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  • 1. Comparison of Different Marketing strategy for Sleep Center --------------------------------------------------------------------------------------------------- -------------------------------------------------------------Dissertation submitted to PRIST UNIVERSITY, Thanjavur in partial fulfillment of the requirement for the award of the degree MASTER OF BUSINESS ADMINISTRATION In Health Care Management Submitted by (Hathi Chirag K.) PRIST UNIVERSITY Thanjavur (June 2012) 1|Page
  • 2. DECLARATION I hereby declare that the dissertation entitled “Comparison of differentmarketing strategy for sleep center” submitted for the M. B. A (Health CareManagement), degree is my original work and the dissertation has not formed the basisfor the award of any degree, associate ship, fellowship or any other similar titles.Place:Date: Signature of the Student 2|Page
  • 3. CERTIFICATE This is to certify that the Dissertation entitled “Comparison of differentmarketing strategy for sleep center” submitted by (Chirag Hathi, Enrolment Number:101114545), is a bonafide record of research work done by her/she under my guidanceat PRIST UNIVERSITY, Thanjavur, in partial fulfillment of the requirement for the awardof the degree MASTER OF BUSINESS ADMINISTRATION in Health CareManagement and the dissertation has not formed on the basis for the award of anydegree, associate ship, fellowship or any other similar titles.Place:Date: Signature of the Guide 3|Page
  • 4. ACKNOWLEDGEMENTI would like to express my sincere thanks and gratitude to SPARSHHOSPITAL, AHMEDABAD for allowing me to complete my dissertationproject in the facility.The structure and the content of this project have been deeply influenced bymany people for whom I wish to express my gratitude.I sincerely thank Dr.Tushar Patel, Dr.Gopal Raval, Dr.Mukesh Patel,Dr.Harjit Dumra & Dr.Varun Patel for giving me the opportunity to do myproject at “SPARSH HOSPITAL, AHMEDABAD”.My sincere thanks go to Mrs. Manju Sharma ICRI-Ahmedabad and Dr.Babita Agrawal (Principal ICRI Ahmedabad) for helping me in designingmy study.Foremost, I would like to thank Dr.Gopal Raval(M.B,D.N.B(respiratorymedicine)DTCD FCCS) and Dr.Varun Patel(MB,DNB,Respiratorymedicine)who were kind enough to spare their valuable time and providedseveral important guidance and suggestions at every stage of my study. 4|Page
  • 5. CONTENTS CHAPTER PARTICULARS PAGE NO./SERIAL. NO. 1 Hospital profile 6 1.1 Services 1.2 About doctors 2 Introduction of topic 9 2.1 Aim 2.2 objectives 3 Review of literature 10 3.1 Sleep Disorders 3.2 Sleep Clinic 3.3 Market environment 4 Research methodology 16 4.1 scope 4.2 Topic 4.3 Time duration 4.4 source of data 4.5 Method of data collection 4.6 Method of data collection 4.7 limitation 5 Planning & 17 Marketing strategy 6 Data collection 20 7 Observation 21 8 Conclusion 23 9 Recommendations and suggestions 24 10 Links and references 25 11 Annexure 26 11.1 forms 5|Page
  • 6. 1 Hospital profileAshrai Associates is a group of young, highlyskilled, experienced and dynamic Pulmonary andCritical care specialists, who have beenproviding comprehensive Respiratory and Criticalcare to patients residing in the Western regionof India for the last 5 years.ASHRAI has played a pioneering role in thedevelopment of several subspecialties in field ofPulmonary & Critical Care Medicine not only inAhmedabad and the state of Gujarat but also inthe entire Western India Region.  Maximum number of Medical Pleuroscopies & Therapeutic Bronchoscopic Procedures in India  The only group to have intensivists who have comprehensive training in Transplants - Liver & Lung. We have now assisted in the maximum number of Liver transplants in the state of Gujarat.  Maximum number of patients of ARDS treated with Extracorporeal Techniques (ECMO) in the state of Gujarat.  The only facility in Gujarat to have state of the art Allergy Testing unit  The First group to start Pulmonary Hypertension and ILD clinics in Western India  The First group to initiate comprehensive Domiciliary care for End stage lung Disease patients with the help of trained medical & paramedical staff  The First facility in Gujarat to be approved for Phase II, III & IV trials  The First Group to Establish a Comprehensive Sleep Diagnostic Center and have a dedicated individual specializing in Sleep Disorders.  The First & Only Group to Organize workshops for hands on Training in Ventilatory Management, Spirometry, Bronchoscopy and Pleuroscopy. 6|Page
  • 7. 1.1 Services  Bronchoscopy  Pleuroscopy  PFT  6MWT  Allergy clinic  Sleep clinic  Smoking cessation  Critical care1.2 ASHRAI Doctors:-Dr.Harjit Dumra:-He is the chief intensivist at the Sterling Hospital. One of the member of theinfection control committee at Medisurge hospital. He is a respected nationaland international faculty and has delivered talks on various topics across thecountry. 7|Page
  • 8. Dr.Tushar Patel:-He is a main member of the ASHRAI group. He has special interest inoccupational lung disease. His area of expertise includes TB, Obstructiveairway disorders, Sleep disorders and PFT.Dr.Mukesh Patel:-He is highly skilled and experienced pulmonary and critical care specialistpracticing in Ahmedabad for last 12 years. He is the first pulmonologist incountry to start medical Pleuroscopy.Dr.Gopal Raval:-He is a dynamic pulmonologist and critical care specialist and he wasresearch fellow in international study of asthma and allergic condition inchildren (ISAAC). He has taken training in sleep medicine from Indianinstitute of sleep science, Mumbai.Dr. Amrish Patel:-He is one of the new generation of pulmonary and critical care specialist. Heis back bone of critical care service at ASHRAI. He is acore member of livertransplant team.Dr. Raj Bhagat:-He is a well known allergy specialist practicing in Ahmedabad. His areas ofinterest are respiratory medicine, allergy and applied immunology. He haspublished various articles in “the Indian Practitioner” and “Gujarat MedicalJournal”.Dr.Varun Patel:-He is youngest member of the group. He has done his DNB (Gold Medalist)from Amrita institute of Medical sciences, Kochi. He has presented number ofpapers in the various states, national international conferences. 8|Page
  • 9. 2 Introduction of topic2.1 Aim: - To compare 3 different marketing strategy for the sleep clinic2.2 Objectives:-  To understand the sleep clinic service.  To study the market environment and competition  To study which marketing strategy is suitable for sleep clinic 9|Page
  • 10. 3 Review of literature3.1 Introduction about sleep disordersDue to rapidly increasing knowledge about sleep in the 20th century,including the discovery of REM sleep and sleep apnea, the medicalimportance of sleep was recognized. The medical community began payingmore attention than previously to primary sleep disorders, such as sleepapnea, as well as the role and quality of sleep in other conditionsSleep apnea:-While there are may be many symptoms for sleep apnea the moresignificant symptoms are:  Loud, irregular, snoring, snorts, gasps and other unusual breathing sounds during sleep  Long pause in breathing during sleep  Excessive daytime sleepiness  Fatigue  Obesity  Changes in alertness , memory  Change in mood personality and behavior  Impotence  Morning headaches  Frequent trips to bathroom at nightNOTE: 40% of OSA patients have diabetes.Sleep apnea is among top 4 causes of heart disease.Although obstructive sleep apnea and cardiovascular disease have commonrisk factors, epidemiologic studies show that sleep apnea increases risks forcardiovascular disease independently of individuals demographiccharacteristics (i.e., age, sex, and race) or risk markers (i.e., smoking,alcohol, obesity, diabetes, dyslipidemia, Arial fibrillation, and hypertension). 10 | P a g e
  • 11. Individuals with severe sleep apnea are at increased risk for coronary arterydisease, congestive heart failure, and stroke.Sleep apnea has several health risks. Untreated sleep apnea maylead to:  High blood pressure  Stroke  Heart attack  Congestive heart failure  Cardiac arrhythmia  Depression  Glaucoma  Obesity  Diabetes  Chronic fatigue 11 | P a g e
  • 12. 3.2 Sleep clinicSleep Medicine is now a recognized subspecialty within internal medicine,family medicine, pediatrics, otolaryngology, psychiatry and neurology in theUnited States. In India it is still a new field. Certification in Sleep Medicine shows that the specialist has demonstratedexpertise in the diagnosis and management of clinical conditions that occurduring sleep, that disturb sleep, or that are affected by disturbances in thewake-sleep cycle.This specialist is skilled in the analysis and interpretation of comprehensivepolysomnography and well-versed in emerging research and management ofa sleep laboratory.Types of Studies  Nocturnal Polysomnogram, NPSG – The standard overnight diagnostic sleep study used to assess sleep disorders, including sleep apnea, periodic limb movement disorders, insomnia, 24 hour sleep- wake cycle disruptions etc. The study includes various physiological measurements such as respiratory effort and airflow, EEG (brain waves), EKG (Heart), EMG (muscle movement), oxygen saturations, and snoring. These parameters are standard on every overnight sleep study both diagnostic and therapeutic.  Continuous Positive Airway Pressure, CPAP Titration – A therapeutic study used to treat obstructive sleep apnea syndrome (OSAS). The purpose of this study is to explore a variety of CPAP pressures to determine which is the most effective in eliminating apneic events and scoring.  Split Study – A sleep study which combines a 2 – 4 hour diagnostic test and a therapeutic test in the same night. This study is possible for every adult so that patients with severe OSAS may be treated immediately. If a patient is not “split” to CPAP then the study is run as a NPSG. The patient may return for a full night of CPAP if the diagnostic test finds evidence of sleep apnea and treatment is advised.  Bi-Level Titration – An alternate therapeutic study used to treat patients that have very high severe obstructive sleep apnea syndrome or those that are intolerant of CPAP. Pressures are explored on the 12 | P a g e
  • 13. inhalation and an alternate pressure on exhalation. This pressure spread is used to ease the work of breathing. REM Behavior Disorder, RBD – a modified NPSG with electrodes added to the arms (in addition to the legs) to determine the presence of movement during REM, a stage of sleep during which the muscles are immobile. This study is performed if a patient is suspected of acting out his/her dreams at night. NPSG with End Tidal CO2 – a modified NPSG with the use of end tidal CO2 monitoring. A useful adjunct to the airway recording to assist in the detection of obesity hypoventilation and Hypercapnia, or CO2 retention. ETCO2 recording is considered the gold standard for pediatric polysomnography. Expanded EEG Sleep Recording – An NPSG performed with a full EEG montage during recording. This study is used to detect the presence of nocturnal seizures in addition to other sleep disorders. Multiple Sleep Latency Test, MSLT – A study performed during the day after a full diagnostic NPSG, this study is used to objectively determine a patient’s level of sleepiness after a night’s sleep. The MSLT is a series of five timed test, two hours apart, during which we look to see whether a patient falls asleep, how quickly, and to what stage of sleep the patient reaches. The MSLT is most commonly used to diagnose narcolepsy or some degree of excessive daytime sleepiness. Maintenance of Wakefulness Test, MWT – A study performed to determine whether a patient is able to remain awake in a sleep induced environment. The MWT is used to assess the efficacy of the treatment of a sleep disorder 13 | P a g e
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  • 15. 3.3 Market environment in IndiaThe prevalence of obesity, sleep apnea, and the metabolic syndrome israpidly increasing in India and other south Asian countries, leading toincreased morbidity and mortality due to type 2 diabetes mellitus (T2DM)and cardiovascular disease (CVD).Obstructive sleep apnea (OSA) has been reported to be present in 7.5% ofAsian Indians in western India. Growing evidence indicates OSA to beindependently associated with obesity, hypertension, and excesscardiovascular risk and mortality.Patients with OSA have a high prevalence of insulin resistance and themetabolic syndrome. Obese Asian Indians with OSA had higher abdominalobesity and fasting blood glucose and a higher prevalence of the metabolicsyndrome as compared with obese subjects without OSA.These data also indicate that the presence of OSA may increase the risk ofatherosclerosis and CHD independent of obesity in Asian Indians. 15 | P a g e
  • 16. 4 Research Methodology4.1 Scope of Study4.2 Topic: - study output of three different marketing strategy4.3 Time Duration of Project: - 45 days4.4 Source of data collection:-  Patient records4.5 Method of data collection:-  By filling up questioner form and feedback form for the patients.  By interaction with doctors  Observation4.6 Methods of data presentation:-  Graphical representation4.7 Limitation: - time period was limited to measure accurate result. 16 | P a g e
  • 17. 5 Planning:5.1 Market researchMarket research is any organized effort to gather information about marketsor customers. It is a very important component of business strategy.Market research is for discovering what people want, need, or believe. It canalso involve discovering how they act. Once that research is completed, itcan be used to determine how to market your productTo know the awareness level of the sleep disorder in people and prevalenceof the disorder in this area a questioner (annexure) is formed and it hadbeen filed by 300 people.Result of marketing researchLevel of awareness about sleep Prevalence of disease in this areaapnea in this area5.7% 48.56%In India awareness level is very low and people do not take sleep disordersseriously. Patients do not complain about symptoms until the condition isworst.OSA is prevalent in upper class of the India. It is also prevalent in top class. 17 | P a g e
  • 18. 5.2 Marketing StrategyTo increase the awareness 3 marketing strategies has been adopted.  Doctors: - o Message: We want to assist you in providing the very best healthcare for your patients. o Local doctors were given informative brochures and basic idea about sleep clinic. o Call on physicians’ offices to educate the physicians and/or their office managers on sleep disorders. Provide physicians and office managers with screening information and educational brochures for their staff and patients o Thank you notes to physicians who have referred patients within 48 hours of referral  Events :- for general public as well as Doctors o Event was organized on the Sunday so that we can target more people. o Advertisement for event was done by flyers which had been distributed via news papers. o A presentation was given by the doctor and self assessment questioners were given to the audiences so that they themselves can evaluate that they had sleep disorder or not?  Advertisement and news:- o Informative advertisement in local language was given in news papers. 18 | P a g e
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  • 20. 6 Data collectionData collection was done by feedback form:-Feedback form was given to each patient and filled form was collected fromthem.(annexure 11.1)From the patient data sheet we came to know about clinical data of thepatient. (annexure 11.1) 20 | P a g e
  • 21. 7 ObservationMarketing Events Referred by Advertisementstrategy Doctor and newsNo. of the 22 118 10patientsPercentage 14.66 78.67 6.66 marketing strategy advertisement 11% referred by doctor 25% events 64% 21 | P a g e
  • 22. Doctors %Cardiologist 60General physician 9.5Pulmonologist 25Others 5.5 Doctors others 6% pulmonologist 25% cardilogist 60% general physicians 9%From the patient clinical data sheet following data was obtained:-  67% of the patients were having high BMI.  25% of the patients were victim of sleep disorder just because of the stress and life style. 22 | P a g e
  • 23. 8 Conclusion and DiscussionSleep diagnosis and sleep disorders are still new for the Indian market.And people are not taking the disorder seriously until and unless theirfamily physician or any Doctor influences them. However, the mindset ofurban Indian patients is changing from treating illness to managingwellness. In case of health care India is a Doctor Driven market.Events and advertisement do have an effect but not satisfactory. Eventsmay influence the patient to think about the sleep disorder.Advertisements helps in creating brand image or may be it createspsychological effect in patient’s mind about the service that it is famousand reliable. But it will not good result in short time. It will take time tocreate a good image in the patient’s mind. Especially in the healthcaremarket. 23 | P a g e
  • 24. 9 Recommendations and suggestions Cardiologist and pulmonologist doctors should be targeted to achieve goal. Obesity being the main reason of the sleep apnea that particular type of the patient should be targeted. These patients may require large-sized wheelchairs and beds and quick access to pre-surgical appointments Sleep lab accreditation may help to create a good brand image. Risk of OSA is more in diabetic patient. Awareness in such patients may help to create good patient base. Weight loss programs: About 67 percent of people with OSA are obese. Partnering with local weight loss programs could increase referral base. A loss of just 10 percent of body weight may cure OSA or diminish it significantly. Transportation industry: Its widely recognized that drowsy driving is very dangerous and that untreated OSA and narcolepsy may increase risks. Both the aviation and the trucking industry now may require sleep disorders screenings and/or maintenance of wakefulness testing for vehicle operators. However cost of sleep clinic is high so need to develop a good pricing strategy is important. 24 | P a g e
  • 25. 10 Links and references http://www.aasmnet.org/ http://www.sleepdt.com/articles/5-2/ National Library of Medicine, Bethesda http://sleepapnea.org/about-asaa.html National Heart, Lung and Blood Institute/National Center on Sleep Disorders Research Expert Panel on Driver Fatigue and Sleepiness. Drowsy driving and automobile crashes: report and recommendations. Available from: URL: www.nhlbi.nih.gov/health/prof/sleep/drsy_drv.pdf. Essentials o healthcare marketing by Eric N. Berkowitz, page no.27-28 25 | P a g e
  • 26. 11 Annexure11.1 Forms:-Format of the questioner:- Name:- _________________________________________________ Age:-__________ Gender: -  Male  Female 1. Do you have problem of snoring?  Yes  No 2. Do you have problem with your alertness?  Yes  No 3. Do you feel morning headache?  Yes  No 4. Do you frequently feel sleepy in the day time?  Yes  No 5. Do you know what sleep apnea is?  Yes  No Patient name:- Age:- Gender: -  Male  Female 1. Do you have problem of snoring?  Yes  No 2. Do you have problem with your alertness?  Yes  No 3. Do you feel morning headache?  Yes  No 4. Do you frequently feel sleepy in the day time?  Yes  No More than one yes means you MAY have sleep disorder. 26 | P a g e
  • 27. Feedback form:- Feedback formPatient name:- ________________________________________________________Ph. No:- ______________You came to know about our sleep center by:-  Doctor  Name of the doctor and contact no:-_______________________________ _______________________________  Advertisement in the news papers   Event  27 | P a g e
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