Implications of Service Quality Model for Medical tourism in India

Akhila R. Udupa¹* and G. Kotreshwar²

¹Senior Lecturer, MBA, Seshadripuram Institute of Management Studies, Yelahanka New Town, Bangalore – 560064

²Dean, Department of Studies in Commerce, Manasagangotri, University of Mysore, Mysore – 570 006

*Corresponding Author E-mail: akhilasubbu@yahoo.com

ABSTRACT:

“Medical Tourism”, refers to the increasing tendency among people from the UK, the USA and many other third world countries, where medical services are either very expensive or not available, to leave their countries in search for more affordable health options, often packaged with tourist attractions (Rao, 2006)¹. Medical tourism is an industry which combines two closely related services, like, medical treatment and tourism (RNCOS,2007) ². This is a booming industry in countries like, India, Singapore, Thailand, Malaysia, Australia, Srilanka, etc. SERVQUAL model developed by Parasuraman, Zeithaml and Berry has high implications for Medical Tourism as it highlights the main requirements for delivering high service quality. As customer is the king, creating “customer delight” to the foreign medical tourist by providing the quality service by reducing the customer expectation gaps is a challenge for medical tourism providers. The application of SERVQUAL model is handy to enable a hospital engaged in Medical Tourism to deliver superior quality service resulting in customer satisfaction amidst competition. This can also be effective for creating customer loyalty and brand building.

KEYWORDS: This paper seeks to study the advantages of applying SERVQUAL model by various hospitals which are engaged in Medical Tourism in India. Some service delivery and marketing strategies by using the SERVQUAL model are discussed to enhance superior service delivery by medical tourism providers.

1. INTRODUCTION:

Medical Tourism can be defined as provision of cost effective private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry, both private and public.(Sankaranarayan, 2005).³India has one of the best-qualified professionals in each and every field, and this fact has now been realized the world over. Regarding Medical Facilities India has the most competent doctors and world class Medical Facilities. With most competitive charges for treatment, India is a very lucrative destination for people wanting to undergo treatment of certain medical problems who do not need immediate emergency treatment.

Medical tourism’ can contribute Rs. 5,000-10,000 crore additional revenue for up market tertiary hospitals by 2012, according to a Confederation of Indian Industry (CII)-McKinsey joint study (CII McKinsey , 2003)⁴. In fact, medical tourism will account for 3-5 per cent of the total healthcare delivery market in this period, the study says. India has immense potential for medical tourism as medical costs are skyrocketing in the developed world. Rajnish Jain (Jain, 2005)⁵, analyses the current scenario of health tourism in India and suggests a strategic framework for professionally managing it. He adds that India has a high potential to attract the foreign medical tourists as it can deliver efficient service in both modern and traditional Indian therapies which has high demand in many European countries and in U.S.A.

2. SERVICE:

It is very difficult to find out the exact difference between products and services in today’s context as what is being offered to consumers as a product is well supported by a bundle of services, during and after the product is purchased and consumed( Panda, 2008)⁶. A service is any act or performance that one party can offer to another that is essentially intangible and does not result in the ownership of anything. (Kotler, 1997)⁷. Some characteristics of services are intangibility, perishability, inseparability, and variability. These features always challenge the marketers top provide service with high quality. In today’s environment, customers are increasingly demanding value for money in terms of price / quality ratio and the actual quality of the product or service. (Kandampully, Mok, Sparks, 2008) ⁸

3. SERVQUAL MODEL:

Perhaps the most widely cited measurement tool of service quality is SERVQUAL .Servqual stands for service quality. This model was developed by Parashuraman, Zeithml and Berry in 1985. This model is also called PZB model. This indicated that customer quality perceptions are influenced by a series of dimensions or service gaps. This causes a shortfall between expectation of service level and perception of actual service delivery (Parasuraman, Zeithmal, Berry, 1988)⁹. This model uses multiple item scale for measuring service quality.

According to this model, there can be five types of gaps in the service quality. They are,

Lack of understanding (G1)

Lack of development (G2)

Poor delivery (G3)

Unrealistic Expectations (G4)

Service gap (G5)

These gaps are shown in the chart below:

Definitions of the SERVQUAL Dimensions:

Reliability: Ability to perform the promised service dependably and accurately.

Assurance: Knowledge and courtesy of employees and ability to inspire trust and confidence.

Tangibles: Appearance of physical facilities, equipment and communication materials.

Empathy: Caring and providing individualized attention to its customers.

Responsiveness: Willingness to help customers and provide prompt and accurate service.

4. IMPLICATIONS OF SERVICE QUALITY DETERMINANTS FOR MEDICAL TOURISM:

The Servqual dimensions like, Reliability, Assurance, Tangibles, Empathy and Responsiveness have huge implications for medical tourism. Janath Shah and L S Murthy( Shah, Murthy, 2004)^10, examines that, a new business model called Arvind Model is a new business model emerging in healthcare , exemplified by the Arvind Eye care Systems, which reaches out to the masses and aims at being affordable. It has built a brand of being a provider of compassionate, high quality health care provider at low cost. This can differentiate the Indian healthcare industry for being the high quality healthcare provider for low cost.

4.1 Reliability:

It is defined as the ability to perform the promised service dependably and accurately. Medical Tourism in India promises to deliver the world class treatment at comparatively lesser price. Reliability with regard to success of the surgeries or any other treatment should be given the highest importance. How dependable the hospital and its staff are in conducting and managing the entire Medical Tourism process wins the trust of the foreign medical tourist. Under Medical Tourism, there is no chance for second time. Right service has to be provided at the first time. Hence, the expertises of the doctors, nurses, paramedical staff, technology, timeliness of service are the critical factors which are to be focused most.

Even while promoting the brand image of the hospital, success rates of various surgeries performed, experience of doctors, patient satisfaction as testimonials could be used to a great extent. This will enable the foreign medical tourist that “they are in the safe hands” and “it was worthwhile for them to travel all the way to India for treatment”.

For example, at Narayana Hrudayalaya, a unique business model is adopted. As C. K. Prahlad puts it, “doctors perform only surgeries” which results in higher success rates of various surgeries and increase reliability of service (Engardio, 2006)^11.

4.2 Responsiveness:

This aspect concentrates on the willingness to help the customers and provide prompt service. Under Medical Tourism, starting from interaction with the foreign medical tourist through video conferencing, e-mails, and numerous information about the case history has to be collected. The hospital should perform it by giving the right information at the right time to the patient. Complete details of the type of treatment, cost of treatment, date of treatment, traveling arrangement, date of treatment, days needed for recuperation, other tourism options available post surgery, mode of payment, precautions that are to be followed should be informed to the patient beforehand. It is all about keeping the foreign medical tourist informed as to when surgery will be performed and at what time other arrangements will be provided.

Providing the service in a prompt way enables the hospital to win in the “service encounter”. The entire team in the hospital needs to show the willingness to help the patients from the starting point till the patient leaves for his country. Hospital personnel should be reachable to the patient easily as and when required. Because, a foreign medical tourist will definitely have numerous doubts and anxiety regarding his health condition. Further, the MIS at the hospital should be so efficient that patient’s request should be addressed as early as possible. This readiness builds the confidence in the heart of patient.

4.3 Assurance:

This relates to the knowledge and courtesy of employees about the service provided and their ability to convey trust and confidence. For a hospital which is into Medical Tourism, starting from the initial query by a foreign medical tourist, till he is discharged, there are many service encounters. In each of them, the doctors, nurses, and all staff should install trust and confidence in his mind. This can be done by providing “service with a smile” and providing testimonials to patient about the expertise of the hospital. Further, visiting the patient good number of times, making queries about the facilities at the hospital, quality of food will increase the trust for the foreign medical tourist. This can be done by a highly motivated team of doctors, nurses, and other paramedical staff, agents, if any.

Enabling the patient feedback as a performance appraisal technique for hospital staff can motivate them to be more courteous with the patients.

E.g.: At Columbia Asia Hospital, before the patient is discharged, he will be asked to mention the name of an employee who performed the service beyond his expectation. This motivates each and every employee to perform prompt service.

Further, all the team players in the hospital should have complete knowledge about the organization on the one hand and the patient’s case on the other hand. This can be done by adequate training facilities, internet and intranet facilities to create more co – ordination, co – operation and information sharing amongst all the team members. This results in better patient interaction and makes them knowledgeable to answer the questions asked by the foreign medical tourists.

4.4 Empathy:

This is related to the provision of caring, and individualized attention to customers. For Medical Tourism, empathizing with the foreign medical tourist is a key factor to superior service delivery. Hospital can provide the foreign medical tourists some exclusive facilities during their stay in the hospital, so that individual attention can be provided to them by the entire team.

E.g.: Some hospitals like, Narayana Hrudayalaya, Apollo, Wockhardt Cardiac Centre have the entire floor reserved for the foreign medical tourists. Here, the staff is highly trained who understand the language of the foreign medical tourist, can handle currency exchange problems. They take care of even the patient’s accompanying person by arranging some sightseeing to tourism spots.

Further, internet facility, customized food delivery leads to higher levels of patient satisfaction. Dealing with patients in a caring fashion like, free conversation, making them feel at home, and providing the things even before the patient requests leads to the improvement of service quality. Further, the employees at the hospital should consider the interest of the patient at heart and deliver the best service. The tastes and preferences of each and every patient may vary. Hence, providing the service according to the needs of the customer is necessary. Nevertheless, the reachability of staff round the clock is essential. Because, this is a case of health and availability of doctors and nurses all the time will boost the confidence level of the patient.

4.5 Tangibles:

It is related to the physical facilities, equipments, personnel and communication materials. During the interaction with a provider, the customer evaluates whether the provider is able to fulfill the customer’s expectations and deliver benefits that generate satisfaction. The provider’s skills, motivations, and attitudes toward a customer greatly influence this evaluation (Bateson, 1995)¹² In the Medical Tourism service; the major players are the ones, who have world class facilities like, infrastructure, diagnostic services and equipments. Most of them are imported as well. These things lead to greater degree of visual appeal of the hospital thereby making the service more tangible.

E.g.: At Columbia Asia Hospital at Hebbal, Bangalore, the employees have a neat, professional appearance. Their uniform dress, smile, eagerness to help the patients improves the quality of service.

Not only this, some value additions like, recuperation at a spa after surgery, facilities for the attendant for sightseeing, arranging free taxi, giving concessions for the next travel can bring good results.

In bringing the servqual model into practice, in the case of Medical Tourism, commitment of the top management is essential. The concern should be imbibed in the organizational culture. As done by the founder of Arvind Eye Hospital, Dr. Venkataswamy, “We have a lot of very capable and intelligent people, all very well trained in theoretical knowledge. But, knowledge by itself is not going to save the world. What we need is dedication and devotion to the practice”. (Legace, 2007) ¹³The same can be seen at Apollo Hospital, Narayana Hrudayalaya, Wockhardt Hospital where they have a commitment to service quality and they have established high standards. This can only lead to “breakthrough” service.

5. CONCLUSION:

A satisfied foreign medical tourist can become the brand ambassador of the hospital. In the case of medical tourism. Word of mouth can be an effective non paid medium of advertising. He can also become an opinion leader and influence his family, friends, colleagues, relatives to visit India for treatment. He can stand as a testimony for servqual dimensions like, reliability, responsiveness, empathy for them. This can give a competitive edge for the hospital in the international marketing scenario. Because, for a foreign medical tourist, quality service is a priority.

6. REFERENCES:

1. Rao Girish, “Packaged Pampering”, Economic Times, February 28^th 2006.

2. “Booming Medical Tourism in India, RNCOS, India, February, 2007

3. Sankaranarayan . G. “Medical tourism is becoming common form of vacationing”, Express Healthcare Management, March, 1-15-2005.

4. CII – McKinsey & Company (2002) – “Healthcare in India: The road ahead”

5. Rajnish Jain “Health Tourism: Strategies for Growth”, ICFAI Journal of Services Marketing, Vol.III, December 2005

6. Panda K Tapan, “Marketing Management Text and Cases”, pp. 291, Excel Books. 2008.

7. Kotler, P. (1997), Marketing Management. Englewood Cliffs, NJ: Prentice Hall.

8. Kandampully Jay, Mok Connie, Beverley Sparks, “Service Quality Management in Hospitality and Tourism, pp 8- 10, Jaico Books, 2008.

9. Parasuraman, A., Zeithmal, V, and Berry, L. (1988), SERVQUAL: A multiple Item scale for Measuring Consumer Perceptions of Service Quality. Journal of Retailing, 64(1): pp 12.

10. Janath Shah and L S Murthy, Professors in IIMB, in conversation with Dr. G. Veankataswamy and R D Thulasiraj, IIMB Management Review, September 2004.

11. Engardio Pete, “Busines Prophet, How C.K. Prahlad is Changing the Way CEOs Think”, BusinessWeek, January 23, 2006.

12. Bateson, J. (1995). Managing Services Marketing: Text and Readings, Third Edition.Orlando: The Dryden Press.

13. Lagace Martha (2007), “The Rise of Medical Tourism – Interview with Tarun Khanna”, www. Medicaltourismindia.com

Received on 14.10.2010 Accepted on 03.11.2010

Asian J. Management 1(2): Oct. – Dec. 2010 page 65-68