fynl sme
Content
Table of Contents
Acknowledgement .................................................................................................2 Chapter1 Introduction ..........................................................................................................3 Industry overview ................................................................................................3 Industry trends ..................................................................................................4 Porter¶s five forces model .................................................................................7 Chapter2 Literature Review .................................................................................................9 Chapter3 Questionnaire analysis and methodology .......................................................... 15 Conclusion ........................................................................................................ 24 Opportunities .................................................................................................. 25 Opportunity gap .............................................................................................. 25
References ........................................................................................................... 26
Appendix ............................................................................................................. 27
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ACKNOWLEDGEMENT
We would like to express our sincere gratitude to PROF. Irfan Siddique for his suggestion and assistance in the preparation of this project. He served as our advisor, gave us valuable guidance and constant encouragement. Without his direction and supervision, this presentation would not have been possible. We are deeply grateful to him for advices and expertise and offering us concrete suggestions in data manipulation and analysis. Many thanks for giving us the opportunity to access and analyze this reporting data.
Finally, we would like to thank our families who gave us constant support and encouragement through the whole process. They paved the way for us to get this thesis done.
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Chapter1 Introduction
The main industry of our study is µHealth care industry¶ and the sub-sector which we have chosen is µChild health care sector¶ in which we have selected pediatric departments of various hospitals. Health plays the key role in determining the human capital. Better health improves the efficiency and the productivity of the labor force, ultimately contributes the economic growth and leads to human welfare. In Pakistan attempts have been made to improve the health conditions of the people through availability of trained personnel, adequate supply of medicines and establishment of health services. Yet the health care system as a whole is not encouraging.
Healthcare Industry overview
The healthcare industry is broadly defined as a category of stocks related to medical/ healthcare goods and services. The industry includes hospitals, pharmaceutical companies, nursing homes, pediatric clinics, maternity homes etc. The industry has high demand as people need healthcare facilities at all times for the ever increasing population. Total public sector expenditure on health, for both the federal as well as provincial governments combined, in the current fiscal year is projected to be 0.54 percent of GDP, which is amongst the lowest of all other countries at a similar income level. According to record of Ministry of Health, there are 122,798 MBBS officers, 8,388 dentists, 62,646 nurses, 27,692 midwives, 8,405 lady health visitors and 85,000 lady health workers all over the country. Hence, it is estimated one doctor is available for 1,254 persons in Pakistan. In developed countries, this ratio is one for 300 persons. Similarly, one dentist is available for 20,839 persons; one nurse for 2,671 persons and one lady health visitor for 18,318 persons. The total GDP contribution of health industry is 2.2% only.
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Recent Healthcare Industry trends
In Pakistan, health status of the population at large has improved considerably over time. However, by international comparison, the status is mixed, but generally improvements on this front have lagged in the case of Pakistan. Recent cross-country studies of vital health indicators show a wide variation in epidemiological pattern between different Asian countries. Compared with Bangladesh, India and Sri Lanka, for example, Pakistan¶s infant mortality rate is higher. While life expectancy is also higher except for Sri Lanka, the overall population growth at 2.1% (latest, revised) is the highest in the region.
Health Expenditure trends: Despite a nearly threefold increase in public sector expenditure since 2001, spending on health remains terribly low ± and has declined as a percentage of GDP. Total public sector expenditure on health, for both the federal as well as provincial governments combined, in the current fiscal year is projected to be 0.54 percent of GDP, which is amongst the lowest of all other countries at a similar income level.
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Child health care trend
The child health care trend shows that 100 children out of every thousand die before reaching their fifth birthday and 73 infants out of every thousand die before their first birthday. Figure 1 presents the trends in achieving the child health care targets under MDGs, Millennium Development goals. It is clear from the graph that there is a desired need to invest in the child care health to achieve the MDG targets by 2015.
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Current Health conditions in Punjab after floods:
The graph below shows the distribution of patient visits by disease vis-à-vis the percentage of patient consultations in the flood-affected districts in Punjab (5 August 2010).
Key: RTI POU AWD Respiratory tract infection fever due to unknown reason Acute watery diarrhea
Other general trends in the health care industry:
y Prior to birth of a baby genetic analysis is done nowadays so that birth defects are eliminated in new born babies such as mental retardation and certain syndromes which have got multiple birth defects. y Counseling of parents for future pregnancies is done nowadays due to first cousin marriage trend which is very much prevalent in Pakistan. If mothers give birth to some
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abnormal child genetic counseling is very vital for either to have further pregnancies or not. y Interfamilial marriages are also being discouraged in Pakistan so as to avoid certain diseases which are dominant in families of the couple. y These days several campaigns and health programs are being started but still rural areas remain aloof from such facilities. y Demand for health nutritionists is also at its peak as people become conscious of their health.
Porter¶s five forces model:
Porter¶s Five Forces
Bargaining power of suppliers Bargaining power of buyers Threat of new entrants Threat of substitutes Competitive rivalry
Position in health industry
Low High High Moderate Moderate
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Explanation of Porter¶s model Bargaining power of suppliers: low
The bargaining power of suppliers is low because hospitals float tenders by giving ads in the newspaper that certain equipments are needed and certain parties respond to these tenders. Then hospital selects which party to chose and which to abandon on the basis of quality of the equipment and cost.
Bargaining power of buyers: high
The bargaining power of buyers is high because they are large in number and so they can bargain on the price of the equipments or anything g they want to purchase from suppliers.
Threat of new entrants: high
As health industry is a very attractive industry so it can attract investors to invest in this business concerning the need of better health facilities in Pakistan and demand for this industry is always high.
Barriers to entry:
Cost of new project, brand name of established health care centers, loyalty of customers, qualified staff
Threat of substitutes: moderate
Threat of substitutes is moderate because substitutes to qualified doctors and hospitals include homeopathic treatments and hakeems and consulting these persons for treatment is from our ancestral times and till now this trend is prevailing.
Competitive rivalry: moderate
Competitive rivalry is moderate because hospitals face not much competitive rivalry mostly. It is prevalent in among private hospitals but not government hospitals.
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Literature Review 1. The effect of market orientation on business profitability
A business that increases its market orientation will increase its market performance. (Narver & Slater, 1990). In the present paper, the relationship between sustainable competitive advantage and market orientation, and why a market orientation is the business culture that most effectively creates superior value for customers. It is hypothesized and describes the tests used to establish the construct validity of measure of market orientation and the expected relationship between market orientation and business profitability. In the research article by Aaker (1998); Kotler (1977); Ohmae (1982); peters and waterman (1982), addresses that market orientation consists of three behavioral components; customer orientation, competitor orientation, and interfunctional coordination and two decision criteria long term focus and profitability. It was hypothesized that each of the five components and decision criteria can be measured reliably with multi-item scale. It was hypothesized a one dimension construct because these five items are conceptually closely related. A sample consisted of 140 strategic business units of a western corporation. The SBUs are all in the forest products division of the corporation. Four hundred forty questionnaires were sent and the response rate was 84%. The total of 113 SBUs (81%) with no missing data consisted of 36 commodity businesses, 23 specialty products businesses, 51 distribution businesses, 3 export businesses. It was randomly splitted the data into two samples before assessing reliability and validity. Then reliability analyses on the first sample and replicated those analyses on the second sample, then conducted test for construct validity on the combined samples. Respondents were asked to consider return on investment, return on assets, and return on net assets as equivalent, for the respondents were to compare their SBUs profitability with that of their competitors in their principal served market. Then it was hypothesized that the greater a business¶s market orientation, the greater the business¶s profitability will be, other things being equal. The relationship among the primary elements in the theory of market orientation is the components of market orientation, business level, market level variables and performance. The eight controlling variable for other influences on business profitability are buyer power, supplier power, self
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concentration, ease of entry of new competitors, rate of market growth ,rate of technological change ,size of business and the average cost of business. Each of the variables was measured with a 7-8 point likert scale. The empirical result indicate that the top management teams of the high market orientation business have the shortest long life, medium group appears to consist of the smallest businesses and to have the least power over suppliers, large businesses may be reluctant or the least able to adopt a market orientation, the low group faces the easiest entry of new competitors. These finding complement the findings of the regression analysis among both commodity businesses and non-commodity businesses, market orientation is strongly related to profitability. The data imply that the commodity businesses with the greatest market orientation have substantial control over the market. The findings do suggest that after controlling for important market-level and business level influences, market orientation and performance are strongly related. The finding gives marketing scholars and practitioners a basis beyond mere intuition for recommending the superiority of a market orientation. A substantial market orientation must be the foundation for a business¶s competition advantage strategy.
References
Narver, J. C. & Slater, S. F., (1990). The effect of a market orientation on business profitability: Journal of marketing, 54, 20-34: American marketing association: http://www.jstor.org/stable/1251757.
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I.
The capabilities of market driven organizations
This research article by Day (1994), focuses on identifying market driven businesses, understanding what they do, and measuring the bottom line consequences of their orientation to their markets. It includes the role of capabilities in creating a market oriented organization. Capabilities are complex bundles of skills and collective learning, exercised through organizational processes that ensure superior coordination of functional activities. Organizations can become more market oriented by identifying and building the special capabilities that set market driven organizations. Capabilities include three types of categories. Inside out capabilities are those which are easier to identify because their activities are contained within the organization. Outside in capabilities define the other organizational capabilities to the external environment and enable the business to compete by anticipating market requirements and creating good relations with the customers. Spanning capabilities are needed to integrate the outside in and inside out capabilities. The emerging capabilities approach to strategy offers a valuable new perspective on how to achieve and sustain competitive advantage. Competitors find difficult to understand and imitate distinctive capabilities the organization has developed. Market sensing capability and customer linking capability are the two important capabilities in bringing the external realities to the attention of the organization. Market sensing capability follows the usual sequence of information processing activities that organization use to learn. Customer linking capability comprises of skills, abilities and processes needed to achieve collaborative customer relationship so individual customer needs are quickly apparent to all functions and well defined procedures are in place for responding to them. The emerging capabilities approach to strategic management when coupled with total quality management offers a rich array of ways to design change programs that will enhance a market orientation. The objective of total quality management is to optimize the flow of activities to reduce cycle time, prevent defects and enable continuous improvement ( Schonberger 1990). By combining the approach to strategy and total quality management why some organizations are more market oriented than others a comprehensive change program was proposed which includes (i) the diagnosis of current capabilities using mapping and
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benchmarking methodologies, (ii) anticipation of future needs for capabilities in light of the strategy for creating customer value, (iii) bottom up redesign of underlying processes based on the formation of teams who are responsible for improvement, (iv) top down direction from senior managers and commitment to putting customer first, (v) creative use of information technology to enable the organization to do things it could not do before and (vi) monitoring of progress towards improvement programs. This change design must be undertaken to enhance the market orientation. Market sensing, customer linking and distinctive capabilities cannot be utilized if no attention is given to beliefs, values, organization structure, employees and decision process.
References
Day, S.G. (1994). The capabilities of a market driven organization: Journal of marketing, 58, 37-52: American marketing association: http://www.jstor.org/stable/1251915 1. Competing strategically through market orientation In the research article by MollyInhofe Rapert addresses As organizations seek to better understand their customers, competitors, and environments, the marketing function effectively serves as the support mechanism for these activities in many industries. Accordingly in many organizations, the marketing concept has been elevated to the stature of a strategic weapon, manifested in the form of market orientation. Market oriented firms emphasis the collection, organization and dissemination of information regarding both customers and competitors. This strategy is especially well suited for the health care industry where customer knowledge is of paramount importance customer interaction is instantaneous and customer satisfaction is essential. Results of a national study of generally service hospital such as that firms which embrace a market orientation benefit through enhanced customer satisfaction and quality marketing is becoming increasingly strategic in nature. Within the services domain the health care industry in particular would benefit from a market orientation given changing customer demands and increasing competitive environment. Yet the industry has not fully implemented the marketing concept. Accordingly we hypothesis that market orientation is positively associated with market share, with growth in net revenues, customer satisfaction and delivering quality services.
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Research design and methodology: General Service hospitals were selected from a membership list of the American Hospital Association utilizing a stratified sampling method to control for profit and size. Surveys were administrated to the chief executive officer of 322 organizations as part of an ongoing longitudinal study. Responses were received from 96 CEO¶s resulting in a response rate of 30%.follow up interviews attribute non participation to the high number of surveys administrated in the health care industry and the deluge of bureaucratic paperwork inherent in hospital regulatory and operating policies. Each of the three scales were measured using a five point likert scale anchored by 1(not emphasized at all) and 5 (emphasized at a great extent) the three scale were first subjected to reliability assessment, beginning with examination of item to total correlations.(relatively uniform in nature).the coefficient alpha values for the scales are 0.78(customer orientation),0.58 (competitor orientation) and 0.70 for interfunctional coordination. Result: The four research hypotheses were tested using multivariate analysis of variance and multiple discriminant analysis. MANOVA was utilized to detect differences between the centroids of low performing and high performing groups based on three traits of market orientation.H1 and H2 were not supported given that significant overall differences were not identified for market share and growth in net revenues. However significant differences across performance groups were identified for customer satisfaction and quality performance. Higher performing groups exhibited higher levels of customer orientation, competitor orientation and interfunctional coordination. Discriminant function analysis is used to identify the direction and intensity of the impact that individual variables have on overall performance differences. These loading indicate that a strong orientation towards the customer, competitor and interfunctional coordination are associated with higher level of customer satisfaction and high level of perceived quality. Conclusion: Those hospitals with strong emphasis on market orientation achieved high levels of quality as well as enhanced customer satisfaction. While a direct linkage was not identified between market orientation and financial performance. For example market orientation was found in this study to
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be related to customer satisfaction and customer satisfaction has been linked in other studies to financial performance. In addition the present study examined customer satisfaction and quality achievements from the perception of hospital administrators, while the results are encouraging, future research should examine these perceptions from the customer¶s point of view. Based on our results, hospital administrators and marketing executives should take advantage of potential benefits to be gained from market orientation. Market orientation, as the enactment of the marketing concept, requires a shift in the role of marketing in the hospital such that all actions should focus on the customer, the competitors and internal network of communication. In the final analysis if a market orientation leads to improvements in both customer satisfaction and service quality, the marketing function will form the strategic competitive advantage.
References:
Anderson,Eugene W.,Fornell, and Donald R.Lehman(1994).
³customer satisfaction,Market share, and Profitability:Finding from Sweden, Journal of marketing, 54, 20-34: American marketing association: http://www.jstor.org/stable/1251757
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Questionnaire methodology and analysis Methodology:
SAMPLE AND ITS CHARACRTERISTICS
This is a quantitative study. The empirical data has been obtained from child health care professional. Sample of this study has been taken from city of Lahore. Pediatric doctors of both public and private hospitals have participated in the study which includes Lahore General Hospital, Children Hospital, Jinnah Hospital, Hameed Lateef Hospital and various child health care clinics practiced by pediatricians. Total 30 questionnaires have been floated to respondents. All of them were self administrated. The method of convenient sampling procedures has been used to ensure an adequate representation of respondents from all major groups and levels. The respondents have been classified into four categories in context to their age group: (a) ³below30´ (b) ³31-45´ (c) ³46-60´ (d) ³60 ± onward´. Control variables are age, gender, public or private employee, years of experience and income level Our questionnaire consisted of 4 pages in length, based on MARKOR scale which comprised of 32 questions division of these was based on intelligence generation, intelligence dissemination and responsiveness. In analysis, the majority are males 18 and 12 are female Pediatric doctors. 23 doctors reported income (less than 30000) and 6 reported income group (30000-45000 and above). The 18 of pediatric doctors in our sample are working at public hospitals and 12 work at private hospitals. Average number of years experience is 5 years, with maximum reported experience 36. However demographic control variables show that participants belong to different age groups, income level, years of experience, work place and qualification level. Likert scale is used to measure the rating on five points where 1=strongly agree, 2= agree,
3=neutral, 4=disagree and 5 = strongly disagree.
Following table shows the results of our survey. The questionnaire is attached in the appendix section.
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Scale items
MEAN
STANDARD DEVIATION
1. Intelligence generation: 1. In Pediatric department of hospital, doctors meet with patients twice or thrice a month to find out whether child¶s health is improving up to their satisfaction level that they want. 1.8 0.6
2. Nurses from our peads department interact directly with patients to learn how to serve them better.
1.4
0.24
3. In finding good and latest information for the benefit of child¶s health, we do a lot of in-house research
2.1
0.11
4. We are slow to detect changes in our patients better health preferences
4.7
0.26
5. We poll end users at least once i.e. quarterly to get to know about the quality of our various diseases treatment for the child.
1.7
0.19
6. We often talk with patients or survey those who can influence our end user¶s i.e. children¶s health
1.2
0.27
7. We collect industry information by informal means (e.g. lunch with various doctors or pharmaceutical companies
1.2
0.28
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8. In our different health units, intelligence on our competition is generated independently by several units
2
0.62
9. We are slow to detect fundamental shifts in our industry
3.1
0.07
10. We periodically review the likely effect of changes in our health sector environment (e.g. regulation) on patients.
1.8
0.16
2 Intelligence generation:
11. A lot of informal ³hall talk´ in child health care units is concerned with our competitor¶s tactics or strategies
4.3
0.29
12. We have interdepartmental meetings at least once a day to discuss health trends and developments in the market
4.5
0.33
13. Doctors in child health department discuss patients future needs with other functional departments
3.4
0.81
14. Our pediatric department circulates weekly new health trends through reports, magazines, news and events that provide information on child
1.83
0.61
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health.
1.9 0.61
15. When something important happens to major patients of hospital (e.g. icons, VIPs or elite class) the whole hospital gets to know about it within some time
16. Data relating to patients satisfaction are disseminated at all levels in the hospital on regular basis
4.86
1.03
17. There is a minimal communication between doctors and various pharmaceutical marketing managers concerning marketing development
1.79
0.61
18. When any of the department finds out anything important about competitors, it is slow to alert other departments
4.55
1.02
3 Responsiveness
19. It takes forever to decide how to respond to our competitors¶ price changes.
4.11 0.91
20. Principles of market segmentation drives new health product development efforts including new technologies to treat various diseases, better child health medicines and distinctive surgical techniques.
1.2 0.55
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21. For some reasons we tend to ignore our patient¶s needs
4.75
1.01
22. We periodically review our child health development efforts to ensure that they are in line with what patients want
1.15
0.54
23. Our business plans relating to child health development are driven more by technological advances than by market research
2.6
0.69
24. Several hospital departments get together periodically to plan a response to changes taking place in our health sector
1.5 0.57
25. The product line regarding better health of child
4.5
that we sell more depends on internal politics than on real health sector needs
0.97
26. If a major patient were to launch an intense campaign targeted at our patients, we would implement a response immediately.
1.4
0.56
27. The activities of the different departments in the hospital are well coordinated.
2
0.62
28. Patients¶ complaints fall on deaf in this Pediatric unit.
4.6
0.99
29. Even if we come up with a great marketing plan,
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we probably would not be able to implement it timely fashion.
4.6
0.99
30. We are quick to respond to significant changes in our competitors pricing structures.
2.5 0.68
31. When we find out patients are unhappy with the quality of our service we take corrective action immediately.
1.2 0.55
32. When we find that patients would like us to modify our child health care service, the department shows the concerned efforts to do so.
1.3 0.55
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ANALYSIS Research problem:
How health professionalism addresses the relationship between market orientation and customer oriented behavior?
MODEL
Pediatric doctors
Market orientation
Customer oriented Behavior
Model shows Pediatric doctors relationship with market orientation and customer orientation. We developed some hypothesis after analysis the results, which are as follows:
Hypothesis 1: Positive relation between pediatric doctors and market orientation In service organizations, the production and consumption of services take place at the same time. Actually, health Professionals are the main marketer of a service organization because they act as the creator and dispenser of end services. We have identified that health professionals in private hospitals are more marketing oriented than public hospitals.
Hypothesis 2: positive relation between market orientation and customer oriented behavior Customer oriented Behavior refers to the helpful behavior of service providers directed toward an organization. It is important to have employees who engage in behaviors that results in
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long-term customer satisfaction In Pakistan, the major source of market orientation and professionalism are the medical research associations like PMDC (Pakistan Medical and Dental Council), Pakistan Medical Association and Medicine companies. The marketing practices of medicine companies like conferences arrangements, refresher courses, free counseling about new issues in health care, publications of medical research also play a vital role to enhance the market orientation of health care professional. This study investigates how the customer oriented behavior of health care professionals is affected by market orientation and eventually results in satisfied employees and customers. Thus, there is positive relation between customer oriented behavior and market orientation, so we can conclude that these marketing efforts of companies enhancing the market orientation which contributes to customer oriented behavior of pediatric doctors.
From the survey we analyzed the following points: Mean 1.8 in the 1st question shows that majority of the pediatric doctors meet with patients more than once in a month to know about the patient¶s health that whether it is improving or not. Almost all of the doctors agreed that nurses interact directly with the patients to learn how to serve them better. They said that the pediatric unit does a lot of in-house research at hospital so as to learn how to treat patients in new efficient ways. They said they were quick at identifying health preferences of patients. Child specialists said that they got feedback of patients for the quality and effectiveness of their treatment. They exchange information regarding new health treatments by arranging lunches and seminars with each other and also with pharmaceutical companies to know about latest drugs. Most of them said they were slow at identifying fundamental shifts in the market. They further expressed that most of their discussion is not based on competitor¶s techniques and strategies in pediatric department. Pediatricians stated that they hold meeting once in a month and not on daily basis to discuss new health tends.
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Only few of the pediatricians discussed future needs of patients with other fundamental departments. Almost all of the pediatricians agreed that they circulated their magazines and reports all over the hospital to provide latest information on child health. Doctors were of the view that data related to patient¶s satisfaction was disseminated at all levels in the hospital on regular basis. The hospitals were not slow at alerting other departments if they find out anything important about other hospitals. Nearly all the hospitals did not take much time to respond to their competitors on price changing structure. About 90% of the doctors agreed that their pediatric department do not neglect needs of their patients. They further said that they periodically review their child health department efforts to ensure that they are in line with what patients want. Hospitals corresponded that they took corrective actions immediately when they find that their patients are unhappy with them. They do try modify their services if their patients want to modify their child care treatments.
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Conclusion
From the survey we can conclude that child health care conditions are improving in Pakistan but if we compare it with actual statistics discussed in trends segment of the report a lot of efforts are needed to improve health of people specially children who are the asset of our country. The health care industry in Pakistan, due to illiteracy, environment pollution and ignorance, has always been a market, with the Demand for medical services far exceeding than supply of services. Therefore, the majority of health care professionals have never felt the need to engage in marketing activities as the demand has been steady increasing. However, a rapidly increasing societal level differences with rising per capita income in certain groups of society cause gradually increasing market competition due to the growing number of new medical institutions and the medical services industry is in need of a new managerial and service focus to anticipate the rapidly changing customer needs. The marketing practices of medicine companies like conferences arrangements, refresher courses, free counseling about new issues in health care, publications of medical research also play a vital role to enhance the market orientation of health care professional. Private hospitals are keener to progress for further development of their pediatric department than public hospitals. This is because they have to face a lot of competition of other hospitals so to attain competitive advantage and to keep their patients loyal they have to focus on their development efforts. Private hospitals are more market oriented than public hospitals
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Opportunities in health sector
High population rate that is 2-2.5% which means more and more hospitals and health care facilities are needed. There is enormous need of health personnel to take the challenge of reducing mortality and morbidity in Pakistan. According to WHO and UNICEF Pakistan is lacking in prevention of diseases which may be fatal if not treated in time like polio, tetanus, tuberculosis meningitis which can make the child disable for whole life. Thus, better goal oriented plans are needed to make awareness among people about these fatal diseases. There is a lot of scope for paramedical staff needed like nurses, vaccinators, lady health visitors. So, training institutes can be beneficial for developing such staff. Separate hospitals are required for children from the age of neonatal to 15 years of age. Refresher courses should be introduced for pediatric physicians so that they are updated with modern techniques for treatment. Special wards in the hospitals are required for children like newborns, separate diarrhea section and separate medicine section.
Opportunity gap
As population is increasing at a very fast rate and most of the people remain remote to what preventive measures should be taken for better health of children therefore, sufficient preventive health program implementation like immunization should be focused by the hospitals. Pakistan¶s target was to make Pakistan free of polio in 2005 but till now that target is not achieved due to lack of education, lack of funds and resources. People still are not aware how important vaccination is for the early years of child. So, need of the situation is proper implementation plans to eliminate diseases which can be fatal for children.
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References :
y www.statpak.gov.pk/.../statistics/...statistics/social_statistics.html
y www.sbp.org.pk/departments/stats/PakEconomy.../index.htm
y en.wikipedia.org/wiki/Health_care_in_Pakistan y www.google.com
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APPENDIX
QUESTIONNAIRE Age:
Gender: male/female
Monthly income:
Experience (in years):
1 means strongly agree and 5 means strongly disagree. Intelligence generation: 1. In Pediatric department of hospital, doctors meet with patients twice or thrice a month to find out whether child¶s health is improving up to their satisfaction level that they want. 1 2 3 4 5
2. Nurses from our pediatric department interact directly with patients to learn how to serve them better. 1 2 3 4 5
3. In finding good and latest information for the benefit of child¶s health, we do a lot of in-house research 1 2 3 4 5
4. We are slow to detect changes in our patients better health preferences ( R) -1 -2 -3 -4 -5
5. We poll end users at least once i.e. quarterly to get to know about the quality of our various diseases treatment for the child. 1 2 3 4 5
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6. We often talk with patients or survey those who can influence our end user¶s i.e children¶s health 1 2 3 4 5
7. We collect industry information by informal means (e.g. lunch with various doctors or pharmaceutical companies 1 2 3 4 5
8. In our different health units, intelligence on our competition is generated independently by several units 1 2 3 4 5
9. We are slow to detect fundamental shifts in our industry ( R) -1 -2 -3 -4 -5
10. We periodically review the likely effect of changes in our health sector environment (e.g. regulation) on patients. 1 Intelligence dissemination: 11. A lot of informal ³hall talk´ in child health care units is concerned with our competitor¶s tactics or strategies 1 2 3 4 5 2 3 4 5
12. We have interdepartmental meetings at least once a day to discuss health trends and developments in the market 1 2 3 4 5
13. Doctors in child health department discuss patients future needs with other functional departments 1 2 3 4 5
14. Our pediatric department circulates weekly new health trends through reports, magazines, news and events that provide information on child health. 1 2 3 4 5
15. When something important happens to major patients of hospital (e.g. icons, VIPs or elite class) the whole hospital gets to know about it within some time
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1
2
3
4
5
16. Data relating to patients satisfaction are disseminated at all levels in the hospital on regular basis 1 2 3 4 5
17. There is a minimal communication between doctors and various pharmaceutical marketing managers concerning marketing development ( R) -1 -2 -3 -4 -5
18. When any of the department finds out anything important about competitors, it is slow to alert other departments ( R) -1 -2 -3 -4 -5
Responsiveness: 19. It takes forever to decide how to respond to our competitors¶ price changes. ( R) -1 -2 -3 -4 -5
20. Principles of market segmentation drives new health product development efforts including new technologies to treat various diseases, better child health medicines and distinctive surgical techniques. 1 2 3 4 5
21. For some reasons we tend to ignore our patient¶s needs ( R) -1 -2 -3 -4 -5
22. We periodically review our child health development efforts to ensure that they are in line with what patients want 1 2 3 4 5
23. Our business plans relating to child health development are driven more by technological advances than by market research ( R) -1 -2 -3 -4 -5
24. Several hospital departments get together periodically to plan a response to changes taking place in our health sector
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1
2
3
4
5
25. The product line regarding better health of child that we sell more depends on internal politics than on real health sector needs ( R) -1 -2 -3 -4 -5
26. If a major patient were to launch an intense campaign targeted at our patients, we would implement a response immediately. 1 2 3 4 5
27. The activities of the different departments in the hospital are well coordinated. 1 2 3 4 5
28. Patients¶ complaints fall on deaf in this Pediatric unit. -1 -2 -3 -4 -5
29. Even if we come up with a great marketing plan, we probably would not be able to implement it timely fashion. -1 -2 -3 -4 -5
30. We are quick to respond to significant changes in our competitors pricing structures. 1 2 3 4 5
31. When we find out patients are unhappy with the quality of our service we take corrective action immediately. 1 2 3 4 5
32. When we find that patients would like us to modify our child health care service, the department shows the concerned efforts to do so. 1 2 3 4 5
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Acknowledgement .................................................................................................2 Chapter1 Introduction ..........................................................................................................3 Industry overview ................................................................................................3 Industry trends ..................................................................................................4 Porter¶s five forces model .................................................................................7 Chapter2 Literature Review .................................................................................................9 Chapter3 Questionnaire analysis and methodology .......................................................... 15 Conclusion ........................................................................................................ 24 Opportunities .................................................................................................. 25 Opportunity gap .............................................................................................. 25
References ........................................................................................................... 26
Appendix ............................................................................................................. 27
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ACKNOWLEDGEMENT
We would like to express our sincere gratitude to PROF. Irfan Siddique for his suggestion and assistance in the preparation of this project. He served as our advisor, gave us valuable guidance and constant encouragement. Without his direction and supervision, this presentation would not have been possible. We are deeply grateful to him for advices and expertise and offering us concrete suggestions in data manipulation and analysis. Many thanks for giving us the opportunity to access and analyze this reporting data.
Finally, we would like to thank our families who gave us constant support and encouragement through the whole process. They paved the way for us to get this thesis done.
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Chapter1 Introduction
The main industry of our study is µHealth care industry¶ and the sub-sector which we have chosen is µChild health care sector¶ in which we have selected pediatric departments of various hospitals. Health plays the key role in determining the human capital. Better health improves the efficiency and the productivity of the labor force, ultimately contributes the economic growth and leads to human welfare. In Pakistan attempts have been made to improve the health conditions of the people through availability of trained personnel, adequate supply of medicines and establishment of health services. Yet the health care system as a whole is not encouraging.
Healthcare Industry overview
The healthcare industry is broadly defined as a category of stocks related to medical/ healthcare goods and services. The industry includes hospitals, pharmaceutical companies, nursing homes, pediatric clinics, maternity homes etc. The industry has high demand as people need healthcare facilities at all times for the ever increasing population. Total public sector expenditure on health, for both the federal as well as provincial governments combined, in the current fiscal year is projected to be 0.54 percent of GDP, which is amongst the lowest of all other countries at a similar income level. According to record of Ministry of Health, there are 122,798 MBBS officers, 8,388 dentists, 62,646 nurses, 27,692 midwives, 8,405 lady health visitors and 85,000 lady health workers all over the country. Hence, it is estimated one doctor is available for 1,254 persons in Pakistan. In developed countries, this ratio is one for 300 persons. Similarly, one dentist is available for 20,839 persons; one nurse for 2,671 persons and one lady health visitor for 18,318 persons. The total GDP contribution of health industry is 2.2% only.
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Recent Healthcare Industry trends
In Pakistan, health status of the population at large has improved considerably over time. However, by international comparison, the status is mixed, but generally improvements on this front have lagged in the case of Pakistan. Recent cross-country studies of vital health indicators show a wide variation in epidemiological pattern between different Asian countries. Compared with Bangladesh, India and Sri Lanka, for example, Pakistan¶s infant mortality rate is higher. While life expectancy is also higher except for Sri Lanka, the overall population growth at 2.1% (latest, revised) is the highest in the region.
Health Expenditure trends: Despite a nearly threefold increase in public sector expenditure since 2001, spending on health remains terribly low ± and has declined as a percentage of GDP. Total public sector expenditure on health, for both the federal as well as provincial governments combined, in the current fiscal year is projected to be 0.54 percent of GDP, which is amongst the lowest of all other countries at a similar income level.
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Child health care trend
The child health care trend shows that 100 children out of every thousand die before reaching their fifth birthday and 73 infants out of every thousand die before their first birthday. Figure 1 presents the trends in achieving the child health care targets under MDGs, Millennium Development goals. It is clear from the graph that there is a desired need to invest in the child care health to achieve the MDG targets by 2015.
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Current Health conditions in Punjab after floods:
The graph below shows the distribution of patient visits by disease vis-à-vis the percentage of patient consultations in the flood-affected districts in Punjab (5 August 2010).
Key: RTI POU AWD Respiratory tract infection fever due to unknown reason Acute watery diarrhea
Other general trends in the health care industry:
y Prior to birth of a baby genetic analysis is done nowadays so that birth defects are eliminated in new born babies such as mental retardation and certain syndromes which have got multiple birth defects. y Counseling of parents for future pregnancies is done nowadays due to first cousin marriage trend which is very much prevalent in Pakistan. If mothers give birth to some
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abnormal child genetic counseling is very vital for either to have further pregnancies or not. y Interfamilial marriages are also being discouraged in Pakistan so as to avoid certain diseases which are dominant in families of the couple. y These days several campaigns and health programs are being started but still rural areas remain aloof from such facilities. y Demand for health nutritionists is also at its peak as people become conscious of their health.
Porter¶s five forces model:
Porter¶s Five Forces
Bargaining power of suppliers Bargaining power of buyers Threat of new entrants Threat of substitutes Competitive rivalry
Position in health industry
Low High High Moderate Moderate
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Explanation of Porter¶s model Bargaining power of suppliers: low
The bargaining power of suppliers is low because hospitals float tenders by giving ads in the newspaper that certain equipments are needed and certain parties respond to these tenders. Then hospital selects which party to chose and which to abandon on the basis of quality of the equipment and cost.
Bargaining power of buyers: high
The bargaining power of buyers is high because they are large in number and so they can bargain on the price of the equipments or anything g they want to purchase from suppliers.
Threat of new entrants: high
As health industry is a very attractive industry so it can attract investors to invest in this business concerning the need of better health facilities in Pakistan and demand for this industry is always high.
Barriers to entry:
Cost of new project, brand name of established health care centers, loyalty of customers, qualified staff
Threat of substitutes: moderate
Threat of substitutes is moderate because substitutes to qualified doctors and hospitals include homeopathic treatments and hakeems and consulting these persons for treatment is from our ancestral times and till now this trend is prevailing.
Competitive rivalry: moderate
Competitive rivalry is moderate because hospitals face not much competitive rivalry mostly. It is prevalent in among private hospitals but not government hospitals.
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Literature Review 1. The effect of market orientation on business profitability
A business that increases its market orientation will increase its market performance. (Narver & Slater, 1990). In the present paper, the relationship between sustainable competitive advantage and market orientation, and why a market orientation is the business culture that most effectively creates superior value for customers. It is hypothesized and describes the tests used to establish the construct validity of measure of market orientation and the expected relationship between market orientation and business profitability. In the research article by Aaker (1998); Kotler (1977); Ohmae (1982); peters and waterman (1982), addresses that market orientation consists of three behavioral components; customer orientation, competitor orientation, and interfunctional coordination and two decision criteria long term focus and profitability. It was hypothesized that each of the five components and decision criteria can be measured reliably with multi-item scale. It was hypothesized a one dimension construct because these five items are conceptually closely related. A sample consisted of 140 strategic business units of a western corporation. The SBUs are all in the forest products division of the corporation. Four hundred forty questionnaires were sent and the response rate was 84%. The total of 113 SBUs (81%) with no missing data consisted of 36 commodity businesses, 23 specialty products businesses, 51 distribution businesses, 3 export businesses. It was randomly splitted the data into two samples before assessing reliability and validity. Then reliability analyses on the first sample and replicated those analyses on the second sample, then conducted test for construct validity on the combined samples. Respondents were asked to consider return on investment, return on assets, and return on net assets as equivalent, for the respondents were to compare their SBUs profitability with that of their competitors in their principal served market. Then it was hypothesized that the greater a business¶s market orientation, the greater the business¶s profitability will be, other things being equal. The relationship among the primary elements in the theory of market orientation is the components of market orientation, business level, market level variables and performance. The eight controlling variable for other influences on business profitability are buyer power, supplier power, self
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concentration, ease of entry of new competitors, rate of market growth ,rate of technological change ,size of business and the average cost of business. Each of the variables was measured with a 7-8 point likert scale. The empirical result indicate that the top management teams of the high market orientation business have the shortest long life, medium group appears to consist of the smallest businesses and to have the least power over suppliers, large businesses may be reluctant or the least able to adopt a market orientation, the low group faces the easiest entry of new competitors. These finding complement the findings of the regression analysis among both commodity businesses and non-commodity businesses, market orientation is strongly related to profitability. The data imply that the commodity businesses with the greatest market orientation have substantial control over the market. The findings do suggest that after controlling for important market-level and business level influences, market orientation and performance are strongly related. The finding gives marketing scholars and practitioners a basis beyond mere intuition for recommending the superiority of a market orientation. A substantial market orientation must be the foundation for a business¶s competition advantage strategy.
References
Narver, J. C. & Slater, S. F., (1990). The effect of a market orientation on business profitability: Journal of marketing, 54, 20-34: American marketing association: http://www.jstor.org/stable/1251757.
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I.
The capabilities of market driven organizations
This research article by Day (1994), focuses on identifying market driven businesses, understanding what they do, and measuring the bottom line consequences of their orientation to their markets. It includes the role of capabilities in creating a market oriented organization. Capabilities are complex bundles of skills and collective learning, exercised through organizational processes that ensure superior coordination of functional activities. Organizations can become more market oriented by identifying and building the special capabilities that set market driven organizations. Capabilities include three types of categories. Inside out capabilities are those which are easier to identify because their activities are contained within the organization. Outside in capabilities define the other organizational capabilities to the external environment and enable the business to compete by anticipating market requirements and creating good relations with the customers. Spanning capabilities are needed to integrate the outside in and inside out capabilities. The emerging capabilities approach to strategy offers a valuable new perspective on how to achieve and sustain competitive advantage. Competitors find difficult to understand and imitate distinctive capabilities the organization has developed. Market sensing capability and customer linking capability are the two important capabilities in bringing the external realities to the attention of the organization. Market sensing capability follows the usual sequence of information processing activities that organization use to learn. Customer linking capability comprises of skills, abilities and processes needed to achieve collaborative customer relationship so individual customer needs are quickly apparent to all functions and well defined procedures are in place for responding to them. The emerging capabilities approach to strategic management when coupled with total quality management offers a rich array of ways to design change programs that will enhance a market orientation. The objective of total quality management is to optimize the flow of activities to reduce cycle time, prevent defects and enable continuous improvement ( Schonberger 1990). By combining the approach to strategy and total quality management why some organizations are more market oriented than others a comprehensive change program was proposed which includes (i) the diagnosis of current capabilities using mapping and
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benchmarking methodologies, (ii) anticipation of future needs for capabilities in light of the strategy for creating customer value, (iii) bottom up redesign of underlying processes based on the formation of teams who are responsible for improvement, (iv) top down direction from senior managers and commitment to putting customer first, (v) creative use of information technology to enable the organization to do things it could not do before and (vi) monitoring of progress towards improvement programs. This change design must be undertaken to enhance the market orientation. Market sensing, customer linking and distinctive capabilities cannot be utilized if no attention is given to beliefs, values, organization structure, employees and decision process.
References
Day, S.G. (1994). The capabilities of a market driven organization: Journal of marketing, 58, 37-52: American marketing association: http://www.jstor.org/stable/1251915 1. Competing strategically through market orientation In the research article by MollyInhofe Rapert addresses As organizations seek to better understand their customers, competitors, and environments, the marketing function effectively serves as the support mechanism for these activities in many industries. Accordingly in many organizations, the marketing concept has been elevated to the stature of a strategic weapon, manifested in the form of market orientation. Market oriented firms emphasis the collection, organization and dissemination of information regarding both customers and competitors. This strategy is especially well suited for the health care industry where customer knowledge is of paramount importance customer interaction is instantaneous and customer satisfaction is essential. Results of a national study of generally service hospital such as that firms which embrace a market orientation benefit through enhanced customer satisfaction and quality marketing is becoming increasingly strategic in nature. Within the services domain the health care industry in particular would benefit from a market orientation given changing customer demands and increasing competitive environment. Yet the industry has not fully implemented the marketing concept. Accordingly we hypothesis that market orientation is positively associated with market share, with growth in net revenues, customer satisfaction and delivering quality services.
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Research design and methodology: General Service hospitals were selected from a membership list of the American Hospital Association utilizing a stratified sampling method to control for profit and size. Surveys were administrated to the chief executive officer of 322 organizations as part of an ongoing longitudinal study. Responses were received from 96 CEO¶s resulting in a response rate of 30%.follow up interviews attribute non participation to the high number of surveys administrated in the health care industry and the deluge of bureaucratic paperwork inherent in hospital regulatory and operating policies. Each of the three scales were measured using a five point likert scale anchored by 1(not emphasized at all) and 5 (emphasized at a great extent) the three scale were first subjected to reliability assessment, beginning with examination of item to total correlations.(relatively uniform in nature).the coefficient alpha values for the scales are 0.78(customer orientation),0.58 (competitor orientation) and 0.70 for interfunctional coordination. Result: The four research hypotheses were tested using multivariate analysis of variance and multiple discriminant analysis. MANOVA was utilized to detect differences between the centroids of low performing and high performing groups based on three traits of market orientation.H1 and H2 were not supported given that significant overall differences were not identified for market share and growth in net revenues. However significant differences across performance groups were identified for customer satisfaction and quality performance. Higher performing groups exhibited higher levels of customer orientation, competitor orientation and interfunctional coordination. Discriminant function analysis is used to identify the direction and intensity of the impact that individual variables have on overall performance differences. These loading indicate that a strong orientation towards the customer, competitor and interfunctional coordination are associated with higher level of customer satisfaction and high level of perceived quality. Conclusion: Those hospitals with strong emphasis on market orientation achieved high levels of quality as well as enhanced customer satisfaction. While a direct linkage was not identified between market orientation and financial performance. For example market orientation was found in this study to
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be related to customer satisfaction and customer satisfaction has been linked in other studies to financial performance. In addition the present study examined customer satisfaction and quality achievements from the perception of hospital administrators, while the results are encouraging, future research should examine these perceptions from the customer¶s point of view. Based on our results, hospital administrators and marketing executives should take advantage of potential benefits to be gained from market orientation. Market orientation, as the enactment of the marketing concept, requires a shift in the role of marketing in the hospital such that all actions should focus on the customer, the competitors and internal network of communication. In the final analysis if a market orientation leads to improvements in both customer satisfaction and service quality, the marketing function will form the strategic competitive advantage.
References:
Anderson,Eugene W.,Fornell, and Donald R.Lehman(1994).
³customer satisfaction,Market share, and Profitability:Finding from Sweden, Journal of marketing, 54, 20-34: American marketing association: http://www.jstor.org/stable/1251757
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Questionnaire methodology and analysis Methodology:
SAMPLE AND ITS CHARACRTERISTICS
This is a quantitative study. The empirical data has been obtained from child health care professional. Sample of this study has been taken from city of Lahore. Pediatric doctors of both public and private hospitals have participated in the study which includes Lahore General Hospital, Children Hospital, Jinnah Hospital, Hameed Lateef Hospital and various child health care clinics practiced by pediatricians. Total 30 questionnaires have been floated to respondents. All of them were self administrated. The method of convenient sampling procedures has been used to ensure an adequate representation of respondents from all major groups and levels. The respondents have been classified into four categories in context to their age group: (a) ³below30´ (b) ³31-45´ (c) ³46-60´ (d) ³60 ± onward´. Control variables are age, gender, public or private employee, years of experience and income level Our questionnaire consisted of 4 pages in length, based on MARKOR scale which comprised of 32 questions division of these was based on intelligence generation, intelligence dissemination and responsiveness. In analysis, the majority are males 18 and 12 are female Pediatric doctors. 23 doctors reported income (less than 30000) and 6 reported income group (30000-45000 and above). The 18 of pediatric doctors in our sample are working at public hospitals and 12 work at private hospitals. Average number of years experience is 5 years, with maximum reported experience 36. However demographic control variables show that participants belong to different age groups, income level, years of experience, work place and qualification level. Likert scale is used to measure the rating on five points where 1=strongly agree, 2= agree,
3=neutral, 4=disagree and 5 = strongly disagree.
Following table shows the results of our survey. The questionnaire is attached in the appendix section.
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Scale items
MEAN
STANDARD DEVIATION
1. Intelligence generation: 1. In Pediatric department of hospital, doctors meet with patients twice or thrice a month to find out whether child¶s health is improving up to their satisfaction level that they want. 1.8 0.6
2. Nurses from our peads department interact directly with patients to learn how to serve them better.
1.4
0.24
3. In finding good and latest information for the benefit of child¶s health, we do a lot of in-house research
2.1
0.11
4. We are slow to detect changes in our patients better health preferences
4.7
0.26
5. We poll end users at least once i.e. quarterly to get to know about the quality of our various diseases treatment for the child.
1.7
0.19
6. We often talk with patients or survey those who can influence our end user¶s i.e. children¶s health
1.2
0.27
7. We collect industry information by informal means (e.g. lunch with various doctors or pharmaceutical companies
1.2
0.28
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8. In our different health units, intelligence on our competition is generated independently by several units
2
0.62
9. We are slow to detect fundamental shifts in our industry
3.1
0.07
10. We periodically review the likely effect of changes in our health sector environment (e.g. regulation) on patients.
1.8
0.16
2 Intelligence generation:
11. A lot of informal ³hall talk´ in child health care units is concerned with our competitor¶s tactics or strategies
4.3
0.29
12. We have interdepartmental meetings at least once a day to discuss health trends and developments in the market
4.5
0.33
13. Doctors in child health department discuss patients future needs with other functional departments
3.4
0.81
14. Our pediatric department circulates weekly new health trends through reports, magazines, news and events that provide information on child
1.83
0.61
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health.
1.9 0.61
15. When something important happens to major patients of hospital (e.g. icons, VIPs or elite class) the whole hospital gets to know about it within some time
16. Data relating to patients satisfaction are disseminated at all levels in the hospital on regular basis
4.86
1.03
17. There is a minimal communication between doctors and various pharmaceutical marketing managers concerning marketing development
1.79
0.61
18. When any of the department finds out anything important about competitors, it is slow to alert other departments
4.55
1.02
3 Responsiveness
19. It takes forever to decide how to respond to our competitors¶ price changes.
4.11 0.91
20. Principles of market segmentation drives new health product development efforts including new technologies to treat various diseases, better child health medicines and distinctive surgical techniques.
1.2 0.55
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21. For some reasons we tend to ignore our patient¶s needs
4.75
1.01
22. We periodically review our child health development efforts to ensure that they are in line with what patients want
1.15
0.54
23. Our business plans relating to child health development are driven more by technological advances than by market research
2.6
0.69
24. Several hospital departments get together periodically to plan a response to changes taking place in our health sector
1.5 0.57
25. The product line regarding better health of child
4.5
that we sell more depends on internal politics than on real health sector needs
0.97
26. If a major patient were to launch an intense campaign targeted at our patients, we would implement a response immediately.
1.4
0.56
27. The activities of the different departments in the hospital are well coordinated.
2
0.62
28. Patients¶ complaints fall on deaf in this Pediatric unit.
4.6
0.99
29. Even if we come up with a great marketing plan,
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we probably would not be able to implement it timely fashion.
4.6
0.99
30. We are quick to respond to significant changes in our competitors pricing structures.
2.5 0.68
31. When we find out patients are unhappy with the quality of our service we take corrective action immediately.
1.2 0.55
32. When we find that patients would like us to modify our child health care service, the department shows the concerned efforts to do so.
1.3 0.55
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ANALYSIS Research problem:
How health professionalism addresses the relationship between market orientation and customer oriented behavior?
MODEL
Pediatric doctors
Market orientation
Customer oriented Behavior
Model shows Pediatric doctors relationship with market orientation and customer orientation. We developed some hypothesis after analysis the results, which are as follows:
Hypothesis 1: Positive relation between pediatric doctors and market orientation In service organizations, the production and consumption of services take place at the same time. Actually, health Professionals are the main marketer of a service organization because they act as the creator and dispenser of end services. We have identified that health professionals in private hospitals are more marketing oriented than public hospitals.
Hypothesis 2: positive relation between market orientation and customer oriented behavior Customer oriented Behavior refers to the helpful behavior of service providers directed toward an organization. It is important to have employees who engage in behaviors that results in
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long-term customer satisfaction In Pakistan, the major source of market orientation and professionalism are the medical research associations like PMDC (Pakistan Medical and Dental Council), Pakistan Medical Association and Medicine companies. The marketing practices of medicine companies like conferences arrangements, refresher courses, free counseling about new issues in health care, publications of medical research also play a vital role to enhance the market orientation of health care professional. This study investigates how the customer oriented behavior of health care professionals is affected by market orientation and eventually results in satisfied employees and customers. Thus, there is positive relation between customer oriented behavior and market orientation, so we can conclude that these marketing efforts of companies enhancing the market orientation which contributes to customer oriented behavior of pediatric doctors.
From the survey we analyzed the following points: Mean 1.8 in the 1st question shows that majority of the pediatric doctors meet with patients more than once in a month to know about the patient¶s health that whether it is improving or not. Almost all of the doctors agreed that nurses interact directly with the patients to learn how to serve them better. They said that the pediatric unit does a lot of in-house research at hospital so as to learn how to treat patients in new efficient ways. They said they were quick at identifying health preferences of patients. Child specialists said that they got feedback of patients for the quality and effectiveness of their treatment. They exchange information regarding new health treatments by arranging lunches and seminars with each other and also with pharmaceutical companies to know about latest drugs. Most of them said they were slow at identifying fundamental shifts in the market. They further expressed that most of their discussion is not based on competitor¶s techniques and strategies in pediatric department. Pediatricians stated that they hold meeting once in a month and not on daily basis to discuss new health tends.
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Only few of the pediatricians discussed future needs of patients with other fundamental departments. Almost all of the pediatricians agreed that they circulated their magazines and reports all over the hospital to provide latest information on child health. Doctors were of the view that data related to patient¶s satisfaction was disseminated at all levels in the hospital on regular basis. The hospitals were not slow at alerting other departments if they find out anything important about other hospitals. Nearly all the hospitals did not take much time to respond to their competitors on price changing structure. About 90% of the doctors agreed that their pediatric department do not neglect needs of their patients. They further said that they periodically review their child health department efforts to ensure that they are in line with what patients want. Hospitals corresponded that they took corrective actions immediately when they find that their patients are unhappy with them. They do try modify their services if their patients want to modify their child care treatments.
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Conclusion
From the survey we can conclude that child health care conditions are improving in Pakistan but if we compare it with actual statistics discussed in trends segment of the report a lot of efforts are needed to improve health of people specially children who are the asset of our country. The health care industry in Pakistan, due to illiteracy, environment pollution and ignorance, has always been a market, with the Demand for medical services far exceeding than supply of services. Therefore, the majority of health care professionals have never felt the need to engage in marketing activities as the demand has been steady increasing. However, a rapidly increasing societal level differences with rising per capita income in certain groups of society cause gradually increasing market competition due to the growing number of new medical institutions and the medical services industry is in need of a new managerial and service focus to anticipate the rapidly changing customer needs. The marketing practices of medicine companies like conferences arrangements, refresher courses, free counseling about new issues in health care, publications of medical research also play a vital role to enhance the market orientation of health care professional. Private hospitals are keener to progress for further development of their pediatric department than public hospitals. This is because they have to face a lot of competition of other hospitals so to attain competitive advantage and to keep their patients loyal they have to focus on their development efforts. Private hospitals are more market oriented than public hospitals
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Opportunities in health sector
High population rate that is 2-2.5% which means more and more hospitals and health care facilities are needed. There is enormous need of health personnel to take the challenge of reducing mortality and morbidity in Pakistan. According to WHO and UNICEF Pakistan is lacking in prevention of diseases which may be fatal if not treated in time like polio, tetanus, tuberculosis meningitis which can make the child disable for whole life. Thus, better goal oriented plans are needed to make awareness among people about these fatal diseases. There is a lot of scope for paramedical staff needed like nurses, vaccinators, lady health visitors. So, training institutes can be beneficial for developing such staff. Separate hospitals are required for children from the age of neonatal to 15 years of age. Refresher courses should be introduced for pediatric physicians so that they are updated with modern techniques for treatment. Special wards in the hospitals are required for children like newborns, separate diarrhea section and separate medicine section.
Opportunity gap
As population is increasing at a very fast rate and most of the people remain remote to what preventive measures should be taken for better health of children therefore, sufficient preventive health program implementation like immunization should be focused by the hospitals. Pakistan¶s target was to make Pakistan free of polio in 2005 but till now that target is not achieved due to lack of education, lack of funds and resources. People still are not aware how important vaccination is for the early years of child. So, need of the situation is proper implementation plans to eliminate diseases which can be fatal for children.
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References :
y www.statpak.gov.pk/.../statistics/...statistics/social_statistics.html
y www.sbp.org.pk/departments/stats/PakEconomy.../index.htm
y en.wikipedia.org/wiki/Health_care_in_Pakistan y www.google.com
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APPENDIX
QUESTIONNAIRE Age:
Gender: male/female
Monthly income:
Experience (in years):
1 means strongly agree and 5 means strongly disagree. Intelligence generation: 1. In Pediatric department of hospital, doctors meet with patients twice or thrice a month to find out whether child¶s health is improving up to their satisfaction level that they want. 1 2 3 4 5
2. Nurses from our pediatric department interact directly with patients to learn how to serve them better. 1 2 3 4 5
3. In finding good and latest information for the benefit of child¶s health, we do a lot of in-house research 1 2 3 4 5
4. We are slow to detect changes in our patients better health preferences ( R) -1 -2 -3 -4 -5
5. We poll end users at least once i.e. quarterly to get to know about the quality of our various diseases treatment for the child. 1 2 3 4 5
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6. We often talk with patients or survey those who can influence our end user¶s i.e children¶s health 1 2 3 4 5
7. We collect industry information by informal means (e.g. lunch with various doctors or pharmaceutical companies 1 2 3 4 5
8. In our different health units, intelligence on our competition is generated independently by several units 1 2 3 4 5
9. We are slow to detect fundamental shifts in our industry ( R) -1 -2 -3 -4 -5
10. We periodically review the likely effect of changes in our health sector environment (e.g. regulation) on patients. 1 Intelligence dissemination: 11. A lot of informal ³hall talk´ in child health care units is concerned with our competitor¶s tactics or strategies 1 2 3 4 5 2 3 4 5
12. We have interdepartmental meetings at least once a day to discuss health trends and developments in the market 1 2 3 4 5
13. Doctors in child health department discuss patients future needs with other functional departments 1 2 3 4 5
14. Our pediatric department circulates weekly new health trends through reports, magazines, news and events that provide information on child health. 1 2 3 4 5
15. When something important happens to major patients of hospital (e.g. icons, VIPs or elite class) the whole hospital gets to know about it within some time
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1
2
3
4
5
16. Data relating to patients satisfaction are disseminated at all levels in the hospital on regular basis 1 2 3 4 5
17. There is a minimal communication between doctors and various pharmaceutical marketing managers concerning marketing development ( R) -1 -2 -3 -4 -5
18. When any of the department finds out anything important about competitors, it is slow to alert other departments ( R) -1 -2 -3 -4 -5
Responsiveness: 19. It takes forever to decide how to respond to our competitors¶ price changes. ( R) -1 -2 -3 -4 -5
20. Principles of market segmentation drives new health product development efforts including new technologies to treat various diseases, better child health medicines and distinctive surgical techniques. 1 2 3 4 5
21. For some reasons we tend to ignore our patient¶s needs ( R) -1 -2 -3 -4 -5
22. We periodically review our child health development efforts to ensure that they are in line with what patients want 1 2 3 4 5
23. Our business plans relating to child health development are driven more by technological advances than by market research ( R) -1 -2 -3 -4 -5
24. Several hospital departments get together periodically to plan a response to changes taking place in our health sector
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1
2
3
4
5
25. The product line regarding better health of child that we sell more depends on internal politics than on real health sector needs ( R) -1 -2 -3 -4 -5
26. If a major patient were to launch an intense campaign targeted at our patients, we would implement a response immediately. 1 2 3 4 5
27. The activities of the different departments in the hospital are well coordinated. 1 2 3 4 5
28. Patients¶ complaints fall on deaf in this Pediatric unit. -1 -2 -3 -4 -5
29. Even if we come up with a great marketing plan, we probably would not be able to implement it timely fashion. -1 -2 -3 -4 -5
30. We are quick to respond to significant changes in our competitors pricing structures. 1 2 3 4 5
31. When we find out patients are unhappy with the quality of our service we take corrective action immediately. 1 2 3 4 5
32. When we find that patients would like us to modify our child health care service, the department shows the concerned efforts to do so. 1 2 3 4 5
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