This report outlines the tasks that were requested in the project description, and they are the following: * Description of the selected service * The description and analysis of the four aspects that we chose * Our Recommendations and Improvements This report outlines the service delivery process at Al Salam Hospital in Mohandseen focusing on the out-patient clinic along with our evaluation of the service there. We visited the hospital several times and also played the role of patients there.
We made reservations and were examined by several doctors (e.g. internal medicine doctor, ear nose and throat, chest and ophthalmology,…etc). We also interviewed one of the doctors (cardiology) for the purpose of gaining more information.
We made a survey and interviewed some patients to see their evaluation of the service and how it meets their perception. Based on our visits and the interview we made we were able to gain enough information to evaluate the offered service and prepare our report. This report was prepared by Ban Faisal, Mariam Riad, Nancy Mustafa and Mohamed Magdi Al Kady.
Process Description at Al Salam Hospital: Al Salam Hospital has 2 buildings, the first one is located on the main street, is the hospital itself, for surgeries, patient hospitalization and it has the blood testing lab and x-rays. The second building which is located on a side street near to the main building is the out-patient clinics. The first step for being examined in one of the hospital’s Out-Patient Clinics, is to select the desired doctor, according to the specialty and available times.
The patient can acquire the needed information through the hospital’s website (http://alsalamhospital. org/reservation. asp), through the telephone or through personal inquiry at the hospital. Reservation Details: The patient should then make a reservation. The reservation can be made either through the telephone or by going directly to the clinics’ reception. This depends on the doctor, some doctors allow reservation through the telephone and others only allow reservation to be done directly at the out-patient clinic along with payment.
If the patient is making his reservation at the clinic, then he can make it on the same day as the desired time or a few days in advance depending on the availability of appointments. There are several payment categories; the patients who pay normally, the ones who have an insurance that gives them a discount (partial or full) and there are members of unions who usually get a partial discount that varies according to the union. Reservation Process The patients head to the reservation area that is set near the main entrance. There are two windows located one for the normal patients and one for the insured ones.
The receptionist begins by asking the patient if this is his/her first visit to the hospital, if it is, the receptionist asks for the patient’s information and a file is created for the patient on the hospital’s computer system. The patient tells the receptionist which doctor and when they want to reserve an appointment. The receptionist then checks on the computer reservation system if there are any available appointments at the desired time and if not he tell the patient the first available appointment. If the desired appointment is available then in the case of the normal patient, the patient pays and gets a receipt.
The patient is given a floor number (where the examination room is on) and is asked to head there and is advised to give the receipt to the nurse who is sitting at a desk on this floor. The nurse then takes the receipt and enters the information in a ledger (the day’s list of patients) she has to organize patients and then gives the patient his number (on a first come first served basis). She checks the patient’s ID and goes to the archive to find the patient’s medical record. If this was his first visit, she gets a new blank medical form. The medical records are given to the doctor later.
If the patient has an insurance or will get a discount the above process is the same the difference is that at the time of payment, the patient presents his/her insurance card (or union membership card) to the receptionist who then checks if he has a contract and with which insurance company and the amount of discount he will get. The payment is settled according to the discount rate and the receptionist finishes the reservation process and gives the patient three sets of papers to sign along with the normal receipt. The papers are for the insurance company or union (One for the hospital, one for the company and one for the patient).
The receptionist keeps one of the signed forms and advises the patients to go to the doctor as previously mentioned. If the doctor cancels his appointments for the day the hospital then calls the patients informing them of this change and gives them another appointment. If the patient has made his appointment in an earlier day, before his appointment he’ll first head to the nurse on the clinic’s floor to give her his papers and take his number. At the time of the appointment, all patients wait in the waiting area for his/her name to be called by the nurse at the desk that already gave him his number on the day’s list of patients.
When the doctor arrives the nurse provides him with the list of patients by their order. She also gives him the medical records of all the patients. After the patient’s name is called he goes into the doctor’s office to be examined and describe his/her complaint. The doctor checks the patient’s medical record, if there is any, to get a clearer background about his health. After the examination, the doctor can then give the patient a prescription or orders a few tests to be made, and if needed advises the patient to schedule a follow up consult to check on the progress of the treatment or to check the results of the test.
The doctor writes everything down in the medical record (the complaint, diagnosis and recommended treatment), the form is given to the nurse to return to the archive at the end of the day. The number of consults may vary depending on the ability of the doctor to pin point the patient’s illness and the treatments effectiveness. The doctor also has a document where he keeps information about all the patients that he has seen on that day. If tests are required then the hospital offers the lab as a complimentary service to the out-patient clinic. There are two labs one in the outpatient clinic building and one in the hospitals main building.
The first step to get the tests done is for the patient to take the papers with the prescribed tests to be registered in the hospitals computer system which is located on the ground floor. The patient will then get a paper which s/he will then take to the nurses sitting at a window located immediately next to the lab, they will take the paper and then tell the patient to go into the lab to be tested. The patient will then be told when his results will be ready to be picked up. The patient can reserve for a consult the same way s/he reserve for a regular examination.
Go to Appendices 1 & 2 for more illustration about the service delivery process at the out-patient clinics. Evaluation and Analysis of Al Salam Hospital’s Service: Service concept and characteristics: Service Concept The hospital should be able to offer all things a patient can need: out-patient clinics for examinations, emergency rooms, intensive care units, x-rays and labs, .. etc The employees should feel that they are saving lives not just having a normal job. The community should treat the hospital as a crucial facility that they need to help and do what they can to help it operate.
The treatment should be as efficient and professional as possible and make the patients feel safe and secure so that they would receive their regular treatments there and recommend it to their families and friends. The design of the hospital takes into consideration the devices needed, emergency rooms, moving large objects as beds in corridors and elevators. The interior design is suited to a hospital and allocation of rooms and floors takes into account the psychology of patients (i. e. departments with a high death rate like intensive care units and cancer patients should be located away from newly born babies and incubators).
The hospital is marketed based on the names of the doctors working there and how successful they are in treatment. Target Market Segment: AL Salam Hospital is a private hospital focusing on average and above average-income families. This market is not usually price-sensitive when it comes to healthcare services. This community needs a professional hygienic hospital which they trust to be able to go to for regular examinations, consultations, tests and emergencies The most important segment is of those of the older generation because they usually get sick more.
However, it is important that the hospital builds it ties of trust with the customers throughout their whole life. Distinctive Characteristics of the Service at Al-Salam: Simultaneity: It is the fact that services are created and consumed at the same time at the hospital, the patient enters the room, the doctor examines the patient (the customer) and the patient receives this service simultaneously. For example if a patient comes to the hospital and is diagnosed as having a very low blood pressure the doctor will hook the patient to a salt solution IV which will raise the patient’s blood pressure.
Perishability: The service is perishable which means it cannot be stored. If the patient doesn’t come at the reserved time, a lost opportunity has occurred at that time. An hour without patients during a doctor’s shift can be considered as a lost opportunity and the money that the hospital was supposed to make at that time will never be compensated. Faced with variable demand and time-perishable capacity to provide the service, the managers of the hospital used the following techniques: * smoothed demand by using reservations or appointments * Allowed patients to wait.
* Accepted more patients than the time capacity. Intangibility: Services are ideas and concepts, not products. The patient experiences the service that the doctor offers; he doesn’t touch it or see it. The intangible nature of services presents a problem for customers. When buying a product, the customer is able to see it, feel it, and test its performance before purchase. But for a service, things are different. The doctor tried to overcome this intangibility feature through making the intangible tangible; trying to stop the pain that the customer feels.
He did this through examination and then medication. Another way through which the hospital overcame this intangibility feature was the reliance on reputation and word-of-mouth. Al Salam hospital is very well-known by its good reputation and its customers who are really satisfied with the service delivery system. This two features encourages people to guarantee that when they go to this hospital, they will be satisfied even though it’s not a product that they can really see and touch. Heterogeneity:
The combination of the intangible nature of services and the customer as a participant in the service delivery system results in a variation of the service being offered from one customer to customer next at the same doctor, let’s take a dentist for instance, each customer might have a different kind of pain and thus, needs a unique method of treatment. On a larger scale each customer needs a certain doctor based on his/her illness. Al Salam hospital offers a variety of doctors with different specializations.
Also, there is a cafeteria for patients; that provides a variety of food and drinks to satisfy as much patients as possible. There is cooked food, biscuits, cheese, sandwiches…etc. And as for the drinks there were many kinds of them such as: juice, tea, coffee…etc. The service package: Service managers have difficulty describing their product, that’s because of the intangible nature of services. The “service package”, however, is a way to describe the service. It is defined as a bundle of goods and services with information that is provided in some environment.
This bundle consists of five features which we will explain using Al Salam Hospital as our case. 1. Supporting facility: the hospital building itself is the supporting facility since it is the physical resource that must be in place before the service can be offered. The hospital has two buildings. One for the hospital itself and one for the out-patient clinic. 2. Facilitating goods:
These are the materials provided by the service provider in the hospital. Which are the chairs of the waiting room, the desks of the nurses and employees, the computers, the tools used by the doctors(e. g.thermometer, blood pressure cuff, cotton balls, mini flashlight, beds, and the medical machines and technology used (e. g. x-ray machines, CT scanners and MRI imaging equipment).
3. Information: which is the data that is available from the customer or service provider to enable efficient and customized service.
In our case, it is the: * receipt * Medical records (That is given to new-patients to be delivered to the doctor. This includes information on the medical history of the patient, his name, his age…etc) * The website of the hospital that gives all information needed about the hospital location, features, doctors available…
etc. * Family history; the patient is asked to provide information about whether he has any relative carrying a certain disease or having a certain kind of sickness. 4. Explicit service: the absence of a pain or symptoms after a patient was examined by a doctor is the explicit service since it is the benefit that is readily observed by the senses, and that is the essential feature of the service. 5. Implicit services: implicit services are the psychological benefits that the customer may sense only vaguely, or the extrinsic features of the service.
In Al Salam hospital, the implicit services that the customer experience are: * The good feeling of being in a hospital that has a good reputation. * The feeling of trust in the doctors since they work in such a hospital. * The feeling of confidence that you are in a professional hospital that will satisfy you. * The feeling of safety and reliability in case of an emergency. * The feeling of being in a safe and well protected place because of the security surrounding the whole service place.
The Service’s Strategic Insights: Nature of the service Act: There are the four classifications for the service act. 1. Tangible actions directed to the customer. 2. Tangible actions directed at the customer’s possessions. 3. Intangible actions directed at the customer’s intellect. 4. Intangible actions performed on the customer’s assets. In our case, the nature of the service act occurring in a hospital between a doctor and a patient is choice number one which is “tangible actions directed to the customer’s body”.
This means that the customer have to be present physically throughout the service. So, he must travel to the service facility which is the hospital. As for the service acts inside the cafeteria, which is a part of the additional services (The hospital), the food and the drinks provided by the waiter are also considered tangible actions directed to the customer’s body. Relationship with customers: Al Salam Hospital was successful in building long-term relationships with customers. Most of the doctors are gentle, kind, and welcoming.
They are effective and efficient in doing their job. That’s why, most of the patients there are very loyal and always looking for no alternative hospitals (We did a survey and asked the old customers who used to come to the hospital since they were young, and they said they are satisfied and never thought of exchanging this hospital with any other one) Degree if interaction and customization: Services are classified across two dimensions that significantly affect the character of the service delivery process.
The first dimension measures the degree of labor intensity (which is defined as the ratio of the labor cost to capital cost), while the second dimension measures the degree of interaction and customization. Al Salam Hospital has a low degree of labor intensity because of its considerable investment in plant and equipment relative to labor costs. And it has a high degree of interaction and customization since the doctor and the patient must interact fully in the diagnostic and treatment phases to achieve satisfactory results.
This combination of low labor intensity level and high interaction and customization, lets the hospital be classified under the “Service shop” category like repair services for example. Customization and judgment: Because services are created as they are consumed and the customer is often a participant in the process, an opportunity exists to tailor a service to the needs of the customer. The customization proceeds along two dimensions either the character of the service permits customization, or the service personal have the discretion to modify the service.
Al Salam Hospital can be considered as a service that has a high degree of customization and high extent of customer contact; employees exercise judgment in meeting customer needs. For example when a patient goes to a doctor, he has to tell him exactly what his problem is so that the doctor will be able to know what’s wrong with the patient.
This is why the extent to which customer contact with employees requires exercising judgment in meeting customer needs. Also, there is a high degree of customization, since each patient might need a different kind of treatment based on his own illness.
Even the way the doctor treats each patient might differ depending on the case. Method of service delivery: The method of service delivery has two dimensions. a geographic dimension and a level-of-customer interaction.
Since its clear that Al Salam Hospital is a service that has a single site/customer travels to service firm and patients have to travel to it to experience the service. Service delivery system: Delivery system: * People: Doctors are the most important asset of the hospital. The doctors should be professional because a mistake can endanger a human life.
Also, nurses need to be hygienic, professional, helpful and re-assuring to the patients. * Technology: The hospital should keep up with the latest technological advancements in methods of treatment, operations and devices to be able to provide a better service. Technology systems should be employed for administrative jobs as well to facilitate operation.
* Equipment: Up-to-date reliable equipment should be in place. All equipment that would be needed for the treatment should be there in the hospital. The equipment should be regularly maintained because the hospital cannot afford any casualties due to machine failure.
* Layout: The layout should be practical and takes into account psychological factors as putting the departments with expected high rate of deaths far from other parts to prevent the other patients’ anxiety or pessimism.
* Procedure: The hospital has many activities going on at the same time so everything needs to be very organized to prevent mistakes. The process has been explained before. For more reference check appendices 1 and 2. An open systems view of service: For Salam Hospital, since it’s a service process, the process is the “product”.
It is considered an “open system” since customer interacts during the process and has an active role in it, unlike manufacturing processes where the customer isn’t involved in the process. He plays no role in it. Customer’s role in the service delivery process: 1. Customer enters the hospital 2. goes to the encounter 3. asks for an appointment 4. pays for the service 5. comes back at the day of appointment 6. takes the receipt from the encounter 7. goes upstairs and gives it to the nurse 8. waits until the nurse calls his name 9. when she does, he enters the patient room
10. communicates with the doctor 11. receives the service Operating Strategy and facing competition: Operating Strategy Important elements: * Operations and Organization: Those are the most important aspects in managing the hospital that needs the maximum focus. An organized process is set for employees and patients of different kinds that should be followed precisely for the hospital to operate. Also, paperwork and archiving is very important. * Control: Constant control and monitoring to the whole system is needed for preventive quality control.
* Human Resources: The human factor is the most important aspect because they are not only constantly in direct contact with the customer (patient) but are responsible for his life and health. Quality: The hospital cannot afford to have mistakes being made by staff or machine failures or any other type of mistakes because it is dealing with human lives. Also, there is no quality-control intervention because the service happens simultaneously with consumption that is why other quality control measures shall be put in place. Preventive quality control is its only option.
Constant maintenance to equipment, taking complaints very seriously, regular evaluation to all staff members by their managers and by the customers to be able to spot week points immediately. Also administration should regularly make sure the process is going as planned and schedules are strictly followed. The hospital has managers present on-site all the time to monitor quality and make sure the rules are being followed. The hospital if not kept 100% clean can provide room for infections and patients can easily carry infections from others.
Constant cleanliness and sterilization is a must. Competitive service strategies: The hospital is using differentiation to compete with its rivals. It uses advanced technology, has very friendly staff and honest doctors that explain to you everything about your condition making you feel re-assured that you are in safe hands that care about your personal health not just another customer.
The hospital keeps personal medical history records for every patient it gets so that you feel that they care about you and know your history well.
You don’t have to go you’re your history every time you go to a different doctor, it is all written down for you. Quality and hygienic factors are taken into great consideration. Strategic analysis for the service: Porter’s five forces: Here are the market forces that the hospital is subject to and how they affect/do not affect it: * Competitive rivalry within industry: There are several surrounding hospitals (e. g. Demeshk Hospital, El Safa Hospital a few blocks away, Ibn Sina Hospital)
But are much smaller than Al-Salam hospital because they need a huge capital to be able to establish a hospital on this scale. Therefore many of them have chosen to open in special fields only; eyes, new borns and kids,…etc (e. g. International Eye Hospital, Kids Hospital,.. etc) * Potential new entrants: The main barrier to entry is the capital and goodwill.
To establish a hospital like this a huge capital investment is needed to get the equipment, labs, professional doctors.. etc. Also earning a patients trust take a long time in healthcare businesses to be established to have a good reputation that attracts patients.
It is difficult to compete with Al-Salam hospital because of the reputation it has established over the years (since august 1982) * Threat of substitutes: The switching costs are high because in Al Salam hospital the patient has a full medical record (his previous illness, treatments he has taken and his response to them, allergies, .. etc) kept by all the doctors who treated him but when he goes to another hospital he will have to tell them everything about his life from the beginning.
* Bargaining power of suppliers: Medical supplies are vital for hospital operation but most supplies are not unique and can be bought from many suppliers. * Barging power of customers:
The hospital has a very wide base of customers (it has contacts with many businesses to treat their employees, many insurance co mpany contracts other than the individuals, like Diamond Medical Services) Customers in the target market are not sensitive to price as much as they care about the quality of the service. Service winners, Qualifiers and losers:
These are the aspects that customers use to evaluate the service upon and on which they compare services and determine their preferences. Service Winners AL Salam hospital tries to win customers in market place by several characteristics: * Availability: The hospital is open 24/7 and ready to accept emergencies and has a 24/7 available ambulance. * Convenience: The hospital is located in a residential area in the heart of Mohandessen which makes it very convenient to all who live in Mohandeseen and nearby areas. It is also has nearby stops of public transportation.
* Dependability: Over the past three decades the hospital has proved to be a reliable treatment place. * Personalization: They try to do this by keeping personal medical records and individual patient attention by doctors and nurses. * Safety and quality: High quality is maintained to ensure safety of patients.
They make sure they are treated from their illness and do not get any infections from being in the hospital. * Reputation: It is one of the most reputable private hospitals in Egypt. It has built this reputation over three decades of successful operation. Service Qualifiers:
* Cleanliness &hygiene: The hospital must not allow patients to get infections inside the hospital from other patients, tools,.. etc. If this happens and people know about it, it would be a scandal that affects the hospital’s reputation. * Professional doctors: doctors cannot make mistakes while operating (cutting a blood vessel, forgetting something inside the patients abdomen, giving a wrong treatment,…etc)
Every mistake puts the hospital’s reputation at stake. Service losers: Possible losers are bad personal treatment (personalisations), waiting times, lack of capacity (e.g. no ICU is vacant when a patient needs intensive care) Service firm competitiveness Distinctive competitiveness achieved: The firm is in stage three. They know what creates value to the customer. Thus, the customer seeks the hospital for its reputation.
They have successful operation managers. The back office plays an integral role with the front office to give a high service quality. Managerial and Structural Service Design Elements: The following is the list of elements that should be considered when designing a service: Structural Elements:
a. Delivery System: The process of delivering the service at Al Salam Hospital’s out-patient clinics is normal, and it doesn’t have anything that truly differentiates it from other businesses offering the same service except for the medical records mentioned above. b. Facility Design: The design of the Al Salam’s out-patient clinics is relaxing, when the patients enter the out-patient clinic they feel at ease beginning with the reception and to the small cafeteria and the doctor’s examination rooms.
The facility is also designed with an eye for efficiency and space maximizing. Even though the space used for the clinics is somewhat limited, the clinic has various comfortable waiting areas on every floor that can accommodate up to 20 patients at the same time. Despite the fact that the building has little room for expansion the managers of the hospital have succeeded in maximizing the usage of the building by rotating each examination room between doctors; each examination room can be used by about 3 doctors in the same day at different for a specific length of time.
The design of each floor is almost similar and has about the same number of examination rooms. There are 2 sets of stairs and an elevator. Despite all this the patients may sometimes feel somewhat lost if they are not familiar with the building’s design. Also, the main staircase is not as clearly visible as the secondary staircase for people going up from the lobby to any of the upper floors. c. Location:
The hospital’s main building along with the clinics are easily accessible, the main building is located in Syria St.in Mohandseen, and the out-patient clinics on a side street that can be easily accessed from Syria St and about 4 minutes away on foot.
The location of the hospital gives it the advantage of easy access since the patients can find different ways of transportation to reach the hospital and easily since the hospital can be considered as a landmark in Mohandseen. Since the hospital is located in a densely populated area, it will have an existing wide customer base in Mohandseen alone, and also patients come from neighboring areas due to the very good reputation that the hospital built for itself over the years.
d. Capacity Planning: For each specialization there are 2 or more doctors available each one has up to 3 shifts the number of shits and the times depend on which rooms are available, at what time and which of these times is suitable for the doctor, this means that for any specialization there is a doctor available on each of the days of the week except for Friday. Also according to the number of doctors available there can be more than one time slot scheduled for the day for one specialization. Managerial Elements:
a. Information: One of the features that act as a positive influence for the patients is the availability of a website for the hospital which has all the times and doctors available for any specialization. This makes it easier for some patients to get the information they want without having to use the telephone or go to the hospital. Also the presence of archives medical records with the patient’s information and previous visits to the doctor, so the patient will have an updated medical history. b.
Quality: The hospital has on site inspectors to monitor the quality of the service being performed and the cleanliness of the hospital. c. Service Encounter: As we mentioned before one of the very important aspects that the service at Al-Salam Hospital hinges upon is trust and comfort. As a result we will see friendly competent doctors and nurses throughout most of the hospital doing their best to put the patients at ease and making them feel safe. d. Managing Capacity and Demand: The capacity of the out-patient clinics can be measured through the number of patients that a doctor is able to examine during each shift.
But the problem with that way of measuring the capacity of the clinics is that the demand may fluctuate depending on the time of day, the day itself and the specialization. So in order to smooth that fluctuation a reservation system was created with a maximum number of reservations daily this number is set by the doctors themselves not the hospitals management, but the problem that may arise from this system is that this maximum may not accommodate the number of patients that wanted to reserve on the same day.
Taxonomy of Service Process: Below we will be discussing the complexity, divergence of the service process at the out-patient clinic and the degree of customer contact during this process as a means of classifying the service process. Degree of Divergence and Complexity: The out-patient clinic is a service that has a high degree of divergence as it offers 29 specializations that the patient can pick from.
Also the service can then be further classified as one that aims at processing people, since the service is made to analyze a patient’s illness and curing or diminishing it and generally the thing that changes is the customers themselves not their possessions. The service is one that has direct customer (patient) contact with the employee performing the service (doctor, nurse, and receptionist). Another reason for classifying the out-patient clinic as a service with a high level of divergence is the nature of the service being offered itself and what is required to make it a successful one.
In order for this service to be successful it needs employees with a very high level of technical and interpersonal skills, since the employees we are talking about are doctors and nurses. Also, there is the fact that this service needs its employees to rely on their judgment, training and skills to treat their patients, because there is no fixed routine for patient treatment. This means that employee empowerment is detrimental for the success of the service offered by the hospitals out-patient clinic.