CONSUMER TEMPERAMENT TOWARDS TOP 5 MULTI

SPECIALITY HOSPITALS IN COIMBATORE

CHAPTER 1

1. INTRODUCTION
The measurement of customer satisfaction has become very important for the health
care sector. The concept of customer satisfaction has encouraged the adoption of a
marketing culture in the health care sector in both developed and developing countries. As
large numbers of hospitals are opening up and the people are becoming more aware and
conscious of health, great competition has emerged in this industry. So to retain their
patients hospitals have to provide better facilities/services to its customers. Various factors
that can affect the patients’ satisfaction include behaviour of doctors, availability of
specialised doctors, behaviour of medical assistants, quality of administration, quality of
atmosphere, availability of modern facilities etc.

As grew the competition, so grew the trend of providing better facilities to the
customers by the hospitals. In last few years, a plethora of hospitals have mushroomed in
and around the city. These hospitals are advertising heavily about the specialized
treatments provided by these hospitals. There are various hospitals that provide specialized
treatments for various diseases. Because of neck to neck competition between hospitals
customers run to these hospitals for specialized treatments. Interestingly all hospitals claim
to have a high success rate. They claim to provide the best treatment and other essential
facilities at reasonable cost and in easy way to their customers. But how much of this is true
and how many of their claims are myth is not known to vast majority of customers. As
competition is increasing, the hospitals are making their best efforts to provide quality
health care services to its customers. They have begun practicing a patient satisfaction
strategy comprising consumer-oriented plans, policies and practices to genuinely meet the
needs of customers. Also, with increased awareness and high expectations of the
customers’ hospitals have to provide them better facilities. Patients have begun to demand
high quality of services i.e. a consumer oriented approach.

These days patients have become more aware about their rights so they want they
should be better facilities like responding to their queries promptly, friendly environment,
understanding their problems, availability of specialized doctors, maintaining cleanliness,
regular reports etc. i.e. providing them every type of essential facilities. So, if the hospitals
want that their customers must be satisfied, they have to provide not only better treatment
but other facilities also.
1.2 PURPOSE OF THE STUDY
The present paper intends to find out customers priority for the selection of private hospital
for their treatment. The paper aims to test the proportion of patients willing to seek a
particular hospital (medical provider) is same across all the attributes for treatment. It also
explores the factors playing significant role in customer preference for a private hospital.
Data have been collected through schedule in five biggest multi-specialty private hospitals
of Coimbatore (India), Kovai Medical Center and Hospital, Sri Ramakrishna Hospital,
G.Kuppuswamy Naidu Memorial Hospital, PSG Hospital, KG Hospital. Patients can choose a
hospital according to what matters most to them, whether it’s location, cost consideration,
infrastructure availability, suggestion from friends, referred by doctors, etc.

1.3 OBJECTIVES OF THE STUDY

1. Patient’s satisfaction level for the behaviour of the doctors.

2. Patient’s satisfaction level for the behaviour of the medical assistants.

3. Patient’s satisfaction level for the quality of administration of hospitals.

4. Patient’s satisfaction level for the services provided by the hospitals.

1.4 SCOPE OF THE STUDY

1.5 LIMITATIONS OF THE STUDY

Any study based on consumer survey through a pre-designed questionnaire suffers from the
basic limitation of the possibility of difference between what is recorded and what is the
truth, no matter how carefully the questionnaire has been designed and field investigation
has been conducted. This is because the consumers may not deliberately report their true
preferences and even if they want to do so, there are bound to be differences owing to
problems in filters of communication process. The error has been tried to be minimized by
conducting interviews personally yet there is no full proof way of obviating the possibility of
error creeping in. So, the study suffers from sddome limitations also. As such generalizing
the results, the following limitations of the study should be taken into the account.

1.As the study was to be completed in a short time, the time factor acted as a considerable
limit on the scope and the extensiveness of the study.

2.The information provided by respondents may not be fully accurate due to unavoidable
biases.

3.The lack of corporation shown by the respondents, because of number of responds not
collected, so the sample was to be shortened.
1.6 RESEARCH FRAMEWORK
The present study is based on explorative and descriptive research design with the objective
of measuring the satisfaction level of patients’ of five major private hospitals in Coimbatore.
The study uses both primary and secondary information. As it is clear from the objectives of
the study, the study was divided into three parts i.e. patients’ expectations, perceptions
from the hospital services and then measuring their satisfaction level from the hospital
services. For both the first and second objective of study i.e. the customers’ expectations
and their perceptions of hospital services, primary data was collected through a structured
questionnaire. Then to meet the third objective of the study proper statistical tools were
used on the information collected for the first two objectives of the study.

1.6.1 DATA COLLECTION

Before an attempt was made to collect the information from the sample, the desk research
was conducted to see the literature and other library material available on the subject.
Various studies were reviewed to have a thorough knowledge before considering how to
collect the information from the respondents. After having the background knowledge a
structured questionnaire was prepared to obtain answer pertinent to the objectives of the
study. For the purpose of the study, eighty indoor patients were selected and interviewed
five private hospitals.

Secondary data was also collected from various books, journals, magazines etc.

1.6.2 SAMPLE DESIGN AND SELECTION

In view of the fact that this was a one person survey to be completed within limited
resources the present study was restricted to only those hospitals which were located in
Coimbatore. The population of this study comprised of the indoor patients only. Five major
private hospitals in Coimbatore were selected namely:

1. Kovai Medical Centre and Hospital

2. Sri Ramakrishna Hospital
3. G.Kuppuswamy Naidu Memorial Hospital
4. PSG Hospital
5. KG Hospital

1.6.3 SAMPLE SIZE

From these hospitals primary data was collected from the respondents. The respondents
were either the patients themselves or their relatives. For sample selection, a multistage
sampling procedure was followed. At the first stage, sample units consisted of total number
of general wards and private wards in the hospital.10% of the general wards and 10%
private wards were selected randomly. Then from each selected general ward 10 patients
were chosen and from each selected private ward 10 patient was chosen. The information
was collected through a pre-designed, structured questionnaire. A sample of 80
respondents selected from these hospitals on the basis of their convenience for the first
objective and the second objective. To suggest solutions to the problems observed during
the survey is done through secondary data.

1.6.4 DATA PRESENTATION TOOLS

ANOVA :- Analysis of variance (ANOVA) is a collection of statistical models and their
associated procedures (such as "variation" among and between groups) used to analyse the
differences among group means. ANOVA was developed by statistician and evolutionary
biologist Ronald Fisher. In the ANOVA setting, the observed variance in a particular variable
is partitioned into components attributable to different sources of variation. In its simplest
form, ANOVA provides a statistical test of whether or not the means of several groups are
equal, and therefore generalizes the t-test to more than two groups. ANOVAs are useful for
comparing (testing) three or more means (groups or variables) for statistical significance. It
is conceptually similar to multiple two-sample t-tests, but is more conservative (results in
less type I error) and is therefore suited to a wide range of practical problems.

CHI-SQUARE :- A chi-squared test, is any statistical hypothesis test where the sampling
distribution of the test statistic is a chi-squared distribution when the null hypothesis is true.
Without other qualification, 'chi-squared test' often is used as short for Pearson's chi-
squared test. The chi-squared test is used to determine whether there is a significant
difference between the expected frequencies and the observed frequencies in one or more
categories.

CHAPTER 2

2.1 REVIEW OF LITERATURE

Many studies have been conducted on the customer satisfaction. An attempt has been
made to present in brief, a review of literature on customer satisfaction in general as well as
on the customer satisfaction from hospital services.

Priscilla et al (1983) proposed a cognitive model to assess the dynamic aspect of consumer
satisfaction/dissatisfaction in consecutive purchase behaviour. They found that satisfaction
have a significant role in mediating intentions and actual behaviour for five product classes
that were analysed in the context of a three- stage longitudinal field study. They found that
repurchases of a given brand is affected by lagged intention whereas switching behaviour is
more sensitive to dissatisfaction with brand consumption.
David and Wilton(1988) have extended consumer satisfaction literature by theoretically and
empirically examining the effect of perceived performance using a model first proposed by
Churchill and Suprenant, investigating how attractive conceptualizations of comparison
standards and disconfirmation capture the satisfaction formation process and exploring
possible multiple comparison processes in satisfaction formation. They suggest that
perceived performance exerts direct significant influence on satisfaction in addition to those
influences from expected performance and subjective disconfirmation.

Saha (1988) made an attempt to investigate the interrelationships between job-satisfaction,

life satisfaction, life satisfaction-over-time and health. The relationship among these four
variables and biographical variables were also examined. The study was conducted over the
nurses in Nigeria. The data was collected from the full time employees only because
statements about job satisfaction and other variables are different when supplied by
retirees, part-time nurses.

Bolton and Drew (1991) proposed a model of how customers with prior experiences and
expectations assessed service levels, overall service quality and service value. They applied
the model to residential customers of local telephone services. Their study explored how
customers integrate their perceptions of a service to form an overall evaluation of that
service. They developed a multistage model of determinants of perceived service quality
and service value. The model described how customers’ expectations, perceptions of
current performance and disconfirmation experiences affected their satisfaction or
dissatisfaction with a service, which in turn affected their assessment of service quality and
value.

Boulding et al (1993) stated that the service quality relates to the retention of customers at
aggregate level. The author has offered a conceptual model of the impact of service quality
on particular behaviour that signal whether customers remain with of defect from a
company. The results of the study show strong evidence of their being influenced by service
quality. The findings also reveal difference in the nature of the service quality.

Aurora and Malhotra (1997) had done a comparative analysis of the satisfaction level of
customer of public and private sector banks, in order to help the bank management to
formulate marketing strategies to lure customers towards them and hence increase
customer base.

Grewal et al had expanded and integrated prior price perceived value models within the
context of price comparison advertising. More specifically, the conceptual model explicates
the effects of advertised selling and reference prices on buyers’ internet reference prices,
perceptions of quality, acquisition value, transaction value, and purchase and search
intentions. Two experimental studies test the conceptual model. The results across these
two studies, both individually and combined, support the hypothesis that buyers’ internal
reference prices are influenced by both advertised selling and reference price as well as
buyers’ perception of product quality. The authors also find that effect of advertised selling
price on buyers’ acquisition value was mediated by their perceptions of transaction value. In
addition, effects of perceived transaction value on buyers, behavioural intentions were
mediated by their acquisition value perceptions.

Voss (1998) had examined the rule of price, performance and expectations to determine
satisfaction in service exchange. When price and performance are consistent, expectations
have an assimilation effect on performance and satisfaction judgments; when price and
performance are inconsistent, expectations have no effect on performance and satisfaction
judgments. To examine these issues authors develop a contingency model that they
estimate using data from a multimedia experimental design. The results generally support
contingency framework and provide empirical support for normative guidelines that call for
creating realistic performance expectations and offering money-back service guarantees.

Garbarino and Johnson (1999) analyse that the relationships of satisfaction, trust and
commitment to component satisfaction attitudes and future intentions for the customers of
a New York off-Broadway repertory thereafter company. For the relational customers (
individual ticket buyers and occasional subscribers), overall satisfaction is the primary
mediating construct between the component attitudes and future intentions and for the
high relational customers (consistent subscribers),trust and commitment, rather than
satisfaction, are the mediators between component attitudes and future intentions.

Sharma and Chahal (1999) had done a study of patient satisfaction in outdoor services of
private health care facilities. They had done a survey to understand the extent of patient
satisfaction with diagnostic services. They have constructed a special instrument for
measuring patient satisfaction. The instrument captures the behaviour of doctors and
medical assistants, quality of administration, and atmospherics. The role of graphic
characters like gender, occupation, education, and income is also considered. Based on their
findings, they also suggested strategic actions for meeting the needs of the patients of
private healthcare sector more effectively. In their study provided suggestions like becoming
more friendly and understanding to the problems of patients, maintaining cleanliness in the
units, both internally and externally, providing regular report regarding the patients’
progress without waiting for them to demand, conducting surveys to know about the
attitude of the patients with regard to the employees and adopting patient-oriented policies
and procedures.

Simester et al (2000) have studied that multinational firm uses sophisticated, state-of-the-
art methods to design and implement customer satisfaction improvement programs in the
United States and Spain. Their experiments reveals a complex and surprising picture that
highlights implementation issues, a construct of residual satisfaction not captured by
customer needs and the managerial need for combining non-equivalent controls and non-
equivalent dependent variables.

Ofir and Simonson (2001) in their study found that customer evaluations of quality and
satisfaction are critical inputs in development of marketing strategies. Given the increasingly
common practice of asking such evaluations, buyers of products and services often know in
advance that they subsequently will be asked to provide their evaluations. In a series of field
and laboratory studies, the authors demonstrate that expecting to evaluate leads to less
favourable quality and satisfaction evaluations and reduces customer’s willingness to
purchase and recommend the evaluated services. The negative bias of expected evaluations
is observed when actual quality is either low or high, and it persist even when buyersare
told explicitly to consider both the positive and negative aspects.

Dholakia and Morwitz (2002) have examined the scope and persistence of the effect of
measuring satisfaction on consumer behaviour over time. In an experiment conducted in a
financial services setting, they found that measuring satisfaction changes one-time purchase
behaviour, changes relational customer behaviours and results in effects that increase for
months afterward and persist even a year later. Their results raised questions concerning
the design, interpretation and ethics in the conduct of applied marketing research studies.

Sharma and Chahal (2003) stated that due to increased awareness among the people
patient satisfaction had become very important for the hospitals. The authors examined the
factors related to patient satisfaction in government outpatient services in India. They said
that there are four basic components which had impact on the patient satisfaction namely,
behaviour of doctors, behaviour of medical assistants, quality of atmosphere, and quality of
administration. They also provided strategic actions necessary for meeting the needs of the
patients of the government health care sector in developing countries.

Folkes and Patrick (2003) in their study showed converging evidence of a positivity effect in
customers’ perceptions about service providers. When the customer has little experience
with the service, positive information about a single employee leads to perception that the
firm’s other service providers are positive to a greater extent than negative information
leads to perception that the firm’s other service providers are similarly negative. Four
studies were conducted that varied in the amount of information about the service
provider, the firm, and the service. The positivity effect was supported despite differences
across studies in methods as well as measures.

Vernoer (2003) had investigated the different effects of customer relationship perceptions
and relationship marketing instruments on customer retention and customer share
development over time. Customer relationship perceptions are considered evaluations of
relationship strength and a supplier’s offerings, and customer share development is the
change in customer share between two periods. The results show that affective
commitment and loyalty programs that provide economic incentives positively affect both
customer retention and customer share development, whereas direct mailings influence
customer share development. However, the effect of these variables is rather small. The
results also indicate that firms can use the same strategies to affect customer satisfaction
that can have impact on both customer retention and customer share development.

Anderson et al (2004) developed a theoretical framework that specifies how customer

satisfaction affects future customer behaviour and, in turn, the level, timing, and risk of
future cash flows. Empirically, they find a positive association between customer
satisfaction and shareholder value. They also find significant variation across industries and
firms.

Reinartz et al (2004) in their study of Customer Relationship Management Process had

stated that it is very important for maintaining healthy relations with the customers in order
to provide them satisfaction. In their study, they (1) conceptualize a construct of the CRM
process and its dimensions, (2) operationalize and validate the construct, and (3) empirically
investigate the organizational performance consequences of implementing the CRM
processes. Their research questions are addressed in two cross-sectional studies across four
different industries and three countries. The key outcome is a theoretically sound CRM
process measure that outlines three key stages: initiation, maintenance, and termination.

Homburget al (2005) conducted two experimental studies (a lab experiment and a study
involving a real usage experience over time) which reveal the existence of a strong, positive
impact of customer satisfaction on willingness to pay and they provide support for a
nonlinear, functional structure based on disappointment theory. In addition, the second
examines dynamic aspects of the relationship and provides evidence for the stronger impact
of cumulative satisfaction rather than of transaction-specific satisfaction on willingness to
pay.

Mithas et al (2005) evaluates the effect of customer relationship management (CRM) on

customer knowledge and customer satisfaction. They analyse archival data of a cross-
section of U.S firms which shows that the use of CRM applications is positively associated
with improved customer knowledge and improved customer satisfaction. They also found
that gains in customer knowledge are enhanced when firms share their customer related
information with their supply chain partners.

Gustafsson et al (2005) in their study of telecommunications services examine the effect of

customer satisfaction, affective commitment, and calculative commitment on retention and
the potential for situational conditions to moderate the satisfaction-retention relationship.
Their results support consistent effects of customer satisfaction, calculative commitment
and prior-churn on retention.

Gruca and Rego (2005) strengthen the chain of effects that link customer satisfaction to
shareholder value by establishing the link between satisfaction and two characteristics of
future cash flows that determine the value of the firm to shareholders: growth and stability.
By using the longitudinal American Customer Satisfaction index and COMPUSTAT data and
hierarchical Bayesian estimation they found that satisfaction creates shareholder value by
increasing future cash flow growth and reducing its variability. They also test the stability of
findings across several firm and industry characteristics and assess the robustness of the
results using multi-measure and multi-method estimation

Thompson (2005) in his study had shown that consumers often misjudge their health risks
owing to a number of well-documented cognitive biases. These studies assume that
consumers have trust in the expert systems that culturally define safe and risky behaviours.
Consequently, this research stream does not address choice situations where consumers
have reflexive doubts toward prevailing expert risk assessments and gravitate toward
alternative model of risk reductions. This study explores how dissident health risk
perceptions are culturally constructed in the natural childbirth community, internalized by
consumers as a compelling structure of feeling, and enacted through choices that
intentionally run counter to orthodox medical risk management norms.
5. QUESTIONNAIRE FOR IN-PATIENTS SURVEY
SHARE YOUR OPINIONS

I need your help to answer the following questions which will be an

important part of the quality assurance process for the hospital. Please take a
few minutes to complete this survey. The information you provide will be
completely anonymous. I am asking you to “rate” your recent experience of
this hospital by marking your level of satisfaction with various services
provided through out your inpatient stay.

DEMOGRAPHIC DATA
1. Name of the Hospital:

2. Name of the Patient:

3. Gender: (a) Male ()

(b) Female ()

4. Age in years : (a) Below 30 Years ()

(b) 31-60 years ()
(c) 61 and above ()

5. Area of Residence : (a) Urban ()

(b) Rural ()

6. Education : (a) No Formal Education ()

(b) Below 12th class ()
(c) Degree or above ()

7. Yearly Income : (a) Below Rs. 50,000 ()

(b) Rs.50,001–1,00,000 ()
(c) Above Rs. 1,00,000 ()

8. Marital Status : (a) Married ()

(b) Unmarried ()