Summer Project

CHAPTER-I

INTRODUCTION:

Health care industry is one of the most prominent industries is service sector. In this fast world

the number of hospital and techniques of service rendered by them are growing and changing rapidly.

Irrespective of the pricing factors the customers pay more attention on “Quality” and “Service”

rendered by the heath care organizations.

Quality is an elusive and indistinct construct. Often mistaken for imprecise adjectives like

“Goodness, or luxury, or weight”, quality and its requirements are not easily articulated by consumers.

Overview of the concept

Service Quality

“Service quality is a measure of how well the service level delivered matches customer's

expectations. Delivering quality service means confirming to customer's expectation on a consistent

basis”. (Lewis and Booms 1983)

According to Asubonteng et al., (1996), due to intense competition and the hostility of

environmental factors, service quality has become a cornerstone marketing strategy for companies.

This highlights how improving service quality is to organization for their survival and growth since it

could help them tackle these challenges they face in the competitive markets. This means that service-

based companies are compelled to provide excellent services to their customers in order to have a

sustainable competitive advantage. There is however, a need for these organizations to understand what

service quality is in order to attain their objectives.

In service marketing literature , service quality is generally defined as the overall assessment of

a service by the customers (Eshghi et al., 2008, p.121) or the extent to which a service meets customer's

needs or expectations , Asubonteng et al., (1996).

According to Douglas & Connor (2003, p.166), Parasuraman et al., (1985, p.42), and Ladhari,

(2008, p.172 ) the intangible elements of a service ( inseparability , heterogeneity and perishability ) are

the critical determinants influencing service quality perceived by a consumer. This means that a service

must be well defined by the provider in terms of its characteristics in order to understand how service

quality is perceived by consumers. According to Johns, (1999, p.954), a service could mean an

industry, a performance, an output, an offering or a process and it is defined differently in various

service industries. The differences in service industries are based on the characteristics of service

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which include; intangibility, heterogeneity, perishability and inseparability means there is no physical

product, nothing to be touched, tasted, smelled or heard before being purchased and this therefore

means that it is difficult for consumer to understand the nature of what they receive. An example would

be a telecommunication company offering mobile service to customers; here the consumer makes just

calls and does not receive and physical product.

Inseparability means service are consumed as they purchased. An example is seen when a

consumer is making a telephone call, he /she consumes the service while paying the chargers. This

implies that the consumer is involved in the production and delivery of the service meaning he/she

special note of what is actually produced by the service provider (Beamish & Ashford, 2007.p.240).

These above mentioned aspects of service make it very difficult measure service unlike product

quality which is measured objectively using factors such as durability and number defects because

tangible nature quality ( Parasuraman et al.,, 1988, p.13). Gronoroos, (1982,p.36-43), developed the

first model to measure service quality. He identified three components of service quality; the technical

quality is concerned with what delivered (outcome), the functional quality deals with the process of

service delivery ( how it is delivered) and the image quality which is identified as corporate image of

company resulting from both technical and functional qualities of service components. The technical

quality component of products unlike services is easy to assess because they are concerned with

tangibility (service scape) such as physical features that are visible to the consumer. Service scape is

defined as the physical facilities of a service company and this concept is related to the SERVQUAL

model in that the tangible aspects of the physical environment are covered in the SERQUAL model.

Service scape therefore plays a great role int that it influences customers' evaluation of other factors

determining perceived service setting quality like empathy, reliability, responsiveness, and assurances

(Reimer & Kuehn, 2004, p.785). Willam & Dargel, (2004, p.310) further suggest that, service scape is

more in service setting because of the unique characteristics of services (intangibility, perishability

inseparability and heterogeneity). Summarily, servicescape is very important inn the delivery of

services and affects perceived service quality which further leads either customer statisfaction or not.

Service quality is an important area to academicians because of its relevancy to service

companies and therefore many researchers have tried to develop various models to measure it, even

though some claim it is hard to measure because of its intangibility which is hard to quantify ( Eshghi

et al., 2008, p.121); (Douglas & Connor, 2003,p.171). This is why as services are intangible in nature,

evaluating the customer's perception of quality can be done through the interaction with the personnel

offering service, (Magi & Julander, 1996, p.35). From their suggestion, interaction between consumer

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and service provider cloud easily understand the consumer better and identify what he/she exactly

wants.

Various models have been developed to measure service quality following these approaches

either attitude-based measures service quality because it allows for comparisons before and after

changes, identifies quality related problems, and helps in developing clear standard for service delivery.

Teas, (1993), developed the Evaluated Performance model which measures the gap between

perceived performance and the ideal amount of a dimension of service quality, rather than the

customer's expectation. This was to solve some of the criticism of some previous models Gronroos,

(1985): Parasuraman et al.,(1985,1988).

The SERVQUAL model was made of ten dimensions of service quality when created; tangibles,

reliability, responsiveness, communication, credibility, security, competence, courtesy, understanding

the customer, and access, Parasuraman et al., (1985, p.47-48) but later on these dimensions were

reduced to five because some dimensions were overlapping (communication, credibility, security,

competence, courtesy, understanding customers and access) and they included,

Tangibles - physical facilities, equipments, and staff appearance.

Reliability- ability to perform the promised service dependably and accurately;

Responsiveness -willingness to help customers and provide prompt service;

Assurance – knowledge and courtesy of employees and their ability to inspire trust and confidence;

Empathy – caring, individual attention the firm provides its customers (Parasuraman et al., 1988,

p.23). These dimensions mainly focus on the human aspects of service delivery (responsiveness,

reliability, assurance, and empathy) and the tangibles of service.

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1.1 INDUSTRY PROFILE

Healthcare Industry:

Health care providers are institutions or individuals providing health care services. Individuals

including health professionals and allied health professions can be self-employed or working as an

employee in a hospital, clinic, or other health care institution, whether government operated, private

for-profit, or private not for profit (e.g non-government organization). They such as in a government

health department or other agency, medical laboratory, or health training institution. Examples of health

workers are doctors, nurses, midwives, paramedics, dentists, medical laboratory technologists,

psychologists, community health worker, traditional medicine practitioners, and others.

The goals for health systems, according to the world health organization, are good health,

responsiveness to the expectations of the population, and fair financial contribution. Progress towards

them depends on how systems carry out four vital factions. Provisions of health care services, resources

generation, financing, and other dimensions for the evaluation of health care system include quality,

efficiency, acceptability, and equity.

Today most governments recognize the importance of public health programs in reducing the

incidence of disease, disability, the effect of ageing and health inequities, although public health

generally receives, although public health generally receives significantly less government funding

compared with medicine. For example, most countries have a vaccinations are voluntary to promote

health, vaccinations are voluntary in some countries and mandatory in some countries, some

governments pay all or parts or the costs for vaccines in a national vaccination schedule.

The rapid emergence of many chronic diseases, which require costly long-term care and

treatment, is making many health managers and policy makers re-examine their health care delivery

practices. An important health issue facing the world currently is HIV/AIDS. Another major public

concern is diabetes.In 2006, according to the world health organization, at least 17, million people

worldwide suffered from diabetes. Its incidence is increasing rapidly, and it is estimated that by the

year 2030, this number will doubted. A controversial aspect of public health is the control of tobacco

smoking linked to cancer and other chronic illnesses.

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Antibiotic resistance is another is another major concern, leading to the reemergence of diseases

such as tuberculosis, the world health organization, for its world health day 2011 campaign, is calling

for intensified global commitment to safeguard antibiotics and other antimicrobial medicines for future

generations.

Health Care Industry in India

Healthcare industry to double in value by 2012: KPMG

ECONOMICTIMES.COM Jul 21, 2009,

NEW DELHI: Propelled by rising income levels as well as changing demographics and illness profiles,

particularly with a shift from chronic to life style diseases, the Indian health care industry is estimated

to double in value by 2012 at $14.2 billion and more than quadruple by 2017, says the latest Indian

health care edition of KPMG’s Global Infrastructure – Trend monitor.

Consultants KPMG in their just published report on the outlook for Indian healthcare

infrastructure in the next five year reveal that against a world average of around four hospital bead per

1000 population, India lags behind at just over 0, 72 clearly indicating an insufficiency.

Rising income levels, charging demographics and illness profiles with a shift from chronic to

lifestyle diseases would propel the Indian healthcare industry to double in value by 2012 and quadruple

by 2017.

The rate of growth of the health care industry in India is moving ahead neck with

pharmaceutical industry and the country much has been said and done in the health care sector for

bringing about improvement. Till date, approximately 12 % of the scope offered by the health care

industry in india has been tapped. The health care industry in india is reckoned to be the engine of the

economy in the year to come. Health care industry in india is worth $ 17 billion and is anticipated to

grow by 13% every year. The health care sector encompasses health care instruments, health care in the

retail market, hospitals enrolled to the hospital networks etc.,

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Expenses incurred by the indian government on health are the highest amongst developing

countries. An Indian expense on health care sector comprises 5.25% of the GDP. Chances are that the

health care market could experience a like and attain a figure ranging between $ 53 to $ 73 billion five

year from now. This in turn will reflect an increase in the gross domestic product to 6.2% GDP. The

health care industry in india earns revenues accounting for 5.2% of gross domestic product.

Employment opportunities are provided to as many as 4 million people in the health care

segment or other related sector catering to the health care industry in india in some way or the other.

Owing to the vast differences in medical expenses in western countries and that or india, India has

become one of the favorites for health care treatments due to the progressive nature of the health care

sector in india, several foreign companies are intending to invest in the country.

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1.2 COMPANY PROFILE

This chapter gives a brief profile of the Meenakshi Mission Hospital and Research Center (MMHRC)

Location of the organization:

This study was conducted at MMHRC, Madurai. It is located at Lake Area, Melur road, Madurai.

Organization of Meenakshi Mission Hospital and Research Center:

Meenakshi Mission Hospital and Research Center (MMHRC), which extends is services from the

temple city of Madurai is managed by the S.R. Trust. MMHRC, which started of with barely 50 beads

in 1990, has after 21 years turned into a 700-bed multi-specialty premiere hospital where patients visit

us with the hope and confidence of getting cured. Dr.N.sethuraman is the chairman, while

Dr.Mrs.RajamSethuraman is the Executive Director of MMHRC. Dr.S.Gurushankar currently

administering the daily activities of MMHRC. Prof. V.N.Rajasearan is the medical director.

The S.R Trust is a public charitable non-profit organization founded by Dr.N.Sethuraman. The

Founder President, Dr.N.Sethuraman, is also the recipient of the prestigious Dr.B.C. Roy National

award for medical social services. He was instrumental in making a medical paradigm shift in health

care, in India.Dr.Sethuraman was inspired by his high School Headmaster, ThiruManikavasagam, who

always urged him not only to provide medical services, but to also work for social upliftment. These

words left an indelible imprint in the heart and mind of young N.Sethuraman. Today,

Thiru.Manikavasagam would have been proud of his student who followed his ideals, and not only

established the S.R. Trust, but made it a full-fledged modern facility with contemporary team-based

care and cutting edge technology.

The S.R. Trust is now managed by its Managing Trustee, Dr. S. Gurushankar, who is a doctor

himself, and a graduate from the Indian Institute of Management (IIM). Since its inception in 1985, the

S.R.Trust continues to grow and develop while adhering to its purpose of existence, to provide

affordable healthcare to all.

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FOUNDER Dr. N. SETHURAMAN

The S.R.Trust (Reg. No. 291/85 dated May 9,1985), is a public charitable non-profit organization

founded by Dr.N. Sethuraman. The Founder, Dr. N.Sethuraman, is also the recipient of the prestigeous

Dr. B. C. Roy National award for medical social services. He was instrumental in making a medical

paradigm shift in health care, in India.Dr. Sethuraman was inspired by his High School Headmaster,

ThiruManikavasagam, who always urged him not only to provide medical services, but to also work for

social upliftment. These words left an indelible imprint in the heart and mind of young N. Sethuraman.

Today, Thiru.Manikavasagam would have been proud of his student who followed his ideals, and not

only established the S.R. Trust, but made it a full-fledged modern facility with contemporary team-

based care and cutting edge technology.The SR Trust is now managed by its Managing Trustee, Dr. S.

Gurushankar, who is a doctor himself, and a graduate from the Indian Institute of Management

(IIM).Since its inception in 1985, the S.R.Trust continues to grow and develop while adhering to its

purpose of existence, to provide affordable healthcare to all.

Trustees

Dr. N. Sethuraman - Founder

Dr. Mrs. RajamSethuraman - Secretary

Dr. S. Gurushankar - Managing Trustee

Mr. S. Manavalan

Mr. S. Regunathan

Mrs. C. KaminiGurushankar

Mr. G. SakthiSaravanan

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Meenakshi Mission Hospital & Research Centre (MMHRC)

Meenakshi Mission Hospital & Research Centre (MMHRC), which extends its services from the

temple city of Madurai, is managed by the S.R. Trust. MMHRC, which started of with barely 50 beds

in 1990, has after 21 years, turned into a 700-bed Multi-specialty premiere hospital where patients visit

us with the hope and confidence of getting cured.Dr. Mrs. RajamSethuraman is the Executive Director

of MMHRC. Dr. S. Gurushankar, who dons the role of Vice Chairman, is currently administering the

daily activities of MMHRC. Prof. V.N.Rajasekaran is the Medical Director.

Vision

No man is too poor to afford first-grade medical treatment

Mission

World-class care within everybody's reach

Values

Care, Compassion, Commitment, Charity, Empathy, Quality Service.

Quality Policy

Meenakshi Mission Hospital & Research Centre, in pursuit of excellence, is committed to comply

with applicable requirements for developing and providing world class health care at an affordable cost.

We shall foster an environment in which every person is motivated to continually improve the

efficiency and effectiveness in the management of health care services.

Goals and Objectives:

Patient Registration should complete with in 5 minutes.

To guide new patient.

To provide promote information’s to the patient.

To maintain below 5 years record.

Nature of service rendered.

To receive the patient, attainders and visitors.

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Our Publications:

Maruthuvamalar – widely circulated allopathic magazine published MMHRC.

MMJ – medical journal published by meenakshi IMA branch for the allopathic doctors

MMHRC news letter carries information to public about services achievement activates of

hospital

Red Ribbon news letter a publication of the STD/HIV/AIDS information technology center

for red ribbon club member.

COMSORT news letter bulletin (Consortiums of service Organization of Tamil Nadu) sup-

ported by MMHRC.

Hemophilia news letter-news letter of the hemophilia club.

“Kasakkumlnippu” Diabetic society MMHRC

Clinical Specialities

Andrology& Urology

Andrology pertains to male health and deals with the male reproductive system and urological

problems peculiar to men. Urology is the medical and surgical specialty focussing on the urinary tract,

kidneys, bladder, urethra, adrenal glands etc. MMHRC offers innovative treatments and management of

these conditions and minimally invasive procedures if necessary. We offer the most comprehensive and

sophisticated services in the hospital. This was the first department to be commissioned at the hospital

under the able leadership of Dr. T.R.Murali, the first full-time consultant, on 22nd. January 1990. The

first patients were seen on 12th. April 1990 and the first urological surgery was performed on 25th

April 1990.The Department caters to ten districts around Madurai and often attracts patients from

Kerala and Chennai for the specialized services like Andrology, TVT "O", ESWL and flexible upper

tract scopy offered at MMHRC

Cardiology

The Department of Cardiology offers innovative and scientifically based treatments for cardiac ail-

ments and quality patient care, backed by a team of qualified, skilled and experienced doctors.

MMHRC provides access to world class cardiac health care, especially to the rural population in the ar-

eas surrounding Madurai. We strongly believe in investing in the latest medical and diagnostic equip-

ment, as well as constantly upgrading the skills of our personnel to offer the very best in care and treat -

ment.MMHRC offers 24 hour emergency services. It is equipped to manage cases of acute myocardial

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infarction for primary PCI and subsequent management, attend to cases of congestive cardiac failure,

manage and stabilize complicated cases, as well as offer round-the-clock management for various other

acute cardiac cases. The Department of Cardiology is well-equipped, offering dedicated critical care

units with monitors, ventilators and all other necessary equipment.

Diabetology

India is known as the diabetes capital of the world and over 40 million people in India are

affected by diabetes. "Diabetes Mellitus" has assumed pandemic proportions and refers to too

much sugar in the blood, which in turn can be the cause of serious health problems. Chronic

diabetes includes Type-1 or Type 2 diabetes, pre-diabetes and gestational diabetes. In India

one out of every five people is a diabetic. Diabetes itself can be the cause of hypertension,

high levels of cholesterol and lingering infections.Uncontrolled diabetes is linked with many

other illnesses and their morbidity, including retinopathy, kidney failure, heart disease,

stroke, gangrene and neuropathy. MMHRC offers a well-equipped Department of Diabetol-

ogy, manned by experienced doctors, providing world class diabetic care at affordable costs.

We offer state-of-the-art diabetic services and the department focuses on creating awareness,

early detection, monitoring, treatment, management of diabetes and the nutritional needs of

diabetics.

Patient Care

At MMHRC we offer, both outpatient and inpatient care for diabetics, at all three levels.

Primary Care

MMHRC offers screening for diabetes. This includes not only those who are affected by Diabetes, but

also those who are at high risk, with family history, obesity, sedentary lifestyle etc.

Secondary Care

All diabetics are treated and monitored at MMHRC to prevent the onset of long-standing or

uncontrolled diabetic complications like retinopathy, neuropathy and nephropathy. This includes

screening for diabetic complications like fundus photographs, heart check-ups, peripheral vascular

screening, tests for micro albumin, urine PCR, nerve conduction study and autonomic nerve system

study.

Tertiary Care

MMHRC offers treatment and management services for all diabetic complications like chronic renal

failure, proliferative retinopathy, erectile dysfunction and diabetic foot ulcers. This is done in

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conjunction with the experienced specialists of the respective departments.

Charity

Diabetes is an expensive condition and treatment / management is often life long. At MMHRC we offer

charitable schemes to assist diabetics who find it difficult to afford the treatment required.

Free Insulin scheme

Type -1 Diabetic patients who are identified and treated in our hospital are provided free insulin in

association with Novo aid program.

At present 10 Type-1 DM patients have benefited from this programme.

Diabetic Club

A diabetic club was initiated at MMHRC in 2009 for diabetic patients and regular awareness

programmes / classes are conducted for them, from time to time. The aim of the club is for diabetics to

network with other diabetics and to empower them to live with diabetes throughout their life. The club

has 540 diabetics enrolled as members, and they are regularly educated about diabetes and the

complications associated with it.

E.N.T.

The branch of medicine dealing with the disorders of the ear, nose, throat, neck and head is better

known as E.N.T or Otorhinolaryngology. Reinforced by cutting edge technology and backed by quali-

fied doctors, the ENT Department at MMHRC is equipped to handle ENT cases and emergencies. The

department handles cases pertaining to voice disorders, hearing loss, tonsil infections, vertigo, cancer,

sinus etc. The advent of laser allows complicated surgeries to be performed with ease and minimal

morbidity. Our physicians provide compassionate care for a broad range of E.N.T / Otorhinolaryngeal

disorders and diseases

General Medicine

General Medicine is a branch of medicine which deals with the diagnosis and treatment of the dis-

eases of the internal organs, especially amongst adults. The treatment is non-surgical and the span of

this specialty includes asthma, respiratory diseases, tuberculosis, haematology and geriatric care. The

Department of General Medicine at MMHRC, has admitted and treated the maximum number of pa-

tients. Several executives have undergone the Health Check-up Programmes and many private insur-

ance companies & T.P.A.s’ have included our department doctors in their Panel of Doctors. The Inten-

sive Medical Care Unit (IMCU) and Intensive Coronary Care Unit (ICCU) are equipped with state-of-

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the-art equipments and manned round the clock by experienced medical personnel.PG Training in Gen-

eral Medicine at MMHRC is recognized by Diplomate National Board of Examinations, New Delhi,

General Medicine and Family Medicine. The PG training programme is quite popular for its depth of

practical training. We attract brilliant and quality aspirants for the PG post every year.

Nephrology

Nephrology is a challenging and complex super specialty requiring knowledge and skill which are

applied with a human touch The Department of Nephrology at MMHRC is spread across 10000 sq. ft.

and has grown to become one of the largest Nephrology centres in India. Since 1992 this department

has become a tertiary referral centre for the management of high risk nephrology cases. This growth

has been under the able leadership of Dr. K. Sampath Kumar, who started his career with two Drake-

Willock old refurbished machines in a humble way and who has been associated with MMHRC for 18

years now. The department has made great strides in diagnosis, treatment and management, offering

patients immense compassion and personalized care. The department has been treating the largest num-

ber of out patients in MMHRC for the last four years, with an average of 80 per day. Every year, a 20%

increase in patient load and growth in all fields of nephrology is seen.

Neurology

The department of Neurology at MMHRC has reached the pinnacle of achievement in its growth

and development between 2010-2011. It offers comprehensive evaluation and treatment for patients

with neurological disorders. The department has two consultant neurologists and four medical officers

available round the clock. We have a state of the art neuro-electro-physiology laboratory for nerve con-

duction study, EEG, Electromyography and evoked potentials. We also offer a separate sleep labora-

tory, where sleep related problems are effectively managed. The number of patients this department has

catered to this year has doubled, as against last year. We have 1351 new cases and 2261 old cases, all

related to neurological disorders. which include diseases related to the brain, spinal cord, nerve roots,

myoneural junctions, muscles, plexus etc

Ophthalmology

The Ophthalmology department at MMHRC, has its own community-oriented programmes to serve

the needy and poor, afflicted with eye problems. The team does excellent work in primary, secondary

and tertiary level eye care in Madurai and covers the southern districts of Tamilnadu. In tune with the

hospitals commitment to serving the impoverished, the department conducts regular eye camps in

seven districts totally free of cost. The department has assumed the role of a comprehensive therapeutic 13

facility in the region, with the fruition of our plans to acquire a perimeter to provide effective screening

and to strengthen the glaucoma clinic.

Orthopaedics& Traumatology

The Department of Orthopaedics and Traumatology at MMHRC, has become one of the tertiary re-

ferral Centre for management of musculoskeletal disorders, joint replacements, trauma, arthroscopic

surgeries and spine surgeries. The department is also recognized by the National Board of Examina-

tions, New Delhi for Post-Graduate training for the award of "Diplomate of National Board" Degree in

Orthopaedics.The department is backed by state-of-the-art facilities at par with international standards

in management of Trauma and is experienced to manage mass casualty cases and disaster management.

Management of polytraumatised victims is a regular feature and multidisciplinary interaction under one

roof has been a boon for successful management of these patients. Round the clock Accident and

Emergency services and readily available specialists provide the best possible treatment and care for

the patients.

Free Meals Scheme

Feed Patients:

The hospital is providing more than 150 patients "Free Meals" 365

days thrice. Become a Contributor today and feed help the poor Pa-

tients. Your gift of Rs. 2000/- a day meal can be a memorable day to 30

poor In-patients in the hospital.

Choose A Day:

The hospital feeds patients on the day the donors choose to provide. You can see the thankful-

ness in the eyes of patients when you provide meals by your hand on your auspicious day like

Birthday

Wedding day

Beloved's birthday

Any memorable day

Donate

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You can donate as

Sponsoring 'one day meals scheme'

Sponsoring 'one day meals for 5 consequent years'

Sponsoring 'one day meals for every year'

Camila Children's cancer Fund

Childhood Cancer Facts

There are more than 200 different kinds of cancer, each with its own name and treatment. But

the causes of childhood cancers are mainly unknown, although there are many theories. Cancers

are not infectious, so they can’t be passed on to anyone who comes into contact with your child.

Most cancers are not caused by an inherited faulty gene and so it is extremely rare for a second

child in a family to develop cancer. Parents often worry that something they did or did not do may

have caused their child’s cancer. This is not the case, and parents should not feel guilty or that they

are to blame for their child developing

Volunteering

About Volunteer Service

Volunteer Service at Meenakshi Mission Hospital and Research Centre offers a wide range of

service activities. The Volunteer programs provide a unique opportunity for national and interna-

tional volunteers to gain Hospital experience. Many are preparing themselves for health-related ca-

reers in medicine, nursing, or other areas, while others do service in non-medical areas such as

branding, marketing, fundraising to develop new skills, meet new friends, and to have fun while

doing things for others!Whatever the assignment, the objectives are the same - the care and welfare

of the patient.

Our Projects

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S.R.Trust is so keen in providing multi-facet services to the society by tieing up with the projects of In-

dian state and central government, national and international foundations:

Direct Relief International(DRI), USA regularly supports us through medical supplies and

equipments to serve the needy persons. DRI extended its support towards successful implementa-

tion of telemedicine project.

Magen David Adom (MDA), UK one of the donor organizations helps us in receiving medical

supplies.

Americares India, Mumbai a disaster relief and humanitarian organization supports us since 3

years.

Hospice care provides human and compassionate care inclusive of medical, psychological and

spiritual support for people in the last phases of incurable diseases. So that they may live as com-

fortable as possible. This care not only assists terminally ill patients to die peacefully but also to

make them live peacefully until the patients die.

Hospice care focuses on bringing comfort, self respect, and tranquility to the dying patient. Pa-

tient’s symptoms and pain are controlled to help reach these goals. However the focus is providing

care not curing because Hospice care is used when one can no longer be helped by curative treat-

ment.Our hospital in collaboration with Lions club international – USA, Lions Club Madurai Dis-

trict and Lions Club Madurai Vaigai is establishing a hospice centre for poor patients who need

end of life care. The hospice centre would be 25 bedded with comprehensive facility of modern

hospice care.

Gnanambal Palliative care centre started with the aim of providing the best quality of life for in-

dividuals, many of whom will be approaching death, and to offer comfort and support to their fam-

ilies and careers as well.

Corrective cleft lip /palate surgeries for the poor…Our hospital established an exclusive Smile

Train Centre for cleft lip/palate centre by the grant assistance of Smile Train, USA.

Blindness Control Program for children in collaboration with the Vitamin Angels Alliance, USA

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to wipe out Vitamin A deficiency among children.

Ekam Project Recently to treat the rural poor children who are in need of acute medical need, we

have initiated a project in collaboration with the EkamTrust, Chennai.

Tamil Nadu Foundation In collaboration with Tamil Nadu Foundation, our hospital conducts free

eye camps at various districts.

Services:

Telemedicine

In India, despite several advancements made in the medical field, the benefits are still available

to the priviledged few residing mainly in the Urban areas. It is a known that 75% of the qualified

doctors practice in Urban Centres, whereas the vast majority of the India’s population live in the

rural areas. Telemedicine is the use of telecommunication and information Technologies in order to

provide clinical health care at a distance. It helps eliminate distance barriers and can improve

access to medical services, that would often not be available in distant rural communities. These

technologies permit communications between patient and medical staff with both convenience and

fidelity as well as the transmission of medical, imaging and health information data from one site

to another. Telemedicine can be extremely beneficial for people living in isolated communities and

remote regions. Patients who live in such areas can be seen by a doctor or specialist, who can

provide an accurate and complete examination, while the patient may not have to travel.

Telemedicine technology critically bridge the distance by all health care professionals using

information and communication technologies for the exchange of valid health information for

diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the

continuing education of health care providers, all in the interests of advancing the health of

individuals and their communities. Meenakshi Mission Hospital & Research centre in Madurai,

extends its helping hands by establishing Meenakshi Tele Care Centre in rural remote areas. So far

Meenakshi Mission Hospital has established 6 centres in and around southern Tamil Nadu and also

Tele consultation services for Davanekare District - Karnataka. Meenakshi Mission Hospital has

plans to start 500 more Telemedicine centres.

Habitat for Humanity: With the help of Habitat for Humanity India, 100 new houses are built

17

under the name “Millard Linda Habitat” at Kathapatti. 1000 more houses will be launched with the

mission of building new houses to the poor with hope & happiness.

Creche and Play school by The District Social Welfare Board, which caters to the needs of

children from diverse social and cultural backgrounds, aged from 4 months to 3 years. The Creche

aims to provide an environment for children which is safe, happy, loving and stimulating. More

than 40 children are enrolled.

Working Women’s Hostel aims to provide young women not only with reasonably priced housing

but also opportunities for growth, making them self confident at the same time sensitive and

responsible to other women.

Integrated Counselling and Testing Centre (ICTC): With the support of Tamil Nadu State AIDS

Control Society (TANSACS), our hospital provides Prevention of Parent to Child Transmission of

HIV/AIDS (PPTCT) services are remodelled as a hub - 'Integrated Counselling and Testing Centre'

(ICTC) to provide services to all clients under one roof. An ICTC is a place where a person is

counselled and tested for HIV of his own free will or as advised by a medical provider. The main

functions of an ICTC are:

Conducting HIV diagnostic tests Providing basic information on the modes of HIV transmission

and promoting behavioural change to reduce vulnerability.Link people with other HIV prevention,

care and treatment services.

RNTCP III Phase Our hospital has been enrolled as an NGO/Private Provider in our district for

the performance of designated microscope centre scheme in accordance with the Revised National

Tuberculosis Control Program policy. MOU has been signed recently with the Deputy Director of

Medical Services (TB unit), Madurai District.

Family Counselling Centre: Marital problems have become the most distressing in the

lives of many married couples. Our family Counselling Centre counsel many such couples and

help them to live in harmony. This year, we have served more than 400 families.

Apart from Family Counselling, we also counsel cancer patients, HIV patients and others to live in

peace at our hospital which is supported by Tamil Nadu Social Welfare Board, Chennai.

2.1 Need of the Study:-

18

This study helps to identify the service quality of the Meenakshi Mission Hospital and

Research Centre by which the hospital can further improve its performance to enjoy

high reputation among the patients

This study also helps to making necessary changes in the attributes of the services

offered by the Meenakshi Mission Hospital and Research Centre.

This study also helps to identify and offer additional services according to the

expectations of the patients.

19

2.2 Objectives of the study:-

To identify the demographic profile of the patients.

To access the gap between the perceived and expected service quality among the Patients.

To identify the determinants of patients satisfaction in Meenakshi Mission Hospital

To know the overall patient satisfaction in Meenakshi Mission Hospital.

To suggest the ways to improve the quality of services in MMHRC

20

2.3 Scope of the study

The project entitled “Assessing the service quality of Meenakshi Mission Hospital and

Research Center, Madurai.” will enable from the patient point of view to refer the performance of the

service provider and their growth, thereby decide on to continue the same.

The outcome of the study, which is based on the above aspects can be utilized by the Hospitals

in India.

2.4 REVIEW OF LITERATURE

The health care service can be broken down into two quality dimensions: technical quality and

21

functional quality (Gronroos, 1984). While technical quality in the health care sector is defined

primarily on the basis of the technical accuracy of the medical diagnoses and procedures or the

conformance to professional specification, function quality refers to the manner in which the health

care service is delivered to the patient (Lam, 1997). In other words, technical quality is about what the

customer get, functional quality is about how they get it. Research has shown that technical quality falls

short of being a truly useful measure for describing how patient evaluate the quality of a medical

ervices encounter (Boers et al., 1994). Ware and Snyder (1975) state that although technical quality has

high priority with patients, most patients do not have the knowledge to evaluate effectively the quality

of the diagnostic and therapeutic intervention process or information necessary for such evaluation is

not shared with the patient. Thus, patient base their evaluation of quality on interpersonal and

environmental factors, which medical professionals have always regarded as less important. Moreover,

most patients cannot distinguish between the caring performance and the curing performance of

medical care providers (Lam, 1997). O’Callaghan (1998) in their studies, Cronin and Taylor (1994) and

Mc Alexander et al.(1994) found that there is a link between the patient’s perception of quality of

service and patient satisfaction. Research has shown that customers tend to evaluate the quality of the

health care service by focusing on more functional issues like physical facilities, interactions with

receptionists or brochures rather than hard-to evaluate technical aspects of the service delivery (Brown

and Swartz, 1989; Barnes and Mowatt, 1986; Crane and Lynch, 1988; Davies and Ware, 1981).

Research finds that patient satisfaction is positively related to purchase intentions (Cronin and Taylor,

1992), loyalty toward health care providers (John, 1992; Woodside et al., 1989) and adherence to

medical treatment recommendation (Hall and Dornan, 1990). According to Oswald et al., (1998),

consumer must rely on attitudes toward caregivers and the facility itself in other to evaluate their

experiences. They point out that there is a strong connection between health service quality perceptions

and customer satisfaction. Healthcare providers’ focus is providing the appropriate treatment to their

patients. They believe that this actually is the focus of the patient as well (Bopp, 1990). However, as

Swartz and Brown (1989) observed, patients’ perception often differ from those of the physician and

physicians may misperceive their patients’ evaluations. This causes dissatisfaction on the patients’ side

and leads the patient to look for an alternative provider and spread negative word of mouth which

would affect potential clients (Brown and Swartz, 1989; Swartz and Brown, 1989).

Parasuraman et al. (1988) described the development of a 22-item instrument of the

SERVQUAL model having 5dimensions to assess perceptions of customers regarding service quality in

22

service and retailing organizations. The researchers had selected four major well known service

providing businesses: a bank, a credit care company, a firm offering appliance repairs and maintenance

services and a long-distance telephone company. They ended up with a 22-item instrument having five

dimensions. All four different firms, from which the data was collected to perform factor analysis,

yielded five extracted factors with the same items loaded on each factor and having factor loadings

greater than 0.5 cut-off value. The reliability coefficients (Cronbach’s Alpha) were all greater than the

cutoff value of 0.6. This signifies the internal validity of the factors. Scale’s validity was also assessed

with the use of analysis of variance. Several tools have been developed to measure patients’

perceptions, but SERVQUAL instrument developed by parasuraman et al. (1988) is the most widely

used tool (Sohail, 2003). While the finding of some studies confirm the five generic quality dimension

of SERVQUAL (Babakus and Mangold, 1992; Youssef 1996), others either identification less number

of dimensions (Lam, 1997) or used a modified version of the instrument and identified additional

dimensions (Reidenback and Sondifer-Smallwood, 1990). Haywood-farmer and Status (1988)

concluded that SERVQUAL was inappropriate for measuring professional service quality since it

exclude the dimensions for “car service”, “service customization” and “knowledge of the professional”.

Coddington, D., and Moore, K. (1990) employed a modified SERVQUAL approach to

understand the relationship among patients’ perception of inpatient, outpatient and emergency room

service their overall perception of service quality satisfaction with their care and willingness to

recommend the hospital’s service to other. Seven dimensions were identified and differential impacts of

these dimensions were found in the three hospital setting. “patient confidence” was found to affect

patient satisfaction in all three setting in addition to influencing perception of service quality in both the

inpatient and the outpatient setting.

Babakus, E and Boller, G (1992) found that SERVQUAL is reliable and valid in the hospital

environment. Silvestro and Johnston (1992) identified care as a quality factor. Johnston (1995) further

developed the research of Silvestro and Johnston (1992) and found eighteen quality dimensions,

namely, cleanliness, aesthetics, comfort, functionality, reliability, reliability, responsiveness, flexibility

communication, integrity, commitment, security, competence, courtesy, friendliness, attentiveness, care

access and availability. Vandamme and Leunis (1993) suggest that SERVQUAL may not be generalized

to hospital services or health care services due to the uniqueness of the services offered.

Bowers et al., (1994) identified two additional quality dimensions, namely, “caring” and

“patient outcomes” to the five generic quality dimensions of SERVQUAL. The findings of the study

23

pointed out that empathy, responsiveness, reliability, communication, and caring were strongly

correlated with overall patient satisfaction.

Similar to Bowers et al. (1994), Gabbott an Hogg (1995) identified “caring” as a dimension, but

they decided not o accept it as a separate dimension since it was already covered by the five

SERVQUAL dimensions. Anderson (1995) used the SERVQUAL instrument to assess the quality of

service offered by a public university health clinic. The finding revealed that the clinic investigated was

poor on the assurance dimension. Youssef (1996) investigated patients’ satisfaction with National

Health Service (NSH) hospital in the UK using SERVQUAL.

Oliver Richard L.(1980) investigated service quality provided in public and private hospital in

Greece. They found that patient in public hospital were satisfied about the competence of physicians

and nurses. Their finding on private hospital show that patient are more satisfied with physical

facilities, waiting times and admission procedures compared to the public hospitals’ patients.

Carmen, J and Taylor, S. examined public and private hospital in Malta in terms of their care

service quality and concluded that both type of hospitals’ service exceeded the corresponding

customer’s expectations. Dean (1999) conducted research in two different health services setting in

Australia to test the transferability of SERVQUAL. It was concluded that quality factor differ not by

industry, but also by the type of health service. Lim and Tag (200) conducted a modified SERVQUAL

with six dimensions, namely, tangibles, reliability, assurance, responsiveness, empathy, accessibility

and affordability on 252 patients in Singapore hospitals. They concluded that hospital needed

improvements across all six dimensions.

Coddington D, and Moore K. (2000) examined patients’ expectations and perceptions about

hospital service quality in Singapore. In the beginning, the survey instrument was designed with five

dimensions of the SERVQUAL model. The instrument consisted of 25 questions having 5 point Likert

scale. In this study another dimension “accessibility and affordability” was added to the questionnaire

in the form of three additional questions that were different from original SERVQUAL model. This

additional dimension would also be included as the part of the present study.

Sohail’s (2003) objective was to assess the dimensions of the SERVQUAL model that influence

the perception of patients regarding the service quality in private hospitals in Malaysia. Patients’

satisfaction was taken as dependent variable and it was measured on the basis of five dimensions

defined in the SERVQUAL model. The research instrument was a questionnaire based upon a modified

version of SERVQUAL having five dimensions Tangibility, Reliability, Responsiveness, Assurance and

Empathy and it consisted of 15 pairs of matching expectation/perception items. A total of 186 responses

24

were obtained and this represented a response rate of 18.6%. To address construct validity of the study,

factor analysis was conducted. None of the reliability alphas were below the cutoff point of 0.60. The

mean scores of the patients’ expectations of service quality were generally low.

Kang and James (2004) applied the SERVQUAL model in the health care industry based on

European perspective1. A total of 464 users of two specific cell phone companies in South Korea were

interviewed. Interviewees were asked to rate questions in the questionnaire constructed for 3 constructs

i.e. functional quality, technical quality, image and their impact on overall service quality and customer

satisfaction. Confirmatory Factor Analysis (CFA) was conducted to check the unit-dimensionality of

the construct. Initial results did confirm the five-factor structure of the SERVQUAL model. The results

of the study indicated that functional and technical quality influence the perceptions that are related to

the overall service quality.

Evans J and Lindsay W. (2005) tested perceptions of service quality in Egypt from the

perspective of public and private hospital patients and attempted to seek an answer to the question; how

do patients evaluate service quality by using relevant dimension. A survey of a total of 500 patients,

from 12 hospitals of Egypt was conducted, and resulted in 332 successfully filled questionnaires. This

questionnaire was designed on the basis of the five dimensional SERVQUAL model having 5-point

Likert rating scale. The results of the survey highlighted a three factor solution of the SERVQUAL

model. A statistically significant difference in terms of service quality was observed between public and

private hospitals.

Karassavidou (2009) aimed to identify the service quality dimension used by patients for

service quality evaluation in Greek NHS (National Services Hospitals). A SERVQUAL questionnaire,

including an expectation and perception section, each consisting of 26 statements having seven point

Likert scale was used for the survey. A survey of 137 patients was conducted in six hospitals method

was used to extract factors. Factor analysis resulted in three extracted factors. Alpha coefficient ranged

from 0.785 to 0.996 and confirmed the reliability of all three dimensions. Gap analysis was also

performed to determine the degree to which the difference between expectations and perceptions exist

among patients surveyed.

Oliveria and Ferreira’s (2008) measured service quality at a higher education institute in Brazil.

This was a survey based research. The survey instrument was five dimensional SERVQUAL model.

The instrument consisted of 19 items having 7 point Likert scale. The gaps between expectations and

25

perceptions for all 19 items had been measured. The questionnaire was applied to 38 beginning

students in the Production Engineering course. The results show that the gaps for all 19 items were

negative and this implies that the expectations of the students were higher as compared to the

perceptions.

Manaf and Nooi (2009) based their study upon the difference in perceptions and expectations of

in-patients and out-patients on the basis of SERVQUAL model adapted for the health care industry in

Malaysia. Surveys of outpatients and inpatients were conducted and 646 inpatients and 570 outpatients’

usable questionnaires were analyzed. Factor analysis was carried out for both inpatient and outpatient

data. This yielded with two factors, namely clinical dimensions of service 2 and physical dimension of

service.

Miranda et.al. (2010) based their study on the SERVQUAL model and measured the gap

between the perceptions of health managers and that of patients’. Patients’ satisfaction was taken

as the dependent variable and the variables, Health staff (doctors and nurses), Efficiency (waiting times

and the time it takes to resolve complaints), No Health Staff (administrative staff), and Facilities

(cleanliness, equipment and the location of the health center) were taken as independent variables. The

gap between the perceptions of health managers and patients were measured and most of them were

found to have statistically significant negative values.

Yesilada and Direktor (2010) extracted the dimensions of the SERVQUAL model in both public

and private hospitals. In the survey, 990 people living in Northern Cyprus, above 18 years of age were

selected for the survey. 806 people contributed their responses. A 22 items-SERVQUAL model with 5-

point “agree-disagree” Likert scale was used. Three factors were extracted through factor analysis, with

61.5% explained variance. Reliability –confidence, empathy and tangibility appeared as the most

important dimensions of service quality. Private hospitals appeared with smaller gaps between

expectations and perceptions (not negligibly small), as compared to the public hospitals and were

perceived as better service providers.

3. RESEARCH METHODOLOGY

Research

Research refers to the systematic method consisting of enunciating the problem, formulating a

26

hypothesis, collection the fact or data, analyzing the factors and reaching certain conclusions either in

the form of solutions to words the concerned problem or in certain generalization for some theoretical

formulation, red man and more define research as a “ systematized effort to gain new knowledge”.

Methodology

Research Methodology is purely and simple the frame work or plan for a study that guide the

collection and analysis of the data. It is a way to systematically solve the research problem. It may be

understood as a science of studying how research is done statistically.

3.1 Research Design

Research Design is the arrangement of conditions for collection and analysis of data in a

manner that aims to combine relevance to the research purpose with economy in procedure. In this

study descriptive research is been used.

3.2 Descriptive Research

It includes surveys and facts finding enquires of different kinds. The major purpose of it is

description of the state of affairs as it exists at present. The main chart of it is the researcher has no

control over the variable; he or she only report. What has happened or what is happening.

3.3 Sampling Technique

Simple Random Sampling technique has been used to select the sample

A Simple Random Sampling is a group of subjects (a sample) chosen from a larger group ( a

population)

3.4 Sources of Data

Primary Data

Secondary Data

3.4.1 Primary Data

It is are those which are collected a fresh and for the first time and thus happen to original in

character. There are several methods of collecting primary data, particularly in surveys and descriptive

researches. Important ones are observation method interview method, through questionnaires, through

schedules, using mechanical devices, through projective technique, Depth interview and content

analysis.

Primary Data has been collected through face to face interview and filling the questionnaire

from the customers of Meenakshi Mission Hospital and Research Centre.

3.4.2 Secondary Data

27

Secondary data means data that are already available. i.e., they refer to the data which have

already been collected and analyzed by someone else. Secondary data may either by published data or

unpublished data.

Secondary Data has been collected through various publications related to hospitals, books,

journals, company publications

3.5 Sample Size

Sample size is the total number of samples selected for the study from the sampling population.

Sample size for the study was arrived at 150 respondents is taken for this study. The sample area

chosen for the study are patients of Meenakshi Mission Hospital and Research Centre.

3.6 Statistical tool used

Percentage Analysis

Reliability

Chisquare

Service Gap Score

Percentage Analysis

The following is the formula to calculate percentage analysis

Percentage of Respondent = No. of Respondent x 100

Total no. of Respondent

CHI - SQUARE Analysis

This test is used to test significance of association between two attributes. Chi- square,

symbolically written as χ 2 (pronounce as Ki- square), is a statistical measure used in the context of

sampling analysis for comparing a variance to a theoretical variance. Formula for finding chi square

is

χ 2 = ∑(O-E)2/ E

4.1. DESCRIPTIVE STATISTICS

4.1.1 Gender wise classification of the Patients

28

Gender of the respondent

Frequency Percent Valid PercentCumulative

Percent

Valid

Male 106 70.7 70.7 70.7

Female 44 29.3 29.3 100.0

Total 150 100.0 100.04.1.2 Gender wise classification of the patients

Source: Primary data

Inference:-

From the above table 4.1.1 reveals that out of 150 samples taken for the survey, 70.7% majority of

the respondents are male remaining 29.3% of the respondents are female.

4.1.2 Age wise classification of the patients

29

Age group of the respondent


Percent

Valid Less than 20 years 10 6.7 6.7 6.7

Between 21years to 30 years

42 28.0 28.0 34.7

Between 31years to 40 years

47 31.3 31.3 66.0

Between 41 years to 50 years

19 12.7 12.7 78.7

Greater than 50 years 32 21.3 21.3 100.0

Total 150 100.0 100.0

4.1.2 Age wise classification of the patientsSource: Primary data

Inference:-

From the above table 4.1.2 inferred that out of 150 samples, 31.3% majority of the respondents are

belongs to the age group of 31 to 40, 28% of the respondents belongs to the age group of 21 to 30 and

the remaining percentage of the respondents belongs to the age group of others.

4.1.3 Marital status of the Patients

30

Marital status of the respondent


Percent

Valid Married 107 71.3 71.3 71.3

Unmarried 43 28.7 28.7 100.0

Total 150 100.0 100.0

4.1.3 Marital status of the PatientsSource: Primary data

Inference:-

From the above table 4.1.3 reveals that out of 150 samples, 71.3% majority of the respondents are

married and remaining 28.7% of the respondents are unmarried.

4.1.4 Level of Education of the Patients

31

Level of Education of the respondent


Percent

U.G 40 26.7 26.7 26.7

P.G 29 19.3 19.3 46.0

Diploma 14 9.3 9.3 55.3

Higher secondary 30 20.0 20.0 75.3

Below 10th 37 24.7 24.7 100.04.1.4 Level of Education of the Patients

Source: Primary data

Inference:-

From the above table 4.1.4 inferred that out of 150 samples, 26.7% majority of the respondents

belongs to Under Graduation(UG), 24.7% of the respondents belongs to below 10th and the

remaining percentage of the respondents belongs to others.

4.1.5 Occupation of the respondent

32

Occupation of the respondent


Percent

Valid Business 62 41.3 41.3 41.3

Professional 31 20.7 20.7 62.0

Student 31 20.7 20.7 82.7

Housewife 26 17.3 17.3 100.0

Total 150 100.0 100.0

4.1.5 Occupation of the respondentSource: Primary data

Inference:-


belongs to Business, 20.7% of the respondents are belongs to both professional and student and

remaining percentage of the respondents are belongs to others.

4.1.6 Monthly family income of the respondent

33

Monthly family income


Percent

Valid Less than 10,000 42 27.3 27.3 27.3

Rs. 10,001 to Rs. 25000

28 20.3 20.3 47.6

Rs. 25,001 to Rs.50,000

33 21.3 21.3 68.9

Rs. 50,001 to Rs. 75000

37 24.4 24.4 93.3

Greater than Rs. 75000 10 6.7 6.7 100.0

Total 150 100.0 100.0

4.1.6 Monthly Family IncomeSource: Primary data

Inference:-


belongs to the income group of Less than 10,000, 20.3% of the respondents belongs to the income

group of Rs 10,001 to 25,000 , 6.7% of the respondents are belongs to the income group of more than

75,000.

34

4.1.7 Referral of hospital by the patients

How do you know about this Hospital?


Percent

Valid Family doctor referral

40 26.7 26.7 26.7

Friends 50 33.3 33.3 60.0

Relatives 46 30.7 30.7 90.7

Advertisement 14 9.3 9.3 100.0

Total 150 100.0 100.0

4.1.7 Referral of hospital to the patientsSource: Primary data

Inference:-


belongs to the referral by friends, 30.7% of the respondents belongs to the referral by Relatives and

the remaining percentage of the respondents belongs to the others.

35

4.2 Reliability statistics for the Expectation and Perception

4.2.1 Reliability for Expectation

4.2.1Reliability for Expectation

4.2.2 Reliability for Perception

Reliability Statistics

Cronbach's Alpha N of Items

.933 24

4.2.2 Reliability for Perception

Inference:- From the above table 4.2.1 and 4.2.2 inferred that the reliablility statistics for expectation is 0.804

and the perception is 0.933.

4.3 Cross tabulation and Chi-Square Test

4.3.1 Cross tabulation between the Age wise classifications of the patients by treatment 36

Reliability Statistics

Cronbach's Alpha N of Items

.804 24

undergone in this hospitals

H0: There is no significant difference between Age and treatment undergone in this Hospital

H1:There is significant difference between Age and treatment undergone in the Hospital

General

Medicine

Andrology

and

Urology

Diabeto

logy E.N.T

Nephr

ology

Neuro

logy

Gynae

cology

Orthopae

dics

Opthal

molog

y

Age

group

of the

respon

dent

Less than

20 years3 0 0 2 0 0 1 0 4 10

Between

21years to

30 years

17 0 2 9 0 0 1 4 9 42

Between

31years to

40 years

14 2 7 9 1 6 1 4 3 47

Between 41

years to 50

years

9 0 4 1 0 3 0 1 1 19

Greater than

50 years8 1 8 2 0 2 1 7 3 32

Total 51 3 21 23 1 11 4 16 20 150

4.3.1 Cross tabulation between the patients undergone treatment in this hospital and age wise

classification

Chi-square

Value dfAsymp. Sig.

(2-sided)

Pearson Chi-Square 45.831a 32 .054

Likelihood Ratio 50.971 32 .018

Linear-by-Linear Association

.106 1 .744

N of Valid Cases 150

37

Inference:-

The above table 4.3.1 shows that the chi-square value is 0.054. Here the value is greater than 0.05. Therefore

the H0 is accepted. Hence there is no significant difference between age and treatment undergone in this

hospital.

4.3.2 Cross tabulation between the Gender wise classification by referral to the patients

H0: There is no significant difference between Gender and Referral by the patients

H1:There is significant difference between Gender and Referral by the patients

How do you know about this Hospital?

Total

Family doctor

referral Friends Relatives Advertisement

Age group of the

respondent

Less than 20 years 1 4 4 1 10

Between 21years to 30

years

3 23 11 5 42

Between 31years to 40

years

12 14 14 7 47

Between 41 years to 50

years

8 2 9 0 19

Greater than 50 years 16 7 8 1 32

Total 40 50 46 14 150

4.3.2 Cross tabulation between the Gender wise classification by referral to the patients

38

Chi-Square

Value dfAsymp. Sig.

(2-sided)



Linear-by-Linear Association

2.907 1 .088


Inference:-

The above table 4.3.2 shows that the chi-square value is 0.123. Here the value is less than 0.05.

Therefore the H0 is rejected. Hence there is significant difference between Gender and Referral for the

patients.

4.3.3 Cross tabulation between the age wise and income wise classification

H0: There is no significant difference between age and income wise classification patients

H1:There is significant difference between age and income wise classification of the patients

Monthly family income

Total

Less than

10,000

Rs. 10,001 to

Rs. 25000

Rs. 25,001 to

Rs.50,000

Rs. 50,001 to

Rs. 75000

Greater than

Rs. 75000

Level of Education of

the respondent

U.G 15 9 10 5 1 40

P.G 3 9 6 5 6 29

Diploma 4 2 5 3 0 14

Higher

secondary

4 8 6 9 3 30

Below 10th 9 7 8 13 0 37

Total 35 35 35 35 10 150

4.3.3 Cross tabulation between the age wise and income wise classification

39

Chi-Square Tests

Value Df

Asymp. Sig. (2-

sided)



Linear-by-Linear

Association

2.173 1 .140


Inference:-

The above table 4.3.3 shows that the chi-square value is 0.026. Here the value is less than 0.05.

Therefore the H0 is rejected. Hence there is significant difference between the age wise and income

wise classification

40

4.4 Service Gap Score:

Step1: Designing SERVQUAL Instrument

Perceptions Expectations Gap

Score

Tangibles P Tangibles E P-E

MMHRC have up to date Equipment 6.2 Ideal Hospitals have modern

Equipment

4.7 1.5

MMHRC physical installations are

visually attractive

5.1 The physical installations

should be visually attractive

4.9 0.2

MMHRC employees are well dressed

and clean

4.9 The employees should be

well dressed and clean

4.9 0

The appearance of MMHRC physical

installations is conserved according

to the service offered

5.0 The appearance of hospital

installations should be

conserved according to the

service offered

4.9 0.1

Total 21.2 19.4 1.8

Average Gap Score[Total of E-P/4] 0.45

Reliability P Reliability E P-E

When MMHRC promise to do

something in a certain time they really

does it

4.9 When these hospitals promise

to do something in a certain

time they must do it

4.9 0

When you have any problem with

MMHRC it is solidary and makes you

feel secure

4.8 When the patient have any

problems the latter must be

solidary and make them feel

secure

4.8 0

MMHRC can be trusted 4.8 These hospital should be of

confidence

4.4 0.4

MMHRC provides the service in the

time promised

5.3 They should provide the

service in time promised

4.4 0.9

MMHRC keeps it records correctly 5.1 They should keep their 4.4 0.7

41

records correctly

Total 24.9 22.9


Responsibility P Responsibility E P-E

MMHRC does not inform exactly

when services will be executed.

4.9 It should be expected that

they inform patients exactly

when the services are to be

executed.

4.2 0.7

You do not receive immediate sevices

form MHRC employees

4.5 It is not reasonable to expect

immediate availability of

hospital employees

4.6 -0.1

MMHRC employees are not always

available to help Patients

4.6 Hospital employees do not

need to be always available to

help clients.

4.7 -0.1

MMHRC employees are always too

busy to respond

4.8 It is normal for them to be too

busy to readily respond to

requests

4.3 0.5

Total 18.8 17.8


Assurance P Assurance E P-E

You can believe MMHRC employees 4.7 Patients should be able to

believe in the Hospital

employees

4.3 0.4

You feel secure negotiating with

MMHRC employees.

4.4 Patients should be able to feel

safe in negotiating with

Hospital employees.

4.4 0

MMHRC employees are polite 4.6 The employees should be

polite

4.6 0

MMHRC employees do not obtain

adequate support from the hospitals to

perform their tasks correctly.

The employees should obtain

adequate support from the

hospitals to perform their 42

4.7

tasks correctly.

4.3 0.4

Total 18.4 17.6


Empathy P Empathy E P-E

MMHRC does not pay individuals

attention to you.

4.8 It should not be expected for

hospitals to pay individuals

attention to patients.

4.4 0.4

MMHRC employees do not give

personal attention to you

4.7 It shoud be expected for the

employees to give

personalized attention to

patients.

4.7 0

MMHRC employees donot know their

needs

4.7 It is absurd to expect the

employees to know the

patient needs

4.1 0.6

MMHRC does not have your best

interest as its objective.

4.9 It is absurd to expect these

hospitals to have the patients

best interest as their

objective.

4.2 0.7

MMHRC does not have convenient

working hours for all patients.

4.7 It should not be expected for

the working hours to be

convenient for all patients.

4.6 0.1

MMHRC give enough treatment for

their patients

4.4 It give enough treatment for

patients

4.4 0

The treatment of MMHRC is in good

quality

4.8 The treatment of hospitals

have good quality

4.7 0.1

Total 33 31.1


43

Step2: Calculation of Service Gap score

Scores for five different categories as calculated in step1 is averaged to compute Service Gap

score is given below

S.no Categories Gap Scores

1 Average score for Tangibles 0.45

2 Average score for Reliability 0.40

3 Average score for Responsiveness 0.25

4 Average score for Assurance 0.20

5 Average score for Empathy 0.27

Total 1.57

Average (Total/5) un-weighted score 0.314

Inference:

From the above 4.4 table shows that the service gap score for the Meenakshi Mission Hospital

and Research Centre in Madurai city, it show that lowest service gap in “Assurance” and

“Responsiveness” dimension and little bigger service gap is occurred in the “Tangibles” and

“Reliability” dimension.

44

5.1 Findings:-

By applying descriptive statistics determined the demographic profile of 150 samples determined,

majority of the respondents are in male (106) and rest of them are female respondents(44) in this re-

search study.

By applying the descriptive statistics determined the demographic profile of 150 samples deter-

mined, majority of the respondents 31.3% belongs to the age group of 31 to 40, 28% respondents

are belongs to the age group of 21 to 30 and the remaining percentage of the respondents belongs to

the age group of others.

By applying the descriptive statistics determined the demographic profile of 150 samples deter-

mined, majority of the respondents 26.7% belongs to the Under Graduate, 24.7% belongs to the

Post Graduate and the remaining percentage of the respondents belongs to the educational qualifi-

cation of others.

The Majority of the respondents, 41.3% belongs to the Own Business category and 20.7% are be-

longs to the professionals and student and the remaining respondents are belongs to the other cate-

gories.

By applying the descriptive statistics, 27.3% majority of the respondents belongs to the income

group of Less than 10,000, 20.3% of the respondents belongs to the income group of Rs 10,001 to

25,000 , 6.7% of the respondents are belongs to the income group of more than 75,000.

The majority of respondents 33.3% belongs to the referral by friends, 30.7% respondents belongs to

the referral by Relatives and the remaining percentage of the respondents belongs to the others.

By applying the chi-square statistics there is no significant difference between age and treatment

undergone in this hospital.

By applying the chi-square statistics there is no significant difference between gender and Referral

to the hospital.

By applying the service gap score analysis for the Meenakshi Mission Hospital and Research Cen-

tre in Madurai city, it show that lowest service gap in “Assurance” and “Responsiveness” dimen-

sion and little bigger service gap is occurred in the “Tangibles” and “Reliability” dimension.

5.2 Suggestions

45

It is suggested to improve the patient’s satisfaction level through providing more amenities to the

patients then only more number of patients are preffered to Meenakshi Mission Hospital and

Research Centre.

It is suggested to reduce the waiting hours of the patients.

It is suggested to reduce the price of the food in the canteen because the price fixed for food in the

canteen is comparatively higher regarding to the quality of the food served.

It is suggested to provide separate room patient cardiology department. The ward secretary must to

give periodical advise to the patient and patient attainders regarding the procedure followed in

hospital.

It is suggested to the cash counter must have additional counters in order to pay faster.

5.3 Conclusion

46

This Research project explained the service quality of Meenakshi Mission Hospital and

Research Centre in Madurai city. The study has been able to accomplish its objectives, by thoroughly

analyzing and identifying the service gap of Meenakshi Mission Hospital and Research Centre

strengths and weaknesses of various service covers among the patients of various places. The company

may highly benefited by outcome of this study.

The outcome of the study has proved that the service quality of the Meenakshi Mission Hospital

and Research Centre strengths and Patients satisfaction towards the MMHRC. The Hospital has a

higher reputation among the patients.

It is concluded that the Hospital could initiate various steps based on the recommendations

given in this report. The hospital by adopting some of the recommendations , if not all can further

improve its service quality .

47

Bibiliography:-

1. Parasuraman A, Zeithaml VA, Berry LL. (1988), “SERVQUAL: “A multiple term scale for measur-

ing customer perceptions of service quality”, Journal of retailing, Vol.No. 61, pp.12-40.

2. Carmen J, and Taylor S. (1990), “Measuring service quality: “A Reexamination and Extension,”

Journal of retailing, Vol.No. 66, pp.33-35.

3. Lanning J.A. (1990), “The Health care Quality Quagmire: some Signposts.” Hospital and Health

sciences Administration, Vol.No.35, pp.39-54.

4. Babakus E, Boller G. (1992), “An empirical Assessment of the SERVQUAL Scale.” Journal of

Business Research”, Vol. No. 24, pp.253-68.

5. Stevenson W. (1999) “Production & operations management”, 6th edition Boston, MA: Irwin Mc-

Graw-Hill, pp. 421-422.

6. Gronroos. C.(1984), ”A service quality model and its marketing implications”, European journal of

marketing, Vol.No. 18, pp.36-44

7. Oliver Richard L.(1980) “A cognitive model of antecedents and consequence of satisfaction deci-

sions”, journal of marketing Research, Vol.No. 17, pp. 46-54.

8. Bowers M, Swan I, and Kohler W.(1994) “What attributes Determine quality and satisfaction With

Health care Delivery?” Health care Management Review Vol.No.19, pp. 49-55.

9. Coddington D, and Moore K. (1987) ”Quality of care as a Business Strategy: How customers De-

fine quality and how to Market it.” Healthcare forum Vol.30, issue no.2, pp. 29-32.

10. Evans J and Lindsay W. (1999). “The management and control of quality”, 4th edition St.Paul, MN:

West. pp.52

11. www.meenakshimission.org

12. www.smilemmhrc.org

13. www.google.com

QUESTIONNAIRE

Dear sir,

48

http://www.smilemmhrc.org/

This is a MBA Academic questionnaire titled “Assessing the Service Quality of Meenakshi Mission Hospital

and Research Center, Madurai”. Your personal details and identity are not revealed in this research. You have

been randomly selected to participate in this survey; please do not mention your address in the questionnaire. I

also express my hearty thanks for spending your valuable time in answering this questionnaire.

Name of the Patient : ____________________________________________________

1. Gender: □ (1) Male □ (2) Female

2. Age Group:

□ (1) Less than 20yrs □ (2) Between 21 yrs to 30 yrs □ (3) Between 31 yrs to 40 yrs

□ (4) Between 41rs to 50 yrs □ (5) Greater than 50 yrs.

3. Marital Status: □ (1) Married □ (2) Unmarried

4. Educational Qualification:

□ (1) SSLC/HSC □ (2) Undergraduate □ (3) Postgraduate □ (4) Diploma □ (5) Others

If (5) Others, Please Specify ___________________________.

5. Occupation:

□ (1) Business □ (2) Professional □ (3) Student □ (4) Housewife □ (5) Others

If (5) Others, Please Specify ___________________________.

6. Monthly Family Income:

□(1)Less than Rs.10,000 □ (2) Between Rs.10,001 to Rs.25,000 □(3) Between Rs.25,001 to Rs.50,000

□ (4) Between Rs.50, 001 to Rs.75, 000 □ (5) Greater than Rs.75, 000

7. How did you come to know about the Meenakshi Mission Hospital and Research Centre?

□ (1) Through Family Doctor Referral □ (2) Through Advertisements

□ (3) Family Members Referral □ (4) Friends Referral

49

□ (5) Others (If Others, Please Specify_________________________________________)

8. Which Type of Treatment you had undergone in Meenakshi Mission Hospital and Research

Centre?

□ (1) Andrology & Urology □ (2) Cardiology □ (3) Venereology

□ (4) Diabetology □ (5) E.N.T. □ (6) Nephrology

□ (7) Neurology □ (8) Ophthalmology □ (9) Orthopaedics

□ (10) General Medicine □ (11) Gynecology □ (12) □ Paediatrics

□ (13) Others (If Others, Please Specify_________________________________________)

Expectations:-

This section deals with your opinion of hospital in Madurai. Please show the extent which you

think. Hospitals should possess the following features. We are interested in knowing your expectations

from ideal Hospitals in Madurai. You should rank each statement as follows;

50

Strongly Disagree ------------------------------------------------------------------Strongly Agree 1 2 3 4 5 6 7

s.no Features

Strongly strongly

disagree agree

1.

Tangibility:-

Ideal Hospitals have modern Equipment

1 2 3 4 5 6 7

2. The physical installations should be visually attractive 1 2 3 4 5 6 7

3. The employees should be well dressed and clean 1 2 3 4 5 6 7

4. The appearance of hospital installations should be

conserved according to the service offered

1 2 3 4 5 6 7

5.

Reliability:-

When these hospitals promise to do something in a certain

time they must do it

1 2 3 4 5 6 7

6. When the patient have any problems the latter must be

solidary and make them feel secure

1 2 3 4 5 6 7

7. These hospital should be of confidence 1 2 3 4 5 6 7

8. They should provide the service in time promised 1 2 3 4 5 6 7

9. They should keep their records correctly 1 2 3 4 5 6 7

10.

Responsibility:-

It should be expected that they inform patients exactly when

the services are to be executed. 1 2 3 4 5 6 7

11. It is not reasonable to expect immediate availability of

hospital employees

1 2 3 4 5 6 7

12. Hospital employees do not need to be always available to

help Patients.

1 2 3 4 5 6 7

13. It is normal for them to be too busy to readily respond

requests

1 2 3 4 5 6 7

14.

Assurance:-

Patients should be able to believe in the Hospital employees 1 2 3 4 5 6 7

51

15. Patients should be able to feel safe in negotiating with

Hospital employees.

1 2 3 4 5 6 7

16. The employees should be polite 1 2 3 4 5 6 7

17. The employees should obtain adequate support from the

hospitals to perform their tasks correctly.

1 2 3 4 5 6 7

18.

Empathy:-

It should not be expected for hospitals to pay individuals


1 2 3 4 5 6 7

19. It shoud be expected for the employees to give personalized


1 2 3 4 5 6 7

20. It is absurd to expect the employees to know the patient

needs

1 2 3 4 5 6 7

21. It is absurd to expect these hospitals to have the patients

best interest as their objective.

1 2 3 4 5 6 7

22. It should not be expected for the working hours to be

convenient for all patients.

1 2 3 4 5 6 7

23. It give enough treatment for patients 1 2 3 4 5 6 7

24. The treatment of hospitals have good quality 1 2 3 4 5 6 7

Perceptions:

The following statement deal with the perceptions of service experienced in Meenakshi

Mission Hospital and Research Centre. Please show the extent to which these statements reflect your

perception of service in Meenakshi Mission Hospital and Research Centre in Madurai.

52

Strongly Disagree ------------------------------------------------------------------Strongly Agree 1 2 3 4 5 6 7

s.no Features

Strongly strongly

disagree agree

1.

Tangibility:-

MMHRC have up to date Equipment

1 2 3 4 5 6 7

2. MMHRC physical installations are visually attractive 1 2 3 4 5 6 7

3. MMHRC employees are well dressed and clean 1 2 3 4 5 6 7

4. The appearance of MMHRC physical installations is

conserved according to the service offered

1 2 3 4 5 6 7

5.

Reliability:-

When MMHRC promise to do something in a certain time

they really does it

1 2 3 4 5 6 7

6. When you have any problem with MMHRC it is solidary

and makes you feel secure

1 2 3 4 5 6 7

7. MMHRC can be trusted 1 2 3 4 5 6 7

8. MMHRC provides the service in the time promised 1 2 3 4 5 6 7

9. MMHRC keeps it records correctly 1 2 3 4 5 6 7

10.

Responsibility:-

MMHRC does not inform exactly when services will be

executed.

1 2 3 4 5 6 7

11. You do not receive immediate sevices form MHRC

employees

1 2 3 4 5 6 7

12. MMHRC employees are not always available to help

Patients

1 2 3 4 5 6 7

13. MMHRC employees are always too busy to respond 1 2 3 4 5 6 7

14.

Assurance:-

You can believe MMHRC employees 1 2 3 4 5 6 7

15. You feel secure negotiating with MMHRC employees. 1 2 3 4 5 6 7

16. MMHRC employees are polite 1 2 3 4 5 6 7

17. MMHRC employees do not obtain adequate support from 1 2 3 4 5 6 7

53

the hospitals to perform their tasks correctly.

18.

Empathy:-

MMHRC does not pay individuals attention to you. 1 2 3 4 5 6 7

19. MMHRC employees do not give personal attention to you 1 2 3 4 5 6 7

20. MMHRC employees donot know their needs 1 2 3 4 5 6 7

21. MMHRC does not have your best interest as its objective. 1 2 3 4 5 6 7

22. MMHRC does not have convenient working hours for all

patients.

1 2 3 4 5 6 7

23. MMHRC give enough treatment for their patients 1 2 3 4 5 6 7

24. The treatment of MMHRC is in good quality 1 2 3 4 5 6 7

25. Did you satisfy with the service rendered by the MMHRC?

1) □Highly satisfied 2) □Satisfied 3) □ Neither satisfied nor unsatisfied

4) □unsatisfied 5) □Highly unsatisfied

26. Your overall satisfaction in MMHRC?

1) □Highly satisfied 2) □Satisfied 3) □ Neither satisfied nor unsatisfied

4) □unsatisfied 5) □Highly unsatisfied

Thank you

Patient’s Signature

54

Summer Project

Documents

cutting edge technology

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gross domestic product

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high school headmaster

obtain adequate support

specialty premiere hospital

fledged modern facility