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St. Andrew’s College Of Arts, Science and Commerce St.Domnic Road, Bandra (W) Mumbai 400050

Certificate
This is to certify that the above mentioned students have done the project on 18 September 2009 as a part of Service sector management Subject. This study has been carried out by the students under my guidance and supervision during the period of 2009-10. The project work is original and authentic to best of knowledge. Place: Mumbai Date:

Signature of the guide

TABLE OF CONTENTS 1. Introduction to Service Sector 2. Concept of Service Marketing 3. Hospitals in India 4. History of Hospitals 5. PEST Analysis 6. Unique Characteristics of Hospitals 7. Classification of Hospitals 8. 7 P’s of Hospital Sector 9. Market sementation 10.Quality Dimension 11.Conclusion

Page No.

INTRODUCTION- SERVICE SECTOR

The service sector has been growing significantly for more than fifty years to the extent that in the developed world, more people earn their living from producing services than making manufactured goods. In fact around three quarters of the population in the United States and the European Union are employed in service industries. Services therefore have a major impact on national economies. The subject of Services Marketing has grown in response to this. Latterly however, manufacturing and technology industries have also recognised the need to provide services not only as a means of adding value to the physical products which they market but also as the basis for a different orientation to the management of their businesses. This module will address the key issues, concepts and models which form the core of Services Marketing theory, focusing, as far as possible, on the service industries of relevance to students taking the module.

What is a Service?
Services include all economic activities whose output is not a physical product or construction, is generally consumed at the time it is produced and provides added value in forms (such as convenience, timeliness, comfort or health). That is essentially intangible concerns of its first purchaser.

Concept of ‘Service Marketing’
The perception of service marketing focuses on selling the services in the best interest of users/ customers. Marketing a service is meant marketing something intangible. It is marketing a promise. In the marketing of services, we go through a number of problems directly or indirectly influencing the business index. The problems like market segmentation, marketing information system, behavioral management are studied minutely which simplify the task of formulating a sound mix for marketing, such as Product mix, Promotion mix, Price mix and the Place mix. It is important to mention that we find “People” an important mix of marketing services. If we market the services in a right direction, the available opportunities can be capitalized on optimally and also it contributes substantially to the process of development. In view of the above, we observe the following key points regarding the concept or perception of services marketing:
• •

It is a managerial process of managing the services. It is an organized effort for providing a sound foundation for the development of an organization. It is a social process helping an organization to understand
Service Management is:



the emerging social problem and to take part in the social transformation process to justify its existence in the society.

1) To understand the utility the customers receive by consuming or using the service offering of the organization

2) To understand how the organization (personnel, technology, physical resources, systems and customers) will be able to produce and deliver this utility 3) To understand how the organization should be developed and managed so that the intended quality can be achieved 4) To make the organization function so that this quality can be delivered on a continuous basis.

THE HOSPITAL INDUSTRY
Today the hospital is a place for diagnosis and treatment of human ailments and restoration of health and well being. The basic function of a hospital is to give proper treatment to the injured and sick without having any social, economic and racial discrimination.

Some of the other important functions and services of modern hospitals are training of the doctors and nurses, support to medical research and assistance to all activities carried out by public health and voluntary agencies to prevent diseases. It is also a center for training of health workers and bio-social research. Today it also acts as an institution that provides accommodation to patients for medical nursing and care. Medical services are primarily provided by the central and state governments.

Hospitals are not for profit making, they are social institutions that make the required medical services available to society. With time the classes and quality of hospitals have changed a lot . Most hospitals today are trying to provide all ultra facilities and

are in the process of making state of the art hospitals. Hospitals provide the infrastructure facility to healthcare

The last two decades have seen the mushrooming of corporate and privately run hospitals. Most large trust and corporate hospitals have invested in modern equipment and focus on superspecialties.

The private sector accounts for 70% of primary medical care and 40% of all hospital care in India. They employ 80% of the country’s medical personnel. The corporate hospital sector is most evolved in the south while charitable/trust hospitals proliferate in the west. However, the north and east are also showing a growing trend in private hospital expansion. Key therapeutic areas are cardiology, nephrology, oncology, orthopedics, geriatrics, maternity and trauma/critical care. Hospitals are not for profit making, they are social institution to make available to society the required Medicare services. However this may not be true for private hospitals. Today hospitals are a place of diagnosis and treatment of human ills, for the training research, promoting health care activities and to some extent a center helping biosocial research. WHO states that

hospitals are socio-medical organization whose functions are: Curative, preventive, patient services and training of health workers in biosocial research.

With time the classes and quality of hospitals have changed a lot today. Most hospitals today are trying to provide all ultra facilities and are in the process of making state of the art hospitals. Hospitals provide the infrastructure facility to healthcare.

Hospitals in India
By the late 1980s, there were approximately 128 medical colleges--roughly three times more than in 1950. Data for 1987 shows that there were 320,000 registered medical practitioners and 219,300 registered nurses. Various studies have shown that in both urban and rural areas people preferred to pay and seek the more sophisticated services provided by private physicians rather than use free treatment at public health centres. The fast pace of development of the private medical sector and the burgeoning middle class in the 1990s have led to the emergence of the new concept in India of establishing hospitals and health care facilities on a for-profit basis.

Current Scenario
India, the growing economic power in Asia is witnessing frenetic growth of its health care sector. India’s much-noted economic growth is rapidly improving living standards and the healthcare industry will be a major beneficiary of the overall increase in incomes. Recent major regulatory reforms have improved the growth prospects for health insurance and, as a result, a large section of middle income families will be able to afford healthcare services leading to high demand. The report of the National Commission on Macroeconomics and Health had estimated the size of private healthcare sector in India to be worth Rs 69,000 crore and projected that size to double to Rs 156,000 crore by 2012,besides an additional Rs 39,000 crore if health insurance picks up. With the current pace, the corporate segment in the private medical service sector is likely to absorb a good share of this business. Large domestic market is well complemented by inflow of overseas Medical tourists. The number of Medical tourists has increased ten-fold from 10,000 in 2000-01 to about 100,000 in 2004-05.

HISTORY OF HOSPITALS
Etymology
During the Middle Ages the hospital could serve other functions, such as almshouse for the poor, or hostel for pilgrims. The name comes from German “hospes” (host), which is also the root for the English words hotel, hostel, and hospitality.

Early history
In ancient cultures, religion and medicine were linked. The earliest known institutions aiming to provide cure were Egyptian temples. Greek temples dedicated to the healergod Asclepius might admit the sick, who would wait for guidance from the god in a dream. The Romans adopted his worship. The Sinhalese (Sri Lankans) are perhaps responsible for

introducing the concept of dedicated hospitals to the world.

Institutions created specifically to care for the ill also appeared early in India. King Asoka founded 18 hospitals in 230 BC. There were physicians and nursing staff, and the expense was borne by the royal treasury. State-supported hospitals later appeared in China during the first millennium A.D.

Statistics
Number of Hospitals:
States Punjab Haryana Maharashtra Gujarat Rajasthan H.P Karnataka W. Bengal Kerala Assam A.P U.P Tamilnadu M.P Bihar Orissa Government 174 58 445 263 218 46 209 242 141 141 141 534 282 363 237 250 Private 39 20 2583 2031 0 6 56 129 1899 80 1722 139 119 0 90 29 Total 217 78 3115 2370 218 57 293 392 2040 268 1863 652 408 363 328 284

PEST ANALYSIS

In India even after 60 years of independence we all have to accept that the government has failed to provide the basic health care facilities in many areas. Health care sector is one of the most neglected which is only meant for slogans by most of our politicians. Following are the list of factors that affect the health

care sector:

POLITICAL FACTORS

 There are non- merit quotas in medical institutions which is adversely affecting the quality & perhaps, the availability of trained and skilled medical professionals. It is said that because of these reservations the quality of the future Indian doctors will be very poor.  It is mandatory for the hospitals to keep 20% of the beds free for those from the lower classes who cannot afford costly treatments.  Providing subsidized land and equipment to Hospitals will help them cater to their poorer patients better.  Reduction in Import duties will help Hospitals acquire new, modern and more sophisticated medical equipment and technologies.

ECONOMIC FACTORS

 Because of the increase in the per capita income amongst the higher and middle classes of the society there has been

an increase in the spending from these classes in the health care sector.  Service Tax on Hospital services @ 12.24% has increased the costs of services provided by the Hospitals. In addition, the cost of input services (electricity, cleaning, maintenance, laboratory, laundry, patient care, transportation, ancillary services etc.) has increased due to imposition of service tax and a hike in Tax rate from 10% to 12%.  Cost advantage in healthcare that India offers coupled with technologically advanced medical treatment system has helped in the growth of medical tourism.  The cost of making and maintaining a hospital is extremely high.  Introduction of Private Medical insurers has increased the reach of medical insurance amongst the Indian public. This is helping the hospitals service more patients.  Third Party Administrators (TPA’s) has increased the claims settlement rate at increased cost of medical insurance.

SOCIAL FACTORS

 Certain percentages of beds have to be kept for poor people. For example in Bombay 20% of the beds have to be kept reserved for poor people whether it is a private or a public

hospital.  Look after the needs of local poor people.  Open counseling and relief centres.  Safe disposal of hospital wastes like used injection needles, waste blood etc & taking care of the environment is to be given high priority.  Campaigns and free medical checkups have to be conducted whenever necessary.  In brief the social aspect of the hospital industry is to see that latest treatment and medicines are available to people at large at concessional rates or free of cost and that its activities are not only restricted to rich people.

TECHNOLOGICAL FACTORS

 A large number of technically qualified professionals have made it possible to expand the medical services.  Computerization and telecommunication services have made remote area treatment a reality.  Use of new age equipments is making the delivery of medical treatment better.

 Stem cell research has opened up a whole new arena of Hospital services, wherein, a new body part can be grown to replace a dead or a diseased organ within the body of the patient.  Robotics micro-surgery: - a greater degree of robotics technology in operating room to provide precise and less traumatic as well as less destructive surgery.  Laser technology  Employment of information technology tools for networking of examination rooms, treatment rooms, operating rooms and diagnostic reporting rooms.  Deployment of information technology tools for generation of specific disease related databases, classified by a number of variables.

UNIQUE

CHARACTERISTICS

OF

SERVICES

With

Respect To Hospitals

There are four commonly cited characteristics of services that make them different to market from goods: Intangibility, Inseparability, Variability and Perishability.

INTANGIBILITY:
Intangible means that which cannot be seen or touched. Intangible services are difficult to sell because they cannot be produced and displayed ahead of time. They are therefore harder to communicate to prospective customers. Example – A services of a surgeon cannot be seen, it can only be felt and the difference in the patient can be noticed when he recovers, hence the doctor charges a premium for the services offered by him.

INSEPARABILITY:
This characteristic is interpreted differently by different service marketing marketers, but all interpretations point out that special operation problems exist for the firm's managers. One interpretation of this term is the inseparability of customers from the service delivery process. In particular, many services require the participation of the customer in the production process. In case of the hospital industry, patient has to present for experiencing the services being offered. Only then can he be treated. In case if he is not present in person he would have to

communicate with the doctor to get some feedback, the doctors can work only when there are patients, A Hospital Industry will not work if there are only patients and no doctors.

VARIABILITY :
The fact that service quality is difficult to control compounds the marketer's task. Intangibility alone would not be such a problem in customers could be sure that the services they were to receive would be just like the successful experiences their neighbors were so pleased with. But in fact, customers know that services can vary greatly. Even the same service provider has good days and bad days or may be less focused at different times of day. Services are performances, often involving the cooperation and skill of several individuals, and are therefore unlikely to be same every time. This potential variability of service quality raises the risk faced by the consumer. In the hospital industry, the services offered by one doctor cannot be indentical to the services of another doctor as it may vary due to several reasons such as experience, degree , knowledge etc. Also the services provided by one doctor to one patient cannot be the same when he operates the same patient again as all these things are even situational.

PERISHABILITY:
The fourth characteristic distinguishing services from goods is their time dependence. Services cannot be inventoried, since they are performed in real time. And time periods during which service delivery capacity sits idle represent revenue-earning potential that is lost forever. Periods of peak demand cannot be prepared for in advance by producing and storing services, nor can they be made up for after the fact. A service opportunity occurs at a point in time, and when it is gone, it is gone forever. This can present great difficulty in facilities planning In the hospital industry, the injection used for one Patient cannot be used for the other patient, there has to be a new set up for the other patient, hence the other items used by one patient cannot be inventoried by the others.

CLASSIFICATION OF HOSPITALS

There are different types of hospitals established with the motto of offering the medcare services and educational and training facilities. In a natural way, we find distinction in their structure, function and performance. The classification is found based on different criteria as mentioned below.

Classification on the basis of objective
On the basis of the objective, there are three types of hospitals, Teaching-cum-research for developing medicos and promoting research to improve the quality of medical aid. General hospitals are for treating general ailments and Special hospitals for specialized services in one or a few selected areas. This shows what is the main intention or motive of setting up the hospital On the basis of the OBJECTIVE there are three types:

Classification of Hospitals on the basis of objective

Teaching cum research
This is for developing and promoting research to improve the medical aid. These hospitals are affiliated with universities for medical research and the training of medical personnel. Large teaching/ research hospitals have a variety of goals. In addition to treating patients, they are training sites for physicians and other health professionals. Teaching institutions are almost always affiliated with a medical school, which means patients have access to highly skilled specialists who teach at the school and are familiar with up-to-the-minute technology. E.g. Pravara Medical Hospital & College, Pravara is a Teachingcum-research hospital.

General
The best-known type of hospital is the general hospital which is set up to deal with many kinds of disease and injury, and typically has an emergency ward to deal with immediate threats to health and the capacity to dispatch emergency medical services. A general hospital is typically the major health care facility in its

region, with large numbers of beds for intensive care and longterm care; and specialized facilities for surgery, plastic surgery, childbirth, bioassay laboratories, and so forth. General hospitals minister to all types of illness.

Special
This is for treating specialized ailments or providing specialized services in one or a few selected areas. Types of specialized hospitals include trauma centers, children's hospitals, seniors' hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems. Special hospitals are concerned with only one disease or group of diseases. VIMHANS is known for gamma-knife therapy and is a preferred centre for brain and spinal surgery. Every year this hospital gets 60-70 patients, half of them from Mauritius with neurological disorders requiring micro-brain surgery.

Classification on the basis of ownership

On the basis of ownership, there are four types of hospitals. This shows who owns a hospital or in other words who are the owners or have possession of the hospital. It can be divided in the

following ways: On the basis of the OWNERSHIP, there are four types:

Classification of Hospitals on the basis of ownership

Government
This is owned managed and controlled by government.

Government hospitals are operated and maintained wholly by the national, provincial, city or municipal government, or other political unit; or by any department, division, board or agency thereof. E.g. Nair Hospital and St. George are Government Hospitals.

Semi-Government

This is partially shared by the government. Semi-Government hospitals are operated and maintained partially by the national, provincial, city or municipal government, or other political unit; or by any department, division, board or agency thereof.

Private
Private hospitals are privately owned, established and operated with funds through donation, principal, investment, or other means, by any individual, corporation, association, or organization. They are profit-making institutions. Proprietary hospitals are owned by corporations or, less often, by individuals such as doctors who practice at the hospital. Hospital corporations usually own a chain of institutions located in several states, and they often own nursing homes or other types of health care facilities as well.

Voluntary Agencies
These agencies are the ones that run hospitals. Hospitals run by voluntary organizations. Many hospitals have hospital volunteer programs where people (usually students and senior citizens) can volunteer and provide various ancillary services. A voluntary hospital is a nonprofit community facility operating under

religious or other voluntary auspices. Ultimate responsibility for all that takes place at the hospital rests with its board of trustees, generally selected from the community's business and professional people, who serve without pay. To manage the hospital the trustees appoint a paid administrator.

Classification on the basis of path
On the basis of path of treatment, we find allopath, the system which is promoted under the English system. This shows the path or trail of treatment. Ayurved is based on Indian system where herbals are used for preparing the medicine. Like this we find Unani and others

On the basis of PATH OF TREATMENT, there are:

Classification of Hospitals on the basis of Path of Treatment

Allopath
This term is generally used to describe the conventional approach to medicine or "Western" medicine. It is the system that is promoted under the English system. It is the method of treating disease by the use of agents that produce effects different from those of the disease treated. It’s the system of medical practice which treats disease by the use of remedies which produce effects different from those produced by the disease under treatment. A system, which treats a disease with drugs having opposite effects to existing symptoms, each successive discovery and development in Allopathy, is the result of extensive research. Each new remedy has helped alleviate pain and suffering and increased the life span of people.

Ayurveda
It is based on the Indian system where herbal are used for preparing medicines. It is India's traditional, natural system of medicine that has been practiced for more than 5,000 years. Ayurveda provides an integrated approach to preventing and treating illness through lifestyle interventions and natural therapies. Published studies have documented reductions in

cardiovascular disease risk factors, including blood pressure, cholesterol, and reaction to stress, in individuals who practice Ayurvedic methods.

Homeopath
A system of therapy based on the concept that disease can be treated with drugs (in minute doses) thought capable of producing the same symptoms in healthy people as the disease itself. According to homeopathy, symptoms are the body's way of fighting disease. It is a system of alternative medicine that strives to treat "like with like". Homeopathy rests on the premise of treating sick persons with therapeutic agents [drugs, remedies] that are deemed to produce similar symptoms in a healthy individual.

Unani
It is a comprehensive system encompassing virtually all of the known healing systems of the world. As an alternative medicine, Unani has found favor in Asia especially India. In India, Unani practitioners can practice as qualified doctors, as the Indian government approves their practice. Unani medicine is very close to Ayurveda.

Others
Many hospitals are maintained solely for the treatment of military personnel and veterans. Some hospitals are placed on special high priority segments of the public works or utilities infrastructure to ensure continuity of care during a state of emergency.

Classification on the basis of size
On the basis of size, we find variation in the size of hospitals. On the basis of the SIZE, there are:

Classification of Hospitals on the basis of size

Teaching
These hospitals have 500 beds and differ according to the tune of students.

District
They have 200 beds which can be raised to 300 beds according to the changing requirements.

Taluka
These generally have 50 beds that can be raised to 100 depending on the needs.

Primary Health Centers
They consist of beds from the range of 6-10.

SEVEN P’S PRODUCT
A product is a set of attributes assembled in an identifiable form. The product is the central component of any marketing mix. The product component of the marketing mix deals with a variety of issues relating to development, presentation and management of the product which is to be offered to the market palce. It covers issues such as service package, core services and peripherals, managing service offering and developing service offering. Hospitals today offer the following services: 1. Emergency services 2. Ambulance services 3. Diagnostic services 4. Pharmacy services 5. Casualty services

Emergency Services: Emergency services and care at most
hospitals is unique and advanced. The hospitals have state of the art ambulances. The CCU’s on wheels under supervision by medical and para-medical staff. There is hi tech

telecommunication available to a patient in an emergency at any given time.

Ambulance Services: Hi Tech ambulances linked by state of
the art telecommunications are fully equipped with doctors that are available to render medical attention and assistance in case of emergencies at the patient’s doorstep.

Diagnostic Services: Modern hospitals are muti-speciality
and muti-disciplinary, that can handle any kind of ailment, they offer a wide range of facilities for e.g : orthopaedics, Oncology, Neurology, plastic surgery etc.

Pharmacy Services:

Most hospitals also have a pharmacy

which is open 24 hrs. It caters to the needs not only of the inpatients and out patients, but also patients from the other hospitals who require emergency drugs.

Casualty services: Includes a 24 hrs casualty department,
which attends to the accident or emergency cases. Apart from the above services, hospital also offer “Health diagnosis programme” which is a comprehensive, complete, periodic health check up provided for busy executives, professional businessmen.

The health diagnosis programme consists of the following:
1. 2. 3.

Master health check up. Executive health check up. Diabetic’s health check up.

PRODUCT LEVELS Core product:
The core product of the service is the service the customer is really getting or the reason why the customer wants the service. In the hospitals the core service is the cure that the customer is expecting. For example, a person who is suffering from “appendicitis” expects relief from the pain and surgical removal of the appendix. Every hospital provides a core service.

Basic service:
The basic product is what is necessary to satisfy the core benefit or need. In the hospital sector, the basic product is the bed that is provided, the various qualified doctors and the nurses that are there in the hospital to look after the patients. The basic product in the hospitals sector also includes the advanced equipment required for diagnosing, operating and curing the patient. This basic service also includes the ward boys who are required for keeping clean and hygienic conditions that are necessary for the patients.

Expected service or benefits:

The expected benefits refer to the standard of the services the customer expects. These are the types of services that the hospitals have to provide, if such services are not provided then the customer may not opt for the service. Here the expected benefits are that the beds should be hygienic and the services provided by the doctors and the nurses should be according to the industry norms. The hospital premises should also be clean. The equipments should be in proper working conditions and there should be a pleasing environment for the patients to rest and get cured quickly.

Augmented benefits or additions:
These refer to the various additions to the services over and above the consumer expectations. These benefits play an important role in attracting patients to the hospital. In India most of the hospitals have tried to adapt the marketing strategies of the western countries. Most of the hospitals provide private air-conditioned rooms for their patients. A few private hospitals also provide maternity wards wherein the babies and their mothers are taken care of. The children’s ward is a special section in which hospitals provide special treatment and care for the children. They are given toys and various other games to play with. Some hospitals have nurses and doctors that provide exceptional services that exceed the customer expectations. They provide the patients with pathology services, a blood bank, there are also the radiology departments. They also have pharmacies within the hospital building itself.

PRICE
Price is one of the prominent elements in the marketing mix. Price charged must be acceptable to target customers and it should co ordinate with other elements of the marketing mix. According to Philip Kotler, one should try to “Sell Value, Not Price”. Price is a major determinant of a buyer’s choice, as a person must have the need, willingness and ability or financial backing to buy the product. In hospital & health care sector services involve the use of expensive and complex machinery, which involve huge investments. Apart from that, the cost of maintaining them and cost of running the hospital is in no terms cheap.

Public sector pricing
In the public sector hospitals the subsidies received from the government are significant sources of income. The public hospitals provide free treatment to those who hail from the poor sections of the society. These costs are incurred by the government. The customers who are above the poverty line have

to pay nominal charges to the public hospitals for their treatment. The rest of the amount is acquired from the respective governments.

Private sector hospitals
The private sector hospitals have a distinctive pricing strategy. They charge low or no price to the poor people. This depends on the subsidy programs offered by the government. Some private hospitals charge a very high price as compared to the cost of the services provided. Most of the private hospitals have extremely good quality services and this justifies their pricing strategies. Now-a-days there are the facilities like medi-claim available that help attract customers to the superior and expensive services.

Private Charity hospital
In private charity hospitals the pricing strategy adopted is different from that of the public hospitals. What the private charity hospitals do is that they provide free treatment to the people from the poor strata of the society; they charge a minimal rate or subsidized rate to the low and middle income groups who can afford to pay and lastly they charge high fares to those belonging to the upper-middle class and high class.

PLACE

This is an important element of the marketing mix which is known as place mix, which focuses on the location of the service factory. It refers to the contact point between the service provider and the customer. It is very important to form the place mix properly in case of hospitals because of the very fact that the customer himself comes to the service factory, also herein quiet a number of factors and limitations come into play like the cost of the place and the area required. Certain hospitals require a lot of space for the building and all the facilities that are necessary for the treatment of the patient; hence they may have to locate the hospital at a place where there is lot of space available and at a cheaper. Some of the essential features which may be taken into consideration are as easy and convenient accessibility, safety or protection availability of the infrastructural facilities, attractive and healthy surroundings. The selection of place is very important in order to avoid the inconveniences to the users in reaching to the hospital in time. Adequate transport and communication facilities should be available where the hospitals are located. Hospitals should be located at easily accessible places i.e. areas which have an easy

access to all modes of transport. Every hospital must provide transport by way of properly equipped ambulances to deal with emergencies. The service product is closely linked to its delivery and nature of the delivery system also has a powerful impact on the patient experience. Example: Tata memorial hospital specializes in cancer treatment and is located at a center place unlike other normal hospitals, which you can find all over other places

PROMOTION

Promotion is an element in an organization’s marketing mix that serves to inform, persuade and/or remind people about an organization’s or individual’s goods, services, image, ideas, feeling, community beliefs, or involvement Behaviour or impact on society. form of Promotion is used in hopes of influencing the recipient’s through any communication.

In

Hospital

Sector,

it

is

considered

to

be extremely

“UNETHICAL” to advertise or promote one’s medical services. This is so because, it is not a good thing to say that you can save someone’s life better than somebody else. Also it is very bad to say that you are profiteering from people’s misery. Hospitals conduct camps in rural areas to give medical check ups at a reasonable price so that the rural people approach the hospital again in the future. Hospitals generally advertise in health and fitness magazines.

Promotional Strategies

• Word of Mouth
This strategy is considered to be the godfather of

promotional strategies in Hospital sector. A patient who has been successfully treated in a hospital will always suggest this to another customer. This is also used to create customer loyalty among potential customers before any actual service has been rendered to them. This is why most of the hospitals have to be very efficient in the service delivery.

• Periodicals
Several Medical Magazines, newspapers and Journals are printed in order to create awareness about the hospitals among the general public. This system is also used by specialists to make a great doctor referral network of specialists in other fields.

• e-Promotions
Websites of several hospitals are coming up as a means of promoting oneself without breaking the “ethical code”. The websites serve as information medium to those people who seek treatment for a particular problem. Also they can be used to provide some tangible evidence about the facilities.

• Mail Campaigns
These can be called as post service techniques used to enhance one’s image in eye of the patient. In this technique the doctor’s send a review mail inquiring about the patients’ health and also asks for a feedback regarding the facilities. This is also being started by the hospitals in order to spread good word of mouth among potential customers.

• Education of Customers
In this system hospitals inform the general public about a particular disease i.e. they create awareness about a particular disease and inform these people about all the necessary symptoms of the disease. This serves in creating customers and a trust among the two as well as this serves as increasing ones market access, this happens as these people who have been informed will further spread the word out thus, increasing coverage. This is termed as “MISSIONARY PROMOTION”.

• Referrals
Doctors who operate from clinics, polyclinics give referrals of Hospitals to get the treatment of their patients done. For the service provided by the referrer the Hospital gives an acknowledgement in the form of a commission also called as a referrer fee. This leads to internal promotion of both the hospital as well as the doctor.

PEOPLE
People refer to both the people inside the organization

(employees) as well as outside the organization (customers).

People in Service Sector Marketing represent both the employees of the company as well as the customers of the company. However, in case of hospital sector the customer cannot be relied on as this is an extremely high knowledge driven sector where it is difficult to filter down the complex information in simpler forms for the customers. The people have to be trained properly in order to keep the customer satisfied. The employees have to be trained properly so that they interact well with the customer. Employee here does not only mean the high level ones but also the lower level ones. Employees are the Human Face to the service delivery provided by a service provider. Clinical Employees  Doctors  Nurses  Medical Assistants  Paramedics:  Pharmacists Non – Clinical Employees  Ward Boys: Aids to nurses who run errands for them  Cleaners: Sweepers, toiletry maintenance etc…  Laundry Department: Replacing and Washing linens  Sterilizers: Sterilizing Equipment and Facilities  Equipment Handlers: X-Ray Machine Operators etc… Provide Physiotherapeutic treatment to recovering patients

 Administrative Staff: Accountants, Cashiers, Bills Collection etc…  Catering & Dietetics: Provide for nutritional needs of the patients

PHYSICAL EVIDENCE
The physical evidence is defined as the environment in which the service is delivered and where the firm and the customers interact; and any tangible commodities that facilitate performance or communicate the service. It plays a role in enhancing customer’s perception of the service quality. The acceptance of services is communicated through the physical evidence; therefore, it is of great significance to the service marketers. How important is the physical evidence of “Wockhardt” or “Lilavati”. In a city like Mumbai where the income of people is higher as compared to the other parts of India, one is ready to spend on one’s health and hence the look of a hospital too would matter.

The environment in which the service is delivered and where the customers and firm interact, and any tangible components that facilitate performance or communication of the service. The physical evidence of services includes all of the tangible representations of the services such as brochures, letterhead, business cards, report formats, signage and equipment. Physical evidence makes a huge impact on the customer. Physical evidence provides customers means of evaluating the service

Elements of Physical Evidence
Often customer evaluates the services on the tangible clues of physical evidence, before its purchase. The general elements of physical evidence are: EXTERIOR ELEMENTS OF HOSPITALS Exterior elements include the outer look of the place of delivery of service. The exterior gives a formal introduction to the customer as to the kind of service he/ she is to receive. In the case of hospitals, the physical evidence is a very crucial element as one is seeking medical help relating to one’s health and no one would take chances in such cases. Hence, exterior as well as interior factors should be kept in mind. Some of the exterior factors essential in Hospitals are as follows: • Exteriors Design

• Entrance • Signage • Parking • Surrounding Environment • Security INTERIOR ELEMENTS OF HOSPITALS In case of hospitals, the interiors play a very vital and important role. If the hospital is not hygienic, does not look up to the standard as it promises to be and the equipment used is not of good quality, patients would hesitate coming for any treatment to such a hospital. Given below are some interior elements in context of hospitals:
• • • • •

Interior Design Safety Signs Rooms Washrooms Equipment

OTHER TANGIBLES
Along with the exterior and interior elements in hospitals, other tangibles also help in putting up a good impression of the hospital in the eyes of the customer. Sometimes, small elements too may make a big difference. This section refers to those small elements. The other tangibles are as follows:

 Uniforms.  Staff  Equipment  Visiting Card  ATM Centers  Telephone service  Ambulances

Service sector management

PROCESS
Process is a set of activities that take an input, convert it and add value to the input and finally, create an output. Process has only recently been given much attention in the service sector although it has been the subject to study in manufacturing for many years. Blueprints design processes, which sets a standard for action to take place and to implement the service.

Joining Phase

The Intensive Consumption Phase Detachment Phase Feedback

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1.

The joining phase – which includes
The arrival of the patient Registration – where a patient has to make an initial deposit at the inpatient billing counter after which a file is opened in the patient’s name to know the patient’s medical history.

2.

Intensive consumption phase – which includes
Diagnosis – where the consultant diagnoses the illness by making the patient undergo various tests Treatment – where the illness is treated with proper medication or surgery Information about further actions – the consultant will instruct the patient regarding the diet to be followed, the medication to be taken etc.

3.

Detachment phase – which includes
Discharge of the patient Payment – after the patient is discharged, the bill will be paid at the billing counter.

4.

Feedback – at this stage, the patient is requested to fill an
evaluation form, which helps the hospital authorities to know the level of satisfaction derived by the patient. Patient’s suggestions are always considered for improving the hospital services.

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General Process Organization in a Hospital

Finance Dept

Billing

Purchase Dept

Stores

Doctors

Patient ( External customer)

Nurses

Within the hospital, if we look at each individual department, we notice that each department serves the needs of another department, for instance, the purchase department serves the need of the stores, the billing department serves of the finance department etc. So in each way, each department is a customer to another department, while at the same time it might be a supplier to another department. Each department is an ‘internal customer’ or the other departments. Only when each unit of the hospital understands who their customers are and what their needs are, will the hospital develop basis for giving the best service in the most efficient way to the patient.

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Market Segmentation
Market segmentation is a useful business tool to identify new and expanded ways to improve services and enhance revenues. This tool identifies unique subsets of the population to target for specialized services and marketing initiatives.

SEGMENTING
Segmenting variables such as geographic, demographic,

Psychographic and behavioral segmentation helps in knowing consumer wants needs and responses of various services and products. It is very essential to know which segment would be right for setting up our hospital as only after studying the diseases and the people who are diseased or at high risk of getting those diseases form our segment.

Geographic Segment
It calls for dividing the market into different geographical units such as nations, states, regions, countries, cities or neighborhood. One can operate in few geographic areas, or operate in all but pay attention to local variations. It is advisable to target all sections of people, by and large the entire mass by delivering varied services to a specific disease.

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Demographic Segment The market is divided into groups on the basis of variable such as age, family size, family lifecycle, gender, income, occupation, education, religion, race, generation, nationality and social class. With these variables of segmentation we get to know the preferences and the usage rates associated with different consumers

Psychographic Segment:
This segmentation is done as per the lifestyle, personality of the people. Different people have different lifestyles and different personality, so for them the expectation of service also differs, so keeping all such points in mind the hospitals provide services. People living with very high level of sophisticated lifestyle prefer hospitals which provide best quality service. On the other hand people having very simple lifestyle may also go to public hospital.

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Behavioral Segmentation
In this the segmentation is done as per the following variables i.e. knowledge of, attitude towards, use of, or response to a product or a service. These behavioral variables – occasions, benefits, user status, user rate, loyalty status, buyer readiness stage and attitude- are the best starting points for constructing market segments. For e.g person having diabetes would go to the hospital after knowing the facilities that they offer and the care, comfort they provide. This would help in creating loyal patients and create goodwill for our hospital.

Quality dimensions

Quality refers to the inherent or distinctive characteristics or properties of a person, object, process or other thing. Such characteristics or properties may set a person or thing apart from other persons or things, or may denote some degree of achievement or excellence. When used in relation to people, the term may also signify a personal character or trait.

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For example, hospitals have to decide what quality of food to buy for their patients. The buying objective here is not profit, because the food is provided to the patients as part of the total service package. Nor is cost minimization the sole objective, because poor food will cause patients to complain and hurt the hospital’s reputation. The hospital purchasing agent has to search for institutional food vendors whose quality meets or exceeds a certain minimum standard and whose prices are low. Knowing this, many food vendors set up a separate division to respond to the special needs of institutional buyers. Thus, Heinz, for example, will produce, package, and price its ketchup differently to meet the different requirements of hospitals, colleges, and prisons.

Quality dimensions by Parasuraman
The quality customer service is the foundation for long run businesses. This quality dimensions will regulate the business process, solutions and services. Quality of service is the most important and the most critical component for a customer. These are five quality dimensions, which can be taken into account for the assessment of service quality. BY Parasuraman et al – Parasuraman, Valerie Zeithaml and Leonard Berry identified five dimensions with which consumers judge services.

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RELIABILITY
It shows the ability of the service provider to perform the promised service accurately and dependably. It means that the service provider should be able to identify and provide business solutions to their customers to achieve their goals and objectives. Reliability assures performing the promise given to the customers in the most effective and efficient manner.

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In the case of hospital industry it is consistently shown to be the most important determinant of service quality because this is the main reason why the customer i.e. patient comes to a hospital for his treatment and as soon as he enters in a hospital, it becomes an implied promise of the management of the particular hospital that they will try their level best to treat him properly. A person should be assured of the acute physical and mental disorders also. So this is the most vital promise which a hospital gives to its customers and if it is broken then it will cause a great problem to its customer as well as it affects the reputation of the hospital but as such there is no hard and fast rule in any of the hospital that a patient will be cured. Basically the main service, which a hospital gives, is cure and treatment only and they shouldn’t compromise a bit in this criteria. Hospitals should hire the best doctors affordable and available to them in the industry, which can provide the best of the services. Hospitals should also provide all the other services like the accommodation, medicines, timely appointments, appropriate diagnosis, and etc. to their level best to the patients.

ASSURANCE
Assurance is all about trust and confidence. It comes with the brand equity, trust and loyalty towards consumers. Consumers should be assured about the service and they should have trust

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on the brand. This dimension is particularly important for hospital industry because it involves a high risk and there is a great uncertainty of the outcomes. Trust and confidence may be embodied in the person who links the customers directly to the company for example securities brokers, insurance agents, etc. but in the hospital industry the customer is not directly linked to the whole organization but with only a part of it in the way of some particular doctors and attendants. So in the early stages customer may use the tangible evidence to assess the assurance dimension like the degrees, honors, awards, and special certifications in this type of professional services. So if the hospital is rated 5 star, than the patient may be assured that at least they are getting treated by the best professionals in the industry and the probability of they getting cured is high in a critical disease with such hospital other than low graded hospitals. So here the knowledge, skills, credentials and reputation of hospital and its employees is of immense importance to assure the customers about the service.

TANGIBILITY
Tangibility means representing the service physically. It stands for the appearance of facilities, equipments, personnel and communication material. Making customers happy with business

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environment is the motto of service providers.

All of these

provide physical representations or images of the service that customers, particularly new customers, will use to evaluate quality. Hospital is a type of service in which the customer himself comes to the service factory hence there is more interaction with the tangible cues. In a hospital the tangibles are the waiting rooms, examination rooms, surgical and operational tools, and facilities inside the rooms, modern infrastructure, essential drugs, equipments for investigations, etc. on which a patient can make out the service quality of a particular hospital. Hospitals should also take good care of their kitchen and canteens. They should be kept absolutely clean and clear to insure hygiene. This is the main aim for a hospital to attract more and more customers. As there is no particular tangible service like in real estate industry or in catering industry in which you can actually try a product and then can approve it. But in this case a patient can’t just try the service of the doctors in the hospital so he will have to rely on these type of tangible goods and the profile of the surgeons and doctors to take a decision to get admitted in a particular hospital.

EMPATHY

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Empathy means the individualized attention and customized service given to the customers by the organization. Understanding the customer’s needs, goals, and objectives and providing solutions with good quality and helping them to overcome their problems. A hospital should acknowledge patient as a person, should remember his previous problems and should than hear to him with patience to treat him in the best possible manner. This industry is all about giving customized service to everyone because every patient has different problems so he should be treated with a great empathy. More than the treatment, what a patient wants is care and comfort. A patient gets distressed when he is alone, when there is no one to hear him and there is nothing to pass his time on. So staff and doctors should always be friendly and there should be a friendly environment in the hospital because it relieves the mental pressure of the patient and so he can be recovered soon. He should be given the best of the food and best of the services, which he demands taking care of his treatment so that he feels good. A patient is the customer of the hospital but not a regular customer so whatever he is experiencing and getting will be his perception throughout his lifetime and this is the only time when a customer can be satisfied and there will be no second chance.

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This will also create the word of mouth publicity when he is discharged from the hospital and he will tell about his experiences to others.

RESPONSIVENESS
Responsiveness reveals the service providers awareness in problem solving with viable business solutions. It can be defined as the way the service provider responds to the customers and his willingness to help. The foremost thing is that the service provider must be accessible to solve the problem whenever it occurs and there the service provider should see through it that there should be no waiting after that. Than the service provider should be willing to listen to the problem and solve it as soon as possible. Attentiveness and promptness is something on which a hospital should emphasis on while dealing with them at the time of their treatment, problems and complaints. To excel in this dimension the hospital must view the process of service delivery and handling the requests from the patient’s point of view and should try to minimize the time taken to respond to the patient problems. Speed and the promptness are the two main criteria, on which a hospital’s responsiveness dimension can be evaluated.

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In

the

case

of

any

emergency

or

critical

matter

the

responsiveness of doctors and staff are very important so they should be alert for such situations at any time of the day. So responsiveness of a hospital is communicated to the patient by the length of time taken to assist them, answer their questions or giving attention to their problems. Training is the most vital tool given to the employees i.e. doctors and the staffs to deal with even the worst conditions during emergency and they should be responsible enough to deal with it then and there.

BY David A. Garvin eight dimensions of quality were identified by Garvin:
1. Performance: every product is supposed to deliver benefits and the measure of its quality is performance of the offer. A dish scourer, which can clean plates completely and quickly, would be a performance. 2. Features: these are in addition to the core product, which does not come as standard ‘features’, like add-ons. 3. Reliability: this is a measure of the degree of probability of the product delivery what had been promised. 4. Conformance: delivery quality meeting design standards. 5. Durability: this is a measure of the length of time that a product can deliver benefits, without deterioration.

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6. Serviceability: if the product can be repaired with ease and speed than it is a measure of quality. It could include the behavioural dimension of service of personnel like their politeness 7. Aesthetics: this is a measure of the product’s looks, design, touch and feel. 8. Perceived Quality: consumers develop a perception due to company – controlled stimuli like advertising, publicity and brand promotion, and social effects like word-of-mouth.

Quality
Some matters which influence perception of quality of service in a hospital are • While making inquiries or giving instruction, nurses and other staff refer to patients by bed numbers or by the disease he suffered from. It makes a lot of difference if the patient is identified by his name. • Letting patients know what they are suffering from, what is being done to them, why particular tests are being conducted, what they can expect in terms of discomfort, caused by a particular medical procedure, etc. Open communication is very satisfying. • Letting patient having an option regarding their treatment or continued hospitalization, because of high costs involved.
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Hospitals tend to treat patient like captives or hostages, who cannot escape, and on whom any treatment, at any cost, can be forced, without their consent. • Letting accompanying relatives know what is being done to the patient and about options. • Patients being escorted by someone senior when they have to be taken else where, for X-rays, Scanning, etc. instead of their being left alone in corridors on wheel chairs or stretchers, waiting for their turn. • Removing particular serious cases from general ward. Patients get depressed when they see other patient in acute distress, or in a terminal condition with a lot of anxious relatives moving around and medical staff rushing about. • A primary nurse being assigned, as an aid to every patient to take care of his need throughout his stay in the hospital.

3-room Intraoperative MRI Suite (IMRIS)
This is India's first 3-room intra operative diagnostic and imaging solution where the patient is never moved. IMRIS brings MRI surgical imaging to patients undergoing surgery and enables surgeons to leverage the unique ability to provide better outcomes for their patients. It is the world's most patient-safe intra-operative imaging solution that allows the surgeon to accurately depict changes in brain position and anatomy during

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surgery. IMRIS provides complete 360° surgical access to the patient and can service multiple operating rooms. At Kokilaben hospital, a 1.5 Tesla ceiling-mounted MRI is stationed in a diagnostic bay with two adjacent operating rooms on either side.

Orthopedic, ENT and Neuro Navigation Systems
World over, navigation systems are redefining the way surgeries are performed. They enable surgeons to achieve greater precision by providing electronic guidance using computers, infrared cameras and wireless instruments. Surgeons can effectively make data-driven decisions in the operating room by incorporating the three technological innovations that provide a data-rich, visual surgical environment that helps reduce procedure invasiveness, risk and operative times.

Radiation Oncology Linac Suites
The Trilogy stereotactic system is the most advanced, sophisticated machine of its kind in the world. As the leading image-guided radiotherapy (IGRT) system, Trilogy marks the beginning of a new generation of cancer care. The versatile system combines imaging and treatment technologies, and can be used to deliver the widest range of external beam radiotherapies: 3D conformal radiotherapy, IMRT, fractionated stereotactic radiation therapy and intensity-modulated radiosurgery for cancer and neurosurgical treatments. Advanced imaging capabilities built into the system allow therapists to position patients for treatment with sub-millimetre accuracy. A respiratory gating system

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Service sector management

compensates for any tumour movement that occurs as a patient breathes. The system at Kokilaben hospital is powerful and can deliver radiotherapy doses at least 60 per cent faster than conventional accelerators. This shortens the length of time patients need to spend undergoing treatment. In addition, the radiation beam is highly precise, allowing clinicians to deliver treatments with unprecedented accuracy.

Stereotactic Radiosurgery
The Novalis Tx at Kokilaben hospital is among the world's first whole radiosurgery systems for indications in the brain, liver, pancreas, prostate and lung. It enables small, deep-seated tumours to be treated by radiation without open surgery and offers a versatile combination of advanced technologies for the treatment of tumours and other anatomical targets. With this platform, the Kokilaben hospital offers state-of-the-art, noninvasive treatment for a wide range of cancers and other potentially debilitating conditions, without harming nearby healthy tissue and without involving traditional surgery.

3 Tesla MRI
Patients today demand the highest quality of care, including a comfortable exam experience and the assurance that the diagnosis is the most accurate possible. When you combine 3T with a 70 cm open bore, you give them just that. More space limits claustrophobic rejections, fewer patients need to be sedated, and sharper images are captured thanks to less anxiety-

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Service sector management

related

movement.

The

3T with

system special

at

Kokilaben and

hospital

accommodates

patients

needs

conditions

including spinal deformities, respiratory problems and those with pain and mobility issues. It also allows us to expand care to a wider range of patients including obese, paediatric, elderly, ICU patients or those dependent upon medical equipment. The 3T broadens clinical possibilities with easy access in interventional MRI and opportunities to perform more functional studies (using the functional MRI tool).

40-slice PET/CT
India's first, Positron EmissionTomography Computed Tomography (PET-CT) is a medical imaging device that combines both a Positron Emission Tomography and an x-ray Computed Tomography, so that images acquired from both devices can be taken sequentially, in the same session, from the patient and combined into a single superimposed image. PET-CT has revolutionised medical diagnosis by adding precision of anatomic localisation to functional imaging, which was previously lacking. For example, in cancers, surgical planning, radiation therapy and cancer staging have been changing rapidly under the influence of PET-CT.

Dual Source Cardiac CT (DSCT)
The latest revolution in CT is the new Dual Source CT technology that pioneers new clinical opportunities. Our DSCT is faster than every beating heart, c an obtain full cardiac detail at half the dose

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Service sector management

of radiation, serves as a one-stop diagnosis in emergencies, and goes beyond visualisation with dual energy. Twice as fast as other cardiac CT scanners and less influenced by irregular heart rhythms, it eliminates the need for beta-blockers to slow down the heart rate prior to cardiac scanning. The DSCT at Kokilaben hospital opens the door to a new world of characterisation, visualising the chemical composition of the human body. The result: two spiral data sets acquired in a single scan providing diverse information, which allows us to differentiate, characterise, isolate, and distinguish the imaged tissue and material composition.

SPECT
Single photon emission computed tomography (SPECT) is a nuclear medicine imaging technique using gamma rays. SPECT can be used to complement any imaging study where a true 3D representation is needed, such as tumour, infection, thyroid or bone imaging. As SPECT permits accurate localisation in 3D space, it is used to provide information about localised functioning of internal organs; for instance, functional cardiac or brain imaging.

CONCLUSION
The nature of surgical operations has changed considerably. Alternate procedures, without resorting to conventional surgery, are becoming available, thanks to new technology, using lasers,

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Service sector management

micro instruments, etc. therefore, there is little post surgical care. Patients can return home the same day, with verry little discomfort, and hardly any possibility of complications. Patients, the world over, are finding it cheaper to arrange for nurses and equipment at home, because of the heavy cost of hospitalization. Equipments can be hired. Care provided at home is more comforting. For these reasons, the occupancy of hospital beds is going down. Similar trends are expected in India. The data on patients, given earlier, points to the need of restructuring hospitals, to meet new usage patterns. Speciality hospitals are being connected to similar hospitals in other parts of the world, through satellite communication networks. Through data exchanges and teleconferences, doctors in one place can confer and consult with colleagues anywhere in the world. Doctors from one city, visit hospitals in other cities, other countries, for short durations, to demonstrate their skills, to teach, and to learn. A good hospital is a place for learning, if the experience gained in the case of a patient is properly recorded and stored in a library. Doctors enhance their knowledge and skills by accessing such records. The quality of both the doctor and the hospital can be enhanced in this way.

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Bibliography Websites
• •
• • • • • • • •

www.expresshealthcaremgmt.com www.ficci.com www.dogpile.com http://en.wikipedia.org/wiki/Hospital http://en.wikipedia.org/wiki/Healthcare http://en.wikipedia.org/wiki/Tertiary_sector_of_the_economy http://www.economywatch.com/world-industries/services-sector/ http://www.economywatch.com/world-industries/health-care/ http://www.economywatch.com/world-industries/health-care/india.html
http://www.himpub.com/frontend/home.asp?UserId=319903243

Reference Books: •


Christopher Lovelock and Jochen Wirtz, Service Marketing, Zeithmal & Bitner, Services Marketing, 3rd edition C. Bhattacharjee, Service Sector Management- An Indian

Pearson Education publication house, Fifth edition • •


perspective, Second Edition. Arun Kumar, Hospital Mangemnt, Second Edition. Talluru Sreenivas, Service sector in Indian Economy, 2nd Edition.

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Vasanti Venugopal and Raghu V.N, Services Marketing, First

Edition

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