Contents

Executive Summary 1.0: Introduction 1.1 Background 1.2 Objectives 1.3 Methodology 1.4 Limitations 2.0: Findings 2.1 Analysis of the Feedback Forms Satisfaction Ratings by the Clients Reasons for Choosing Umkal Hospital Recommendations of Umkal hospital by Patients 2.2 Analysis of the IPD Data Market Segmentation By Gender Market Segmentation By Location Market Segmentation By Age Market Segmentation By Ward Market Segmentation By Cash/Panel Inflow to IPD by Location and by Panel/cash Inflow to IPD by Room and by Panel/cash Patient Inflow by Time Slot Patient Inflow by Day of the Week Inflow to IPD by Age and by Room Inflow to IPD by Age and by Gender 2.3 Analysis of the OPD Data Market Segmentation By Gender Target Market by Location Target Market By Age Target Market by Cash \ Panel 3.0: Recommendations Expand the Market Build a Comprehensive Strategic Plan Improve the Existing Services Enhance Visibility and Build Relationship Annexure: Map

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List of Tables & Figures

Table 1: Satisfaction Ratings on Critical Parameters Table 2: Satisfaction Ratings on Utility Services Table 3: Satisfaction Ratings on Support Services Table 4: Reasons Behind Choosing Umkal Hospital Table 5: Recommendations of Umkal Hospital by Patients Fig 1: IPD Patient by Gender Fig 2: IPD Patient by Location Fig 3: IPD Patient by Age Fig 4: IPD Patient by Room Fig 5: IPD Patient by Panel Fig 6: Inflow to IPD by Location and by Panel/cash Fig 7: Inflow to IPD by Panel/cash and by Room Fig 8: Patient Inflow by Time Slot Fig 9: Patient Inflow by Day of the Week Fig 10: Inflow to IPD by Age and by Room Fig 11: Inflow to IPD by Age and by Gender Fig 12: Market Segmentation By Gender Fig 13: Target Market by Location Fig 14: Target Market By Age Fig 15: Target Market by Cash / Panel

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Executive Summary
Umkal Hospital & Metro Heart Institute is a 150-bed super-specialty hospital established more than two years back by Dr. Umesh Gupta, Chief Cardiologist. The hospital is located in the posh residential area of Palam Vihar in Gurgaon. Dr Gupta has already been successfully running a 60-bed hospital for nearly 15 years at Sushant Lok, Gurgaon. Considering the investments in the new hospital, returns so far have not been very good. A pilot study was awarded to EMPI Business School to analyze Feedback Forms, IPD and OPD data and recommend actions.

Feedback Forms
Though the number of forms handed over to the consultants was small in numbers, feedback on most parameters has been observed to be quite good. Some services particularly around Kitchen and Front Office do need improvement. Most people are visiting this hospital because of either Location advantage or Reference by friends or Based on their previous experience. Inflow of patients due to references by Doctors has been low. It is heartening to note that most patients would strongly recommend this hospital to others.

IPD
Majority of the patients (70%) visiting the hospital are from nearby areas such as Bijwasan (30%), Palam Vihar (16%) and Sectors 21-23 (24%). Presently bulk of IPD patients is from organizations which are on panel and only 28% are in the cash category. Surprisingly, 61% of the patients are Youth in the 20-35 age group. One would expect Adults and Elders to be accounting for such a large share and not Youth. Maximum patients inflow occurs during the 12 noon to 6:00 pm time slot (39%). Hospital needs to maintain maximum staff at this time.

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OPD
Similar to IPD, maximum inflow of OPD patients is from the immediate surrounding areas- Brijwasan, Sectors 21-23 and Palm Vihar. In terms of age, 44% of the patients are Youth in the age group of 20-35 followed by Adults at 24% in the age group of 36-55. Majority of the OPD patients (58%) coming to the hospital pay by cash and remaining 42% are institutional or panel members.

Recommendations
Based on the analysis of the three data sets, several recommendations have been made towards driving footfalls to the hospital. Some of the important ones are as follows: Since majority of the patients who are presently visiting the hospital (IPD & OPD) are from the immediate surrounding areas, there is a strong need to expand the customer base by evaluating, identifying and developing other nearby areas. Even amongst panel members some of the good brands such as Maruti, BPCL and IFFCO require further market development efforts for driving traffic to the hospital. Presently the client base is dominated by Youth. Considering that this is a Super Specialty hospital, efforts are required to reposition the hospital to attract Adults and Elders. Following services have shown low customer satisfaction ratings and therefore need immediate attention to improve them: o Response time to bell o Timely medicine o Courtesy and politeness of Front Office o Time taken for admission formalities o Behavior of kitchen staff o Quantity of food o Timely serving of food Maximum facilities have to be maintained between 12 noon and 6 pm as this time slot attracts maximum number of IPD patients. To enable better analysis and data capture, feedback form, IPD and OPD data formats need changes in design.
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The hospital must enhance its visibility and build relationship with residential areas in order to drive traffic to the hospital. Several measures have been suggested in the report towards meeting this goal.

Since the present recommendations are based on limited data sets, a comprehensive study is recommended which would entail (i) An internal exercise to evaluate the present mix of clients for profitability and growth (ii) A primary survey amongst potential clients to understand perceptions and expectations, and (iii) A detailed analysis of 6 months data pertaining to IPD & OPD. The inputs from these three studies would help in developing a concrete plan for the hospital.

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1.0: Introduction
Background
EMPI Business School, New Delhi is amongst the premier leading business schools in the country formed nearly 15 years back under the leadership of its founding chairman Late Shri Ajit N. Haksar (Chairman Emeritus ITC Ltd.). It has over the years evolved into a group of institutions comprising Centers of Excellence under the guidance of distinguished achievers of India. The institute runs full time, two year AICTE approved PGDM program in a number of disciplines. The program is fully residential. The institute runs a unique two-year full time program in Research and Business Analytics, an emerging area globally. Professor Ravi Sangal, Academic head, Mentor (RBA) and Director (EMPI Knowledge Services) had approached Dr. Umesh Gupta, Chief Cardiologist offering his expertise in Research and Business Analytics to Umkal Hospital to solve its business concerns. Dr. Gupta was kind enough and extended his support by providing data for a pilot project.

Objectives
Umkal Hospital and Metro Heart Institute have been established 2-3 years back in a posh residential area of Gurgaon. Dr. Gupta feels that considering the investments made, the hospital has not been generating expected cash flows. Dr. Gupta agreed to provide one-month data namely Feedback forms, inflow of patient to OPD, and inflow of patient to IPD in the month of August to address the following objectives. How to increase the footfalls and ensure growth of Umkal Hospital How to promote the hospital (Present method mouth to mouth and bill boards)

Methodology
In order to address the above objectives, an analysis of the feedback forms, IPD data of August and OPD data for August 2011 have been done. For each of the inputs, data was cleaned, coded and exported to SPSS. All analysis has been done using SPSS.

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Feedback Forms (34 Cases)

Study Objectives IPD Data of August 2011 (277 cases) How to increase the footfalls & ensure growth of Umkal Hospital How to promote the hospital (Present method mouth to mouth and bill boards) Findings Recommendations

OPD Data of August 2011 (2552 Cases)

Limitations
Being a pilot study we had access to only 34 Feedback Forms, OPD and IPD data relating to only August 2011. Since the data sets are small, analysis cannot be generalized and has to be used as indicative in nature.

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2.0: Findings

2.1Analysis of the Feedback Forms

Satisfaction Ratings by the Clients Parameters on which the satisfaction data has been collected from patients on 1 to 4 scale, 1= Poor, 2= Average, 3= Good, 4= Excellent, have been divided into three broad categories for better analysis. These categories are Critical, Utility and Support. Critical parameters relate to services being provided by doctors and nursing staff. Following important observations can be made, as can be read from Table 1 below: Table 1: Satisfaction Ratings on Critical Parameters Number of Responses General behavior of Resident Doctors Response Time of Resident Doctors to Complains Timely Rounds by Resident Doctors General Behavior of Nurses Response Time to Bell Timely Medicines 26 Mean 3.46 Std. Deviation .647

25

3.44

.651

27

3.30

.724

25

3.16

.624

30 23

3.13 3.13

.629 .626

o Satisfaction ratings on Resident Doctors in terms of Timely Rounds, Response Time to Complaints and on Behavior are very high. Satisfaction levels drop significantly when we talk about nursing staff. Essentially it means, Response Time and other Services from the nursing staff must improve.

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 Utility services include services relating to Front Desk, Kitchen Staff, Ward Boys and Laundry Services. Following services need improvement: o Courtesy and politeness of front office o Time taken for admission formalities o Quantity of food o Timely serving of food Table 2:Satisfaction Ratings on Utility Services Number of Mean Responses Timely Cleaning of Room General Laundry Cleanliness by 25 26 25 25 26 3.28 3.27 3.24 3.20 3.15 3.12 3.08 3.08 3.08 3.00 0.542 0.724 0.779 0.645 0.675 0.726 0.56 0.64 0.776 0.525 Std. Deviation

Timely Changing of Linen Quality of Cleaning Quality of Food

General Behavior of Ward 25 Boys Behavior of Kitchen Staff Quantity of Food Timely Serving of Food 26 25 24

Time Taken for Admission 30 Formalities Courtesy and Politeness of 19 Front Office

2.84

0.501

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 The satisfaction ratings on Support Services are shown in Table 3. Mean scores of these support services are high and should be maintained. Table 3:Satisfaction Ratings on Support Services Number of Responses Mean Security Emergency Services Pharmacy Billing 26 25 3.50 3.48

Std. Deviation .583 .586

24 25

3.42 3.36

.654 .700

Reasons for Choosing Umkal Hospital Unfortunately number of cases at 34 is too small to get a good picture on this issue. However Location, Reference by Friends and Previous Experience are some of the major reasons for people to visit this hospital. The data also reflects poor Reference by Doctors. Table 4:Reasons Behind Choosing Umkal Hospital Number of Percent of Percent Of Responses Responses Cases Choose On Location Referred By Doctor Reference Friends/Relatives Choose On Experience By 7 Previous 6 5 7 36 16.70% 13.90% 19.40% 100.00% 20.00% 16.70% 23.30% 19.40% 23.30% 8 3 22.20% 8.30% 26.70% 10.00%

Reputation Of Hospital Other Reason Of Choosing Total

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Recommendations of Umkal hospital by Patients Although number of cases that responded is only 17, there is an overwhelming response from patients to Strongly Recommend the hospital to others. It implies a high degree of satisfaction and positive experience during the stay in the hospital. Recommendation remains Strong irrespective of whether the patient stays for a Short duration, Medium or Long duration.

Table 5:Recommendations of Umkal Hospital by Patients

Duration Total Short Stay Recommend To Hesitatingly Others Strongly Total 1 5 6 Medium Stay 0 5 5 Long Stay 2 4 6 3 14 17

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To Sum up the Feedback Forms Analysis:

Analysis Issues

1. Feedbacks from the patients on Critical and Support services are very good. However as regards utility services, a few areas need improvement, such as front office services, behavior of kitchen staff, quantity of food and timely serving of food. 2. Most people have chosen Umkal hospital due to location, reference by friend & relatives and previous experience. Reference by doctors is low. 3. Most patients have strongly recommended Umkal hospital to others.

Though the feedback is good, the inflow of traffic is low: o Understanding is required on the following: Perception hospital and image of

Expectations amongst potential clients

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2.2: Analysis of the IPD Data

Data Set Description The IPD data pertaining to the month of August : 277 cases Variable list: Gender: Address: Male Kapashera-Bijwasan Female Sectors Panel: Palam Vihar Cash Manesar CISF Others ECHS Age: ESI Infant (0-5) Others Child (6-19) Room: Youth (20-34) ICU Adult (35-55) NICU Elder (Above 55) General Day: Casualty Monday HCU Tuesday Nursery Wednesday Time: Thursday Midnight 12.00 to 6 A.M Friday 6 A.M to 12 Noon Saturday 12 Noon to 6 P.M Sunday 6 P.M to 12.00 Midnight

Market Segmentation By Gender The IPD dataof 277 cases for the month of August 2011, shows an equal distribution of incoming patients to the hospital by gender (Fig. 1). Our cursory discussions with some of the practioners seem to indicate the distribution to be at par with other hospitals.

Base 277

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Market Segmentation By Location Analysis of the addresses reveals that majority of the inflow (70%) to the hospital is from the immediate surrounding areas. These areas include BijwasanKapashera (30%), Palam Vihar (16%) and Sectors -21/22/23 (24%). A look at the map, reveals number of areas surrounding the hospital which are still lyinguntapped. Some of these areas include (Sectors 111-113, Sector105, Sector 27-29, Ashok Vihar, Laxman Vihar and IFFCO Colony). A copy of map is enclosed at annexure I.
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Market Segmentation By Age Majority of the patients who are visiting the hospitals IPD are Youth in the age group of 20-35 (61%) followed by Infant in the age group 0-5 (20%) and Adult in the age group 36-55 (12%). One would expect Elder and Adult to constitute a larger proportion of patients coming to the hospital. As the distribution also has implications on the Hospitals positioning, the hospital decide on the desired mix.

Base 277

The hospital must also work out the average profitability from each of the age categories and accordingly work out the positioning and promotion strategy.

Market Segmentation By Ward Maximum occupancy of the rooms is seen in the category of General rooms (59%) followed by ICU (20%). The occupancy of HCU (Heart Command Unit) is only 2% which is very less given the present positioning of the hospital as a heart institute.

Base 277

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Market Segmentation By Cash/Panel Majority of the IPD patients are panel members at 72%, the rest being patients paying by cash at 28%. From the point of view of driving the footfalls to the hospital, we need to know if the present mix between panel and cash is as intended. Amongst panel/cash members E.S.I and C.I.S.F account for the maximum inflow at 35% and 23% respectively.

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It is important to understand the per unit realization/profit which arises from these categories.Accordingly a push would be required to enhance the desired category.

Inflow to IPD by Location and by Panel/cash

Following observations can be made from the analysis of Fig 6: - While majority of the patients come from Kapashera-Bijwasan, nearly 73.5% are C.I.S.F employees. Patients paying by cash are very small at 18.1%.
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- Sectors account for 24% of the inflow of patients. E.S.I is accounting for the major share at 47% followed by cash - In the case of Palam Viharthe trend is differentwhere more than half of the patients pay by cash.

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Inflow to IPD byPanel/cashand by Room -Majority of the patients paying by cash are admitted in ICU (36%) and General room (42%). -In case of C.I.S.F beneficiaries, majority (79%) of them occupy General room. -The trend differs in case of E.C.H.S where 50% occupancy is in ICU.

Base 277

Patient Inflow by Time Slot Maximum patient inflow is occuring in the time slot of 12 noon to 6:00 PM (39%). While 26% of patients are coming between 6 AM to 12 noon. 22% of patients are coming between 6 oclock in the evening to 12 oclock at night.Least number of patients(13%) are coming in the midnight.

Base 277

Hospital needs to maintain maximum possible staff in the time slot of 12 noon to 6 PM for ensuring proper service and care of the patients.

Patient Inflow by Day of the Week A Study of the patients inflow to IPD by day of the week shows almost an equal distribution, with Wednesday being slightly higher.

Base 277

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Inflow to IPD by Age and by Room As observed from Figure 3, Youth accounts for 61% of the traffic inflow. Correspondingly thepercentage of Youth in Casualty, General and ICU continues to be very high; however in case of ICU Adult percentage also climbs up substantially

Base 277

We think that by targeting adult and elders inflow can be substantially improved.

Inflow to IPD by Age and by Gender -Gender wise analysis of IPD patients belonging to different age group reflects equal distribution of males and females coming to the hospital. -This trend remains same for Infant, Child, Youth and Adult.

Base 277

-In case of Elder patients Female accounts for 100%.This could be because of very less presence of Elder patients in the given IPD data.

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To Sum up the IPD Data Analysis:

Analysis Issues

1. Equal distribution of incoming patients 1. Inflow of traffic for IPD is too low at by gender. 277 in the month of August 2011. 2. High patient inflow (70%) immediate surrounding areas. from 2. Probable gap between the desired target market & present achieved market. 3. Majority of the patients are Youth in the age group of 20-35 (61%). 4. Maximum occupancy of the rooms is 3. Majority of the patients visiting the seen in the category of General rooms hospital is youth whereas the same (59%). HCU rooms are only at 2%. should have been adults and elders. 5. Majority of IPD patient are panel members. Amongst panel members E.S.I and CISF account for the maximum 4. Patients are either not aware or are not perceiving this hospital as a heart inflow at 35% and 23% respectively. Institute. Patients paying by cash are only 28%. 6. The patients, who come from KapasheraBijwasan regions, belong mostly to CISF 5. People from C.I.S.F. camp & E.S.I. camp. beneficiaries are showing more interest in the hospital. 7. The ESI beneficiaries are forming the major group in Gurgaon sectors. 8. No male patient is present in elder category. 9. Maximum inflow of patients taken place between 12 Noon and 6 PM.

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2.3: Analysis of the OPD Data

Data Set Description The OPD data pertaining to month of August 2011 : 2552 cases. Variable list: Gender: Address: Male Kapashera-Bijwasan Female Sectors Panel: Palam Vihar Cash Manesar C.I.S.F. Others E.C.H.S. Surya Hotel ESI Age: Others Infant (0-5) Surya Hotel Child (6-19) Youth (20-34) Adult (35-55) Older (Above 55)

Market Segmentation By Gender

Given the OPD data which consisted of 2552 cases in the month of August 2011, the distribution by gender has been shown with the help of a 3D pie chart. It shows the proportion of male and female patients coming to Umkal Hospital i.e., out of a total of 2522 cases 55% are Male and the rest 45% are Female.
1

Base 2552

In 2011, Gurgaon had a population of 1,514,085 of which male and female were 817,274 and 696,811 respectively. With regards to Sex Ratio in Gurgaon, it stood at 853 per 1000 male. This can be reason for higher percentage of male patients.

1. http://www.census2011.co.in/census/district/225-gurgaon.html EMPI Business School Research and Business Analytics Program

Target Market by Location

An analysis of the addresses reveals that majority of the inflow to the hospital is from the immediate surrounding areas. This area include Bijwasan-Kapashera (26%), PalamVihar (35%) and Sectors 21/22/23 (25%). A quick look at the map surrounding the hospital reveals a large number of areas, which are lying uncovered. Some of these areas include Sector 106-115 and IIFCO Colony. A copy of map is enclosed at Annexure I.
Base 2552

Target Market By Age

Majority of the patients who are visiting the hospital are youth in the age group of 20-35 followed by Adult (36-55) and Older (55+). This is an unxpected scenario because Elder and Adult should constitute a larger proportion of patients coming to the hospital. It will be important for the hospital to Base 2536 work out profitability per patient for each of the age categories and accordingly a promotion strategy for the target audience should be worked out.

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Target Market by Panel / Cash

Majority of the OPD patients coming to the hospital 58% are paying by cash and remaining (42%) are institutional or panel clients. Some of the panel members include C.I.S.F, E.C.H.S, E.S.I, and Surya Hotel. It is important to understand the per unit realization profit which arises from these two categories of panel and cash

Base 2551

accordingly plan a promotion plan. There are large organizations in the surrounding area which are panel members such as Maruti Udyog Ltd, T.C.S, Airport Authority, and HPCL but are not visiting the hospital frequently. Special efforts are required to attract patients from these and other such large organizations.

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To Sum up the OPD Data Analysis:

Analysis Issues

OPD patients by Gender Male: 55% Female: 45% By Location Bijwasan and Kapashera: 26% Palam Vihar: 35% Sector 21,22,23: 25% Manesar: 2% Surya Hotel: 8% Others: 4% By Age Youth (20-35): 44% Adult (36-55): 24% Infant (0-5): 5% Children (6-19): 7% Older (55+): 20% By panel Cash: 58% CISF: 14% Surya Hotel: 8% ESI: 5% ECHS: 4% Others: 11%

1. Why are OPD numbers so small? Are we addressing the potential market in and around hospital?

2. From profitability point of view what changes in mix are desired?

3. From image point of view what changes in the mix are desired?

4. Are we meeting the requirements & expectations of potential clients?

5. Are there any image or perceptions issues?

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3.0: Recommendations
Expand the Market
o It is observed that the majority of the patients visiting the hospital are from the immediate surrounding areas such as Kapashera, Palam Vihar and Sectors 2123. In order to drive traffic to the hospital, the present geographical base will have to be expanded. Umkal Hospital must evaluate market potential in the following areas- Sectors 111-113, Sector105, Sector 27-29, Ashok Vihar, Laxman Vihar and IFFCO Colony amongst others. High potential clusters should be short-listed and promotional activities must be initiated which would drive traffic to the hospital. o A large percentage of traffic to the hospital is currently Youth in the age of 2235. This situation holds true for both OPD and IPD patients. Focus is required to increase percentages for Adults and Elders. Amongst other things, special programs should be initiated for Adults and Elders to bring them to the hospital such as subsidized heart, diabetic, cataract and arthritis check-ups. Also all communication from the hospital must communicate a sense of greater preparedness for attending to Adults and Elders. o Further development is required with organizations such as Maruti, BPCL and IFFCO to drive traffic from these organizations. o Build a customer database through society offices of senior residents. o In order to increase flow of patients referred by doctors, an exercise must be initiated to identify doctors/ nursing homes in the nearby areas. Efforts must be made so that these doctors and nursing homes can refer patients to this hospital.

Build a Comprehensive Strategic Plan

o The present analysis and recommendation are based on a limited data and therefore cannot be generalized. In order to draw a more generalized picture and develop a strategic plan following are recommended: The hospital must carry out an internal exercise to evaluate the present mix of clients such as by gender, by age and by panel and shortlist segments keeping in mind three parameters profitability, image and potential. A primary survey amongst potential clients is recommended which would attempt to answer the following:
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 Perceptions about the hospital-General or Heart, image, facilities, perception on the expertise available. Expectations A detailed analysis of 6 months data pertaining to IPD and OPD

Improve Levels for Some of the Existing Services

o Following services have shown low satisfaction ratings and therefore need immediate attention to improve them: Response time to bell Timely Medicine Courtesy and politeness of front office Time taken for admission formalities Behavior of kitchen staff Quantity of food Timely serving of food

o Since inflow of patients to IPD is the highest between 12 noon and 6 pm, maximum resources must be deployed at this time to ensure good service. o E.S.I accounts for a very big percentage of patients coming to the hospital. The hospital must carry out a profitability/image exercise. If OK, specialized resources can be deployed to cater to this category. o An exercise must be carried out to: redesign the present Feedback form change and improve the process of data collection incorporate changes to the present IPD & OPD formats by adding new fields such as department/disease/doctor etc.

Enhance Visibility & Build Relationship

o Approach society offices and build relationship with office bearers as a means to driving traffic to the hospital: Invite senior officials to the hospital and show them the facilities Organize talks for residents on issues such as heart care, health and wellness, eye-care, old age diseases etc. Sponsor events, organize blood donation camps and free health checkup camps to enhance visibility and image. For residents in potential areas, provide ambulance facility at special rates as a goodwill measure
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 Hoardings must be put at critical points near the hospital to create awareness and drive traffic. Hoardings must be designed to attract Elders and Adult patients.

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