondents with 34.65% expressed agree opinion in
Apollo and in Care 65 respondents with 81.36% expressed. 5 respondents with 6.66% expressed
neutral opinion in respect of the both Hospitals of Apollo and Care. The disagree opinion has
taken place among 6 respondents with 7.98% in Apollo and 2.66% in case of Care. In the same
way, 4 respondents with 5.32% expressed strongly disagree opinion in Apollo and 2.66% in case
of Care Hospital. The statement of analysis shows that majority of respondents are under the
opinion that the doctors in both the Hospitals are having excellent skills.
276
An attempt was made on the Hospital having doctors with right attitude 26 respondents with
34.65% expressed strongly agree opinion in Apollo whereas in Care 10 respondents with 13.30%
expressed. 24 respondents with 32.06% expressed agree opinion in Apollo and in Care 45
respondents with 57.41% expressed. The neutral opinion came up from among 5 respondents
with 6.66% in Apollo and in Care 9 respondents with 11.97%. 9 respondents with 11.97%
expressed disagreed opinion in Apollo and in Care 11 respondents with 14.66% expressed. The
strongly disagree opinion was expressed by 11 respondents with 14.66% in Apollo and 2.66% in
Care Hospital. It can be seen from the above analysis of statement that majority of respondents
are under the impression that these Hospital doctors are with right attitude.
The survey has taken place on the Hospital doctors dealing with all the patients alike 11
respondents with 14.66% expressed strongly agree opinion in Apollo and in case of Care 5
Apollo and in Care 19 respondents with 25.32% expressed. The neutral opinion expressed by 19
respondents with 25.32% in Apollo and in Care 25 respondents with 33.37%. The disagreed
opinion was expressed by equal number of 21 respondents with 27.99% in both the Hospitals of
Apollo and Care. 15 respondents with 20.06% expressed strongly disagreed opinion in respect of
Apollo whereas in Care 5 respondents with 6.66% expressed. It is seen from the able table
majority of respondents are unable to express their opinions on the aspect of doctors deal with all
the patients alike.
On the aspect of the Hospital the supporting staff plays an important role for better recovery
of the patients 31 respondents with 41.35% expressed strongly agree opinion in Apollo whereas
in case of Care 25 respondents with 33.32% expressed. 29 respondents with 38.66% expressed
agree opinion in Apollo whereas in Care 40 respondents with 49.39% expressed. The neutral
opinion has taken place among 13 respondents with 17.33% in Apollo and in Care 10
respondents with 13.30%. only one respondent with 1.33% expressed disagree opinion in Apollo
also in Care. In the same way, only one respondent with 1.33% expressed strongly disagree
opinion in case of Apollo Hospital and in Care it is 2.66%. From the above analysis of statement,
it reveals that more number of respondents are under the opinion that the supporting staff will
certainly play an important role for better recovery of patients in these Hospitals.
As regards the Hospital supporting staff and nurses are well qualified 24 respondents with
32.05% expressed strongly agree opinion in Apollo and in Care 40 respondents with 52.01%
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respondents with 13.30% expressed. The neutral opinion has taken place among 19 respondents
with 25.32% in respect of Apollo and in Care 15 respondents with 20.06% expressed. 6
respondents with 7.98% expressed disagree opinion in Apollo and in Care 10 respondents with
13.30% expressed. 5 respondents with 6.66% expressed strongly disagreed opinion in Apollo
and 1.33% came forward to express in case of Care Hospital. From the above, it clearly shows
that the supporting and nurses are well qualified in their Hospitals.
As regards the house keeping personnel in the Hospital are well mannered, gentle, hygienic
and meticulous 15 respondents with 20.06% expressed strongly agree opinion in Apollo and in
Care 10 respondents with 13.30% expressed. 24 respondents with 32.09% expressed agree
opinion in case of Apollo whereas in Care 25 respondents with 31.99% expressed. The neutral
opinion has taken place among 21 respondents with 27.90% in Apollo whereas in Care 25
respondents with 33.32%. 9 respondents with 11.97% expressed disagreed opinion in Apollo and
in Care 15 with 20.06% expressed. 6 respondents with 7.98% expressed strongly disagreed
opinion in case of Apollo and 1.33% in Care Hospital. It is observed from the above analysis of
statement that more respondents are under the impression that the house keeping personnel in
these Hospitals are all well mannered, gentle, hygienic and meticulous.
On the subject of customer awareness programs enable patients in getting the value and
quality health Care 21 respondents with 27.99% expressed strongly agree opinion in Apollo and
in Care 25 respondents with 33.29% expressed. 34 respondents 45.35% expressed agree opinion
in case of Apollo and in Care Hospital 29 respondents with 38.66% expressed. The neutral
opinion was expressed by 11 respondents with 14.66% in Apollo and in Care 15 respondents
with 20.06% expressed. The disagreed opinion was expressed by 5 respondents with 6.66% in
both the hospitals of Apollo and Care. 4 respondents with 5.34% expressed strongly disagree
opinion form Apollo and only one respondent with 1.33% expressed in Care Hospital. On going
through the above analysis it can be understood that more respondents are under the impression
that customer awareness programs enable patients in getting the value and quality health Care in
these Hospitals.
The survey further took place on the aspect of the staff at the Hospital are sympathetic
towards patient problems pertaining to the facilities in the Hospital 39 respondents with 52.65%
expressed strongly agree opinion in Apollo and in Care 31 respondents 41.38% expressed. 10
278
respondents with 13.30% expressed agree opinion in Apollo and in Care 29 respondents with
38.66% expressed. The neutral opinion was taken place among 20 respondents with 26.06% in
Apollo and in Care 9 respondents with 11.97%. Only one respondent with 1.33% expressed
disagree opinion in respect of Apollo and in Care 5 respondents with 6.66% expressed. 5
respondents with 6.66% expressed strongly disagreed opinion in case of Apollo and only one
respondent with 1.33% expressed in Care Hospital. Hence it can be concluded from the above
analysis that respondents are of the opinion that the staff of these Hospitals are sympathies
towards patients problems pertaining to the facilities in the Hospitals.
From the above discussion, it may be concluded that in two hospitals doctors are recruited on
the basis of their educational qualifications and experience. In Apollo management is
considering their reputation in the hospital industry, but in Care importance is giving for their
attitude, next their work experience. Most of the respondents are accepting in Care, doctors will
deal the patients alike but it is observed in Apollo it is not become possible because of over
flowing of patients. In two hospitals nurses are recruiting from reputed nursing schools and
importance is giving to the experience in corporate hospitals. Even the supporting staff also
appointed strictly on merit basis only. In Apollo the management is very serious about the
behavior of house keeping personnel but in Care they are liberally going. On overall in two
hospitals the staff is sympathetic towards patients and the hospitals arranging customer
awareness programmes for assisting the patients. By and large, it is found that the two sample
hospitals having right people mix. Now let us move on to the perceptions of nurses about the
people mix of the sample hospitals.
279
Perceptions of Nurses about the People Mix of Sample Hospitals
Table no: 4.4 representing perceptions of nurses about the people mix of the sample
hospitals
Table No: 4.4
Perceptions of Nurses about People Mix of the Sample Hospitals
(1) (2) (3) (4) (5)

NO % %
1 20.14 26.64
2 33.65 53.40
1
knowledge. 4 12.65 7.32
5 7.32 7.32
Total 100.00 100.00
1 26.64 34.08
2 34.08 39.29
3 12.65 13.32
4 13.98 12.65
5 12.65 0.66
Total 100.00 100.00
1 33.00 19.99
2 33.00 40.12
3 12.65 19.31
4 13.32 13.98
5 8.03 6.60
Total 100.00 100.00
1 33.00 13.30
2 19.99 40.76
3 6.60 32.63
4 21.10 12.65
5 19.31 0.66
Total 100.00 100.00
1 53.41 53.41
2 39.29 39.29
5
5 1.32 0.66
Total 100.00 100.00
1 53.40 52.74
2 39.29 40.62
6
qualified. 4 5.99 0.66
5 0.66 0.66
Total 100.00 100.00
280
(1) (2) (3) (4) (5)
1 27.30 27.30
2 26.64 52.80
7
5 12.65 0.66
Total 100.00 100.00
1 41.29 26.64
2 26.09 39.96
8
5 5.99 6.60
Total 100.00 100.00
1 27.97 50.69
2 25.48 27.30
9
5 6.60 1.32
Total 100.00 100.00
A study was made on the Hospital having doctors with excellent knowledge 150
respondents participated in each hospital, 31 respondents with 20.14% expressed strongly agree
opinion in Apollo and in Care 40 respondents with 26.64% expressed. 49 respondents with
33.65% expressed in Apollo and in Care 80 respondents with 53.40% expressed agree opinion.
40 respondents with 26.24% expressed neutral opinion in respect of Apollo and in Care also 8
respondents with 5.32% expressed the same. 19 respondents with 12.65% expressed disagreed
opinion in respect of Apollo and in Care 11 respondents with 7.32% expressed. 11 respondents
with 7.32% expressed strongly disagreed pinion in both of the Hospitals of Apollo and Care. The
respondents of both the Hospitals are having an opinion that they are possessing doctors with
excellent knowledge.
On the query of the Hospital having doctors with excellent skills 40 respondents with
expressed. Agree opinion took place in Apollo by 51 respondents with 34.08% where as in Care
59 respondents with 39.29% expressed. The neutral opinion has taken place among 19
respondents with 12.65% in Apollo and in Care it was from 20 respondents with 13.32%. The
disagree opinion expressed by 21 respondents with 13.98% in case of Apollo and in case of Care,
it was 19 respondents with 12.65%. 19 respondents with 12.65% expressed strongly disagree
opinion from Apollo and in case of Care only one respondent with 0.60% expressed. In
281
conclusion of the above shown analysis, a large number of respondents are of the opinion that
these Hospitals are having doctors with excellent skills.
On the aspect of the Hospital having doctors with right attitude 50 respondents with 33.00%
expressed strongly agree opinion in Apollo and in Care 30 respondents with 19.99% expressed.
50 respondents with 33.00% expressed agree opinion in Apollo and in Care 60 respondents with
40.12% expressed. The neutral opinion came up from among 19 respondents with 12.65% in
Apollo and in Care 29 respondents with 19.31% expressed. Disagree opinion in respect of
Apollo have taken place by 20 respondents with 13.32% where as in Care 21 respondents with
13.98% expressed. 11 respondents with 8.03% expressed strongly disagree opinion in respect of
Apollo and 10 respondents with 6.60% in case of Care Hospital expressed. It shows that majority
of respondents in both the Hospitals are of the opinion that these Hospitals are having doctors
with right attitude.
An attempt was made to know that the Hospital doctors dealing with all the patients alike
50 respondents with 33.00% expressed strongly agree opinion in respect of Apollo and in Care
Hospital 20 respondents with 13.30% expressed. 30 respondents with 19.99% expressed agree
opinion in Apollo and 61 respondents with 40.76% expressed. The neutral opinion camp up from
among 10 respondents with 6.60% expressed in Apollo and in Care 49 respondents with 32.63%
expressed. 31 respondents with 21.10% expressed disagreed opinion in Apollo and 19
respondents with 12.65% in Care Hospital. 29 respondents with 19.31% expressed strongly
disagreed opinion in Apollo and in Care only one respondent with 0.66% expressed. The analysis
of statement reveals that a large number of respondents are of the opinion that these Hospital
doctors deal with all the patients alike.
The survey has further taken place in respect of the Hospital supporting staff plays an
important role for better recovery of the patients 80 respondents with 53.41% strongly agree in
Apollo and in Care the same opinion was expressed by 80 respondents with 53.41%. In the same
way 59 respondents with 39.29% expressed agree opinion in both the hospitals of Apollo and
Care. The neutral opinion was expressed by only one respondent with 0.66% in both the
Hospitals of Apollo and Care. 8 respondents with 5.32% expressed disagreed opinion in Apollo
and in Care 9 respondents with 5.98% expressed. 2 respondents with 1.32% expressed strongly
disagreed opinion in case of Apollo and only one respondent with 0.66% in Care. From the
282
above analysis, it reveals that in these Hospitals the supporting staff plays an important role for
better recovery of the patients.
As regards the Hospital supporting staff and nurses are well qualified 80 respondents with
53.40% expressed strongly agree opinion in Apollo and in Care Hospital 79 respondents with
52.74% expressed. 51 respondents with 39.29% expressed agree opinion in Apollo and in Care
Hospital 61 respondents with 40.62% expressed. Only one respondent with 0.66% in Apollo and
in Care 8 respondents with 5.32% expressed neutral opinion. 9 respondents with 5.99%
expressed disagree opinion in respect of Apollo and in Care only one respondent with 0.66%. In
the same way only one respondent with 0.66% expressed strongly disagree opinion in both the
Hospitals of Apollo and Care. It can be seen from the analysis of statement that a large number
of respondents are under the opinion that these Hospital supporting staff and nurses are well
qualified.
An attempt was made to know that the house keeping personnel in this Hospital are well
mannered, gentle, hygienic and meticulous 41 respondents with 27.30% expressed strongly
agree opinion in respect of both the Hospitals of Apollo and Care. 40 respondents with 26.64%
expressed agree opinion in Apollo and in Care 79 respondents with 52.80% expressed. The
neutral opinion has taken place among 29 respondents with 19.43% in Apollo and in Care 20
respondents with 13.30%. The disagreed opinion was expressed by 21 respondents with 13.98%
in Apollo and in Care Hospital 9 respondents with 5.94% expressed. 19 respondents with
12.65% expressed strongly disagreed opinion in respect of Apollo Hospital and only one
respondent with 0.66% expressed in Care Hospital. On the whole the respondents are under the
impression that the house keeping personnel in both the Hospital well mannered, gentle, hygienic
and meticulous.
The survey has further taken place in respect of Customer awareness programs enable
patients in getting value and quality health Care 62 respondents with 41.29% expressed
strongly agree opinion in Apollo and in Care 40 respondents with 26.09% expressed. 39
39.96% expressed. The neutral opinion was expressed by 19 respondents with 12.65% in Apollo
and 31 respondents with 20.81% in case of Care Hospital. 21 respondents with 13.98%
expressed disagreed opinion in Apollo and in Care 9 respondents with 5.99% expressed. 9
respondents with 5.99% expressed strongly disagreed opinion in Apollo and in Care 10
283
respondents with 6.60% expressed. On going through the analysis of statement it can be
observed that a large number of respondents agree that customer awareness programs enable
patients in getting value and quality health Care.
The opinion poll, further has taken place in respect of the staff at the Hospital is sympathetic
towards patients problems pertaining to the facilities in the Hospital 42 respondents with
expressed. 38 respondents with 25.48% agree opinion in Apollo and in Care 41 respondents with
27.30% expressed. The neutral opinion was expressed by 41 respondents with 27.30% in Apollo
and 30 respondents with 20.09% in Care. 19 respondents with 12.65% in Apollo expressed
disagreed opinion whereas in Care 0.60% only expressed. In the same way 10 respondents with
6.60% expressed strongly disagree opinion in Apollo but only 1.32% expressed the same in
Care. Finally it can be seen from the statement that respondents in large number are under the
opinion that the staff at these Hospitals is sympathetic towards patients problems pertaining to
the facilities in the Hospital.
The above discussion reveals that, most of the respondents in Care accepted that the doctors
are having excellent knowledge and skills. But in Apollo it is quit opposite to the Care hospital.
But in attitude point of view Apollo is better than the Care hospital. It is noticed that in Care,
doctors are not dealing the patients alike. In two hospitals respondents are accepted that the
nurses and supporting staff are well qualified and they are playing important role for better
recovery of the patients. The house keeping personnel are well in two hospitals in the aspects of
their mannerism etc. In arranging customer awareness programmes for enabling the patients
Apollo is better than the Care hospital. But in Care hospital most of the respondents are accepted
that the staff of the hospital is sympathetic towards patients but not in Apollo. In conclusion, it
can be stated that the two hospitals having right people mix. Now let us move on to the
perceptions of administrative personnels perceptions on people mix of sample hospitals.
284
Perceptions of Administrative Personnel about the People Mix of Sample
Hospitals
Table no: 4.5 representing perceptions of administrative personnel about the people mix of
the sample hospitals
Table No: 4.5
Perceptions of Administrative Personnel about People Mix of the Sample Hospitals
(1) (2) (3) (4) (5)

NO % %
1 37.05 14.25
2 43.00 43.00
1
knowledge. 4 11.40 14.25
5 2.85 14.25
Total 100.00 100.00
1 39.90 43.00
2 40.15 39.90
3 2.85 11.40
4 2.85 2.85
5 14.25 2.85
Total 100.00 100.00
1 34.20 31.35
2 34.20 51.55
3 17.35 2.85
4 2.85 8.55
5 11.40 5.70
Total 100.00 100.00
1 31.35 28.50
2 34.20 51.55
3 20.20 5.70
4 5.70 5.70
5 8.55 8.55
Total 100.00 100.00
1 45.85 45.85
2 45.60 45.60
5
5 2.85 2.85
Total 100.00 100.00
1 43.00 45.85
2 48.45 45.60
6
qualified. 4 2.85 2.85
5 2.85 2.85
Total 100.00 100.00
285
(1) (2) (3) (4) (5)
1 37.05 39.90
2 43.00 40.15
7
5 5.70 2.85
Total 100.00 100.00
1 34.20 39.90
2 31.35 45.85
8
5 14.25 2.85
Total 100.00 100.00
1 43.00 51.55
2 14.25 39.90
9
5 14.25 2.85
Total 100.00 100.00
The survey was under taken in respect of the Hospital having doctors with excellent
knowledge 13 respondents with 37.05% expressed strongly agree opinion in Apollo and in Care
5 respondents with 14.25% expressed. 15 respondents with 43.00% expressed agree opinion in
Apollo and in Care also 15 respondents with 43.00% expressed. 2 respondents with 5.70% in
Apollo and in Care 5 respondents with 14.25% expressed neutral opinion. The disagree opinion
expressed by 4 respondents with 11.40% in Apollo and in Care 5 respondents with 14.25%
expressed. Only one respondent with 2.85% expressed strongly disagree opinion in Apollo and
in Care 5 respondents with 14.25% expressed. On the whole, the majority of respondents are of
the opinion that these Hospitals are having doctors with excellent knowledge.
An attempt was made to know that the Hospital is having doctors with excellent skills 14
respondents with 39.90% expressed strongly agree in Apollo and in Care 15 respondents with
16 respondents with 39.90% expressed. Only 2.85% was expressed neutral opinion in Apollo but
4 respondents with 11.40% expressed same in Care. The disagreed opinion was expressed by one
respondent with 2.85% in both the sample hospitals. 5 respondents with 14.25% expressed
strongly disagreed opinion in Apollo and in case of Care only 2.85% expressed. On the whole, it
can be noticed that a large number of respondents are of the opinion that these Hospitals are
having doctors with excellent skills.
286
On the subject of the Hospital is having doctors with right attitude 12 respondents with
respondents with 51.55% expressed. The neutral opinion has taken place from 6 respondents
with 17.35% in Apollo and only one respondent with 2.85% in Care expressed. Only one
respondent with 2.85% expressed disagree opinion in respect of Apollo and in Care Hospital 3
respondents with 8.55% expressed. 4 respondents with 11.40% expressed strongly disagreed
opinion in Apollo and in Care Hospital 2 respondents with 5.70% expressed. On going through
the analysis of statement that large number of respondents is of the opinion that these hospitals
are having doctors with right attitude.
A study has taken place on the subject of the Hospital doctors dealing with all the patients
alike 11 respondents with 31.35% expressed strongly agree opinion in Apollo and in Care 10
Apollo and in Care 18 respondents with 51.55% expressed. The neutral opinion was expressed
by 7 respondents with 20.20% in Apollo and 2 respondents with 5.70% expressed. Two
respondents with 5.70% expressed disagreed opinion in both the Hospitals of Apollo and Care.
In the same way 3 respondents with 8.55% expressed strongly disagree opinion in both the
Hospitals of Apollo and Care. On the whole, it is known that a large number of respondents are
of the opinion that these Hospital doctors deal with all the patients alike.
As regards the Hospital supporting staff plays an important role for better recovery of the
patients 18 respondents with 45.85% expressed strongly agree opinion in Apollo and in Care
also same number of respondents expressed the same opinion. Equal number of 16 respondents
with 45.60% expressed agrees opinion in both the Hospitals of Apollo and Care. The neutral
opinion has taken place among one respondent with 2.85% in both the hospitals. Only one
respondent with 2.85% expressed disagree opinion in Care and Apollo hospital. In case of
strongly disagreed opinion also 2.85% expressed in both the sample hospitals. From the above
analysis of statement it can be understood that most of the respondents are under the opinion that
Hospital supporting staff plays an important role for better recovery of the patients.
An opinion poll was conducted on the subject of the Hospital supporting staff and nurses are
well qualified 16 respondents with 43.00% expressed strongly agree opinion in Apollo and in
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opinion in Apollo and in Care 16 respondents with 45.60% expressed. The neutral opinion came
up from one respondent with 2.85% in Care and Apollo hospitals. In the case of disagree and
strongly disagree opinions, only 2.85% of respondents came forward in both the sample
hospitals. The above analysis of statement reveals that more number of respondents is of the
impression that the supporting staff and nurses are well qualified.
As regards the house keeping personnel in the Hospital are well mannered, gentle, hygienic
and meticulous 13 respondents with 37.05% expressed strongly agree opinion in Apollo and in
opinion in Apollo and in case of Care 1 respondent with 2.85% only expressed. The neutral
opinion came up from among four respondents with 8.55% in Apollo and none in the case of
Care Hospital. 2 respondents with 5.70% expressed disagreed opinion in Apollo and in Care 5
respondents with 14.25% expressed. The strongly disagree opinion has taken place among 2
respondents with 5.70% in Apollo and in Care only one respondent with 2.85%. On the whole
more number of respondents is of the opinion that housekeeping personnel in these Hospitals are
well mannered, gentle, hygienic and meticulous.
Survey has been undertaken in respect of Customer awareness programs enable patients in
getting the value and quality health Care. 13 respondents with 34.20% expressed strongly agree
opinion in Apollo and in Care 14 respondents with 39.90% expressed. 15 respondents with
31.35% expressed agree opinion in Apollo whereas in Care 15 respondents with 45.85%
expressed. The neutral opinion was expressed by 6 respondents with 17.35% in Apollo and in
Care only one respondent with 2.85% expressed. 3 respondents with 8.55% expressed disagreed
opinion in case of Care and 2.85% in Apollo. The strongly disagree opinion was expressed by 5
respondents with 14.25% in Apollo and in Care only one respondent with 2.85% expressed. On
going through the above analysis of statement it reveals that a large number of respondents are of
the impression that customer awareness programs enable patients in getting the value and quality
health Care.
An attempt was made on the aspect of the staff at the Hospital is sympathetic towards patient
problems pertaining to the facilities in the Hospitals 15 respondents with 43.00% expressed
strongly agree opinion in Apollo and in case of Care Hospital 18 respondents with 51.55%
respondents with 39.90% expressed. 5 respondents with 14.25% expressed neutral opinion in
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Apollo and in Care only one respondent with 2.85% expressed. The disagree opinion has come
up from among 5 respondents with 14.55% in Apollo and one respondent with 2.85% in Care.
The strongly disagree opinion came up from among 5 respondents with 14.25% in Apollo and
one respondent with 2.85% in Care Hospital. The above analysis of statement says that a large
number of respondents are of the opinion that the staffs at these Hospitals are sympathetic
towards patients problems pertaining to the facilities in the Hospital.
From the above discussion it can be stated that, the Apollo is having doctors with excellent
knowledge than the Care hospital. But in skills and attitude point of view two hospitals are
having same opinion from the respondents. No evidence is appeared in the two hospitals about
the doctors will not deal the patients alike. In two hospitals majority of respondents agreed that
the nurses and supporting staff are well qualified and they are playing crucial role for better
recovery of the patients. House keeping personnel in two hospitals are well mannered, gentle,
hygienic and meticulous. But staff is not supportive towards patient problems in Apollo
comparatively with Care hospital. On the whole, it is observed that the two hospitals are having
good people mix for their services marketing. Now observe the Mean and S.D Values of doctors
perceptions on the people mix of the sample hospitals.
Mean and Standard Deviation values of Doctors Perceptions on the People

Mix of Sample Hospitals
Table no: 4.6 representing mean and standard deviation values of perceptions of doctors about
the people mix of the sample hospitals.
Table No: 4.6
Mean and S.D of Doctors Perceptions on the People Mix of the Sample Hospitals
(N=75)
1 2 3 4
Apollo Care
Sl.No Statement
Mean S.D Mean S.D
This hospital is having doctors with Excellent knowledge.
1 1.60 0.61 2.00 0.36
This hospital is having doctors with Excellent skills.
2 2.18 1.13 2.00 0.36
This hospital is having doctors with right attitude.
3 2.40 1.41 2.20 0.85
In this hospital, doctors deal with all the patients alike.
4 3.14 1.36 2.90 0.97
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1 2 3 4
In this hospital the supporting staff plays an important role for

5 1.93 0.93 1.77 0.64
In this hospital the supporting staff and nurses are well
6 2.26 1.18 1.94 1.37
qualified.
The house keeping personnel in this hospital are well mannered,
7 2.56 1.16 2.56 0.96
gentle, hygienic and meticulous.
Your customer awareness programs enables patients in getting
8 2.22 1.10 2.00 0.90
the value and quality healthcare.
The staff at this hospital is sympathetic towards patient
9 1.94 1.19 1.86 0.89
problems pertaining to the facilities in the hospital.
Point Scale: 1-strongly agree.5-strongly disagree
Table no: 4.6 representing the perceptions of doctors on people mix of Apollo hospital as
doctors with excellent knowledge (1.60), doctors having skills (2.18), right attitude of the
doctors (2.40), doctors dealing with all the patients alike (3.14), supporting staff play
impotent role for better recovery of patients (1.93), qualified nursing and supporting staff
(1.93), house keeping personnel well mannered, gentle, hygienic and meticulous (2.56),
customer awareness programs enables patients in getting the value and quality health care
(2.22), staff sympathy towards patient problems (1.94). Therefore it can be said that the
respondents having positive opinion on people mix of the hospital.
In the case of Care hospital; doctors with excellent knowledge (2.00), doctors having
skills (2.00), right attitude of the doctors (2.20), doctors dealing with all the patients alike
(2.90), supporting staff play impotent role for better recovery of patients (1.77), qualified
nursing and supporting staff (1.94), house keeping personnel well mannered, gentle, hygienic
and meticulous (2.56), customer awareness programs enables patients in getting the value and
quality health care (2.00), staff sympathy towards patient problems (1.86). From the
description it can be said that, the respondents having right opinion on people mix of the
hospital. Let us see the Mean and S.D Values of nurses perceptions on the people mix of the
sample hospitals.
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Mean and Standard Deviation values of Nurses Perceptions on the People Mix
of Sample Hospitals
Table no: 4.7 representing mean and standard deviation values of perceptions of nurses about
the people mix of the sample hospitals.
Table No: 4.7
Mean and S.D of Nurses Perceptions on the People Mix of the Sample Hospitals
(N=150)
Apollo Care
Sl.No Statement
Mean S.D Mean S.D
1 2.60 1.20 2.12 1.08
2 2.52 1.35 2.06 1.00
3 2.26 1.24 2.48 1.16
4 2.73 1.57 2.43 0.87
5 1.62 0.82 1.62 0.82
6 1.66 0.79 1.54 0.63
qualified.
7 2.32 1.18 2.00 0.81
8 2.19 1.27 2.26 1.12
9 1.68 0.60 1.67 0.79
Table no: 4.7 representing the perceptions of nurses on people mix of Apollo hospital as
(2.19), staff sympathy towards patient problems (1.68). From the description it can be said that,
the respondents having right opinion on people mix of the hospital.
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quality health care (2.26), staff sympathy towards patient problems (1.67). Therefore it can be
said that the respondents having positive opinion on people mix of the hospital. Next see the
Mean and S.D Values of doctors perceptions on the people mix of the sample hospitals.
Mean and Standard Deviation values of Administrative personnels

Perceptions on the People Mix of Sample Hospitals
Table no: 4.8 representing mean and standard deviation values of perceptions of Adm.People
about the people mix of the sample hospitals.
Table No: 4.8
Mean and S.D of Administrative personnels Perceptions on the People Mix of the Sample Hospitals
(N=35)
Apollo Care
Sl.No Statement
Mean S.D Mean S.D
1 2.11 1.27 2.71 1.29
2 2.08 1.27 1.68 0.67
3 2.22 1.28 2.00 1.13
4 2.25 1.22 2.08 1.19
5 1.57 0.60 1.54 0.65
6 1.57 0.64 1.51 0.56
qualified.
7 1.97 1.12 1.85 1.00
8 2.22 1.35 1.88 1.02
9 2.57 1.42 1.65 0.90
Table no: 4.8 representing the perceptions of nurses on people mix of Apollo hospital as
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(2.22), staff sympathy towards patient problems (2.57). From the description it can be said that,
the respondents having right opinion on people mix of the hospital.
quality health care (1.88), staff sympathy towards patient problems (1.65). Therefore it can be
said that the respondents having positive opinion on people mix of the hospital.
Conclusion
The people component reflects the important role played by the individuals in the provision of
services. People are also an important element in the marketing mix. Service personnel play an
important role in an organization which provides services. The behavior and attitude of the
personnel providing services will influence the customers overall perception of the service.
Customers are a source of influencing other customers by word of mouth. It is necessary that the
staff in a hospital is trained to provide quality patient care with human touch using state of art
technology. The objective of providing quality service to the patients can be achieved by
motivating employees to be efficient, dedicated and loyal to the organization, providing regular
on-job-training of employees to ensure continuous improvement in health care, utilizing services
of professionally competent medical consultants and use of latest technology. Motivation is not
necessarily by giving high salaries. There are many other ways to motivate the employees.
Concessions should be given to the employees near ones. There should be regular liaison with
them at all times. Know what the employee wants. There should be active participation of the
employees in the activities of the hospital. In hospital the staff has to cater to the needs of sick,
depressed and agitated lot. Warm ambiences with cheerful and efficient staff help make the
experience of the public a memorable one. Therefore, it is very important that the staff of the
hospital is friendly and comforting, always wearing a smile.
In the two sample hospitals people are recruited on the merit basis but not on other sources.
So the two hospitals are having doctors, nurses, supporting staff with knowledge and skills. In
Apollo the management is giving importance to the reputation of the doctors in the medical
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industry and the Care hospital is giving the importance to the attitude of the people. The
employee motivation is good in two hospitals so they are working very supportively towards
patients problems. In conclusion, it can be stated that the two hospitals are good in their people
mix. Next we will discuss the physical evidence mix in sample hospitals.
Physical Evidence Mix in Hospitals

The physical evidence of service in hospital includes all the tangible representation of the
service. In other words the environment in which the service is delivered and where the firm
and customer interact, and any tangible components that facilitate performance or
communication of the service1 Physical evidence cues provide excellent opportunities for the
hospital to send consistent and strong messages to the service utilisers. Especially physical
evidence is important when consumers have little on which to judge the actual quality of service
they will rely on these cues, just as they rely on the cues provided by the people and the service
process.
Apart from the location, the ambiance of a hospital is also very important for making a
positive impression on patients and their attendants. Therefore, corporate hospitals should be
very, careful about presenting the right kind of atmosphere, which is both hygienic and relaxing,
a large open lawn or garden with a simple layout and comfortable seating arrangement for
patients has become essential for hospitals to remove the perceived risk of patients.
Apart from interior decoration, lighting and ventilation, attention should also be paid to
necessary infrastructure like electricity, water, sewerage, communication and transportation,
security etc. the certifications and awards won by doctors of the hospital and the service
certificates won the hospital can all be displayed at the reception to instill confidence in the
customers.
General elements of physical evidence in hospital:
The physical evidence of hospital includes all aspects of the hospital physical facility (the
services cape) as well as other forms of tangible communication. Elements of services cape that
affect patients and their attendants includes both exterior attributes (such as signage, parking, and
the landscape) and interior attributes (such as design, layout, equipment and dcor). General
elements of physical evidence in hospital are shown in the Table no: 4.4.
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Fig. No: 4.4
General Elements of Physical Evidence Mix in Hospital
Physical Evidence
Services Cape Other Tangibles
Building exterior Uniforms
Parking Reports/ stationary
Signs Billing statements

Hospital
Admissions office Website etc.
Patient care room
Medical equipment
Recovery room etc.
Web Pages and Virtual Services Capes

Hospital website and virtual services capes conveyed over the interest are more recent forms
of physical evidence that hospitals can use to communicate about the service experience, making
services more tangible for customers both before and after purchase.
Consumer researchers known that the design of the physical evidence can influence consumer
choice, expectations, satisfaction, and other behavior. The challenging task of hospitals in many
service settings is to design the physical evidence because it can support the, not only needs and
performances of consumers (patients) but also the employees (doctors, nurses, supporting staff
etc,) simultaneously.
Use of Physical Evidence or Physical Facility
There are three types of service organizations that differ in terms of whom the services cape
will actually affect i.e.
Self-Service Environment: Where the customers perform most of the activities and few if any
employees are involved.
Remote Services: Where there is little or no customer involvement with the services cape. For
example: telecommunications etc,.
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Interpersonal Services: These are placed between the two extremes and represent situations
where both the consumer and the employee must be present in the services cape. Hospitals are
best example for this. In these cases the service cape must be planned to attracts, satisfy, and
facilitate the activities of both consumers and employees simultaneously. Special attention must
also be given to how the services cape affects the nature and quality of the social interactions
between and among consumers and employees.
Complexity of the Physical Facilities
Complexity of the physical facilities depends upon the environment. Some service
environments are very simple with few elements, few spaces, and few pieces of equipment. Such
environments are termed as lean. Some other environments are very complicated with many
elements and many forms like hospitals. They are termed as elaborate environments.
A hospital with its many floors and rooms, sophisticated equipments, and complex variability
in functions performed within the physical facility. In such an elaborate environment, the full
range of marketing and organizational objectives theoretically can be approached through careful
management of the physical facilities.
In a hospital patients room can be designed to enhance patient comfort and satisfaction while
simultaneously facilitating employee productivity. Hospitals that are positioned in the elaborate
interpersonal service cell face the most complex physical facility decisions.
Role of the Physical Evidence in Hospitals
By locating itself in the appropriate cell of the typology, a hospital can start to answer the
following questions.
Who should consulate in making physical facility decisions?
What organizational goals might be targeted through physical facilities design?
How complex is the set of decisions regarding the physical facility?
Within the cells of the typology, the physical facilities can play many roles simultaneously.
An examination of the variety of roles and how they interact makes clear how strategically
important it is to provide appropriate physical evidence of the service.
Package: Similar to a tangible products package, the physical evidence essentially wraps the
service and convey an external image what is inside to consumers. The physical setting of a
service in hospital does the 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
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patient and their attendants expectations. It is a visual metaphor for the intangible service. The
physical surroundings of hospital offer an opportunity to convey an image. The packaging role
extends to appearance of contact personnel through their uniforms or dress and other elements of
their outward appearance.2
Facilitator: The physical evidence can also serve as a facilitator in aiding the performances of
persons of persons in the hospital. How the setting is designed can enhance or inhibit the
efficient flow of activities in the service setting, making it easier or harder for patients and
employees to accomplish their goals. A well-designed functional facility can make the service a
pleasure to experience from the patient point of view and a pleasure to perform from the
employees. On the other hand, poor and inefficient design may frustrate both patients and
employees.
Socializer: The design of the physical facility aids in the socialization of both employees and
consumers in the sense that it helps to convey expected roles, behaviors, and relationships. The
design of the facility can also suggest to consumers what their role is relative to employees only,
how they should behave while in the environment, and what types of interactions are
encouraged.
Differentiator: The design of the physical facility in hospitals can differentiate from its
competitors and signal the market segment the service is intended for changes in the physical
environment can be used to reposition a hospital and/or to attract new market segments. The
design of a physical facility can also differentiate one area of a hospital from another. Price
differentiation is also often partially achieved through variations in physical settings, rooms in
hospitals with more physical amenities cost more, and others may change less. Taking advantage
of this alternative, patients who are willing to occupy the rooms by paying higher price can
experience the service in an entirely different environment.
Human behavior is also influenced by the physical facility in hospitals. Environmental
psychologists suggest that individuals react to places with two general, and opposite forms of
behavior i.e. approach and avoidance. Approach behaviors include all positive behaviors that
might be directed at a particular place, such as desire to stay, explore work and affiliate.3
Avoidance behaviors reflect the opposite i.e. a desire not to stay, to explore, to work, or to
affiliate. In addition to its effect on their individual behaviors, the physical facilities influence the
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nature and quality of consumers and employee interactions. It has been stated that all social
interaction is affected by the physical container in which it occurs4
Employees and customers respond to dimensions of their physical surroundings cognitively,
emotionally, and physiologically. A persons beliefs about a place, a cognitive response, may
well influence the persons emotional response, and vice versa. For example patients who come
into a dentists office that is designed to calm and sooth their anxieties (emotional responses)
may believe as a result that the dentist is caring and competent (cognitive responses).
The perceived physical facilities can have an effect on peoples beliefs about a place and their
beliefs about the people and service found in that place. In a sense the physical facility can be
viewed as a form of nonverbal communication, imparting meaning through what is called object
language5
In addition to influencing beliefs, the perceived physical facility can directly elicit emotional
responses that, in turn, influence behaviors. Just being in a particular hospital environment can
make us feel happy, lighthearted, and relaxed, whereas being in another place may make us feel
sad, depressed, and gloomy. The colors, dcor and other elements of the hospital atmosphere can
have an unexplainable and sometimes very sub consciousness effect on the moods of people in
the place
The physical evidence may also affect the patients and their attendants in purely physiological
ways. Noise may cause physical discomfort, the temperature of patient rooms may cause to
shiver or perspire, the air quality may make it difficult to breath, and the glare of lighting may
decrease ability to see and cause physical pain. A vast amount of research in engineering and
design has addressed human physiological responses to ambient conditions as well as
physiological responses to design6 i.e. called ergonomics.
In general, people respond to the environment in the just as cognitively, emotionally
physiologically and their responses influence how they have in the environment. However, the
response will not be the same for every individually every time. Personality differences as well
as temporary conditions such as moods or the purpose for being there can cause variations in
how people respond to the physical facilities.7 Environment features also influence the behavior
of consumers. Specifically, environmental dimensions of the physical surroundings can include
all of the objective physical factors that can be controlled by the firm to enhance employee and
customer actions. There is a exhaustive list of physical factors i.e. lighting, color, signage,
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textures, quality of materials, style of furnishings, layout, wall dcor, temperature composite
dimensions i.e. ambient conditions, spatial layout and functionality and signs, symbols and
artifacts.
Ambient Conditions
Ambient conditions include background characteristic of the hospital environment such as
temperature, lighting, music, noise, color and smell. All of these factors can profoundly affect
how people feel, think, and respond to a hospital services. In some hospitals at lobby they use
piano music to reduce stress. Some other studies have similarly shown the effect of smell or
scent on consumer responses.8 In hospitals patients and their families believed that unpleasant
odors signified an unclean facility, whereas the odor of cleaning solvents signified that
unpleasant odors were being covered up. As a general rule, ambient conditions affect the five
senses. Sometimes such dimensions may be totally imperceptible (gases, chemicals, infrasound)
yet have profound effects, particularly on employees who spend long hours in the environment.
Special Layout and Functionality
Generally hospital services exist to fulfill specific purposes or needs of patients and their
attendants, spatial layout and functionality of the physical surroundings are particularly
important. Spatial layout refers to the ways in which machinery, equipment, and furnishings are
arranged, the size and shape of those items, and the spatial relationship among them.
Functionality refers to the ability of the same items to facility the accomplishment of consumer
and employee goal.
Signs, Symbols, and Artifacts
Signs, symbols, and artifacts are particularly important in forming first impressions and for
communicating, new service concept in the hospital. When consumers are unfamiliar with a
particular service, they will look for environmental cues to help them categorize the place and
begin to form their quality expectations. In a study of dental hospital it was found that consumers
use the environment, in particular its style of duration and level of quality, as a cue to the
competence and manner of the service provider.9 Many items in the physical environment of the
hospital service as explicit or implicit signals that communicate about the place to its users. Signs
displayed on the exterior and interior of a structure are examples of explicit communicators.
They can be used as labels i.e. name of the hospital, name of the section and so on, for
directional purpose i.e. entrances, exists and to communicate rules of behavior like no smoking,
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do not use cell phones etc. adequate signs have ever been shown to reduce perceived crowding
and stress. Other environmental symbols and artifacts may communicate less directly than signs,
giving implicit cues users about the meaning of the place and norms and expectations for
behavior in the place. Quality material used in construction, artwork, presence of awards,
certificates won by doctors photographs on walls, and personal objects displayed in the
environment can all communicate symbolic meanings and create an overall aesthetic impression.
Therefore physical evidence of hospital is very important to create positive impression in the
minds of patients about the hospital. Now we will discuss the different approaches for
understanding the effects of physical evidence in hospital.
Approaches for understanding the effects of physical evidence in hospitals
There are several ideas, frameworks, psychological models, and research approaches for
understanding the effects of physical evidence and most specifically the effects of physical
facility. There are several guidelines for an effective physical evidence strategy.
Recognize the Strategic Impact of Physical Evidence
Physical evidence can play a prominent role in determining service quality expectations and
perceptions in the hospital. For effective strategy, it must be linked clearly to the hospitals
overall goals and vision. Therefore planners know what those goals are and then determine how
the evidence strategy can support them at a minimum, the basic service concept must be defined,
the target markets identified, and the firms broad vision of its future known. Because physical
evidence decisions are relatively permanent and costly.
Clarify Roles of the Physical Facility
Physical facility can play many roles simultaneously. Hospitals have to examine the variety
of roles and how they interact. Clarifying roles played by the physical facility in a particular
situation will aid in identifying opportunities and deciding just who needs to be consulted in
making facility design decisions.
Asses and Identify Physical Evidence Opportunities
The hospitals has to identify, is there any missed opportunities to provide service evidence?
A strategy might be developed to provide more evidence of service to show customers exactly
what they are paying for. Another set of questions to address concerns whether the current
physical evidence of service suits the needs and preferences of the target market. Finally, does
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the evidence strategy take into account the needs of both consumers and employees? This
question is particularly relevant in making decisions regarding the physical facility.
Frequent or Periodic Updating and Modernizing the Evidence
Even if the vision, goals and objectives of the hospital dont change, time it self takes a toll
on physical evidence, necessitating change and modernization. Therefore some aspects of the
evidence require frequent or at least periodic updating and modernizing. There is clearly an
element of fashion involved, and over time different colors, designs, and styles may come to
communicate different messages.
Work Cross-Functionally
Physical evidence decisions are made overtime and by various functions within the
organization. Usually in the hospital, the decisions regarding employee uniforms may be made
by the human resources area, physical services design decisions may, be made by options
managers, and advertising and pricing decisions may be made by the marketing department.
Thus it is not surprising that the physical evidence of service may at times be less than
consistent. Service mapping, or blue printing, can be a valuable tool for communicating within
the firm, identifying existing service evidence, and providing a springboard for changing or
providing new forms of physical evidence. A multifunction team approach to physical evidence
is often necessary, particularly for making decisions about the physical facility. Now we will
discuss the physical evidence mix in sample hospitals. Now observe the physical evidence mix in
sample hospitals.
Physical Evidence Mix 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 all of the above elements of evidence for each service communicates
something about the service. Apollo hospital located on a 35 acre site, the hospital houses 178
hospital rooms on three floors. What is observed by the researcher about this hospital facility in
the tremendous care that was taken in its design to serve the needs of patients, doctors, staff and
visitors. The hospital is designed as a healing environment focused on patient needs.
When the patients/visitors enter the Apollo, they encounter a five star hotel lobby with
relaxing music through out the day. An abundance of plants and glass gives the lobby a natural
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Exhibit No: 4.1
Apollo Physical Evidence-1
Inner View of Apollo Hospital
Patient Ward
302
Exhibit No: 4.2
International Patient Waiting Area
Patient Waiting Area
303
Exhibit No: 4.3
Equipment at Operation Theater
Equipment at Operation Theater
304
Exhibit No: 4.4
Sewerage
Laundry Services
305
Exhibit No: 4.5
Apollo Entrance
Apollo Signage system
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feel and provides a welcoming atmosphere. On entering visitors see the elevator bank directly in
front of them across the atrium but here the researcher observed that the patients and visitors are
confusing to find where to go.
At patient rooms, there are well marked corridors, the atmosphere becomes even quitter.
Room all of them private are arranged in 20-bed pods surrounding a nursing station. Nurses are
within 40 steps of any patient room. The rooms them selves having features like multi shelf
display area on which patients can put cards, flowers and other personal items. Fold-out,
cushioned bed-chairs are in each room so family members can nap or even spend the night.
Special attention is paid to the ceilings, colored with light shades given pleasant look. All
rooms have windows with curtains and a white board on the wall at the foot of each bed displays
important information that patients want to know like the name of the nurse on duty, the date, the
room, phone number and other information.
In the case of general wards, the pod design puts nurses are not close to their patients. They
are maintaining a single board for all the patients to display the information. Another point
observed by the researcher, the departments are not closely housed each other, so it is creating
problems for free flow of communication and also increasing walking time between areas.
At each and every place in Apollo hospital, there are signs displayed to communicate
information to the patients and visitors. They are also using labels containing department name
etc, and for directional purpose i.e. entrance, exits and to communicate rules of behavior like no
smoking etc.
Exhibit no: 4.1, 4.2, 4.3, 4.4 and 4.5 explore some of the photographs taken from Apollo
hospital. These pictures will give understanding on physical evidence of Apollo hospital. Now
Let us move on to the physical evidence mix in Care hospital.
Physical Evidence Mix In Care Hospital
The physical evidence mix in Care hospital can be described in terms of entrance and lobby
area, parking area, main public entrance, public waiting area, public toilet facilities, signage
system, gift, book and florists 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.
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Physical evidence mix in Care hospital starts from entrance and lobby area. 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 administrative and other areas of the hospital.
The main waiting area provided seating for the largest estimated number of people who may
occupy it at a given time. Here Care hospital is not remembered the fact that all patients are
usually accompanied by one or two relatives or attendants. So researcher has observed that some
people feeling inconvenience for not having seating arrangements. Gift shop, book shop and
florists shop is located off the main lobby but not it is visible to the visitors. There is a coffee
shop-cum-snack bar nearer to the waiting area for the convenience of visitors. Following are the
some of the points observed at main entrance and lobby area of Care hospital by the researcher.
There is a programme board announcing seminars, conferences and other special events
with proper location.
Directory of floor plan and the building.
Senior doctors name board.
Cashiers counter. It is conveniently accessible to the main flow of lobby traffic.
Retiring facility for anxious or braved relatives.
Public waiting area.
Water coolers.
Reception and information centre.
Wheel chairs.
Public toilet facility etc.
There is a simple and effective signage system in Care hospital to find way by the patients.
For this hospital is using simple signs and figures for easy understanding of patients and visitors.
The patients wards are designed with minimum floor are of 300 sq.ft. There is no less than
four feet of space between the beds. Sufficient space is allowed for nurses to pass between the
bed and the wall. Movable furniture in each private room is provided which includes a bed, a
lounge chair, visitors chair, a beside locker and an over bed table etc. The patient room toilet is
provided with a grab bar, an emergency call button within easy reach and a flush valve for
bedpan cleaning are also provided. Electrical outlets for a reading light, nurses call and television
308
Exhibit No: 4.6
Care Hospital Physical Evidence-1
Care Entrance
Care Signage
309
Exhibit No: 4.7
Operatin Theatre
Scanning Equipment
310
Exhibit No: 4.8
Patient Waiting Area
Patient Ward
311
Exhibit No: 4.9
Linen services of Care
Sewerage of Care
312
Exhibit No: 4.10
O.P Ambulance Services
Blood Bank Emergency Services
Pharmacy Services Corporate Partnering
Finance and Insurance Education Programmes
313
is provided at the head of bed, and also the telephone. Windows are located with in three feet
height to allow the patient the outside view. The nursing station is located as centrally as possible
to the activities of the unit, but it is observed that the nurses taking time to enter the patient
rooms from their stations.
The staff following dress code, entire hospital is centralized air conditioned with reasonable
lighting facilities and care is taken for ventilation by air-conditioning. Few photos are given at
Exhibit no: 4.6, 4.7, 4.8, 4.9 and 4.10 will give idea about the physical evidence of Care hospital.
By observing the physical evidence mix in two hospitals, it is cleared that the sample
hospitals are having good physical evidence mix. Now we will take up the perceptions of
Doctors, nurses and administrative personnel about physical evidence mix of the sample
hospitals.
Perceptions of Doctors about the Physical Evidence Mix of Sample Hospitals
Table no: 4.9 representing perceptions of doctors about the physical evidence mix of the
sample Hospitals
Table No: 4.9
Perceptions of doctors about physical evidence mix of the sample hospitals
(1) (2) (3) (4) (5)

NO % %
1 33.32 14.66
2 32.07 52.03
In your opinion, this hospital is making a positive 3 14.66 25.32
1
impression on patients and their attendants. 4 11.97 6.66
5 7.98 1.33
Total 100.00 100.00
1 45.39 21.32
2 20.00 45.39
3 14.66 6.66
2 The interior decoration in this hospital is very good.
4 7.98 14.66
5 11.97 11.97
Total 100.00 100.00
314
1 2 3 4 5
1 20.00 26.66
2 34.71 28.06
Lighting and ventilation in this hospital is good. 3 18.66 25.32
3
Especially in patient wards. 4 11.97 13.30
5 14.66 6.66
Total 100.00 100.00
1 57.40 50.72
2 14.66 26.66
This hospital is good in the aspect of Electricity.
3 7.98 13.30
4
4 13.30 6.66
5 6.66 2.66
Total 100.00 100.00
1 46.68 56.05
2 20.00 26.66
This hospital is good in the aspect of drinking water. 3 1.33 13.30
5
4 20.00 2.66
5 11.99 2.66
Total 100.00 100.00
1 33.34 48.02
2 56.01 41.33
This hospital is good in the aspect of sewerage. 3 6.66 6.66
6
4 2.66 1.33
5 1.33 2.66
Total 100.00 100.00
1 25.40 42.65
2 27.99 37.39
This hospital is good in the aspect of communication. 3 26.66 6.66
7
4 11.97 5.32
5 7.98 7.98
Total 100.00 100.00
1 14.66 1.33
2 25.32 26.66
This hospital is good in the aspect of transportation. 3 38.70 50.69
8
4 14.66 18.66
5 6.66 2.66
Total 100.00 100.00
1 54.73 27.99
2 11.97 52.05
This hospital is good in the aspect of security. 3 20.00 6.66
9
4 5.32 5.32
5 7.98 7.98
Total 100.00 100.00
1 25.32 13.30
2 28.08 33.32
Your hospital is able to build up confidence in the
3 25.32 45.39
10 patients by displaying awards won by doctors and the
4 7.98 6.66
service certificates won by the hospital.
5 13.30 1.33
Total 100.00 100.00
315
The survey was taken up on the opinion, of the Hospital making a positive impression on
patients and their attendants. 75 respondents who participated in the survey, 25 respondents with
respondents with 52.03% expressed. The neutral opinion was taken place among 11 respondents
expressed disagree opinion in Apollo and in case of Care 5 respondents with 6.66% expressed. 6
respondents with 7.98% expressed strongly disagreed opinion in Apollo and only one respondent
with 1.33% expressed. On the whole the majority of respondents are of the opinion that these
Hospitals are making positive impression on patients and their attendants.
As regards the interior decoration in the Hospital is very good 34 respondents with 45.39%
expressed strongly agree opinion in respect of Apollo and in Care 16 respondents with 21.32%
expressed. 15 respondents with 20.00% expressed agree opinion in Apollo and in case of Care 34
respondents with 45.39% expressed. The neutral opinion has taken place from 11 respondents
expressed disagreed opinion against Apollo and 11 respondents with 14.66% in case of Care. 9
respondents with 11.97% expressed strongly disagreed opinion in Apollo and in Care also the
same opinion arrived. From the above analysis, it reveals that most of the respondents are having
opinion that in these Hospitals the interior decoration is very good.
In the aspect of lighting and ventilation in the Hospitals is good, especially in patients wards
the opinion follows as, 15 respondents with 20.00% expressed strongly agree opinion in case of
Apollo and in Care 20 respondents with 26.66% expressed. 26 respondents with 34.71% in
Apollo and 21 respondents with 28.06% in Care Hospital expressed agree opinion. The neutral
opinion was expressed by 14 respondents with 18.66% in Apollo and 19 respondents with
25.32% in Care Hospital. 9 respondents with 11.97% expressed disagreed opinion in Apollo and
10 respondents with 13.30% expressed in case of Care. 11 respondents with 14.66% expressed
strongly disagreed opinion in Apollo whereas in Care 5 respondents with 6.66% expressed. On
the whole, the statement says that a large number of respondents are of the opinion that lighting
and ventilators especially in patients wards in these Hospitals are good.
On the subject of Hospital is good in the aspect of electricity 43 respondents with 57.40%
316
26.66% expressed. The neutral opinion has taken place among 6 respondents with 7.98% in
Apollo and in Care 10 respondents with 13.30% expressed. The disagreed opinion took place
among 10 respondents with 13.30% in Apollo and in case of Care 5 respondents with 6.66%
expressed. 5 respondents with 6.66% expressed strongly disagreed opinion in Apollo and 2.66%
only in case of Care expressed. Most of the respondents are under the opinion that the electricity
supply in this Hospital is good.
The survey turned on the subject of the Hospital having drinking water facility 35
respondents with 46.68% expressed strongly agree opinion in Apollo and in case of Care 45
Apollo and in Care 20 respondents with 26.66% expressed. In Apollo only one respondent with
1.33% but in Care 10 respondents with 13.30% expressed neutral opinion. 15 respondents with
20.00% expressed disagreed opinion in Apollo and in Care 2.66% has expressed. 9 respondents
with 11.99% have expressed strongly disagree opinion in Apollo and only 1.33% has expressed
in Care. From the above analysis of statement, it can be noticed that majority respondents are
under the impression that these Hospitals are having good drinking water facility.
The opinion poll took place on the subject that the Hospital is good in the aspect of
sewerage 25 respondents with 33.34% expressed strongly agree opinion in Apollo and in Care
36 respondents with 48.02% expressed. 45 respondents with 56.01% expressed agreed opinion in
by 5 respondents with 6.66% in Apollo as well as in Care Hospitals. 2.66% in Apollo and 1.33%
in care came forward to express disagree opinion and strongly disagreed opinions in both the
Hospitals of Apollo and Care are 1.33% and 2.66% respectively. From the above discussion it
can be concluded as the respondents in both the sample hospitals having positive opinion on
sewerage.
The survey turned against the aspect of the communication in the hospital is good 19
respondents with 25.40% expressed strongly agrees opinion in Apollo and in Care 32
by 20 respondents with 26.66% in Apollo and 5 respondents with 6.66% in case of Care. 9
respondents with 11.97% expressed disagreed opinion in Apollo and in Care 4 respondents with
317
5.32% expressed. Equal number of 6 respondents with 7.98% expressed strongly disagree
opinion in both the hospitals of Apollo and Care. On going through the above said analysis, it is
noticed that a large number of respondents are of this opinion that communication in respect of
both the hospitals is good.
As regards the hospital is having good transportation facility 11 respondents with 14.66%
expressed strongly agree opinion in Apollo and only 1.33% in Care hospital expressed. 19
26.66% expressed. The neutral opinion took place among 29 respondents with 38.70% in Apollo
and in Care 41 respondents with 50.69%. 11 respondents with 14.66% expressed disagree
opinion in Apollo and 14 respondents with 18.66% in case of Care hospital. 5 respondents with
6.66% expressed strongly disagreed opinion in case of Apollo and 2.66% expressed in Care. On
the whole, the analysis reveals that the respondents are on neutral opinion about the
transportation facility in both the hospitals of Apollo and Care.
On the subject of the hospital is having good security 41 respondents with 54.73%
expressed strongly agree opinion in Apollo and in Care 21 respondents with 27.99% expressed. 9
respondents with 11.97% expressed agree opinion in Apollo and in case of Care 39 respondents
with 52.05% expressed. The neutral opinion came up from among 15 respondents with 20.00%
in Apollo and 5 respondents with 6.66% in Care. 4 respondents with 5.32% expressed disagreed
opinion from each hospital of Apollo and Care. In the same way, 6 respondents with 7.98%
expressed strongly disagreed opinion from each hospital of Apollo and Care. Finally the survey
of statement shows that these hospitals are good in the aspect of security.
The survey has further taken place on the aspect of the hospitals being able to build up
confidence among the patients by displaying awards won by doctors and the service certificates
won by the hospital 19 respondents with 25.32% expressed strongly agree opinion in Apollo
and in Care 10 respondents with 13.30% expressed. 21 respondents with 28.08% expressed agree
opinion in Apollo and in Care 25 respondents with 33.32% expressed. The neutral opinion took
place among 19 respondents with 25.32% in respect of Apollo and in Care 35 respondents with
45.39%. The disagreed opinion took place among 6 respondents with 7.98% in Apollo and in
Care.5 respondents with 6.66%. 10 respondents with 13.30% expressed strongly disagreed
opinion and only 1.33% has expressed in Care. From the above analysis of statement, it can be
noticed that different opinions are expressed. In respect of Apollo almost all the respondents are
318
on the positive attitude, whereas in Care, all the agree opinions and neutral opinions are the
same. Hence it can be concluded that the subject got no importance in minds of respondents.
From the above discussion it can be concluded that, the interior decoration of Apollo hospital
was good comparatively with Care as per the opinion of the respondents. The patients wards of
Care was maintaining good in the aspects of lighting, ventilation etc. In providing drinking water
facilities, un interrupted electricity, sewerage two hospitals are gained respondents support. Care
hospital has to improve the transportation services to the patients by extending the services and
frequency. In the same way Care has improve the security levels by appointing the security
guards in various places of the hospital. Two hospitals are good in arranging communication
facilities by providing coin boxes etc. Apollo is displaying awards won by the doctors and
service certificates at various places but the visitors are not observing because they are not
placed at suitable places. But in Care hospitals these awards won by the doctors and service
certificates displaying at suitable places and they are gaining the attention of the visitors. On the
whole, it is observed that the physical evidence mix is good in two sample hospitals. Let us see
the perceptions of nurses about physical evidence mix of the sample hospitals.
Perceptions of Nurses about the Physical Evidence Mix of Sample Hospitals
Table no: 4.10 representing perceptions of nurses about the physical evidence mix of the
sample hospitals
Table No: 4.10
Perceptions of nurses about physical evidence mix of the sample hospitals
(1) (2) (3) (4) (5)

NO % %
1 40.08 26.64
2 27.30 39.29
1
5 7.32 7.32
Total 100.00 100.00
1 34.10 13.98
2 32.63 52.78
3 13.30 26.64
4 13.98 5.94
5 5.99 0.66
Total 100.00 100.00
319
1 2 3 4 5
1 40.80 26.81
2 39.29 53.28
3
5 6.60 0.66
Total 100.00 100.00
1 40.80 53.40
2 25.97 25.97
3 12.65 0.66
4
4 13.98 13.98
5 6.60 5.99
Total 100.00 100.00
1 27.30 39.17
2 25.97 40.92
5
4 13.30 12.65
5 12.65 0.66
Total 100.00 100.00
1 33.45 27.30
2 32.60 39.43
6
4 7.32 12.65
5 12.65 7.32
Total 100.00 100.00
1 34.10 33.42
2 32.63 39.29
7
4 13.30 12.65
5 7.32 0.66
Total 100.00 100.00
1 27.06 33.66
2 26.74 32.34
8
4 12.54 13.54
5 13.86 0.66
Total 100.00 100.00
1 40.08 53.40
2 39.29 32.63
9
4 5.99 5.99
5 7.32 0.66
Total 100.00 100.00
1 25.97 40.74
2 20.78 19.31
Your hospital is able to build up confidence in the
3 25.97 31.31
10 patients by displaying awards won by doctors and the
4 13.30 7.32
service certificates won by the hospital.
5 13.98 1.32
Total 100.00 100.00
320
The survey has taken place in respect of the hospital making a positive impression on
patients and their attendants. 100 respondents with 40.08% expressed strongly agree opinion in
Apollo and in Care 40 respondents with 26.64% expressed.41 respondents with 27.30%
expressed agree opinion in Apollo and in Care 59 respondents with 39.29% expressed. The
neutral opinion took place among 19 respondents with 12.65% in Apollo and in Care 29
respondents with 19.43%. 19 respondents with 12.65% expressed disagree opinion in Apollo and
in Care 11 respondents with 7.32% expressed. Equal number of 11 respondents with 7.32%
expressed strongly disagree opinion in both the hospitals of Apollo and Care. From the above
analysis, it can be seen that majority of respondents are of the impression that these hospitals are
making positive impression on patients and their attendants.
An opinion poll has taken place on the interior decoration in the hospital is very good. 51
respondents with 34.10% expressed strongly agree opinion in Apollo and in Care 21 respondents
with 13.98% expressed.49 respondents with 32.63% expressed agree opinion in Apollo whereas
in Care 79 respondents with 52.78% expressed. The neutral opinion has taken place among 20
respondents with 13.30% in Apollo and in Care 40 respondents with 26.64%.The disagree
opinion was expressed by 21 respondents with 13.98% in Apollo and in care 9 respondents with
5.94%. 9 respondents with 5.99% expressed strongly disagree opinion in Apollo and in Care
only one respondent with 0.66% expressed. The above analysis of statement shows that a large
number of respondents are of the opinion that interior decoration in both the hospitals is very
good.
An attempt was made on the aspect of lighting and ventilation especially in patient wards in
the hospital is good. 61 respondents with 40.80% expressed strongly agree opinion in Apollo
and in Care 40 respondents with 26.81% expressed.59 respondents with 39.29% expressed agree
opinion in Apollo and in care 80 respondents with 53.28% expressed. The neutral expression was
made by 9 respondents with 5.99% in Apollo and in Care 19 respondents with 12.65%.The
disagree opinion has taken place among 11 respondents with 7.32% in Apollo and 10
respondents with 6.60% in Care hospital.10 respondents with 6.60% expressed strongly disagree
opinion in Apollo and only one respondent with 0.66% expressed in Care. From the above it can
be found that majority of respondents are of the opinion that lighting and ventilation especially in
patient wards in these hospitals is good.
321
As regards the the hospital is good in the aspect of electricity 61 respondents with 40.80%
expressed strongly agree opinion in Apollo and in Care 80 respondents with 53.40%
expressed.39 respondents with 25.97% expressed agree opinion in Apollo and in Care also the
same number of respondents expressed. The neutral opinion has taken place among 19
respondents with 12.65% in Apollo and in Care only one respondent with 0.66%.Equal number
of 21 respondents with 13.98% expressed disagree opinion in both the hospitals of Apollo and
Care.10 respondents with 6.60% expressed strongly disagree opinion in Apollo and 9
respondents with 5.99% expressed in Care hospital. On going through the analysis of statement it
is noticed that majority of respondents are of the opinion that the supply of electricity in both the
hospitals is good.
An opinion poll was taken on the subject of providing drinking water in the hospital is good.
41 respondents with 27.30% expressed strongly agree opinion in Apollo and 58 respondents with
39.17% expressed in Care.39 respondents with 25.97% expressed agree opinion in Apollo and in
Care 62 respondents with 40.92% expressed. The neutral opinion came up from among 31
respondents with 20.78% in Apollo and 10 respondents with 6.60% in Care.20 respondents with
13.30% expressed disagree opinion in Apollo and in Care it was 19 respondents with 12.65. 19
respondents with 12.65% expressed strongly disagreed opinion in Apollo and in Care only one
respondent with 0.66% expressed. The above analysis of statement reveals that a large number of
respondents are of the opinion that these hospitals are good in terms of providing drinking water.
The survey was made to know whether the sewerage condition in the hospital is good. the
50 respondents with 33.45% expressed strongly agree opinion in Apollo and in Care 41
respondents with 27.30% expressed.49 respondents with 32.60% expressed agree opinion in
Apollo and in Care 59 respondents with 39.43% expressed. The neutral opinion has taken place
among 21 respondents with 13.98% in Apollo and in Care 20 respondents with 13.30%. 11
respondents with 7.32% expressed disagree opinion in Apollo and 19 respondents with 12.65%
expressed in Care.19 respondents with 12.65% expressed strongly disagree opinion in case of
Apollo and 11 respondents with 7.32% expressed in Care. On going through the above analysis it
shows that majority of respondents are of the opinion that these hospitals are good in the aspect
of sewerage.
A study was made on the subject of communication in the hospital is good. 51 respondents
with 34.10% expressed strongly agree opinion in Case of Apollo and in Care 50 respondents
322
with 33.42% expressed.49 respondents with 32.63% expressed agree opinion in case of Apollo
and in Care 59 respondents with 39.29%expressed.The neutral opinion came up from among 19
respondents with 12.65% in Apollo and in Care hospital 21respondents with 13.98% expressed.
20 respondents with 13.30% expressed disagreed opinion in Apollo and in Care 19 respondents
with 12.65% expressed. 11 respondents with 7.32% expressed strongly disagree opinion in
Apollo whereas in Care only one respondent with 0.66% expressed. From the above analysis of
respondents, the impression that is carried is that these hospitals are good in respect of
communication.
An attempt was made to know whether the hospital is good in terms of providing
transportation facility. 41 respondents with 27.06% expressed strongly agree opinion in Apollo
and in Care 51 respondents with 33.66% expressed. 39 respondents with 26.74% expressed agree
opinion in respect of Apollo and in Care 49 respondents with 32.34% expressed. Equal number
of 30 respondents with 19.80% expressed neutral opinion in case of both the hospitals of Apollo
and Care. The disagree opinion took place among 19 respondents with 12.65% in the hospital of
Apollo and Care. 21 respondents with 13.86% expressed strangely disagree opinion in Apollo
and in Care is expressed by only one respondent with 0.66%. On going through the above
analysis it can be understood that a large number of respondents are of the opinion that these
hospitals are good in the aspect of providing transportation.
On the subject of the hospital is good in respect of security 60 respondents with 40.08%
32.63% expressed. The neutral opinion has taken place among 11 respondents with 7.32% in
both the Apollo and Care hospitals. In the same way 9 respondents with 5.99% expressed
disagree opinion in both the hospitals of Apollo and Care. 11 respondents with 7.32% expressed
strongly disagreed opinion in Apollo and only one respondent with 0.66% expressed. On the
whole, the analysis says that more number of respondents of both the hospitals are good in the
aspect of security.
On the subject that the hospital is able to build up confidence among the patients by
displaying awards won by doctors and the service certificates won by the hospital 39
with 40.74% expressed. 31 respondents with 20.78% expressed agree opinion in Apollo and in
323
Care 29 respondents with 19.31% expressed. The neutral opinion took place among 39
respondents with 25.97% in Apollo and in Care 49 respondents with 31.31%. 20 respondents
with 13.30% expressed disagree opinion in Apollo and in Care 11 respondents with 7.32%
expressed. 21 respondents with 13.98% expressed strongly disagreed opinion in Apollo and in
Care only 1.32% has expressed. The analysis of statement reveals that a large number of
respondents are of the opinion that displaying awards won by the doctors and the service
certificates won by the hospital will certainly build up confidence among patients.
From the discussion it is noticed that, in providing the transportation services two hospitals
equally performing. Most of the respondents are positively responded for the Apollo is making
positive impression on patients than the Care hospital. In providing drinking water and
uninterrupted power supply Care is better than the Apollo. Lighting, ventilation in patient wards,
sewerage is at satisfactory level in the two hospitals. Two hospitals are arranging communication
facilities equally but in providing security to the patients Care is better than the Apollo hospital.
The awards won by the doctors and service certificates are displaying in Care at proper places to
build the confidence of the patients. In conclusion, it can be stated that the two hospitals are
having good physical evidence mix for marketing their services. Now let us move on to the
perceptions of administrative personnels perceptions on physical evidence mix of sample
hospitals.
324
Perceptions of Administrative Personnel about the Physical Evidence Mix of
Sample Hospitals
Table no: 4.11 representing perceptions of administrative personnel about the physical
evidence mix of the sample hospitals
Table No: 4.11
Perceptions of administrative personnel about physical evidence mix of the sample
hospitals
(1) (2) (3) (4) (5)

NO % %
1 43.00 37.05
2 48.45 45.85
1
5 2.85 5.70
Total 100.00 100.00
1 31.13 34.45
2 48.92 48.45
3 14.25 8.55
4 2.85 5.70
5 2.85 2.85
Total 100.00 100.00
1 34.20 39.90
2 28.05 51.55
3
5 2.85 2.85
Total 100.00 100.00
1 28.50 48.70
2 43.00 39.90
3 14.25 2.85
4
4 8.55 5.70
5 5.70 2.85
Total 100.00 100.00
1 39.90 45.60
2 31.60 43.00
5
4 14.25 5.70
5 2.85 2.85
Total 100.00 100.00
1 48.70 37.05
2 28.50 48.70
6
4 11.40 5.70
5 8.55 5.70
Total 100.00 100.00
325
(1) (2) (3) (4) (5)
1 34.20 40.15
2 23.05 45.60
7
4 14.25 5.70
5 2.85 2.85
Total 100.00 100.00
1 45.60 42.75
2 23.05 31.60
8
4 11.40 14.25
5 5.70 5.70
Total 100.00 100.00
1 45.85 45.85
2 28.50 42.75
9
4 11.40 2.85
5 8.55 2.85
Total 100.00 100.00
1 40.15 45.85
2 37.05 37.05
Your hospital is able to build up confidence in the patients by displaying 3 5.70 2.85
10
awards won by doctors and the service certificates won by the hospital. 4 8.55 8.55
5 8.55 5.70
Total 100.00 100.00
The survey has taken place on the aspect of the hospital making a positive impression on
patients and their relatives Among 35 respondents participated in each hospital, 15 respondents
with 43.00% expressed strongly agree opinion in Apollo and in Care 13 respondents with
37.05% expressed. 17 respondents with 48.45% expressed agree opinion in Apollo whereas in
Care 16 respondents with 45.85% expressed. The neutral opinion took place among only one
respondent with 2.85% in Apollo and also in Care. Only one respondent with 2.85% expressed
disagree opinion in Apollo and in Care 3 respondents with 8.55% expressed. 2 respondents with
5.70% expressed strongly disagree opinion in Care hospital and 2.85% was expressed in Apollo.
On going through the analysis it reveals that majority of respondents are of the impression that
these hospitals are making positive impression on patients and their attendants.
An attempt was made on the interior decoration in the hospital is very good 11 respondents
16 respondents with 48.45% expressed. Neutral opinion has taken place among 5 respondents
326
with 14.25% in Apollo and 3 respondents with 8.55% in Care. The disagreed opinion has taken
place among 2 respondents with 5.70% in Care hospital and only 1 respondent with 2.85% in
case of Apollo. In the same way only one respondent with 2.85% has forward to give strongly
disagree opinion among of the both hospitals of Apollo and Care. It can be observed from the
above analysis of statement that majority of respondents are under the opinion that the interior
decoration in these hospitals are very good.
The opinion poll was conducted among 35 respondents on the lighting and ventilation in the
hospital is good, especially in patient wards 12 respondents with 34.20% expressed strongly
agree opinion in case of Apollo and in Care 14 respondents 39.90% expressed. 10 respondents
with 28.50% expressed agree opinion in Apollo and in Care 17 respondents with 51.55%
expressed. The neutral opinion was expressed by 7 respondents with 19.95% in Apollo and only
one respondent with 2.85% in Care. 5 respondents with 14.95% expressed disagreed opinion in
Apollo and only one respondent with 2.85% expressed in Care. The strongly disagree opinion
was expressed by one respondent with 2.85% in both the hospitals. On going through the above
statement, it is learnt that most of the respondents are under the opinion that lighting and
ventilation in these hospitals is good especially in patient wards.
On the aspect of providing electricity in the hospital is good 10 respondents with 28.50%
39.90% expressed. The neutral opinion came up from 5 respondents with 14.25% in Apollo
where as in Care only 2.85% expressed. 3 respondents with 8.55% expressed disagreed opinion
in case of Apollo and 2 respondents with 5.70% in Care hospital. The strongly disagree opinion
was expressed by 2 respondents with 5.70% in case of Apollo and only one respondent with
2.85% in Care. On the whole it can be understood that majority of respondents are of the
impression that these hospitals are good in the aspect of supplying electricity.
Further study was conducted on the aspect of providing drinking water in the hospital is
good 14 respondents with 39.90% expressed strongly agree opinion in respect of Apollo and in
opinion in Apollo and in Care 16 respondents with 43.00%expressed. The neutral opinion has
come up among 4 respondents with 11.40% in Apollo and only one respondent with 2.85%
expressed the same in Care. 5 respondents with 14.25% expressed disagree opinion in Apollo
327
and in Care 1 respondents with 2.85% expressed. Only one respondent with 2.85% expressed
strongly disagree opinion in both the hospitals of Apollo and Care. From the above analysis, it is
observed that a large number of respondents are of the opinion that these hospitals are having
good facility for supplying drinking water.
The survey has further taken place on the aspect of sewerage in the hospital is good 17
respondents with 48.70% expressed strongly agree opinion in Apollo and 13 respondents with
37.05% in Care hospital expressed. 10 respondents with 28.50% expressed agreed opinion in
Apollo hospital but in Care it is 17 respondents with 48.70%. Equal number of only one
respondent with 2.85% expressed neutral opinion in both the hospitals of Apollo and Care. 4
respondents with 11.40% expressed disagreed opinion in Apollo and in Care two respondents
with 5.70% expressed. 3 respondents with 8.55% expressed strongly disagreed opinion in Apollo
and 2 respondents with 5.70% expressed in Care. Hence it is observed from the above analysis
that more respondents are of the impression that these hospitals are good in the aspect of
sewerage.
An attempt was made on the aspect of communication in the hospital is good. 12
respondents with 34.20% expressed strongly agree opinion in case of Apollo and in Care 14
respondents with 40.15% expressed. In case of agree opinion, 8 respondents with 23.05% in
Apollo and in Care 16 respondents with 45.60% expressed. Neutral opinion expressed by 9
respondents with 25.65% in Apollo and same expressed by only two respondents with 5.70% in
Care hospital. 5 respondents with 14.25% expressed disagreed opinion in Apollo and in Care it is
2 respondents with 5.70%. only one respondent with 2.85% has expressed strongly disagree
opinion in both the hospitals of Apollo and Care hospital. From the above analysis it can be seen
that more respondents are under the impression that in these hospitals of Apollo and Care the
communication is good.
On the aspect of providing transportation in the hospital is good, 16 respondents with
respondents with 31.60% expressed. The neutral opinion was taken place among 5 respondents
with 14.25% and 2 respondents with 5.70% in Apollo and Care respectively. 4 respondents with
11.40% expressed disagree opinion in Apollo and in Care 5 respondents with 14.25% expressed.
2 respondents with 5.70% expressed strongly disagree opinion in Apollo and in Care also the
328
same position has taken place. On going through the analysis it can be seen that in these hospitals
the transportation facility is good.
Further study has taken place on the subject this hospital is good in the aspect of security 16
Care 15 respondents with 42.75% expressed. In both the hospitals of Apollo and Care only 2
respondents with 5.70% expressed neutral opinion. 4 respondents with 11.40% expressed
disagree opinion in Apollo and 2.85% in case of Care hospital. 3 respondents with 8.55%
expressed strongly disagree opinion in Apollo and only one respondent with 2.85% in case of
Care hospital. From the above analysis of statement it can be understood that majority of
respondents are under the impression that these hospitals are good in the aspect of security.
Further the study took place on the aspect of the hospital building up confidence among the
patients by displaying awards won by doctors and the service certificates won by the hospital
Apollo and in Care also the same position has appeared. Neutral opinion has taken place in
respect of Apollo by 2 respondents with 5.70% and in Care only one respondent with 2.85%.
Equal number of 3 respondents with 8.55% expressed disagree opinion in Apollo and in Care. 3
respondents with 5.70% expressed. On going through the statement, it reveals that a large
number of respondents are of the opinion that this hospital is building up confidence among the
patients by displaying awards won by doctors and the service certificates won by the hospital.
From the above discussion it can be concluded that Apollo doing well in the aspects of
making positive impression on patients and interior decoration. In providing lighting and
ventilation in patient wards, uninterrupted power supply, drinking water and sewerage two
hospitals are satisfied maximum respondents. The transportation services of Care hospital
gaining support of the respondents but in Apollo hospital theses service has to improve. In the
same way two hospitals providing good security and having good communication facilities.
Awards won by the doctors and service certificates are properly displaying in the two hospitals
for building the patient confidence. On overall two hospitals are having good physical evidence
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mix. Now we will see the perceptions of respondents (Doctors, Nurses and Administrative
Personnel) with Mean and S.D values to get better understanding.
Mean and Standard Deviation values of Doctors Perceptions on the Physical

Evidence Mix of Sample Hospitals
Table no: 4.12 representing mean and standard deviation values of perceptions of doctors
about the physical evidence mix of the sample hospitals.
Table No: 4.12

Mean and S.D of Doctors Perceptions on the Physical Evidence Mix of the Sample Hospitals
(N=75)
Apollo Care
Sl.No Statement
Mean S.D Mean S.D
In your opinion, this hospital is making a positive impression on
1 2.26 1.24 2.26 0.77
patients and their attendants.
The interior decoration in this hospital is very good.
2 2.00 1.21 2.13 0.89
Lighting and ventilation in this hospital is good. Especially in
3 2.66 1.30 2.46 1.21
patient wards.
4 1.92 1.35 1.73 0.93
This hospital is good in the aspect of drinking water.
5 2.33 1.54 1.52 0.72
This hospital is good in the aspect of sewerage.
6 1.70 0.56 1.60 0.61
This hospital is good in the aspect of communication.
7 2.46 1.21 2.00 1.16
This hospital is good in the aspect of transportation.
8 2.69 1.07 2.93 0.68
This hospital is good in the aspect of security.
9 2.01 1.27 2.13 1.09
10 Your hospital is able to build up confidence in the patients by
displaying awards won by doctors and the service certificates 2.53 1.31 2.46 0.81
won by the hospital.
Table no: 4.12 reveals that the perceptions of doctors on physical evidence in the hospital;
making positive impression on patients (2.26), interior decoration is good (2.00), lighting
and ventilation is good (2.66), electricity is good (1.92), good in the aspect of drinking water
(2.33), good in the aspect of sewerage (1.70), good in the aspect of communication facilities
(2.46), good in the aspect of transportation facilities (2.01), good in the aspect of security
(2.01), able to build up confidence in the patients by displaying awards and certificates by the
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doctors (2.53). In the above discussion it can be said that the respondents are positively
responded for the physical evidence of the hospital.
The response of respondents in Care hospital reveals that on physical evidence making
positive impression on patients (2.26), interior decoration is good (2.13), lighting and
ventilation is good (2.46), electricity is good (1.73), good in the aspect of drinking water
doctors (2.46). The results reveals that the respondents having positive impression on physical
evidence in the hospital.
Mean and Standard Deviation values of Nurses Perceptions on the Physical

Evidence Mix of Sample Hospitals
Table no: 4.13 representing mean and standard deviation values of perceptions of nurses
about the physical evidence mix of the sample hospitals.
Table No: 4.13

Mean and S.D of Nurses Perceptions on the Physical Evidence Mix of the Sample Hospitals
(N=150)
Apollo Care
Sl.No Statement
Mean S.D Mean S.D
1 2.20 1.27 2.26 1.12
2 2.26 1.24 2.26 0.77
3 1.99 1.14 1.99 0.80
patient wards.
4 2.19 1.27 1.93 1.29
5 2.59 1.36 1.92 0.99
6 2.33 1.35 2.32 1.19
7 2.26 1.24 2.06 1.00
8 2.14 1.20 2.13 1.02
9 1.99 1.14 1.68 0.87
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Table no: 4.13 reveals that the perceptions of nurses on physical evidence in the hospital;
making positive impression on patients (2.20), interior decoration is good (2.26), lighting
and ventilation is good (1.99), electricity is good (2.19), good in the aspect of drinking water
doctors (2.66). In the above discussion it can be said that the respondents are positively
responded for the physical evidence of the hospital.

Perceptions on the
Physical Evidence Mix of Sample Hospitals
Table no: 4.14 representing mean and standard deviation values of perceptions of
Adm.People about the physical evidence mix of the sample hospitals.
Table No: 4.14

Mean and S.D of Adm.People Perceptions on the Physical Evidence Mix of the Sample Hospitals
(N=35)
1 2 3 4
Sl.No Statement Apollo Care
Mean S.D Mean S.D

1 1.68 0.83 2.00 1.18
2 1.71 0.71 1.85 0.80
3 2.14 1.14 1.74 0.88
patient wards.
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1 2 3 4

4 2.17 1.07 1.68 0.96
5 2.11 1.02 1.68 0.79
6 2.02 1.33 1.91 1.09
7 2.17 1.09 1.74 0.81
8 2.20 1.20 2.08 1.26
9 2.08 1.33 1.54 0.61
Table no: 4.14 reveals that the perceptions of administrative staff on physical evidence in the
hospital; making positive impression on patients (1.68), interior decoration is good (1.71),
lighting and ventilation is good (2.14), electricity is good (2.17), good in the aspect of
drinking water (2.11), good in the aspect of sewerage (2.02), good in the aspect of
communication facilities (2.17), good in the aspect of transportation facilities (2.20), good in
the aspect of security (2.08), able to build up confidence in the patients by displaying awards
and certificates by the doctors (2.08). In the above discussion it can be said that the respondents
are positively responded for the physical evidence of the hospital.
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Conclusion
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 a good ambience. Right from the reception one finds very cordial and comforting staff.
The ambience plays an important role because when a patient walks in to the hospital he
immediately forms an opinion about the hospital. The staff follows a dress code to show
professionalism and to maintain discipline. The staff is trained to be understanding, warm and
comforting because the clientele that goes to the hospital is usually disturbed or unhappy. The
entire hospital needs to be centrally air-conditioned with good lighting. Ventilation is taken care
of by air-conditioning. Special care should be taken to maintain hygiene, cleanliness in whole
hospital. A hospital has to keep in mind both the aspects of physical evidence that is essential
and peripheral evidence. Physical evidence plays an important role in the hospital where the
patients are already depressed or traumatized and a good atmosphere could make all the
difference.
In two sample hospitals from reception onwards they are maintaining right environment to
create a positive feeling in the minds of the patients and visitors. The interior decoration in
Apollo is some better than the Care hospital. But the two sample hospitals are maintaining good
ventilation, safe drinking water and sewerage. For uninterrupted power supply sample hospitals
are maintaining latest power generators and maintaining well. Transportation system and
communication facilities are maintaining up to the level in two hospitals. Apollo and Care rightly
placing the awards and service certificates won by the doctors for building confidence in the
minds of patients. On the whole, it is observed that the two sample hospitals are having good
physical evidence mix. Finally we will see the last element in 7Ps i.e. process mix in hospitals.
Process Mix in Hospitals

Process is termed as Interactive Marketing in services marketing. It is one of the important
seven components of services marketing mix. 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
quality10
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Interactive marketing take place between contact employee of the service hospital and service
consumers. Through internal marketing, service hospitals prepare contact employees, physically
and mentally, to perform the service. Consumers are also educated and trained to participate in
service production and consumption through external marketing. The actual process of service
production, delivery and consumption takes place simultaneously during the interactions of
contact employees and consumers. The meeting between contact employee and service
consumers is called service encounter
In hospitals services process starts under two broad categories, viz services for inpatients and
those for outpatients. The process for these two services is a little different. The basic process
however starts with reporting at the reception at the appointed time and meeting the doctor
concerned for diagnosis and treatment. If the doctor says that simple medication is required, the
patient can avail of the services as an outpatient. If the doctor says that the patient needs special
continuous care and needs to be admitted to the hospital, then the patient becomes an inpatient.
The services process in hospitals for inpatients are spread over operation theaters, intensive
care units, emergency units, regular wards etc,. Administrative work like registration, stores, diet
for the in-patients, maintenance of the patient records, security etc, is carried on by the staff
assisting the line officers. Apart from the in-house treatment, some hospitals run mobile clinics
to provide patients easy access to services. Providing online consultation is also fast gaining
popularity in the west, though in India, where technical awareness is comparatively low, it may
take some time for the masses to welcome such innovative concepts. Corporate affairs are
managed by professionals specially appointed for this purpose. Affiliated academic institutions
educate and train healthcare professional and research institutions concentrate on discovering
and developing new concepts.
The basic service package of hospital involves a service of activities a patient has to pass
through. The patient will interact with a variety of variables. Each variable has the capacity to
influence the quality perception of the patient. The interacting points from the point of view of a
service consumer are
Physically Setting Of the Service Outlet
Patients interact with the location, exterior of the service outlet, interior service layout and
other elements of the physical environment.
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Tangibles
The equipment, tools, furniture and so on.
Systems
The queue systems, process system, billing payment system, patient information recording
system, communication system and so on.
Co-patients
The patients who are also seeking service from the hospital.
Contact Hospital Employees
The staff at the service counters for interaction with patients.
Other Staff on the Line of Visibility
The supporting staff that may not interact with patients directly but are visible to the patients.
Signage and Other Communication Material
Sign boards, directions, displayed rules and regulations, cautions and other material.
Other Facilities
Drinking water, toilets, ventilation, canteen facilities, and recreation facilities so on.
Among above interacting points, there are four quality generating resources in process mix
for hospital patients are directly involved in the service production systems as quality generating
resource. They are active participants and take part in production. Contact persons are those
employees who directly interact with patients. Any one in hospital can be a contact person
irrespective of his position or job. Interaction may take place directly or face to face or indirectly
over the telephone, fax, mail or internet. Contact personnel are the most crucial resource for a
hospital. The other resources such as system, technology and physical resources work to support
the contact person. Systems operational routines include queuing, billing and payment systems.
When systems and routine are complex and complicated, patients may keep away from the
service. Therefore it is necessary for hospitals to design service-oriented systems and documents
to facilitate an effective interactive process. Physical resources and equipment include all kinds
of resources such as computers, documents and other tools that are used in service production
system. These will influence not only the technical quality of the service but also functional
quality. Therefore, every signal part in hospital has to blend with the total system in order to
perform the service activity qualitatively. The hospital process can be divided into three phases.
This can be explained in the Fig. no: 4.5.
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Fig No: 4.5
A Typical Process in a Hospital
Joining Phase
The Intensive Consumption Phase
Detachment Phase
Feed Back
The Joining Phase

When the services are providing by the hospital, the patient begins with the joining phase.
The three important activities in this phase are the arrival of the patient, registration and the
direction to the next contact. At the arrival phase, the patient looks for parking place. He also
interacts with the watchman or parking boy and seeks assistance. Easy identification of the entry
points the ease of entry and courteous welcome influence the quality perception of the patient.
During registration, easy identification of the registration counter, where a patient has to make an
initial deposits at the in-patient billing counter after which a file is opened in the patients name
to know the patients medical history, the speed of the recording process, the equipment used for
recording, the employ and patient roles during recording, the instruments used, the courteous
intention and empathy from the side of contact employee, the understanding of patient problems,
the space, furniture and the layout at the registration counter. Finally the directions to the next
contact are the issues that influence the patient. At the entry levels as well as during registration,
patient may need to wait for some time. How the wait line is organized and what facilities are
provided for managing the waiting time also matter at this phase. Providing well furnished rooms
latest magazines and entertainment facilities reduce waiting pressure.
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The Intensive Consumption Phase
This phase includes diagnosis where the consultant diagnoses the illness by making the
patients undergo various tests treatment when the illness is treated with proper medication or
surgery etc. Information about from the actions the consultant will instruct the patient
regarding the diet to be followed the medication to be taken when to consult him again etc.
There are many factors that influence the effectiveness of the process at the stage.
Documentation, queue system, time consumed, accuracy, transparency, easy flow, equipment
used, performance of the equipment, piracy, flexibility and exceptions are some of the factors
that influence the quality. At the end of the intensive consumptions phase, the hospital personnel
should try to get confirmation from the patient as to whether the service provided was as per his
expectations or not. This the next phase is called feed back.
The Detachment Phase
The detachment phase includes, discharge of the patient- a patient can be discharged from the
hospital on the advice of the consultant. Payment- after the patient is discharged, the bill will be
paid at the billing counter.
Feed Back
At the phase, the patient is required to fill an evaluation from, which helps the hospital
authorities to know the level of satisfaction delivered by the patient. Patients suggestions are
always valued and considered and many times are very useful for improving the service of the
hospital. A general process of hospital can be observed in Fig. no: 4.6
Fig. No: 4.6
General Process in a Hospital
Finance Billing
Department
Purchase Stores Doctors Patient (external

Department customer)
Nurses
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Within the hospital, if we look at each individual department, we notice that each department
serves the needs of another department, for instance, the purchase department serves the needs of
the stores, and the billing department serves of the finance department, etc. so in a way, each
department is a customer to another department, while at the same time it might be a supplier to
another department. Each department is an internal customer or the other departments.
Only when each unit of the hospital understands who their customers are and what their needs
are, will the hospital develop basis for giving the best service in the most efficient way to the
patient. In a way, each department or unit should consider itself to be a service provider serving
the needs of the customer department. In a superficial level it may seen as if each department is
functioning as an independent unit rather than a team. However, the world-over in many
hospitals that have used this concept, it has found that this kind of a customer-supplier
relationship helps to provide an important system of checks and balances and gives the hospital a
more focused patient orientation.
In the hospital services process mix, the above discussed phases need to be integrated
effectively so that the phase-to-phase delays, communication gaps and flow errors can be either
eliminated or minimized. Hospitals need continuous research to identify service gaps and also to
take measures at the right time eliminate the gaps. Following are the some of the important
measures for effective interactive marketing in hospitals.
Enhancing Patient Participation
Enhancing patient participation in the key for effectiveness in interactive marketing. Patients
may vary in this participative ability. Thee are many intervening variables, including the need
pressure, patient goals time available, situation pressure, mood, impression formed on contact
employees, physical environment, other employees, co-patients, importance of the service, value
of the service and so on, which will influence patients in the participation of service production
and consumption. Hospitals need to identify the factors influencing patient participation and
develop appropriate strategies for encouraging effective participation of service utilisers.
Following are the some of the strategies for encouraging patient participation.
Define the Process Where Patient Have To Perform
It is essential to identify clearly the processes where patient participation is vital for service
quality. In hospitals patient participation at the level of diagnosis and following the treatment by
consuming timely medicines, as per the direction of the doctor, are important for service quality.
339
Hospitals should communicate effectively what roles the patients need to play and what is the
level of expectation from the hospitals point of view. The description of patient job cannot be
universalized. It varies with the types of service and the hospitals desired position within the
industry. Here also, some patient services may require helping themselves, some services
require helping others, and some other may be to promote the hospital by providing word-of-
month endorsements.
Provide an Appropriate Patient Mix
In hospital services delivery process, patients interact quite often with other patients. The
status, culture and behavior of the other patients will influence the level of participation of a
patients significantly. Some patients do not want to take the treatment in the presence of other
known patients. Some like to mix with different age groups. Some may have status preference;
some may not have status barriers. The likes and dislikes of patients with respect to the follow
patients vary. The hospital should study the feelings and dispositions of various categories of
patients and schedule the services, taking into consideration the compatibility of patient mix. In
hospitals compatibility management is very important. According to Martin and Prant
compatibility means a process of first attracting homogeneous consumers to the service
environment, their actively managing both the physical environment and customer-to-customer
encounters in such a way as to enhance satisfying encounters and minimize dissatisfying
encounters. All persons are not right customers for the hospital. People may need to possess
some qualities, skills and positive attitude for a particular service. The hospital must be capable
of attracting the right consumers to make participation more effective. For this hospitals offer
consumer orientation programs to help patients understand the roles they have to play and the
kind of expectations they should have before experiencing the service. In addition to the above,
the code of conduct for consumers training employees to observe consumer-to-consumer
interactions and to be sensitive to potential conflicts will help in enhancing participation of
consumers in the services process mix.
Patient Complaints
In hospitals, if services are performed right at the first time, the question of deficiency or
failure does not arise. But hospitals often face complaints from patients of poor performance,
delayed performance, and no performance or part performance of the hospitals. These complaints
arise due to several reasons. Human error is dominant reason in hospitals. Some times, there is a
340
failure in support services or efficiency variations in contact personnel. Service deficiencies and
failures affect the interactive process and result frequent complaints from patients.
Patients have grievances against hospital service when they experience deficiency in service
or service failures. All patients may not settle their grievances in the same manner. The possible
responses of patients are as follows.
Some patients will take it easy.
Some will wait for failure the second time.
Some do not complain but vote with the feet.
Some complain but do not shift loyalty.
Some complains; seek compensation; promote negative word-of-mouth; do not continue.
From the above discussion it becomes clear that there are two types of responses from the
patients when there is a service deficiency or failure. The responses are: to complain and not to
complain.
The aggrieved patients may choose any of the following to make their complaint.
The contact employee.
The in charge of the particular service section.
The corporate office.
The police.
The consumer court.
Managing Patient Complaints
Hospitals need to give special importance to handling complaints from the patients. When
complaints are handled properly, the patients, whose grievance was settled, became a strong
loyalist to the hospital. Hospitals should provide accessible complaint making facilities at every
servicing section. Hospitals should believe in the philosophy that complaints are opportunities
to excel and encourage patients to register even minor grievances. Such steps indicate the
positive orientation of the hospital. Following are the steps for complaint handling.
Registration: A mechanism needs to be discharged to register each and every complaint and to
give an identity number to each complaint.
Acknowledgement: Each complains should be acknowledged and be communicated to by
identity number of his complaint.
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Collection and Classification: The complaints received at various service outlets should be
pooled and classified. The complaints classified need to be routed to the responsible personnel in
the organization.
Analysis and Responses: Complaints need to be analyzed and a proper and early response given
to each and every complaint.
Consumer Grievance Recovery Strategies
Sincere efforts by the service provider are essential to settle the grievances of the patients.
Negligence on the spot results in another service failure and triggers consumer grievance further.
Prof. Rammohan Rao has suggested recovery strategies for services marketing. This can be
shown in the Fig.no: 4.7
Fig. No: 4.7
Strategies for Recovery
Apology Do it right
again
Compensate
Do it first
Value Aggrieved
Consumer
Institutionalize
Correction
Process Do it
more
Source: Prof. K. Ramohan Rao, Services Marketing Pearson Education, p.241.
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Apology: The intensity of grievance can be reduced by apologizing sincerely to the aggrieved
patient. Here the hospitals have to observe that, all the patient complaints may not be correct or
rational. Some patients have the habit of finding fault in everything; some may not have
sufficient information to develop expectations. Experts suggest that though the patient may be
wrong, the hospital should not feel that he has a right to be angry about such complaints.
Fast Response: A fast response will ensure a happy patient and the hospital may find him a
positive word-of-mouth campaigner. Otherwise, delay in settlement of grievance may multiply
the problems of the hospital and may also provide time to the aggrieved patient to spread
negative word-of-mouth because the aggrieved patient do not have the patience to wait for longer
time to settle their grievances.
Compensate for the Damage Done: Some times a service failure may lead to the death of a
patient, in such a situations the hospital can not rectify the mistake. The only way is
compensating the damage done. Hospitals may reduce the grievance through the payment of
compensation. In selective cases of hospital services delivery, one of the best ways is doing the
service correctly again.
Improving the Quality: By offering better quality level service to the hospital service
consumers when there is a service failure, the hospital can turn the patients grievance into
delight.
Institutionalizing Correction Process: The settlement of a complaint relating to one service
outlet should not be the end of the problem. Hospitals should address the grievances of patients
and also focus upon correction processes. Hospitals should study the possibility of the
occurrence of such failures in other service outlets and take precautionary measures. The
corrective measures in the process reduce complaints and improve efficiency. The reasons for
deficiencies need to be identified; analyzed and appropriate measures have to be initiated for
prevention. For this the involvement of employees as well as patients yields good results.
Hospital should seek suggestions from patients as well as employees and incorporate them as per
their suitability.
From the above discussion it can be concluded as the efficient performance in hospital
services delivery process can save a poorly designed or defective technical service. But an
effective technical service with a very poor delivery process can not yield desired result.
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Hospitals here one thing should be remember that the patients in hospitals cannot be controlled
but can be influenced. Now let us move on to the process mix in sample hospitals.
Process Mix 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 prior permission 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.
At the registration counters, patients information forms are available and those who want to
get treatment have to fill up the forms with all the required details as sought by the hospital. The
Apollo is charging Rs.150/- towards registration in the hospital. The patients information is
recorded in two files. One is given to the patient and the other file is kept in the office for official
use. All documents relating to the patients disease are kept in these files. The patients are asked
to wait at the patient waiting halls till their stipulated time comes for consultation.
The Apollo management has taken meticulous care in providing all required amenities in the
waiting halls, where the patients feel relaxed. The patient record files are handed over to the
concerned doctors secretaries. Approximately Rs.300 to 600 is charged towards consultation
fee. Then the patients are called and sent to nurses assessment rooms for general checkup of
their health, like blood pressure, weight, height etc. All the findings are recorded in the patients
files. Then the patients are taken to the Assistant doctors for further consultation. Basing on the
reports, the doctors diagnose the disease or sometimes if required, the patients will be sent for
further diagnostic tests. In that situation, the patients may have to move to the pathology
department for further investigation of their disease. In the pathology department, the clinical
clerks attend to the patients and conduct the required tests and the findings are reported back
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Chart No: 4.1
Flow Chart of Process Mix in Apollo Hospital (Main Block)
Blood
Collection Area Toilets
Echo/ECG/TM
Emergency T/Holter
Microbiology
Blood Bank
Hematolog
Emergency Report y
Tele
Medicine Registration
Tissuety Ping & Mmunopathology
& EOT Cardiology Counters

Hisb Pathology & Cytology
PFT Consultation
Lab Lobby
Entrance
Help Desk
Lift
Reception
Pharmacy
MRI
Cath Lab
Consult O.P. Cash

ation Counter
CTS Scan Consultation Suit
345
Chart No: 4.2
Flow Chart of Process Mix In Apollo Hospital (Second Block)
Patient Service
International
Libestro Restaurant
ECHO
TMT
TMT
Lift
10 11 12 13
Lift
Entrance
Apollo
ECG
Health
Check
Travel
Pharmacy
s
Ultra Blood Department
X-Ray
Collection Of Basement
Desk
Help
Sound Apollo Health Registration Counter
Psychology Toilets Checkup
346
Chart No: 4.3
Flow Chart of Process Mix in Apollo Hospital (Third Block)
Diet Clinic Diabetic Centre Blood Nurses Assessment

Collection Room
Area
Center for Liver Disease
Lift Cash
Counter
Lithotripsy
Lift
Cash
Counte
r
Toilets
Toilet
Gynecology, Aandrology Lab, Ultrasound Aesthetic Centre
Department Of Consultation
Urology
347
with in one to two hours to the patients by collecting required charges. On examining the
reports, the patients get treatment from senior doctors.
In case of any complexity, which requires for the patients to stay in the hospital wards for
close monitoring of the progress of health, the patients have to stay as in-patient in the
hospital as per the recommendations of the doctors. Hospital pharmacy is opened all the 24
hours for the benefit of the patients. X-ray Units, Ultra Sound, Blood Bank, ECG Unit,
Apollo Health Checkup, Diabetic Center, Direct Clinic, Center for Liver Diseases,
Cardiology Consultancy, Echo/ECH/TMT/Halters/PFT Labs, Microbiology Labs,
Hormonology, CTS Scan Department of Urology, Aesthetic Center, Gynecology,
Aandrology, Lithotripsy like all these departments have been arranged in one premises at
different blocks for the convenience of the patients in getting wholesome and timely
treatment. Chart no: 4.1, 4.2 and 4.3 will explain the process mix of Apollo hospital.
Process Mix 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.
As and when the turn of the patient comes, he may go to the concerned doctors chamber
for consultation. In case of any delay at the doctors room, the patients may have to wait a
couple of minutes at the sub-waiting halls adjacent to the doctors chamber. After the
consultation, the patient will have to move to the department concerned as per the direction of
the doctor. If the doctor recommends for any diagnosis or therapeutic examination like X-ray,
ECG, physical therapy etc, the patients may have to move to diagnostic center situated in the
first and second floors of the hospital. In case of treatment or for purchase of medicine, the
patients may have to go to treatment centre or pharmacy situated at ground floor as shown in
the flow chart.
348
Based on the clinical examinations and the gravity of the ill health, the patients may be
recommended to join as inpatient. Spacious and hygienic patient wards with all the facilities
are provided in the third and fourth floors in the hospital as shown in the flow chart 3.
Patients may undergo treatment while staying in the patients wards for the required period of
time. In case of emergency medical cases, the care hospital staff responds immediately and
attends to the patients without any further delay. The patient will be shifted either to the
surgery room or wards as per the medical need after providing first aid.
In case of maternity patients, a special maternity ward with adjacent delivery room is
provided as shown in the flow chart no:. The care hospital allows visitors in to premises
during stipulated hours. They also have to take the prior permission in consultation with the
department of registration before visiting their relatives or friends in the hospital. The people
visiting the hospital for various other purposes like medical certificates, insurance claims,
medical records etc, have been provided with all the facilities in the department of social
services as shown in the flow chart no: 4.5. To facilitate the easy payment or settlement of
hospital bills and to avoid congestion, Care hospital is providing 6 cash counters within the
reach of the patients and their attendants. Chart no: 4.4, 4.5, 4.6 and 4.7 explores the process
mix of Care hospital.
349
Chart No: 4.4
Flow Chart of Process Mix In Care Hospital
Nursing Floors/wards (Second and Third Floors)
Nursery
Diagnostic services
(X-ray, Clinical Lab
Etc). other Therapeutic
Services (Physical Services
Therapy, Inhalation Support services
Therapy, etc.) ECG, (kitchen, laundry,
Pharmacy etc. Surgery Delivery CSSD, etc.) storage,
Room Mechanical Plant,
etc.
Out patient Emergency Administration

Department Room
Out Patients Emergency Maternity Staff Patients Visitors

Patients Patients
350
Chart No: 4.5
Flow Chart of Process Mix in Care Hospital
(Administrative Department)
Out Patient Department

Hospital Departments
Wards
Medical Director Chief

Records Social Service Nursing Executive
Officer
Admitting
Staff Staff
lockers
Conference
Lounge
Library Cashier
Toilets Lobby Gift
Shop
Registration Florist
Toilets Business
Information Waiting Telephone
Telephone Office
Staff Patients Visitors
351
Chart No: 4.6
Flow Chart of Process Mix In Care Hospital
(Obstetrics Department)
Patient Rooms/Wards
Nursery
Recovery
Nursery
Delivery Rooms
Delivery
Room
Scrub-Up
Labor Rooms
Supervisor
Doctors Nurses
Change Preparation Fathers
Change
Room Room Waiting Sub-sterilizing
Rooms Room
Clean-up
Doctors Nurses Patients Supplies, Janitors Closet,

stretchers
352
Chart No: 4.7
Flow Chart of Out Patient Department in Care Hospital
Patient Patient
Wards Wards
(Third Diagnostic & Therapeutic Facilities (X- Ray Labs, (Third
and ECG, Physical Therapy, etc.) and
Fourth (First and Second Floor) Fourth
Floor) Floor)
Treatment Pharmacy
(Ground Floor) (Ground Floor)
Doctors Offices Consultation, Examination, Minor

Procedures, etc. & Dental Services.
( Ground and First Floor)
Sub Waiting Sub Waiting

(Ground Floor) (Ground Floor)
Social Admitting
Service (Ground Floor)
Records Waiting Toilets
Appointment
Information Telephones
Medical record Registration
Department
Out patient & Visitors
353
By observing the process mix in two sample hospitals it is cleared that the hospitals designed
process for different categories of hospital services utilisers in a simple manner. Without any
confusion patients can move in the process to get their required service in the hospital. Further it
is also cleared that the two hospitals designed the process by keeping the time factor, and
maintaining least possible time to finish the treatment for the patients.
Let us see the perceptions of Doctors, nurses and administrative personnel about the process
mix of the sample hospitals.
Perceptions of Doctors about the Process Mix of Sample Hospitals

Table no: 4.15 representing perceptions of doctors about the process mix of the sample
hospitals
Table No: 4.15
Perceptions of doctors about process mix of the sample hospitals
(1) (2) (3) (4) (5)

NO % %
1 2.66 1.33
2 2.66 13.30
In this hospital, to get treatment the process is very 3 31.99 14.66
1
lengthy and time consuming. 4 50.72 64.05
5 13.30 6.66
Total 100.00 100.00
1 20.00 26.66
2 52.04 45.36
3 14.66 18.66
2 Your hospital bill settlement process is simple.
4 5.32 6.66
5 7.98 2.66
Total 100.00 100.00
1 31.91 34.65
2 34.65 25.32
The process to discharge the patient is simple in this 3 12.12 13.30
3
hospital. 4 14.66 20.07
5 6.66 6.66
Total 100.00 100.00
354
1 2 3 4 5
1 13.30 13.30
2 25.32 18.74
The process for emergency discharge is complicated in 3 14.66 21.32
4
this hospital. 4 32.06 25.32
5 14.66 21.32
Total 100.00 100.00
1 39.90 20.00
2 36.12 65.36
3 14.66 7.98
5 Service counters provided in this hospital are sufficient.
4 6.66 6.66
5 2.66 2.66
Total 100.00 100.00
1 13.30 6.66
2 50.72 64.05
The length of waiting time of patients in this hospital is 3 31.99 14.66
6
reasonable. 4 1.33 13.30
5 1.33 1.33
Total 100.00 100.00
The survey has taken place in respect of the hospital treatment process is very lengthy and
time consuming 75 respondents participated in the survey, out of which two respondents with
2.66% in Apollo hospital and one respondent with 1.33% has expressed strongly agree opinion in
Apollo and Care respectively.10 respondents with 13.30% expressed agree opinion in Care
hospital whereas in Apollo only 1.33% has expressed the same. The neutral opinion has taken
place from among 24 respondents with 31.99% in Apollo and in Care 11 respondents with
14.66%.The disagree opinion took place among 38 respondents with 50.72% in Apollo and in
Care 48 respondents with 64.05% expressed. 10 respondents with13.30% expressed a strongly
disagree opinion in Apollo and in Care 5 respondents with 6.66% expressed. On the whole it
reveals that the respondents are of the opinion that the treatment in the hospital is very lengthy
and time consuming is not agreeable.
A study was made on the aspect of billing process for settlement in the hospital is simple. 15
case of Care 34 respondents with 45.36% expressed. The neutral opinion took place among 11
respondents with 14.66% in Apollo and in Care 14 respondents with 18.66% expressed. The
disagreed opinion took place among 4 respondents with 5.32% in Apollo and in Care hospital 5
355
opening in Apollo and two respondents with 2.66% in Care hospital expressed. On going through
the analyses of statement, it can be noticed that a large number of respondents are of the opinion
that the billing process for settlement is simple in these hospitals.
As regards the procedure to discharge the patient is simple in the hospital 24 respondents
34.65% expressed. Agree opinion in Apollo and in Care 19 respondents with 34.65% expressed.
9 respondents with 12.12% expressed neutral opinion in Apollo and in Care 10 respondents with
13.30% expressed. 11 respondents with 14.66% expressed disagreed opinion in Apollo and in
Care 15 respondents with 20.07% expressed. 5 respondents with 6.66% expressed strongly
disagreed opinion in Apollo and in Care also expressed same number of respondents. On going
through the above analysis it can be seen that majority of respondents are of the opinion that the
procedure to discharge in the hospital is simple.
An attempt was made to know on the procedure for emergency discharge is complicated in
the hospital. 10 respondents with 13.30% expressed strongly agree opinion in Apollo and in
Care also the same number of respondents expressed. 19 respondents with 25.32% expressed
agree opinion in Apollo whereas in Care 14 respondents with 18.74% expressed. The neutral
opinion was taken place among 11 respondents with 14.66% in Apollo and in Care 16
respondents with 21.32%. 24 respondents with 32.06% expressed disagree opinion in Apollo and
in Care 19 respondents with 25.32% expressed. 11 respondents with 14.66% expressed strongly
disagree opinion in Apollo in Care 16 respondents with 21.32% expressed. On going through the
above analysis, it is understood that most of the respondents are under the impression that in both
the hospitals of Apollo and Care the procedure for emergency discharge is not complicated.
The study further extended on the service counters provided in the hospital is sufficient. 30
Care 47 respondents with 62.70% expressed. The neutral opinion has taken place among 11
respondents with 14.66% in Apollo and 6 respondents with 7.98% in Care. Equal number of 5
respondents with 6.66% expressed disagree opinion in Apollo and Care hospitals. 2 respondents
with 2.66% expressed strongly disagreed opinion in Apollo and only 2.66% has expressed the
356
same in case of Care hospital. From the above analysis it can be known that majority of
respondents are satisfied with the number of service counters provided in these hospitals.
The opinion poll has taken place on the length of waiting time of patients in the hospital is
reasonable. 10 respondents with 13.30% expressed strongly agree opinion in Apollo and in Care
5 respondents with 6.66% expressed, 38 respondents with 50.72% expressed agree opinion in
Apollo and in Care 48 respondents with 64.05% expressed. The neutral opinion has taken place
among 24 respondents with 31.99% in Apollo and in Care 11 respondents 14.66%. The
disagreed opinion was 1.33% expressed by respondent in Apollo and in Care 10 respondents
with 13.30%. The strongly disagree opinion has taken place from 2.66% of the respondents in
Apollo and in Care it is 1.33%. On going through the above analysis, it can be noticed that a
large number of respondents are of the opinion that the length of waiting time of patients in these
hospitals is reasonable.
From the above discussion it can be stated that, the bill settlement is easy at Care hospital
than Apollo. Some times it is observed in Apollo patients are feeling difficult while they are
discharging. Two hospitals are not creating any complications when the patient is discharging on
emergency situations. Further it is observed that the 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. On the whole, it is observed that the process mix is good in the two sample
hospitals. Now we will take up the perceptions of nurses about the process mix of the sample
hospitals.
357
Perceptions of Nurses about the Process Mix of Sample Hospitals
Table no: 4.16 representing perceptions of nurses about the process mix of the sample
hospitals
Table No: 4.16
Perceptions of nurses about process mix of the sample hospitals
(1) (2) (3) (4) (5)

NO % %
1 1.32 1.32
2 1.32 1.32
1
5 26.64 33.04
Total 100.00 100.00
1 26.64 13.30
2 26.10 53.49
3 27.30 7.32
2 Your hospital bill settlement process is simple.
4 13.30 19.90
5 6.66 5.99
Total 100.00 100.00
1 52.13 25.42
2 27.30 57.30
The process to discharge the patient is simple in this 3 6.66 13.98
3
hospital. 4 5.99 1.32
5 7.92 1.98
Total 100.00 100.00
1 5.99 1.98
2 7.32 13.30
The process for emergency discharge is complicated in 3 19.99 33.00
4
5 19.99 7.32
Total 100.00 100.00
1 39.96 13.98
2 39.96 64.73
3 5.99 5.99
5 Service counters provided in this hospital are sufficient.
4 7.32 13.98
5 6.77 1.32
Total 100.00 100.00
1 26.75 32.63
2 48.65 34.37
The length of waiting time of patients in this hospital is 3 20.64 29.04
6
reasonable. 4 1.98 1.98
5 1.98 1.98
Total 100.00 100.00
The survey has taken place on the subject of the hospital treatment the process is very
lengthy and time consuming Out of 150 participants involved, two respondents with 1.32% has
expressed strongly agree, or agree opinions in both the hospitals of Apollo and Care. Neutral
358
opinion has taken place among 31 respondents with 20.75% in Apollo and in Care 46
respondents with 30.36%. The disagreed opinion has taken place among 75 respondents with
49.97% in Apollo and in Care 51 respondents with 33.96%. 40 respondents with 26.64%
expressed strongly disagreed opinion in Apollo and in Care 49 respondents with 33.04%. From
the above analysis of statement it can be understood that majority of respondents in both the
hospitals do not agree with the statement of treatment procedure is very lengthy and time
consuming.
An attempt was made whether the hospital bill settlement process is simple 40 respondents
13.30% expreesed.39 respondents with 26.10% expressed agree opinion in Apollo and in Care
80 respondents with 53.49% expressed. The neutral opinion has taken place among 41
respondents with 27.30% in Apollo and in Care 11 respondents with 7.32%.The disagree opinion
has taken place among 20 respondents with 13.30% in Apollo and in Care 30 respondents with
19.90%. 10 respondents with 6.66% expressed strongly disagreed opinion in Apollo and in Care
9 respondents with 5.99% expressed. The analysis of statement, reveals that majority of
respondents are of the opinion that in these hospitals bill settlement process is simple.
An Opinion poll was conducted in the aspect of procedure to discharge the patient is simple
in this hospital. 79 respondents with 52.13% expressed strongly agree opinion in Apollo and in
opinion in Apollo and in Care 86 respondents with 57.30% expressed. The neutral opinion has
taken place among 10 respondents with 6.66% in Apollo and in Care 21 respondents with
13.98% expressed. The disagreed opinion has taken place among 9 respondents with 5.99% in
Apollo and two respondents with 1.32% only expressed in Care. 11 respondents with 7.92%
expressed strongly disagreed opinion in Apollo and 3 respondents with 1.98% in case of Care.
From the above statement, it is understood that a large number of respondents are of the opinion
that the procedure to discharge the patient is simple in these hospitals.
As regards the process of emergency discharge is complicated in this hospital 9 respondents
with 5.99% expressed strongly agree opinion in Apollo and in Care three respondents with
1.98% has expressed. 11 respondents with 7.32% expressed agree opinion in Apollo and in Care
20 respondents with 13.30% expressed. The neutral opinion was expressed by 30 respondents
with 19.99% in Apollo and in Care 50 respondents with 33.00% expressed. 70 respondents with
359
46.71% expressed disagreed opinion in Apollo and in Care 66 respondents with 44.40%
expressed. 30 respondents with 19.99% expressed strongly disagree opinion in Apollo and in
Care 11 respondents with 7.32% expressed. It can be seen from the above analysis of statement
that majority of responds are of the impression that the procedure for emergency discharge is not
complicated in these hospitals.
The survey further has taken place in respect of service counters provided in the hospital are
sufficient 60 respondents with 39.96% expressed strongly agree opinion in Apollo and in Care
21 respondents with 13.98% expressed. Agree opinion in Apollo by 60 respondents with 39.96%
and in Care 97 respondents with 64.73% expressed. Equal number of 9 respondents with 5.99%
expressed neutral opinion in both the hospitals of Apollo and Care. 11 respondents with 7.32%
respondents with 6.77% expressed strongly agree opinion in Apollo and in Care two respondents
with 1.32% has expressed. On going through the above analysis of the statement, it can be
understood that a large number of respondents are under the opinion that the service counters
provided in these hospitals are sufficient.
The survey further extended on the aspect of the length of waiting time of patient in the
hospital is reasonable. 40 respondents with 26.75% expressed strongly agree opinion in respect
of Apollo hospital and in Care hospital 49 respondents with 32.63% expressed. 73 respondents
with 48.65% expressed agree opinion in Apollo and in Care 51 respondents with 34.37%. The
neutral opinion also came up among 31 respondents with 20.64% in Apollo and in Care 46
respondents with 29.04% expressed. There are three respondents with 1.98% of respondents
expressed disagree and strongly disagree opinion in both of the hospitals Apollo and Care. From
the above analysis of the statement, it is known that majority of respondents are of the
impression that the waiting time of patients in these hospitals is reasonable.
From the above discussion it can be concluded that the process for discharging the patient
are feeling comfortable at Apollo than Care hospital. The bill settlement process is getting
acceptance in the two hospitals but in emergency conditions patients are feeling difficult for their
procedure in Care hospital. In the case of waiting time at doctor, Care is better than the Apollo
hospital. Majority of the respondents are complainting that they are wasting time at service
counters. On overall the process is good to get the treatment in two hospitals.
360
Perceptions of Administrative Personnel about the Process Mix of Sample
Hospitals
Table no: 4.17 representing perceptions of administrative personnel about the process mix of
the sample hospitals.
Table No: 4.17
Perceptions of administrative personnel about process mix of the sample hospitals
(1) (2) (3) (4) (5)

NO % %
1 2.85 2.85
2 5.70 2.85
1
5 2.85 28.50
Total 100.00 100.00
1 37.30 34.45
2 39.90 51.30
3 5.70 2.85
2 Your hospital bill settlement process is simple. 4 8.55 5.70
5 8.55 5.70
Total 100.00 100.00
1 48.70 39.90
2 39.90 45.85
The process to discharge the patient is simple in 3 2.85 2.85
3
5 2.85 5.70
Total 100.00 100.00
1 31.35 2.85
2 28.50 54.15
The process for emergency discharge is 3 23.05 20.20
4
complicated in this hospital. 4 14.25 14.25
5 2.85 8.55
Total 100.00 100.00
1 43.00 34.45
2 28.50 28.50
Service counters provided in this hospital are 3 2.85 28.50
5
sufficient. 4 17.10 8.55
5 8.55 2.85
Total 100.00 100.00
1 2.85 28.50
2 51.30 51.55
The length of waiting time of patients in this 3 37.30 14.25
6
hospital is reasonable. 4 5.70 2.85
5 2.85 2.85
Total 100.00 100.00
361
The survey has been undertaken about the treatment process is very lengthy and time
consuming in the hospital. 35 respondents participated in this survey, out of which only one
respondent with 2.85% expressed strongly agree opinion in Apollo and Care hospitals. 2
respondents with 5.70% expressed agree opinion in Apollo and one respondent with 2.85% in the
case of Care. The neutral opinion has taken place among 13 respondents with 37.30% in Apollo
and in Care 5 respondents with 14.25%.16 respondents with 51.55% expressed disagree opinion
in Apollo and 20 respondents with 57.25% expressed in Care. Only one respondent with 2.85%
expressed strongly disagree opinion in Apollo and in Care 10 respondents with 28.50%
expressed. On the whole it is understood that majority of respondents are under the impression
that the statement treatment procedure is very lengthy and time consuming is not agreeable.
An opinion poll was conducted on the statement of hospital bill settlement process is simple
Apollo and in Care 18 respondents with 51.30% expressed. Only two respondents with 5.70%
expressed neutral opinion in both the hospitals of Apollo and Care. 3 respondents with 8.55%
respondents with 5.70% expressed. The analysis of the statement reveals that majority of
respondents are of the opinion that these hospital bill settlement procedure is simple.
An attempt was made on the subject the procedure to discharge the patient is simple in the
hospital 17 respondents with 48.70% expressed strongly agree opinion in Apollo and in Care 14
Apollo and in Care 16 respondents with 45.85% expressed. Only one respondent with 2.85%
expressed neutral opinion in Apollo and in Care also. 2 respondents with 5.70% expressed
disagreed opinion in both the hospitals of Apollo and Care. One respondent with 2.85% has
expressed strongly disagree opinion in Apollo, but two respondents with 5.70% expressed same
opinion in Care. From the above opinions, it is understood that a large number of respondents are
of the opinion; the process of discharging the patient is simple in both the hospitals of Apollo
and Care.
As regards the process for emergency discharge is complicated in the hospital 11
respondents with 31.35% expressed strongly agree opinion in Apollo whereas in Care it is one
362
respondent with 2.85% only has expressed. 10 respondents with 28.50% expressed agree opinion
in case of Apollo and in Care 19 respondents with 54.15% expressed. The neutral opinion has
taken place among 8 respondents with 23.05% in Apollo and in Care 7 respondents with 20.20%
expressed. Equal number of 5 respondents with 14.25% expressed disagree opinion in both the
hospitals of Apollo and Care. 3 respondents with 8.55% expressed strongly disagreed opinion in
respect of Care and only one respondent with 2.85% has expressed in Apollo. From the above
analysis of statement, it can be understood that majority of respondents are of the opinion that
the procedure for emergency discharge is not complicated in these hospitals.
The survey has been extended in respect of service counters provided in the hospitals are
sufficient 15 respondents with 43.00% have expressed strongly agree opinion in Apollo and in
Care 11 respondents with 31.60% expressed. Equal number of 10 respondents with 28.50%
expressed agrees opinion in both the hospitals of Apollo and Care. 10 respondents with 28.50%
expressed neutral opinion in case of Care and one respondent with 2.85% has expressed in
Apollo. 6 respondents with 17.10% expressed disagree opinion in Apollo and in Care 3
opinion in case of Apollo and one respondent with 2.85% in Care hospital. On going through the
above analysis of the statement, it can be understood that a large number of respondents are
under the opinion that the service counters provided in these hospitals are sufficient.
On subject of the length of waiting time of patients in the hospital is reasonable one
respondent with 2.85% expressed strongly agree opinion in Apollo and 10 respondents with
28.50% expressed in case of Care.18 respondents with 51.30% expressed agree opinion in case
of Apollo and in case of Care 18 respondents with 51.55% expressed. The neutral opinion has
taken place among 13 respondents with 37.30% in Apollo and in case of Care 5 respondents with
14.25%. Two respondents with 5.70% expressed disagreed opinion in case of Apollo and one
respondent with 2.85% in case of Care expressed. Only one respondent with 2.85% expressed
strongly disagree opinion expressed in both the hospitals. The above analysis of statement
expresses that majority of respondents are of the opinion that the length of waiting time of
patients in these hospitals is reasonable.
From the above discussion it is noticed that the length of waiting time at doctors in Care is
better than the Apollo hospital. But in Care majority of respondents are not satisfied with the
number of service counters. In Apollo respondents are feeling comfortable for the procedure to
363
discharge the patients in emergency situations. But in normal conditions the process to discharge
the patients is good in the two hospitals. Almost two hospitals having simple bill payment
procedures. On overall two hospitals are not following lengthy and complex process for giving
the treatment to the patients. Now let us move on to the Mean and S.D values of Doctors
perceptions on the process mix of the sample hospitals.
Mean and Standard Deviation values of Doctors Perceptions on the Process

Table no: 4.18 representing mean and standard deviation values of perceptions of doctors
about the process mix of the sample hospitals.
Table No: 4.18
Mean and S.D of Doctors Perceptions on the Process Mix of the Sample Hospitals
(N=75)
Apollo Care
Sl.No Statement
Mean S.D Mean S.D
In this hospital, to get treatment the process is very
1 3.80 0.65 3.66 0.79
lengthy and time consuming.
Your hospital bill settlement process is simple.
2 2.08 0.98 2.06 0.85
The process to discharge the patient is simple in this

3 2.26 1.24 2.4 1.31
hospital.
The process for emergency discharge is complicated in
4 2.85 1.30 3.21 1.32
this hospital.
Service counters provided in this hospital are sufficient.
5 1.86 0.89 2.00 0.73
The length of waiting time of patients in this hospital is

6 2.20 0.65 2.33 0.79
reasonable.
Table no: 4.18 reveals that the perceptions of doctors on the process mix of the Apollo
hospital. to get treatment the process is very lengthy and time consuming (3.80), bill
settlement process is simple (2.08), process to discharge the patient is simple (2.26),
complicated process for emergency discharge (2.85), sufficient service counters (1.86), length
of waiting time is reasonable (2.20). From the above results it is noticed that the respondents are
having positive opinion on process mix of the sample hospital.
In the case of Care hospital; process is very lengthy and time consuming (3.66), bill
364
of waiting time is reasonable (2.33). According to the above results, it can be concluded as the
respondents having positive opinion on process mix of the sample hospital.
Mean and Standard Deviation values of Nurses Perceptions on the Process

Table no: 4.19 representing mean and standard deviation values of perceptions of nurses
about the process mix of the sample hospitals.
Table No: 4.19
Mean and S.D of Nurses Perceptions on the Process Mix of the Sample Hospitals
(N=150)
Apollo Care
Sl.No Statement
Mean S.D Mean S.D
1 4.06 0.68 4.00 0.81
2 2.46 0.68 2.53 1.15

3 1.88 1.20 1.86 0.62
hospital.
4 3.66 1.07 3.46 0.80
this hospital.
5 1.99 1.14 2.20 0.83

6 1.93 0.68 2.00 0.81
reasonable.
Table no: 4.19 reveals that the perceptions of nurses on the process mix of the Apollo
of waiting time is reasonable (1.93). Therefore it can be said that the respondents are having
positive opinion on process mix of the sample hospital.
respondents having positive opinion on process mix of the sample hospital.
365
Perceptions on the Process Mix of Sample Hospitals
Table no: 4.20 representing mean and standard deviation values of perceptions of
Adm.People about the process mix of the sample hospitals.
Table No: 4.20
Mean and S.D of Adm.People Perceptions on the Process Mix of the Sample Hospitals
(N=35)
Apollo Care
Sl.No Statement
Mean S.D Mean S.D
1 3.45 0.78 4.11 0.63
2 2.11 1.30 1.97 1.07

3 1.62 0.80 1.71 0.75
hospital.
4 2.20 1.05 2.74 1.01
this hospital.
5 2.14 1.39 2.11 0.99

6 2.57 0.85 1.88 0.63
reasonable.
Table no: 4.20 reveals that the perceptions of nurses on the process mix of the Apollo
complicated process for emergency discharge (2.20), sufficient service counters (2.14),
length of waiting time is reasonable (2.57). Therefore it can be said that the respondents are
having positive opinion on process mix of the sample hospital.
settlement process is simple (1.97), process to discharge the patient is simple (171),
respondents having positive opinion on process mix of the sample hospital. Following are the
consolidated Grand Mean and S.D values of perceptions of respondents on marketing mix (Last
3Ps) of sample hospitals.
366
Perceptions of Respondents on the Marketing Mix (Last 3Ps) of Sample
Hospitals
(Grand Mean and S.D)
Following tables indicating the Grand Mean and S.D of perceptions of respondents on
marketing mix i.e. last 3Ps of sample hospitals.
Table no: 4.21

Perceptions of Doctors on the Marketing Mix (Last 3Ps)
In Sample Hospitals (Grand Mean and S.D)
(N= 75)
Apollo Care
Sl.No Statement
Mean S.D Mean S.D
1 People 2.24 0.33 2.13 0.25
2 Physical Evidence 2.25 0.37 2.12 0.26
3 Process 2.50 0.36 2.61 0.47
5 Point Scale: 1-strongly agree.5-strongly disagree
Table no: 4.22

Perceptions of Nurses on the Marketing Mix (Last 3Ps)
(N= 150)
Apollo Care
Sl.No Statement
Mean S.D Mean S.D
1 People 2.17 0.41 2.02 0.36
3 Process 2.66 0.61 2.67 0.36
Table no: 4.23

Perceptions of Administrative Personnel on the Marketing Mix (Last 3Ps)
(N= 35)
Apollo Care
Sl.No Statement
Mean S.D Mean S.D
1 People 2.06 0.40 1.87 0.30
3 Process 2.34 0.59 2.42 0.37
Rating of Marketing Mix

Table no: 4.21 shows the perceptions of doctors on marketing mix (last 3 Ps) The Ps entire
are positively opinioned by the respondents in two sample hospitals. The mean scores are in the
367
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 3Ps) of the sample hospitals is agreeable to the respondents.
Table no: 4.22 indicating the perceptions of nurses on marketing mix (last 3 Ps) The Ps
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 3Ps) of the sample hospitals is agreeable to the
respondents.
Table no: 4.23 indicating the perceptions of administrative personnel on marketing mix (last
3Ps) The Ps 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 3Ps) of the sample hospitals is
agreeable to the respondents.
Conclusion
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. Hospitals must pay as much attention to proper planning,
designing, organizing and functioning of the various departments (specialties) as for any other
department. Some facets of the out-patient department are maintained separately from the
inpatient services. Never the less, the two should be integrated physically, functionally and from
the clinical and administrative points of view. Because, in most of the cases 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 during convalescence. Besides these the other
services like investigative procedures and counseling services will be there in the out-patient
department.
Two sample hospitals are not creating any complications when the patient is discharging on
emergency situations. Further it is observed that the 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
368
hospital. But in Care majority of respondents are not satisfied with the number of service
counters. In Apollo respondents are 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. Almost two hospitals having simple bill payment procedures. On
overall two hospitals are having good process mix.
On the whole, it is observed by the researcher that both the hospitals have been successful in
promoting hospital services with negligible limitations. This proposition can be substantiated by
two aspects. Firstly when 7Ps are compared and analysed in respect of both the hospitals, it is
found that they are very close to the standard opinions expressed by the experts. Secondly, the
survey report on employees (Doctors, Nurses and Administrative Personnel) clearly the
statistical results depicts that the opinions expressed in both the hospitals are very close to the
scale of Agree.
Statistical analysis and Methodology

Statistical Methodology
The objective of this study is to analyze the marketing mix (7Ps) and how far this tool useful
in the present situations and compare the hospitals which run under different managements. For
this purpose, the researcher made an attempt to rate the performance on basis of count of the
response for strongly agree, agree, cant say, disagree, strongly disagree. Here the nature of
statements in the questionnaire is such that numbers 1 Strongly agree is a criterion of strong
agreement with the given statement. Number 2 Agree is a criterion of just agreement with the
statement. Number 3 Cant say is a criterion of unable to judge whether he/she is agreeing or
disagreeing with the given statement i.e. neutral performance. Number 4 Disagree is a
criterion of disagreement with the given statement and number 5 Strongly Disagree is a
criterion of strong disagreement with the given statement.
As important inputs for hospitals are doctors, nursing staff and administrative personal and
important output is patients. The researcher collected data from all four categories of sample
respondents by giving weightage to the strength in two hospitals under study. Researcher
transformed the collected count data (expressed in percentage to the total respondents) in to well
known Arc sine data for diagnosing the problems involved in marketing the services in sample
369
hospitals. Further to know the 7Ps (Product, Price, Place, Promotion, People, Physical Evidence
and Process) of the concern hospital in marketing their services differ significantly among
themselves with respect to the average scores of the responses. For this responses are mixed over
all the announced categories of heads and are analyzed by the statistical technique i.e. ANOVA
(Analysis of Variance) in a one way classified data followed by corresponding Least Significant
Difference Test (<0.05) which are indicated by *. Later the averages are ranked in ascending
order. This is to know the key element of marketing mix among 7Ps in perception of respondent
for effective marketing of their hospital services.
Following tables represents the statistical analysis of data collected from doctors, nurses,
administrative personnel of Apollo and Care hospitals. Statistical analysis of patient opinion on
performance indicators of the sample hospitals discussed at the end of chapter-6.
Table No: 4.24

Mean Values of Doctors Opinion on 7Ps in Apollo Hospital
7Ps Product Price Place Promotion People Physical- Process

Evidence
Questions
Q1 1.9733 2.7333 2.6266 2.5333 1.6000 2.2666 3.8000
Q2 2.2000 3.2666 3.3733 2.8266 2.1866 2.0000 2.0800
Q3 2.6000 2.9200 2.6666 2.9466 2.4000 2.6666 2.2666
Q4 2.2000 3.1466 2.8000 2.9466 3.1466 1.9200 2.8533
Q5 2.4666 3.6000 2.5600 2.5333 1.9333 2.3333 1.8666
Q6 2.3333 3.0000 2.7866 2.2000 2.2666 1.7066 2.2000
Q7 2.4000 - 2.7866 - 2.5600 2.4666 -
Q8 2.7333 - - - 2.2266 2.6933 -
Q9 2.4000 - - - 1.9466 2.0133 -
Q10 2.6666 - - - - 2.5333 -
Q11 2.0000 - - - - - -
Q12 2.5600 - - - - - -
Q13 2.0000 - - - - - -
Q14 2.4666 - - - - - -
Q15 2.6933 - - - - - -
Q16 2.1066 - - - - - -
Q17 1.9333 - - - - - -
Q18 1.8666 - - - - - -
Q19 2.4266 - - - - - -
Q20 2.9333 - - - - - -
In order to find whether the perceptions of the doctors are indistinguishable the null
hypothesis is framed as-
370
The perceptions of the doctors are indistinguishable with respect to the 7Ps of Apollo
hospital
Table No: 4.25

ANOVA of Doctors Opinion on 7Ps in Apollo Hospital
values
Sum of Squares df Mean Square F Sig.
Between Groups 4.615 6 .769 5.360 .000

Within Groups 8.179 57 .143
Total 12.794 63
Table no: 4.25 representing ANOVA of doctors opinion on 7Ps 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 No: 4.26

Mean Values of Nurses Opinion on 7Ps in Apollo Hospital
1 2 3 4 5 6 7 8
7Ps Physical-
Product Price Place Promotion People Process
Questions Evidence
Q1 1.9333 2.7333 2.3333 2.7333 2.6066 2.2000 4.0666
Q2 2.4666 3.4666 3.6666 2.2666 2.5266 2.2666 2.4600
Q3 2.3466 3.4666 2.2000 2.2000 2.2666 1.9933 1.8000
Q4 1.6066 3.6666 4.4533 2.2000 2.7333 2.1933 3.6666
Q5 2.4000 2.5266 2.2000 2.5266 1.6200 2.5933 1.9933
Q6 1.9933 2.6600 2.2666 2.4600 1.6600 2.3333 1.9333
Q7 1.8666 - 2.2666 - 2.3266 2.2666 -
Q8 2.2666 - - - 2.1933 2.1400 -
Q9 1.6800 - - - 1.6800 1.9933 -
Q10 1.4800 - - - - 2.6666 -
Q11 2.6000 - - - - - -
371
1 2 3 4 5 6 7 8
Q12 2.3266 - - - - - -
Q13 2.4600 - - - - - -
Q14 2.6000 - - - - - -
Q15 2.1400 - - - - - -
Q16 2.1400 - - - - - -
Q17 1.6000 - - - - - -
Q18 1.6133 - - - - - -
Q19 2.5333 - - - - - -
Q20 2.6800 - - - - - -
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 7Ps of Apollo
hospital
Table No: 4.27

ANOVA of Nurses Opinion on 7Ps in Apollo Hospital
values
Between Groups 6.228 6 1.038 3.730 .003

Total 22.090 63
Table no: 4.27 representing ANOVA of nurses opinion on 7Ps 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.
372
Table No: 4.28
Mean Values of Administrative personnels Opinion
on 7Ps in Apollo Hospital
Evidence
Questions
Q1 2.08571 2.4000 1.8285 2.0857 2.1142 1.6857 3.4571
Q2 2.8285 2.2285 4.1714 1.8000 2.0857 1.7142 2.1142
Q3 2.6285 2.3714 1.7714 1.9142 2.2285 2.1428 1.6285
Q4 2.0571 2.4000 4.5142 1.9142 2.2571 2.1714 2.2000
Q5 2.3714 1.7714 1.9428 1.9428 1.5714 2.1142 2.1428
Q6 1.8000 2.000 1.8285 1.8857 1.5714 2.0285 2.5714
Q7 1.6857 - 1.8285 - 1.9714 2.1714 -
Q8 1.8857 - - - 2.2285 2.2000 -
Q9 1.9428 - - - 2.5714 2.0857 -
Q10 1.5714 - - - - 2.0857 -
Q11 1.5428 - - - - - -
Q12 1.9714 - - - - - -
Q13 1.8571 - - - - - -
Q14 1.9142 - - - - - -
Q15 2.2000 - - - - - -
Q16 1.8571 - - - - - -
Q17 1.9428 - - - - - -
Q18 1.5428 - - - - - -
Q19 2.0571 - - - - - -
Q20 2.0000 - - - - - -
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 7Ps
of Apollo hospital
Table No: 4.29
ANOVA of Administrative Personnels Opinion on 7Ps in

Apollo Hospital
values
Between Groups 2.356 6 .393 1.538 .183

Total 16.910 63
373
Table no: 4.29 representing the ANOVA of administrative personnels opinion on 7Ps 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 7Ps.
Table No: 4.30
Mean Values of Doctors Opinion on 7Ps in Care Hospital
Evidence
Questions
Q1 1.6666 3.0000 3.1333 2.7333 2.0000 2.2666 3.6666
Q2 2.5333 3.2266 2.8666 2.5333 2.0000 2.1333 2.0666
Q3 3.2000 2.8000 2.2666 2.9333 2.2666 2.4666 2.4000
Q4 2.3333 3.5333 4.3866 2.9333 2.9066 1.7333 3.2133
Q5 3.0000 3.7333 2.6000 2.8666 1.7733 1.5200 2.0000
Q6 2.4000 3.6666 2.9333 2.4000 1.9466 1.6000 2.3333
Q7 2.4133 - 2.9333 - 2.5600 2.0000 -
Q8 2.3866 - - - 2.0000 2.9333 -
Q9 2.3600 - - - 1.8666 2.1333 -
Q10 2.4666 - - - - 2.4666 -
Q11 1.9466 - - - - - -
Q12 2.5600 - - - - - -
Q13 2.0000 - - - - - -
Q14 2.4666 - - - - - -
Q15 2.9333 - - - - - -
Q16 2.4000 - - - - - -
Q17 2.0266 - - - - - -
Q18 2.2000 - - - - - -
Q19 2.3333 - - - - - -
Q20 2.9466 - - - - - -
In order to find whether the perceptions of the doctors are indistinguishable, the null
hypothesis is framed as-
The perceptions of the doctors are indistinguishable with respect to the 7Ps of Care
hospital
374
Table No: 4.31
ANOVA Of Doctors Opinion On 7Ps in Care Hospital
values
Between Groups 8.922 6 1.487 7.426 .000

Total 20.335 63
Table no: 4.31 representing the ANOVA of doctors opinion on 7Ps in Care hospital showing
the level of significance or risk probability is less than the 0.5 so the hypothesis is rejected.
Therefore it can be said that, the perceptions of doctors are distinguishable i.e. the perceptions
of the doctors are differ from one another.
Table No: 4.32
Mean Values of Nurses Opinion on 7Ps in Care Hospital
Evidence
Questions
Q1 1.6600 2.6000 1.9933 2.1933 2.1266 2.2600 4.0000
Q2 2.0666 3.7333 3.9866 2.2666 2.0666 2.2666 2.5333
Q3 2.1333 3.0000 2.3266 2.3333 2.4800 1.9933 1.8666
Q4 1.6600 3.6000 4.8000 2.3333 2.4333 1.9333 3.4666
Q5 2.3266 2.4733 1.6133 2.5933 1.6200 1.9266 2.2000
Q6 1.6800 2.7200 2.3400 1.8133 1.5466 2.3266 2.0000
Q7 1.8600 - 2.3400 - 2.0000 2.0666 -
Q8 2.2000 - - - 2.2600 2.1333 -
Q9 2.2666 - - - 1.6733 1.6800 -
Q10 2.0000 - - - - 2.0600 -
Q11 1.3800 - - - - - -
Q12 2.0000 - - - - - -
Q13 2.2000 - - - - - -
Q14 1.7333 - - - - - -
Q15 2.1333 - - - - - -
Q16 2.2666 - - - - - -
Q17 1.4200 - - - - - -
Q18 1.6733 - - - - - -
Q19 2.1266 - - - - - -
Q20 2.2000 - - - - - -
375
In order to find whether the perceptions of the nurses are indistinguishable, the null hypothesis
is framed as-
The perceptions of the nurses are indistinguishable with respect to the 7Ps of Care hospital
Table No: 4.33
ANOVA of Nurses Opinion on 7Ps in Care Hospital
values
Between Groups 8.923 6 1.487 5.012 .000

Total 25.836 63
Table no: 4.33 representing the ANOVA of nurses opinion on 7Ps in Care hospital showing
the level of significance or risk probability is less than the 0.5 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 No: 4.34
Mean Values of Administrative personnels Opinion
on 7Ps in Care Hospital
1 2 3 4 5 6 7 8

Evidence
Questions
Q1 2.0000 1.8571 2.0000 1.7714 2.7142 2.0000 4.1142
Q2 1.4285 3.9142 4.0000 1.8000 1.6857 1.8571 1.9714
Q3 2.4857 2.3428 1.9142 1.8285 2.0000 1.7428 1.7142
Q4 2.7142 4.1142 4.2571 1.8285 2.0857 1.6857 2.7428
Q5 2.1428 2.0857 1.7428 2.1714 1.5428 1.6857 2.1142
Q6 1.7714 2.1142 1.8857 1.9428 1.5142 1.9142 1.8857
Q7 2.6285 - 1.8857 - 1.8571 1.7428 -
Q8 1.9428 - - - 1.8857 2.0857 -
Q9 2.7142 - - - 1.6571 1.5428 -
Q10 2.0285 - - - - 1.9142 -
Q11 1.5714 - - - - - -
Q12 1.8571 - - - - - -
Q13 1.9428 - - - - - -
Q14 1.9428 - - - - - -
376
1 2 3 4 5 6 7 8
Q15 2.0857 - - - - - -
Q16 1.6857 - - - - - -
Q17 2.0000 - - - - - -
Q18 1.6571 - - - - - -
Q19 1.9142 - - - - - -
Q20 1.9428 - - - - - -
In order to find whether the perceptions of the administrative personnels are

indistinguishable, the null hypothesis is framed as-
The perceptions of the administrative personals are indistinguishable with respect to the 7Ps
of Care hospital
Table No: 4.35

ANOVA of Administrative Personnels Opinion on 7Ps in
Care Hospital
values
Between Groups 5.932 6 .989 2.781 .019

Total 26.198 63
Table no: 4.35 representing the ANOVA of administrative personnels opinion on 7Ps in
Care hospital showing the level of significance or risk probability is less than the 0.5 so the
hypothesis is rejected. Therefore it can be said that, the perceptions of administrative personnels
are distinguishable i.e. the perceptions of the administrative personnel are differ from one
another.
377
Table No: 4.36
Consolidated Statistical Result
Apollo Care
Category *
* * Administrative * *
Administrative
Doctors Nurses Personnel Doctors Nurses
7Ps Personnel
(1) (2) (3) (4) (5)
(6)
2.0228
Product 2.3479 (3) 2.1366 (1) 1.9871 2.4286 (3) 1.9493 (1)
(4)
3.0211 2.7380
Price 3.1110 (7) 3.0866 (7) 2.1952 3.3266 (7)
(7) (7)
2.7714 2.5265
Place 2.7999 (6) 2.7694 (6) 2.5550 3.0171 (6)
(6) (6)
2.2555 1.8904
Promotion 2.6644 (5) 2.3977 (4) 1.9237 2.7333 (5)
(4) (3)
2.0229 1.8729
People 2.2518 (1) 2.1792 (2) 2.0666 2.1466 (2)
(2) (2)
2.0706 1.8171
Physical evidence 2.2599 (2) 2.2646 (3) 2.0399 2.1253 (1)
(3) (1)
2.6777 2.4237
Process 2.5110 (4) 2.6533 (5) 2.3523 2.6133 (4)
(5) (5)
* The ANOVA gave significant difference between the means of the 7Ps.
Table no: 4.36 representing the 7Ps differ significantly among themselves with respect to the
average scores of the responses provided by them in 1,2,4,5 and 6.
The ANOVA gave significant difference between the means of the 7Ps (Product, Price,
Place, Promotion, People, Physical Evidence and Process) of marketing
services.
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 7Ps 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.
378
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.
Conclusion
The statistical analysis and the conclusions revealed that the 7Ps from the hospitals
people side, the responses have given a relative rating of the 7Ps 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.
379
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383

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Chapter - 4

Marketing Mix in Hospitals II

People Mix In Hospitals

Fig. No: 4.1

Internal marketing External marketing

Providers Interactive marketing customers

Encourage the attitude that every one has a customer

Patients Role in Hospital Services Delivery

Fig. No: 4.3

Define the Process where Patient have to Perform

Employees Total Number

Employees Total Number

(1) (2) (3) (4) (5)

(1) (2) (3) (4) (5)

(1) (2) (3) (4) (5)

Mean and Standard Deviation values of Doctors Perceptions on the People

In this hospital the supporting staff plays an important role for

Mean and Standard Deviation values of Administrative personnels

Physical Evidence Mix in Hospitals

Services Cape Other Tangibles

Building exterior Uniforms

Parking Reports/ stationary

Signs Billing statements

Patient care room

Recovery room etc.

Web Pages and Virtual Services Capes

Inner View of Apollo Hospital

International Patient Waiting Area

Patient Waiting Area

Equipment at Operation Theater

Equipment at Operation Theater

Apollo Signage system

Patient Waiting Area

Linen services of Care

O.P Ambulance Services

Blood Bank Emergency Services

Pharmacy Services Corporate Partnering

Finance and Insurance Education Programmes

Perceptions of Doctors about the Physical Evidence Mix of Sample Hospitals

(1) (2) (3) (4) (5)

Perceptions of Nurses about the Physical Evidence Mix of Sample Hospitals

(1) (2) (3) (4) (5)

(1) (2) (3) (4) (5)

Mean and Standard Deviation values of Doctors Perceptions on the Physical

Table No: 4.12

Mean and Standard Deviation values of Nurses Perceptions on the Physical

Table No: 4.13

Mean and Standard Deviation values of Administrative personnels

Table No: 4.14

Sl.No Statement Apollo Care

Mean S.D Mean S.D

This hospital is good in the aspect of Electricity.

Process Mix in Hospitals

The Intensive Consumption Phase

The Joining Phase

Purchase Stores Doctors Patient (external

Source: Prof. K. Ramohan Rao, Services Marketing Pearson Education, p.241.

& EOT Cardiology Counters

Consult O.P. Cash

CTS Scan Consultation Suit

Diet Clinic Diabetic Centre Blood Nurses Assessment

Nursing Floors/wards (Second and Third Floors)

Out patient Emergency Administration

Out Patients Emergency Maternity Staff Patients Visitors