NUST Business School

MKT-323 SERVICES MARKETING Final Project Report Submitted to; Sir Bilal Chohan Submitted by;
Maria Salman Anum Iqbal Ujala Liaqat Fehmeen Anwar Komal Nadeem

Date: 9th January, 2014

BBA 2k11 A

Project Introduction:
The industry that we have decided to work with, for the duration of this project, is the health care industry. The rapidly changing and insecure environment of Pakistan has increased the importance of health care institutes and the current conditions of publically owned hospitals are a huge discussion. For this very reason we chose this industry and for our report we will be looking, in depth, at three well known members of the health care industry namely: Shifa International Hospital, Quaid-e-Azam International Hospital and Combined Military Hospital Rawalpindi. We will be analyzing the quality of their services and the running operations and will then compare them on the basis of few prominent features.

PUBLIC HEALTHCARE SECTOR Introduction:

Pakistan inherited a poor healthcare infrastructure after independence. This comprised of a single medical college and a few practicing doctors. The real development on the public healthcare system came in Zulfiqar Ali Bhutto's government in 1970s. Pakistan was also a supporter of WHO's "health for all by 2000" initiative.The healthcare infrastructure was developed on various levels; "basic health units" for villages, the Tehsil headquarter hospital for secondary healthcare and district hospitals and teaching and referral units for tertiary care. The healthcare network of Pakistan now comprises of 919 hospitals, 5334 Basic Health Units and Sub-Health Centers, 560 Rural Health Centers, 4712 Dispensaries, 905 Maternal and Child Health Centers and 288 Tuberculosis Centers. Despite this infrastructure, poor financing, inadequate resources and mismanagement, results in underutilization of the system.

SWOT Analysis:

Strengths:

Weakness:

Government ownership and funding Wide network Experienced staff Professional handling Availability of all departments Availability of equipment Latest medical facilities like bone marrow transplant, cardio vascular treatments, kidney transplant, cancer treatments etc

Weak utilization of equipment Lack of maintenance Corruption Doctors indifferent attitude Free treatment makes doctors less concerned (lower staff) greater number of patients and less doctors to treat them Discrimination and red tape Cronyism and Nepotism - appointing of people based on preferences and liking rather than merit Inefficiency Lack of beds/rooms to accommodate patients

Opportunities

Threats:

Greater government funding for R & D Increased budget allocation for health sector Growth Modernization will facilitate improved healthcare Making systems corruption free and enhancing management T & D of staff

Security concerns Political concerns Law and order Financial strength of the state

Marketing Mix:
Product:
Core services: Providing treatment facilities including; medical, surgical, pediatric, obstetric and cardiac intensive care etc. Supplementary services: Wards and private rooms, Diagnostic services, pharmacy, blood bank, laboratory, ambulance etc. Auxiliary services: housekeeping, cafeteria and catering etc.

Price:
There is no pricing strategy as the government aims to provide free treatment to general people. The price floor is determined by the compulsory costs but the aim is to provide free service to all the patients, therefore charges are kept minimal in even most expensive cases.

Place:
Government hospitals are strategically planned and placed to cater all the population in different geographic locations. From the villages to the cities different levels of health care are present like the "Basic health units" for the villages. The Tehsil headquarter hospital represented secondary health care, and district hospitals and teaching and referral units represented tertiary care units. Central hospitals, the most primary and advanced healthcare units are not necessarily in every district but are present in major cities across the country.

Promotion:
Awareness campaigns for dengue prevention and treatment, polio vaccinations etc.

People:
Basically the nursing staff, doctors and general staff are the main working people. Overall attitude of staff that comes in direct contact with the customers is indifferent towards the patients. Overcrowding and high workload results in frustrating moments for the patients as well as the staff. Medical malpractices are a common sight with zero accountability. Patients are ill-treated because of the inefficiency of the administration and corrupt practices of staff. Doctors are outnumbered by patients, which leads to lack of attentive health care.

Process:
The process is very lengthy with more than necessary delays due to the over-crowding of patients and unavailability of sufficient number of doctors. Waiting time for the procedure to get started is very long and tiresome. Lengthy erroneous paper works are often time consuming but important, and renders the speedy execution of treatment. The process however can be accelerated by extending money to the staff and getting treatment ahead of the deserving patients. Corruption, nepotism are common practices affecting the functionality of government hospital

Physical Evidence:
Fair observance of dress code The hospital is not cooled or heated appropriately which causes suffocation in hot weather and inconvenience for patients in winters The waiting areas are not strategically planned to make the waiting time bearable. Patients have to bear the harsh weather conditions as well as the rush and noise in the area. Sanitation is poor. Neglect in maintaining hygienic conditions of the hospital Food for the patients is not of good quality either Unpleasant smell

COMBINED MILITARY HOSPITAL RAWALPINDI Introduction:

The Combined Military Hospital Rawalpindi is a tertiary care military hospital in Rawalpindi. It is headed by an army medical corps doctor of Major General Rank. It provides specialized treatment to Army personnel and their immediate family. It is the chief medical hospital of cantonment along with Military Hospital which is at Abid Majeed Road. This 550 bedded hospital mainly looks after the surgical diseases and caters for all ranks. It has units of General surgery, Neurosurgery, ENT, facio-maxillary Surgery, Urology, Orthopedic, Oncology, Surgery, Trauma Centre etc. There is also a battle casualty/artificial limb section attached to the hospital. The General Medical Council of UK recognizes the hospital for Postgraduate training in different surgical fields. The medical students of Army Medical College are imparted clinical training by the concerned specialists and the professors.

SWOT Analysis:
Strengths: Weakness:

Armys backing: financial n manpower Large system : instability cannot affect its operations Wide network in major cities Reliability: availability of doctors 24/7 Experienced staff professional handling Computerized systems and database Well maintained departments Latest medical facilities like bone marrow transplant, cardio vascular treatments, kidney transplant, cancer treatments etc SOPs Training of nursing staff Training of officers(doctors)

Doctors change with each shift and hence a patient is in hands of multiple doctors which can lead to mishandling/unnecessary procedures, tests Less attention towards patients Free treatment makes doctors less concerned (lower staff) Mediocre Workload greater number of patients and less doctors to treat them Discrimination and Red tape

Opportunities

Threats:

Greater R & D Availability of funds Increased awareness towards health: people are getting health conscious Increased disposable income Growth in infrastructure

Security concerns Private practice of doctors

Marketing Mix:
Product:
Health care is a necessity of existence. Customers need for health care will never diminish. Offering services in every field to facilitate the patients and combining them at one place is the service offering. Core services: Providing treatment facilities including; medical/ surgical, pediatric, obstetric and cardiac intensive care etc. Supplementary services: Wards and private rooms, Diagnostic services, pharmacy, bloodbank, laboratory, ambulance. Auxiliary services: housekeeping, laundry, cafeteria and catering, transportation services, reception services

Price:
The pricing strategy is made for the civilians who prefer CMH for their treatment. It is adequately priced where middle class can afford to get their treatments. The floor of the price is determined by the overhead, the consultation fee, lab charges and inpatient charges. Military personnel and their families are entitled to free health care as the purpose of this hospital is to facilitate those serving in the army. However, some services are not free even for army staff like some dental services etc.

Place:
CMH is located in the cantt of every major city of Pakistan.

Promotion:
No promotion campaign. Focus on constant improvement and innovation is their key source of word of mouth type of promotion.

People:
They also include the nursing staff, doctors, and general staff. Attitude of the staff varies with the rank of the patient. The protocol and red tape in army leads to these disparities. Families of JCOs, SMs and all the ranks below officer level are not treated and welcomed the way higher ranked personnel and families are. Crowding and workload is different for different departments. Trauma center will always have overcrowding with high workload whereas departments like radiology, dermatology have medium to low workload.

Process:
Days for officers are different from those of all the ranks below grade 17. This facilitates the families of army personnel to divide the rush and evenly distribute it in all the days of the week. Officers days are

less crowded than the normal days. Waiting time for the procedure is bearable. The process has been highly automated with no paperwork. CMH has maintained state of the art technology for this purpose and made the process completely computerized and error free.

Physical Evidence:
Strict observance of dress code The hospital is cooled or heated appropriately with televisions and newspapers in every waiting room to make the waiting time bearable and less frustrating. The hospitals walls are painted off-white to build and environment of openness and calmness Sanitation is good Special attention towards maintaining the general hygienic conditions of the hospital is paid. Food for the patients is good. The food prepared for officers is of better quality than what is given in general wards. There is an unpleasant smell which is usually of medicines. Layout of the hospital is strategically planned with plenty of plantations and open spaces for the patients to relax

SHIFA INTERNATIONAL HOSPITAL ISLAMABAD

Introduction:
The hospital was established in September 20, 1987 as a private limited company in the residence of Dr. Zaheer Ahmad in sector F-8/3 of Islamabad. Their growth in the initial period was remarkable enough that the need for a bigger site rose. Thus to cater to their ever growing patients needs, they first moved to a rental space and finally they started working on their own facility in January 1988. On October 12, 1989 the hospital went public to raise capital for the international standard medical facility. The new facility officially opened on June 26, 1993. At the time of its opening the facility had over 400 sponsors from all over the world with a total equity of Rupee 500 million. At its beginning Shifa was working with eight consultants in only seven specialties, today it has progressed to more than 70 highly qualified consultants in almost all specialties under one roof. At the moment Shifa is providing clinical services, diagnostic services and support services, which include the following facilitations: Medical Check-Ups, Specialized Services, Medicine, Clinical Support, Surgical Services, Clinical Laboratory, Specialized Diagnostics, Diagnostic Imaging, Hospital Support, General Facilities, Technical Services, Human Resource, Security and Transport, Medical Education and Research and Development. They also have separate specialized centers for: Liver Transplant Shifa, Cancer Center, and Kidney transplant, Services Orthopedic, Services Shifa and Heart Center

SWOT Analysis:
Strengths: Weakness:

Endowment of resources: Strong physical facility Committed staff. Stakeholders commitment to quality improvement. Foreign investors Availability of substantial capital funding. Future funding prospects good More than 70 consultants Well supplied Multiple specialized Centers. Provision of high quality medicine Qualified and experienced staff Quality lab services Advanced technology and Updated equipment Efficient senior management Demonstrated ability to provide training Strong interdepartmental communications. Strong system of accountability or transparency International medical expertise. Teaching hospital

Too much reporting No drug protocols/treatment guidelines Shortage of staff residences High dependency on external resources High workload No competition among staff themselves Nursing shortage Staff conflicts (local versus outside/ senior management and staff) High Care providing costs Management and lower staff communication gap. No incentive based rewards.

Opportunities

Threats:

Outside funding opportunities New building structures Further specialized centers Remote medicine Computer technology Not for profit status Land available for expansion Further nationwide expansion Vaccinations Surveillance Good relationship with government Ability to expand the hospital departments New training programs

Private practice of doctors Re-emerging disease Inflation Security Recruitment of staff through MOH Nursing shortage in medical sector

Marketing Mix:
Product:
Core services: Providing treatment facilities including; medical/ surgical, pediatric, obstetric and cardiac intensive care etc. Supplementary services: Wards and private rooms, Diagnostic services, pharmacy, blood bank, laboratory, ambulance. Auxiliary services: housekeeping, laundry, cafeteria and catering, transportation services, reception services

Price:
Their pricing strategy does not depend upon the price offered by the competitors. The pricing strategy is formulated after consulting the concerned heads of the department while keeping their overheads in mind. The floor of the price is determined by the overhead, the consultation fee and inpatient charges but since the qualities of all the services they offer exceed the competitors they charge premium prices. Pric es of various facilities are revised depending on the changes in the technology. But the bottom-line is, that prices charged are high and well worth the quality and services provided in return. A lot of times cost of laboratory tests and diagnostic procedures are separate.

Promotion:
At Shifa International Hospital, they believe that the quality of treatment speaks for itself therefore they do not see the need to employ promotions of any kind. They believe that the successful, complete, recovery rate is itself the best form of advertisement of their services. For Shifa International Brand recognition is an important promotional factor.

Place:
The aim of the Hospital is to be placed in such a location that is easily accessible to the patients and adequately protected from pollution. Thus Shifa kept in mind two major distribution decisions; the physical access (location, and facilities), time access. With their target market in mind they have placed the hospital in H-8 and diagnostic center in F-11.

People:
The people under the marketing mix of hospital all the different people involved in the service prov iding process (internal customers of the hospitals) which includes doctors, nurses, housekeeping, technical staff, management and supporting staff. The staff that comes in direct interaction with the patients is well trained to provide high quality patient care with human touch by means of state of art of technology. In order to provide quality treatment Shifa International Hospital is running their own medical and nursing schools to train the staff according to their requirements. Currently Shifa engages more than 1600 utilizing services of professionally competent medical staff in doctors, nurses, paramedics, clinical staff and management professionals to manage over 400 beds across hospitals.

Process:
The length of waiting time of patients in this hospital is reasonable, as is the time for admission. In case of emergency the priority is treatment, the paper work can wait. The diagnosis process is very efficient; both at the doctor and the laboratory; but on average the treatment the process is very lengthy and time consuming but this is not on the part of the hospital, as most patients taken there are serious cases. All patients are handled with maximum care. The post treatment care is done with consideration and not hurried though. The hospital tries not to keep the patients in longer than necessary as there is always demand for beds. Bill settlement process is kept as simple as possible. The process to discharge the patient is straightforward and uncomplicated in this hospital unless it is emergency discharge which is relatively complicated as it has more paper work. Service staff at every service counter is helpful and well trained to handle all procedures. They also have SOPs for more or less all procedures.

Physical Evidence:
Following are the physical evidences of the comfortable hospital environment. Staff follows a dress code. The entire hospital is centrally air conditioning with good lighting. Colors on wall are light because it helps people to be calm.

Constant spraying of disinfectants. Janitors with floor polishing machines or mops can be seen working. Particular attention given to hygiene is highly visible. Open and airy spaces in the waiting area, the wards and rooms. Apart from that admission office, signs, lobby area, patient care room, waiting area, public toilet facilities, medical equipment, building exterior, reports and stationary, parking area, cafeteria, uninterrupted power supply, telephone facilities, security and display of awards and certificates won by doctors and hospital etc

QUAID-E-AZAM INTERNATIONAL HOSPITAL

Introduction:
Quaid-e-Azam International Hospital (QIH) is a project of Global Health Services, which is a public limited company (unquoted) registered with SECP. QIH is a 400 bed state of the art hospital near Golra morr, Peshawar Road, Islamabad. This hospital is not only conveniently located to serve the people of Rawalpindi and Islamabad but is very close to all the exits to the rest of the country including motorway and highway to KPK, Punjab, Kashmir and Afghanistan.

SWOT Analysis:
Strengths: Weakness:

Latest medical technology on par with the latest world-wide developments Presence of highly foreign qualified doctors and staff working through the courage, conviction, hard work and dedication. Complete infrastructure Competent care and heartfelt hospitality. Provision of quality clinical health care and services Efficient and well managed facilities. Providing the best practices in specialties such as orthopedics, spine, neurology, gastroenterology, peads, nephrology, urology, gynecology, critical care and dentistry. Presence of daycare centre, gym, cafe Provision of bonuses to the staff, free treatments (50% off) for staffs Medical expertise at par with the international standard Patient has a single doctor throughout his treatment that enhances level of trust Availability of doctors 24/7

Absence of any Nursing training programs Inefficient Paramedical staff Funding depends greatly on external resources Targets only to limited people/patients Very expensive affecting its affordability factor

Opportunities

Threats:

Introduction of new training programs for medical staff Improved and enhanced technology worldwide New specialized departments Funding opportunities Introduction of more branches, expansion of hospital

Security conditions of Pakistan New entrants in the business Private practice of doctors in clinics Political instability

Marketing Mix:
Product:
Core services: Providing treatment facilities including; medical/ surgical, Diagnostic & Interventional Radiology, Endoscopy Suites, Dialysis Centre, Physiotherapy & Rehabilitation Department, Central Sterilized Supplies Department, Dietary Services, Speech Therapist, Respiratory Therapy, Supplementary services: Ambulance Services, Patient Service Department, Wards and private rooms, Diagnostic services, pharmacy, Laboratory & Blood Transfusion Services, Pharmacy, Human Resource Department, IT Department, Media & Publications Department, Biomedical Engineering Department, Admission & Billing Department, Accounts Department Auxiliary services: Maintenance Department, Cafeteria, Food & Nutrition Department, Laundry Department, transportation services, reception services, Security Staff, House keeping Department, Patient Facilitation Department

Price:
High pricing in comparison to government hospitals is maintained. This is due to the facilities they provide as compared to the other hospitals.

Place:
It is located near Golra morr, Peshawar Road, Islamabad. Many complex factors, including the areas population, currently available services, and present and future demand were considered while locating it. It is very close to all the exits to the rest of the country including motorway and highway to KPK, Punjab, Kashmir and Afghanistan.

Promotion:
The hospital believes that marketing is all about building relationships with the patients and staff working there. They provide such good treatment to their patients, based on international levels, that they do not believe in any other promotional activities for the hospital.

People:
Doctor staff: Internees (House jobs), Observer ship, MBBS/BDS doctors, Specialized doctors Nursing staff: Nurses, Paramedical staff General staff (peons, cooks etc) Management and Supporting staff

Process:
Patients do not have to wait for that long in order to get their treatment. In busy wards such as emergency or medicine ward, number of patient increases and so does the pressure on the doctors due to which the time duration of waiting is affected. Other than that, wards like dentistry etc. are not that busy and patients get treated calmly. Paper work is present but it does not hinder the process and mostly consists of history and treatment of the patient. All the facilities are present that facilitates the hospital in providing efficient and effective service. All the patients are taken care of until they are discharged. Even after a patient is discharged, regular visits for some time are ensured. Since its a hospital, they have their standard procedures that are to be maintained by the whole staff.

Physical Evidence:
There is no dress code for the doctors but all the staff is required to wear a lab coat. The hospital is air conditioned and generators are present. The hospital is painted in light color of white that keeps the environment calm and soothing Particular attention given to hygiene can be easily observed. Janitors with mops and cleaning carts can be seen working. No congested and suffocating spaces in the waiting area, the wards and rooms. Other rooms besides patient wards include admission office, lobby and waiting area, patient care room, toilet facilities, Kitchen, Dispensary, parking area, cafeteria, uninterrupted power supply, morgue, tea room for nurses on most floors, doctors rooms, a central sterilizing depot, operating theatre block.

COMPARING ANALYSIS
After doing the thorough analysis of the three hospitals individually and then comparing them with each other and generally with the public health care industry of Pakistan we can say that over all, all three of them are doing a much better job than other public hospitals. Their conditions and services although not to the optimum level but still are a lot more enhanced and improved. On comparing these three hospitals with each other we can say that if we rate these CMH is the lowest, then comes Quaid-e-Azam International Hospital and the best one is Shifa International Hospital (The perception map is given at the end of the report in an appendix). All three offer almost same services with similar core services and slightly different supplementary and auxiliary services. They all are located in the areas where they can serve more of their target market or where their customers, which are the patients, can access them easily like other government hospitals. The prominent factors that differentiate them from each other are the facilities they provide, the experience that patients get and their pricing. CMH does not charge fee from its most of the patients like many government hospitals. They mostly belong to army background and even civilians are charged a very little fee, which covers only the very basic costs. This is the reason they call themselves a not for profit organization. This gives them an advantage over the others in terms of pricing but in terms of service it hinders their performance. Doctors become less concerned towards the patients as they are not being charged well and a lot of discrimination is evident in CMH for this very reason. As for the people, in services, the ones with higher posts are treated with better attitude as compared to the lower staff. This is also because they are not rewarded for their work or the value they are providing, which mostly the case in government hospitals. Their standard is below the other private hospitals due to this reason as well. Even though all these issues are prevailing there, still there are a lot of factors that keep them ahead of many other government owned hospitals. The environment they provide is much better than a lot of hospitals, its clean and hygienic. They have skilled and experienced doctors and try to keep a check on their staff, and a very important factor is their availability. Now if we look at the other two hospitals which are under consideration, we can see that they are very much alike. They can differ in their operations which are not visible to others but are very close on the perception map, as they both provide very similar atmosphere to the patients. Both offer their service at high prices in comparison to the others in this industry, but if we compare, then Shifa is a little more expensive than Quaid-e-Azam hospital. These prices are justified with respect to the facilities they provided to their patients, as their services are much better than other public hospitals. The fact that they depend a lot on the external financing which is way riskier than the government funding as in the case of CMH, also support their pricing. These high prices are a major aspect that

differentiates them from others and the value they provide in return for these prices give them an edge over the others. The processes are very efficient in both the hospitals but Shifa has a structure that consists of a lot of reporting. These reports even though are very important to maintain their work efficiency, do not hinder their services as the patients are treated immediately in case of emergency. This is a very major issue in government hospitals, as people have to go through many reporting processes before they are treated. Work load is very high in both these hospitals unlike CMH. CMH has planned its week days in such a way that equalizes their burden and reduces the waiting time for the patients. Whereas, in Quaid-e-Azam hospital either people have to wait a lot or they need to get appointments beforehand. Even though they have many specialized doctors yet they are not sufficient and they need more skilled and qualified doctors and other staff. Another difference in Shifa international hospital and Quaid-e-Azam International hospital is, that Quaid-e-Azam hospital does not have required amount of staff and it is not present in other cities than Islamabad. The ambience, of both Quaid-e-Azam and Shifa, is more soothing then CMH or government hospitals. However the three of them pay focused attention to hygiene. Shifa and Quaid-e-Azam pay more attention towards the comfort of their patients and try to provide them a relaxed environment. To sum this all up, we can easily say that Shifa and Quaid-e-Azam are close to each other in many aspects but have their differentiating points as well. CMH is a little different as it is slightly less efficient than the other two hospitals and can be improved with slight more effort. But over all they are doing a lot better than other government hospitals, whose conditions are a lot worse and require many improvements. Seeing their conditions and analysis their existing situation, we have made few recommendations which according to us can help all these three hospital to improve a little more. These improvements and enhancements in their service can help them in providing us with a better facility and can fulfill the gap present in this industry in Pakistan.

RECOMMENDATIONS FOR IMPROVEMENT:

1. In Pakistan there is lack of empowerment at the front line in hospitals. Hospital boards need to embrace a devolved style of leadership that values and encourages staff and respects their judgment when they are the people working closest with older people and their families. Hospitals must enable staff to do the right thing for patients. Feedback from patients and their families should be discussed and responded to on the ward every day. Hospitals should give staff the time to reflect on the care they provide and how they could improve; this is an essential part of giving good care. Hospitals in Pakistan lack Nursing training programs which leads to unskilled staff and poor service provided by the hospital. Regular training programs should be held in order to keep the staff updated and efficient. Many hospitals have hygiene issues which cause infections to the patients. The staff, especially the nurses should be trained to wash hands and cleanliness should be the motto as contact to patient may transfer the disease. Hospitals need to improve the quality and safety of providing care for adults and children needing urgent and specialist. This should be done to ensure that senior, experienced clinicians are available to treat the most seriously ill patients every hour of the day, every day of the week. Online patient organizer: In an effort to reduce the time it takes for patients to schedule appointments and fill-in questionnaires while they wait, patients could do many of these things before they set foot in the doctors office. A web-based application could provide these services, help patients navigate the hospital campus, they may find out what documents or medications they need to bring to their appointment, etc. They could also read about the doctor they are scheduled to see. Hospitals should try giving its customers a better service by striving the to deliver services on the schedule of the patient instead of looking at the ease of the hospital. This should be done to ensure customer satisfaction because customers are of great importance for any service provider.

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In order to improve performance of hospitals, improvement of the patient experience is necessary. The process of checking out of a hospital can be tied up by waiting for x ray and lab results that can cause a delay in patients leaving much needed hospital beds. Hospitals should have rooms with reclining chairs with TV and Internet connection would help patients remain comfortably at the hospital while reducing the traffic around hallways and reception areas. The patients should be treated well and welcomed whether it is a private hospital or a government hospital.

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10. Hospitals should introduce facilitated, practice-based development programmes learning through doing to ensure staff caring for people are given the confidence, support and skills to do the right thing for their patients.