1. The document discusses customer expectations and satisfaction regarding diagnostic laboratory services in Bangladesh during the COVID-19 pandemic. It notes that diagnostic centers are failing to meet customer expectations or provide adequate service due to lack of protective equipment and staffing shortages. 2. Customers report long wait times to get tested for COVID-19, and many are being denied regular checkups and tests due to centers prioritizing COVID-19 patients or shutting down temporarily. This has caused distress and health issues for patients with other conditions. 3. Word of mouth about negative experiences is spreading and further eroding trust in healthcare providers. With expectations and experiences of poor service quality during the pandemic, customer satisfaction has reached very low levels.

1. An Individual Report
On
Evaluation Service Expectation and Customer Satisfaction in
Pandemic Situation in Bangladesh and Develop Service
Blueprint New-normal Business Environment: A Case Study
on a Diagnostic Laboratory Service
Submitted to
Professor. Dr. Sheikh Mohammed Rafiul Huque
School of Business and Economics
United International University
Submitted by
Name ID
Md. Ismail Hossen 112 192 017
Masters of Business Administration, School of Business and Economics
Course: Service Marketing (MKT 615)
Sec: A
Submission Date: 4th June, 2020

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With the emergence of novel corona virus, the health system of many major developed
countries are struggling to provide support to the immense number Covid-19 patients.
However, amidst this panic the Non-Covid-19 patients are also suffering, which is being
passed under the radar. It is not expectation that a developing country such as Bangladesh is
also suffering from the same tragedy. On top that, Bangladesh heath care system has always
under criticism for having lower standards, lack of doctors, technician, nurses and what not.
According to WHO, Bangladesh’s doctor-to-patient ratio is 5.26 per 10,000 people, the
second-lowest in South Asia (UNDP, 2020). There are more than 5,816 hospitals in
Bangladesh and is ever increasing, however, the ratio of doctors to people still falls short.
According to statistical data, 25,615 physicians are working with government facilities while
only 5,184 medical technologists and 1,417 lab technologists are under Directorate General
of Health Services (DGHS). But the country should have 128,075 medical technologists to
maintain the WHO standard (UNB, 2020). This mass panic has once again reminded as the
need of investment required in the health care industry to support its citizens.
People going to do regular check-up or test in various diagnostic centers across the nation
has returning empty handed with only a suggestion to contact on a later date. An official of
Ibne Sina Diagnostic Centre said they did not shut down their outlets, but doctors stayed away
from their chambers (The Independent, 2020). Many diagnostic Centers decline to carry
diagnosis or testing activities of the general patients (Daily Industry, 2020). In many cases it
has been seen that, even after managing to see a doctor or talking over the phone with one,
when a patient goes for testing the diagnostic center has failed to carry out the service due to
lack of technicians on the job. Both Covid-19 and Non-Covid-19 patients are suffering from
the lack of medical support due to low number of doctors. The mismanagement and lack of
coordination is just adding fuel to the fire. Doctors, nurses and technicians are refusing to
provide service with corona virus roaming free around the country. The worries and woes are
justified at the same time because government as well as their hospital has failed to provide
them with necessary equipment’s required to maintain safety. Nirupam Das, BDF's chief
administrator, said "Without medical-grade PPE, our front-line healthcare workers are
exposed to possible COVID-19 infection," (AlJazeera, 2020). This is led to meet the needs of
proper healthcare of millions of patients suffering from Non-Covid diseases. An additional
secretary, Gautam Aich Sarker, to the government suffering from kidney diseases died as he
could not get admitted to a number of leading hospitals. Finally, he got a place in the Kurmitola
General Hospital, but died there without any ICU support though he needed it most (The
Financial Express, 2022). This only adds to the fact that how the healthcare has failed to
provide us proper support.
Customer Expectation
Amidst this pandemic customer expect the minimum amount of service they should be
receiving from the diagnostic labs around the country. At present there are dedicated
diagnostic centers where the presence of non-Covid patient is low due to fear and safety
precaution. However, even in this centers, the patient who goes to do Covid-19 test has to
wait long periods of time for receiving service. Some patients have even claimed to wait in line
for 3 days around 3 hours each day still failing to get a sample done. ‘We’ve expanded the
COVID-19 testing to 17 private hospitals and diagnostic centres, 14 in the capital, two in
Chattogram and one in Bogura,’ said Nasima Sultana, additional director general of the Health
Services (NewageBD, 2020). Still it is not sufficient to meet the demands of the people of
country boasting a population of 17 cores (aprox). What is intriguing is that, the panic has
overshadowed any other major diseases. People with chronic disease are not being able to
go for their routine check-ups along with tests. My father a chronic diabetic and kidney patient
is holed up in his house for the last two months. He was advised by his doctor not to visit the
hospital. He was due for regular blood and kidney check-up but has failed to do so as they are
not willing to give service at this moment.

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Many service takers are at their wits ends, running from one test facility to another just to get
their test done in the past two months, while majority of them had to return empty handed. A
customer expects the hospital to provide minimum support at least for the emergency patients
but due to the freight of getting infected, the diagnostic centers themselves are shutting their
doors to patients regardless of symptoms. Fiona a thyroid patient living in Mirpur was due for
a blood test on March 25th
but was denied of service and then she tried to book on two more
occasion but failed. However, now is worried about medication overdoes and does not know
whether she should continue her current medication or not. Their pleas are left unheard and
they are left on their own wits. The only communication method left open for them is over
phone or through any other digitalized channel. To our surprise,many patients’ regular doctors
have switched of their phone and refusing to establish any communication with their regular
patient.
We cannot obviously put all the fault on the shoulder of the doctors. Because it has been
observed in plenty of occasions that the patients are also lying on their part. Many patients
comes to diagnostics centers with the pretense of just a regular blood check, however, hide
the fact that they are suffering from corona like symptoms.This leads to the temporary closure
of quite few diagnostic centers around the country. Many non-coronavirus patients are also
being deprived of regular checkup and treatment as many senior doctors are declining to
attend the patients to avoid the virus transmission(The Financial Express,2020). Government
has also failed to provide necessary equipment’s to maintain safety and check patients on
regular basis. Dr Ehteshamul Haque Chowdhury Dulal, Secretary General of BMA said, “The
government has shortage can’t ensure the safety of doctors, nurses and health workers in this
situation, though the health ministry and health department claiming that everything is okay.”
(Daily Industry, 2020). Doctors are constantly in shortage of PPE and protective masks as
quoted by Dr. Sahana, head of the virology department of the Dhaka Medical College “We
need quality PPE and N-95 masks to protect healthcare personnel from getting infected with
the virus,” (UNB, 2020). With all this complication, people are also afraid to go outside and get
a test done. Due to numerous reports of mismanagement people have lost faith and stopped
visiting hospitals unless there is an emergency, not only to avoid infection but also harassment
from the facilitators.
Desired Service vs Adequate Service
Hospitals and diagnostic centers are in many cases refusing to treat or test patients even
when they are not showing corona symptoms or running a very mild fever. They ask these
patients to show corona negative report and we all know it takes days to get these reports by
then the condition of the service taker might worsen, which in various cases has led to death.
Among these death some of them had no corona symptoms but came only for kidney and
cardiac ailments. Under these circumstance people are in no want for a desired service but
as long as they are getting the adequate amount of service they are more than willing to
receive them.
This corona pandemic is a situational factor that the service provider nor takers has control
over. We all know that, until a suitable vaccine emerges, everyone has to cope-up with this
current situation somehow.Still the many people expect to get the adequate amount of service
as promised from the providers. However, these testing centers around our country has even
failed to produce the adequate service a customer should receive. Their safety is at stake in
many places. Especially, the people waiting in line for corona test. Many of the people are
waiting in line is not even maintaining the minimum distance among them, endangering people
who just went there for test but does not have corona. Only a handful of diagnostic centers
have corona testing facility. Most of them does not Bio Safety Level (BSL) 2. Whereas World
Health Organization has given a guidance to maintain a BSL 3 lab. A breakout in one lab may
endanger everyone present in the premises. On top of that, many hospitals and diagnostic
centers authorities and officials often misbehave with the patient, if someone comes with cold
fever, asthma and cough, many victims complained (Daily Industry, 2020). A patient never

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expects harsh treatment while receiving service, as he or she is already in peril but behaving
roughly with them only reduces the trust on the health care industry. Also, some doctors are
taking advantage of this situation and charging addition fees from the customers (Daily
Industry, 2020). Government, however, has promised to put an end to this kind of activities.
We cannot brass of the fact that the technicians, nurses and doctors are at risk as well. “We
used ordinary surgical masks and gloves as protective gear. Those items were below
standard, without a doubt,” claimed Shahidullah, chairman of the dermatology and
venereology department (DhakaTribune, 2020). This statement also proves that, from their
point of view, they are also limited in terms of giving service as we cannot lose the minimum
amount of doctors we have.
1. Explicit service promises: Health is a basic need of everyone in this world
and service providers are endowed with the task to provide them under any
circumstances.This pandemic has derailed the health providers and diagnostic
centers from their promise.People seeking help are returning without any tests.
If we look at the case of Shahdat Hossain who went Labaid Diagnostic Center
at Merul Badda, we can see that he was denied of an X-ray test on top of that
they forced him out of the hospital without any test and misbehaved with him
the same time. There are numerous cases like this happening across the
country. This is a clear evidence that, they have to fail to keep their service
promises and managed to lose the trust of their customers at the same time.
But the doctors are at risk as well as it is suspected that a sizeable number of
people do not showany symptoms despite being infected with the corona virus.
2. Implicit Service promises: Every diagnostic center has an implicit service
promise to treat the patients with upmost care and conduct tests diligently. If
we look at our surroundings, this has proved to be false in the past two months.
Not only did they not care about the patients’ health they ignored them by
shutting down their facilities temporarily. Newspapers are flooded with news of
harassments of patients as the patients moved from one testing center to
another for simple tests.
3. Word of mouth: Negative word of mouth is spreading like fire and further
reducing the faith placed on service providers and creating ambivalence in
service seekers minds. Every day, newspaper as flooding with negative
remarks on the health care providers, which are than being shared by many
over the net. Customer now even with serious condition want to stay inside
their houses and avoid any kind of testing believing the fact that they will return
empty handed. People also know that, both parties are at risk and shortage of
necessary protective kits are mainly leading to this woes. As we can see from
a report that 150 doctors of his hospital were forced to go into quarantine after
two of them were found to be infected. The two doctors had handled a male
patient who hid his symptoms to avoid quarantine (AlJazeera, 2020).
4. Past experience:Bangladesh was never perfect in management the country’s
health from past. Many patients has allegations against the health care
industry. However, many reputed diagnostic center still management satisfy
their customer through proper and desired level of service. However, a health
emergency like this has put immensepressureon all the aspects of health care
industry including the diagnostic centers where tests of all sorts are primarily
done and on mismanagementat their point canlead to death of a patient. Given
the current temporary closure of many testing centers and chambers the
experience has never been bitter among the customers as many failed to
receive any service even after trying 3 or 4 times. Patients are increasing, but
service capacity is not increasing at all as per the claim. Doctors, nurses and
health workers are performing with less safety measure. There are shortage of
standard quality Personal Protective Equipments (PPE) (Daily Industry, 2020).
When observing such phenomenon, patient are more willing to stay home due

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to the fear of being contracted from someone else or the service provider while
receiving the service.
Zone of Tolerance
Zone of Tolerance has seeming narrowed down due to the fact that customer with less time
in hand tend to have low zone of tolerance. Adding the fear of the pandemic, they want to
receive the service as soon and as safe as possible. The patient visiting the diagnostic centers
are mostly emergency patients who must have to test result to know what kind of disease are
cause them suffering or getting an update on their current condition of the chronic disease.
However, many patients with emergency cases are not getting admitted in the hospitals as
physicians and hospital authorities are declining to get them admitted in fear of COVID-19
transmission causing immense sufferings to the general patients (Daily Industry, 2020). This
kind of incidents only lowers their zone of tolerance as it becomes a life and death situation
for the service takers.
Customer Satisfaction
With customer complaints rising on daily basis, the satisfaction is just a far-cry under corona
outrage. We already know, government hospitals has always failed to live up to customer’s
expectation and can hardly satisfy the customer. Private hospitals on the other hand used to
provide satisfactory service specifically the top rated ones. But the picture has taken a turn for
the worstand satisfied patients are hardly a catch.Similar scenario is present in the diagnostic
centers as well. First of all, the diagnostic centers are related with the hospitals doctors. If a
patient cannot visit a doctor they cannot go to a diagnostic center to do any kind of test.
However, it is been noted, even when they have referred test lists from certified doctors,
diagnostic center still stop the customer from doing the test mostly due to fear of corona. Most
of the private hospitals and diagnostic centers refer the patients to the government hospitals
on excuse of safety issue.But, condition of the government hospitals is moredilapidated (Daily
Industry, 2020). Customers arereturning moredissatisfied without receiving service has again
raised the quality of service in healthcare industry and government’s capacity in handling crisis
situations. Customers are resorting to self-treatment of using antibiotics, which WHO has
strictly prohibited without doctors’ advice. However, everyone is getting desperate in the
current condition and is looking for a solution. Even a minor fever is leading people to take
azithromycin, which is not a good treatment method even when it reduces their fever. Visiting
a doctor has become difficult for the lack of space in the facility. Maintaining a safe distance
is necessary but adequate space is not there. This proximity between HCWs, patients and
caregivers serve as a dangerous pool for rapid transmission of Covid-19 (The Daily Star,
2020). This kind of situation only increase the distress among the mass people giving them
more of a cause to stay home.
Point of Evaluation
1. Interaction Quality: The quality of interaction amidst the social distancing has
not been favorable for the either party. It has been observed that Physicians,
nurses and other attendants in the hospitals treating patients are still not
adequately sincere and devoted to their tasks (The Financial Express, 2020).
On top of that we can also see that patients themselves are putting the lives of
the healthcare workers in danger. A recent incident led to sealing of a
diagnostic center in Panchagarh after a corona patient intentionally hide her
condition and went there for a test (UNB News, 2020).
2. Physical Environment Quality: Physical environment quality has mostly
changed in the protection department. Every staff is now equipped with PPE
for safety and disinfection is being carried out on every stage of inspection.
Measures have been taken to maintain social distancing in the premises. Still
there is not adequate space to allocate all the patients.

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3. Outcome Quality: Majority of people could not get tests done and resulted in
no outcome. People risked their health in this pandemic to visit these centers
only to end up without any result and visiting from one door to another. As most
clinics, diagnostic centers and doctors’ chambers in the capital remained close
or unattended many people are in dire trouble without treatment and diagnosis.
Service Quality
1. Reliability: As many doctors have stopped attending their chambers in fear of
contracting the infection people are not getting the referral for tests. On top of
that diagnostic centers tests have reduced significantly due to the absence of
technicians. One another reason can be the extreme shortage PPE that is
preventing this healthcare workers to give service and feel safe.
2. Responsiveness:Service providers have been busy in most parts saving their
own life while forgetting their original duty. Service seekers complained that
both government and private hospitals imposed restrictions on the entrance of
patients with fever and flue with the suspicion that they might be infected with
coronavirus (NewAgeBD, 2020). Lack of safey for the service provider is being
questioned here as well as Dr Ehteshamul Haque Chowdhury Dulal, Secretary
General of BMA said, “The government has shortage can’t ensure the safety
of doctors, nurses and health workers” (Daily Industry, 2020).
3. Assurance: The doctors are still experts in their part but the lack of supports
has resulted in loss of faith on them. Abdul Majid was able to visit a doctor but
could not get a colonoscopy done due to the absence of technicians at Popular
Diagnostic Centre even after coming from a very far place (BDnews24, 2020).
4. Empathy: In many occasion the doctors or technicians has failed to show any
sympathy while giving service. There are allegations galore that doctors and
other medical attendants there are not very sympathetic towards their patients
(The Financial Express, 2022). They behaved rudely to service taker while
telling them to leave the premises.
5. Tangibles:Dhaka being one of the most densely populated cities in the world,
health facilities often have up to four persons per ten meter square of floor
space, partly due to patient caregivers who provide much of the daily nursing
duties (The Daily Star, 2020). Still we can observe the diagnostic centers that
are working are maintaining safety measure using safety equipment’s and
maintaining social distance as much as possible while disinfecting the area.
Service Blueprint: Saic Digital Diagnostic Lab
For developing the blueprint of a service in a Diagnostic lab we have chosen Saic Digital
Diagnostic Lab. It is in service since 2008 in Mirpur 1. It has been providing relentless service
since then. They have a range of service given to the patient. We will assuming the patient
will be visiting the premises to have a blood test done. There will be two different blueprint,
one that was present in the past. The second one will be after the corona pandemic that
highlight the changes of the blueprint as well.

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Old Service Blueprint
The customer will first arrive in front of the Saic Diagnostic Center and will be greater by the
gatemen. He will have a look at the outer decoration of the center and the gate, which will he
use to enter. Following that, the customer will visit the reception and have discussion with the
receptionist regarding where he can do the test and get the cost details and such. Here the
interior of the center will be observed by the customer like, direction charts, test charts with
costs and other factors.After getting the information, the customerwill then move to the report
submission counter where he will discuss with the Nurse regarding the tests he needs to carry
out. The nurse will inform him about the cost of the necessary test and tell him to make an
advance payment. The counter of service, dress-up, equipment’s used can be the physical
evidence. Here, the customer will be having a blood test. Once he makes the payment and
the cash is collected by the Nurse, which than will be entered in the patient registry system.
Following that, the customer will be provided a token and have to wait for some to reach his
serial number. Token and waiting area where he will sit will be tangibles. Soon after that, an
assistant nurse will come and accompany the patient to the lab room. There, the blood
pressure of the patient will be checked to validate if he can give blood or not. Once it is done,
a phlebotomist will come to collect blood and use the blood collection kit to draw the blood
from the patient. During this procedure, the phlebotomist will be assisted by nurse. The medi-
kit required are refilled by their supplier boy each time it ends. Soon after storing the blood
sample, nurse will forward it to the technician who will be using the Blood testing machine to
carry out the diagnosis and get the report. Once the patient gives the sample, he will move to
the report booth again to collect his receipt and information regarding receiving time. After
that, customer will leave the premises and wait around 4-5 days for the report to arrive. Once
the diagnosis is done, the technician will generate the report and forward it to the bill
processing counter. After waiting, customer will again visit the center and move to the report
collection booth, which is the same booth for report submission. He will give his report and
details to get identified. Once,the procedure is done and final clearance carried out, diagnosis
report and bill will be handed over to the customer and data will be stored in the registry
system. With the report in hand, the customer will leave the Diagnosis Laboratory center.
The New Normal Blueprint Changes
In the New Normal Blueprint of giving service for the blood test, all the previous steps are still
intact with some added steps and physical evidences. Therefore, instead of going over the
whole process again, we will see the areas of changes. Firstly, after arriving at the gate and
while climbing up the stairs, customer will have to wash his hands on the given buckets using
the hand wash provided. Following that, he will move upwards and then will be sprayed a
disinfection spray on his hands and a Temperature checking handgun camera will be used to
quickly gauge his temperature. If the temperature is 100 or more, then the customer will be
denied of access. Otherwise, he will enter the premises. There is a office staff designated to
carry out this task. The next change we can notice is after collecting the token. In the area,
now there is a safety guard roaming who is guiding the patients on social distancing and
cleanliness, such as stopping anyone from entering wearing outside shoes, maintaining
distance between sitting area. As soon as the assistant nurse arrives to take the patient to lab
room, just before entering the lab room another disinfection process is carried out for the
customer. In case of backstage employee, a premises cleaner is observed cleaning the area
on a regular interval, and the whole area looks much more hygienic than ever. For the support
position, a special waste management person has been added who now manages the waste
generated after tests every day. In the past, the Medi-kit supplier boy used look out for this
kind of things. When the patients leaves and reenters the premises he has to go through the
cleaning and temperature checking process once again to have access in the center.

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What lead to such changes?
As we have observed how, uncertainty of getting infected by the invisible virus has griped us
hard. It has manage to halt the health care system for quite a long time. Many things lead to
this chaotic situation. First of the lack of preparation by the government has obviously caused
panic. There was clear shortage of PPE that the doctors needed to treat the patient, which
then lead to the temporary closure many facilities. We also have to rememberthat, health care
workers are human being too, and they have the right to feel fear as well. Of the total number
of people found infected with coronavirus, 11 per cent are reportedly doctors, nurses and other
health workers. The rate, compared to the global rate of 1.46 per cent, is very high (The
Financial Express, 2020). This tells us, how much of a risk they are also taking to take care of
us. There is not enough space in most of the diagnostic centers as well, and in busy hours the
area is overcrowded with people endangering everyone for viral infection. Hygine was always
a clear concern for many health care facility. They are believed to be clean, yet besides some
few well develop and know service provider, most diagnostic centers cleanliness was in
question. With the emergence of corona virus, we were again reminded the importance of
staying clean and how it can protect us from many kind of diseases.
Most visible changes in New Normal life
While visiting the diagnostic center, it is clear that, the best changes that were broth in was
the hygiene factor. Every patient now entering the building washes their hand properly and is
disinfected in both hands and feet. On top of that, they cannot bring their shoes inside the
diagnostic center, making the area more secure than ever. They have also focused on the
waste management as well, as virus from wastes can spread and cause infection.
Where, there used to be casual dresses for the staffs, now everyone is wearing PPE making
the customer more at ease while they stay safe as well. Appointing new staff to maintain the
order in the waiting area is a brilliant move as well. It ensures social distancing even when the
patient is aware about the term. The implementation for better standard was always needed
for all the diagnostic center and the one I visited is surely following their newly developed
standards.
A mobile future
Now that health care system is in disarray many patients have taken things on their hand like
consulting just a local pharmacistand taking antibiotics for a simple fever. However, The WHO
has recommendedagainst using several drugs including azithromycin, remdesivir and plasma
therapy for the treatment of Covid-19 (Dhaka Tribune, 2020). Dr. Barakat Ullah said “patients
can also seek such advice through email and video conferencing at this critical moment. In
emergency cases, patients should visit major hospitals in the city” (The Independent, 2020).
A woman saw patients not taking precautionary measures, so instead visiting she uses the
telemedicine services when she needs advice for herself and her parents (UNDP, 2020).
However, in case of diagnostic center we need to deliver sample directly. To make this
possible institute like Pravaa health and Health Bridge BD are coming to the patients for
collecting samples. The industry itself is moving towards more e-healthcare service than ever.
This will not only make the patients realize getting home service for basic problems better.
This will reduce clutter in the service area and the rate of contraction.

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