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A STUDY OF CUSTOMER RELATIONSHIP
MANAGEMENT CRM PRACTICES IN HOSPITALS IN
PUNE

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A STUDY OF CUSTOMER RELATIONSHIP MANAGEMENT (CRM)
PRACTICES IN HOSPITALS IN PUNE. ABSTRACT
1. Introduction of the topic:
We often receive mails or phone calls from banks, our favourite hotels informing us
about their new services or even wishing us on our birthday. Such exercises are part of
Customer Relationship Management (CRM) strategies, a process or methodology used to
learn more about customers’ needs and behaviour in order to develop stronger
relationships with them.
In the current era there has been increase in the competition in all fields. The increased
competition has led to more choices for customers who have become more demanding
and are also well informed of the available choices for a particular product or service.
The service industry has grown exponentially with availability of high quality products
universally leading to a change in customer expectations and behaviour. The service
sector started to focus on quality much later than the manufacturing sector because of the
intangible nature of services.
Specifically, a new focus has emerged in the service industry on the creation of
‘relationships’ with customers. The use of customer information has helped in cementing
relationships with customers and thereby in the course helps organizations improve the
return on their investments. Also the service sector consumers have been included under
the protection of the Consumer Protection Act and therefore have the right to initiate
legal action against a service providing organization for provision of negligent or
incomplete services. This scenario has led to organizations realizing the fact that only
investing in marketing to increase customers is less beneficial in the long term as

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compared to being able to retain the existing customer base by achieving customer
satisfaction and even customer delight in some cases.
(a)Rationale of the study: Healthcare which is a part of the service sector is no
exception to the increased competition in the service sector. Hospitals which come under
healthcare have to confront the essential issue which is how to utilize Customer
Relationship Management to improve healthcare services quality. Pune is no exception to
current medical scene with reference to study of CRM, patient behaviour and services
offered by hospitals. In the last two decades there has been an increase in the number of
patients in Pune due to increased population. To provide healthcare
i

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service to this increased population there has been an increase in the number of
hospitals.
There has been an increased influx of medical tourism in Pune due to availability of
world class treatment facilities at reasonable costs both in comparison to Indian cities
as well as International standards.
CRM requires huge database which already exists in most hospitals of Pune.
3. Objectives of the study:
The objectives of the study were divided into primary objectives and secondary
objectives.
Primary Objectives:
1.) To study the CRM practices and problems of hospitals in Pune.
2.) To compare the practices of small, medium and large hospitals of Pune.
3.) To study the CRM factors which affect the patient satisfaction criteria such as
patient care, patient cure, patient communication, patient comfort in hospitals of Pune.
4.) To identify the factors affecting the choice of hospitals.
5.) To find out whether the huge available database in hospitals of Pune is used for
CRM practices.
6.) To suggest a suitable CRM model for hospitals in Pune.
Secondary Objectives:

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1.) To find out whether CRM software is used in hospitals in Pune.
2.) To study if the CRM software is utilized in hospitals to process feedback about
hospital services received from the patients and improving the CRM practices.
4. Scope of the study:
The researcher has included in the study the CRM practices in hospitals established in
Pune after year 2006.
a.) Hospitals which were included in the study:
The study has been conducted in Pune and included allopathic hospitals, secondary,
tertiary and quaternary level hospitals with different treatments being provided in the
hospital premises. The study included small and medium allopathic hospitals with
between 1 to 99 beds intake capacity and large allopathic hospitals with 100 beds and
above intake capacity with presence of both IPD and OPD facilities.
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b.) Hospitals which were not included in the study:
The study has excluded purely ayurvedic, homeopathic, unani, electropathy practicing
hospitals. The study excluded stand-alone or single pure specialty and super specialty
hospitals like maternity and nursing homes, diet and slimming centre’s which are not
attached or included in the infrastructure facilities of hospitals.
5. Literature Review:
The literature review was conducted for the research topic and included research
papers, print media and online articles, reports, books, news clippings. The significant
highlights of the review concerned to the analysis of CRM practices in hospitals and
the differences in various hospitals, patient satisfaction criteria with hospital services,
patient expectations of hospital services.
The following gaps were found after the literature review:
a.) The focus of various researches which have been conducted was on CRM
practices in hospitals. The effect on practice of CRM due to size and type of hospital
was not specifically studied.
b.) The comparison between patients’ perception and hospital personnel’s perception
about hospital services was not specifically studied.
c.) The comparison between patient satisfaction levels with different types of
hospitals was not specifically studied.
d.) There has been no such study conducted in hospitals in and around Pune city, and
thus this research has tried to fill in that gap.

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6. Type of Research: The conducted research is exploratory as well as descriptive. It
is also a Qualitative research.
7. Population: a.) This research covers the city of Pune and Pimpri-Chinchwad area.
b.) Hospital personnel belonging to small, medium, large, private and government
hospitals.
8. Sampling technique: a.) Non-probability purposive convenience sampling
technique was used for collecting patients responses.
b.) Non-probability judgement sampling technique was used for collecting hospital
personnel responses.
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9. Sample size:
a.) Patients sample: The population sample size was taken 1000 patients including
500 IPD patients and 500 OPD patients.
b.) Personnel sample:
The population for number of hospitals is finite hence sample size for hospital
personnel was taken as 100 for hospital personnel including 35 large hospital
personnel and 65 small and medium hospital personnel.
10. Sources of data and data
collection: Primary data:
a.) Structured questionnaires for IPD and OPD patients.
b.) Structured questionnaires for hospital personnel.
c.) Personal interviews of patients and hospital personnel.
d.) Focused group discussions with patients.
e.) Observation method.
Secondary Data:
Books on management, marketing management, services marketing, CRM, CRM in
hospitals and hospital management, government publications – journals and reports,
hospital publications, medical journals, earlier research articles and case studies from
newspapers and other sources, publicized service records of hospitals, publicized
legal records of judicial cases, internet websites of hospitals, internet blogs, etc.

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11. Reliability of questionnaire:
The reliability of the IPD patient’s questionnaire i.e. the Cronbach alpha = 0.869
The reliability of the OPD patient’s questionnaire i.e. the Cronbach alpha = 0.868
The reliability of the personnel’s questionnaire i.e. the Cronbach alpha = 0.934
12. Data analysis:
The collected primary data has been statistically processed, classified and tabulated
using the appropriate methods. The computer software used for analysis was IBM
SPSS (Statistical Package for Social Science). The study has used two types of
hypothesis null and alternative for testing.
The hypotheses were tested using Chi-square test, Kruskal Wallis, Mann Whitney
ANNOVA wherever applicable.
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13. Hypotheses of the study:
Hypothesis no. 1:
The existence of Formal CRM Department depends on the size of Hospital.
Hypothesis no. 2:
CRM practices and their implementation depend on the type of hospital.
Hypothesis no. 3:
There is a difference between the perception of patient and hospital personnel
regarding service quality parameters.
Hypothesis no. 4:
All the listed reasons influencing choice of hospital are equally important to patients.
(Note : There may be other reasons apart from the listed reasons such as staff
behaviour with patients, staff behaviour with each other, general hygiene of the
hospital, personal hygiene of staff, etc. Such reasons are too specific to the hospital).
Hypothesis no. 5:
Five Dimensions of perceived service quality affect customer satisfaction.
14. Chapter Scheme:
Chapter 1: This chapter includes an introduction to the topic, CRM in healthcare
sector, CRM and Indian healthcare with reference to hospitals, rationale of the study,
area of the study, types of research, objectives of the study, hypotheses of the study,

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period and scope of the study, research methodology used for the study, data
collection, data analysis, significance of the study and limitations of the study.
Chapter 2: This chapter include theoretical framework and literature review
discussing CRM and CRM in service sector with help of review of literature. It also
includes concept, evolution and history of CRM.
Chapter 3: This chapter includes development of healthcare in India, reforms in
Indian healthcare, healthcare services in India, present situation of Indian hospitals,
medical scene in Pune.
Chapter 4: This chapter will deal with primary data along with analysis for IPD and
OPD patients and hospital personnel. The chapter also includes observations and
conclusions for CRM practices implemented.
Chapter 5: This chapter will include profiles of selected large private hospitals,
government hospitals and small-medium private hospitals. The chapter also includes
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select case studies, medico-legal cases in relation to hospitals of Pune, secondary data
analysis including qualitative and quantitative data for CRM practices in large,
government, and small-medium capacity hospitals of Pune.
Chapter 6: This chapter includes hypotheses testing.
15. Testing of Hypotheses: done by using different tests for accepting or rejecting
the null hypothesis versus the alternative hypothesis.
a.) Hypothesis1: The existence of Formal CRM Department depends on the size of
Hospital.
Hypothesis Testing: The test used is chi test for two independent samples on the data
obtained from for ‘Hospital Personnel – Questionnaire’.
Interpretation for hypothesis 1: Here chi square calculated = 37.74 with 2 degrees
of freedom; p value = 0.00
Since p value < 0.05, the level of significance; there is strong evidence to reject the
null hypothesis.
Conclusion for hypothesis 1: Hence the existence of Formal CRM Department
depends on the size of the Hospital. The hospitals with greater number of beds have
the Formal CRM Department. Thus the alternate hypothesis is accepted and the
hypothesis is proved.
b.) Hypothesis 2: CRM practices and their implementation depends on the type of
hospital.
Explanation: The hypothesis is divided into two parts Part
One.) CRM practices differ from Hospital to Hospital.

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Part Two.) Implementation of CRM practices differs from (type) Hospital to
Hospital.
Hypothesis Testing: Part One is tested with the help of secondary data and primary
data (through observation).
Conclusion for Part One of hypothesis 2: The first part of the hypothesis is proved
i.e. CRM practices differ from Hospital to Hospital.
Hypothesis Testing: Testing Part Two this hypothesis is done with the help of
responses obtained for ‘Hospital Personnel – Questionnaire’ using Kruskal Wallis test
for three independent samples.
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Interpretation for Part Two of hypothesis 2: Since p values are less than 0.05, level
of significance for all factors; there is strong evidence to reject the null hypothesis for
all factors.
Conclusion for Part Two of hypothesis 2: The implementation of CRM practices
differs from (type) Hospital to Hospital. Thus the alternate hypothesis is accepted and
the hypothesis is proved.
c.) Hypothesis 3: There is a difference between the perception of patient and hospital
personnel regarding service quality parameters.
Hypothesis Testing: The hypothesis is tested using responses from IPD patient, OPD
patient and hospital personnel questionnaire using Mann Whitney test for two
independent samples.
Part A] IPD - Interpretation for Part A of hypothesis 3: Since p value for each
dimension is less than 0.05, the level of significance; there is strong evidence to reject
the null hypothesis.
Conclusion for Part A of hypothesis 3: There is difference in the perception of
patient and hospital personnel regarding Tangibility, Reliability, Responsiveness,
Assurance and Empathy on an average. Thus alternate hypothesis is accepted and
Part B] OPD - Interpretation for Part B of hypothesis 3: Since p value for each
dimension is less than 0.05, the level of significance; there is strong evidence to reject
the null hypothesis.
Conclusion for Part B of hypothesis 3: There is difference in the perception of
patient and hospital personnel regarding Tangibility, Reliability, Responsiveness,

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Assurance, Empathy on an average. Thus alternate hypothesis is accepted and
d.) Hypothesis 4: All the listed reasons influencing choice of hospital are equally
important to patients.
Hypothesis Testing: Testing of this hypothesis is done with the help of responses
obtained for ‘Patient – Questionnaire’ using chi square test for goodness of fit.
Part A] IPD Large Hospitals - Interpretation for Part A of hypothesis 4: The Chi
square value = 185.56 with 6 degrees of freedom; P value = 0.00.
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null hypothesis.
Conclusion for Part A of hypothesis 4: At least one of the reasons is of differently
important than the others. Thus alternate hypothesis is accepted and hypothesis is
proved.
Part B] OPD Large Hospitals- Interpretation for Part B of hypothesis 4: The Chi
square value = 542.12 with 6 degrees of freedom; P value = 0.00.
null hypothesis.
Conclusion for Part B of hypothesis 4: At least one of the reasons is of differently
proved.
Part C] IPD Small Medium Private Hospitals-Interpretation for Part C of
hypothesis 4: The Chi square value = 72.54 with 6 degrees of freedom; P value =
0.00.
null hypothesis.
Conclusion for Part C of hypothesis 4: At least one of the reasons is of differently
proved.
Part D] OPD Small Medium Private Hospitals - Interpretation for Part D of
hypothesis 4: The Chi square value = 179.82 with 6 degrees of freedom; P value =
0.00.

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null hypothesis.
Conclusion for Part D of hypothesis 4: At least one of the reasons is of differently
proved.
e.) Hypothesis 5:
Statement: Five Dimensions of perceived service quality affect customer satisfaction.
Hypothesis Testing: Testing of this hypothesis is done with the help of responses
obtained from IPD and OPD ‘Patient – Questionnaire’ using one way ANOVA.
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Part A] IPD:
Interpretation for Test statistics for Part A: Since p value for each dimension is
less than 0.05, the level of significance; there is strong evidence to reject the null
hypothesis.
Conclusion for Test statistics for Part A: At least one of Tangibility, Reliability,
Responsiveness, Assurance, Empathy on an average according to level of satisfaction
is different than the others. Thus alternate hypothesis is accepted and hypothesis is
proved.
Part B] OPD:
Interpretation for Test statistics for Part B: Since p value for each dimension is
less than 0.05, the level of significance; there is strong evidence to reject the null
hypothesis.
Conclusion for Test statistics for Part B: At least one of Tangibility, Reliability,
Responsiveness, Assurance, Empathy on an average according to satisfaction is
different than the others. Thus alternate hypothesis is accepted and hypothesis is
proved.
15. Conclusions:
The summary of conclusions drawn from observation and analysis of primary and
secondary data are given below:
A.) Conclusions from Primary data of Patients:

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The conclusions for primary data for patients are drawn from the analysis of IPD and
OPD patient questionnaires, conclusions obtained through focused group discussions
with patients, and observation method are as follows:
a.) Conclusions drawn from IPD and OPD patient questionnaires:
1.) Facilities and well known doctors are the major factors attracting patients to the
hospital where as cost is not an important factor in the choice of a hospital.
2.) Large Hospitals- Patients are more satisfied with accessibility and patient friendly
approach. Small medium private hospitals- Patients are not satisfied with accessibility
and patient friendly approach. Parking space is a problem in all hospitals.
3.) Large hospitals-Patients are satisfied with comfort and hygiene. Small- medium
private hospitals and government hospitals- Patients are not satisfied with comfort and
hygiene.
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4.) Large private hospitals- Patients are satisfied with the response time efficiency of
staff for room admittance but are not satisfied with the same in small-medium private
hospitals and large government hospitals. The response time efficiency of nursing
staff is not satisfactory in case of all the hospitals.
5.) Large private hospitals- Patients are satisfied with respect to patient friendly
approach and personalized attention of doctors but are not satisfied with attention
from other staff. Small-medium private hospitals and large government hospitals-
Patients are not satisfied with respect to patient friendly approach and personalized
attention from doctors and staff.
6.) Large private hospitals – Patients are satisfied with respect to the treatment
provided Small-medium private hospitals and large government hospitals – Patients
are not satisfied with respect to treatment provided.
7.) Large private hospitals -Patients are not satisfied with the discharge and billing
process and promptness in providing reports and information about drugs at pharmacy
therefore causing inconvenience but patients are satisfied since large private hospitals
provide better information and follow-up instructions to patients. Small-medium
private hospitals and large government hospitals have not been able to satisfy the
patients on these fronts.
8.) Patient feedback is not taken seriously in hospitals except for a few large private
hospitals. Patients or their relatives are not pursued actively by the staff to fill in the
feedback forms and return them through the drop box.
9.) Hospitals have not been able to satisfy patients on front of the value for money at
the hospital.
10.) The distributions of recommendations by patients on basis of treatment and better
facilities are as follows-

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S. No. Type of hospital Recommended Not Recommended
1.) Large Private hospitals 60% 8%
2.) Small-Medium Private hospitals 21% 5%
3.) Large Government hospitals 5% 1%
4.) Total of all hospitals 86% 14%
11.) Hospitals are not taking patients complaints seriously. The behaviour of staff is
one of the major complaints of patients in hospitals.
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12.) Overall satisfaction of patients:
Hospitals have been able to satisfy patients with treatment and facilities but are not
able to satisfy patients on account of staff behaviour.
S. No. Overall satisfaction Satisfied % Not Satisfied %
1.) Treatment 91% 9%
2.) Facilities 87% 13%
3.) Staff Behaviour 43% 57%
13.) Friends/relatives/others and on road advertisements are the most important
factors contributing to patient knowledge about the presence of a hospital. Websites
are still not very popular. Hospitals are not successful in creating loyalty on the basis
of previous experience.
b.) Conclusions drawn from Focus Group Discussions:
1.) Hospitals have not been much successful in using customer relationship
management for improving staff behaviour and in providing better services for
satisfying patients.
2.) Most of the hospitals except large government hospitals have realized the
importance of providing online or telephonic appointments for patient convenience
and its role in CRM.
3.) Some of the hospitals utilize centralized and outsourced or locally operating call
centre services for communication.

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c.) Conclusions drawn from Observation method:
1.) Large private hospitals have realized importance of CRM in medical tourism and
have a separate department for assisting international patients. Small-medium private
hospitals - are using services of a PRO for assisting international patients as they are
not so conscious for utilizing CRM in medical tourism. Large government hospitals
do not support medical tourism.
2.) The large private hospitals have realized the importance of outreach activities
camps and campaigns in CRM practices, small-medium private hospitals are not so
conscious about outreach activities. Large government hospitals do not support such
CRM practices.
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3.) Majority of the hospitals have not realized the importance of CRM department in
conducting outreach activities and providing value added services which is helpful in
achieving customer satisfaction.
4.) Majority of the hospitals have not realized the importance of providing well-
equipped mobile clinic-ambulances with emergency services for patient care and its
role in CRM.
5.) Majority of the hospitals have not realized the importance of providing organized
security arrangement in hospitals for patient assurance and its role in CRM.
B.) Conclusions from Primary data of Hospital Personnel:
The conclusions for primary data for hospital personnel are drawn from the analysis
of hospital personnel questionnaires and interviews of hospital personnel.as follows:
a.) Conclusions drawn from hospital personnel questionnaire:
1.) Hospital personnel perceive that patients of large private hospitals and small-
medium private hospitals do not find it difficult to access the hospital , find it easy to
register at the hospital and are provided with proper information at the hospital where
as patients of large government hospitals have to face difficulty on the above fronts.
medium private hospitals are satisfied with comfort and hygiene in the rooms and in
the hospital premises whereas patients of large government hospitals are not satisfied
on the above fronts.
medium private hospitals are satisfied with responsiveness and timeliness of the staff

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during provision of services. Patients of large government hospitals are not satisfied
with responsiveness and timeliness of the staff during provision of services.
medium private hospitals are satisfied with care and attention provided by the staff
and staff empathy towards patients and their relatives whereas patients of large
government hospitals are not satisfied on the above fronts.
medium private hospitals are satisfied with discharge process at the hospital, bill
settlement, insurance processing and instructions regarding follow up. Patients of
large government hospitals are not satisfied on the above fronts.
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6.) Hospital personnel perceive that large private hospitals and small-medium private
hospitals are more successful in patient satisfaction. Large government hospitals have
not been successful in patient satisfaction.
7.) CRM activities are existing at large private hospitals. Small and medium private
hospitals are still to realize the importance of having a separate CRM department.
Formal CRM department is absent in large government hospitals.
8.) Large private hospitals and small-medium private hospitals are successful in
improving efficiency with the help of CRM .Large government hospitals have still not
realized the importance of CRM in helping to provide efficient treatment to the
patients.
9.) Large private hospitals and small-medium private hospitals use the data collected
through CRM department as they have realized the importance of its role in customer
satisfaction. Large government hospitals have to realize the importance of collecting
and processing patient information through CRM department and its role in customer
satisfaction.
10.) CRM helps in improving efficiency in patient care in large private hospitals and
small-medium private hospitals. Large government hospitals have not utilized CRM
in improving patient care.
11.) Hospitals have not realized the importance of intra and inter departmental co-
ordination in customer relationship management.
b.) Conclusions drawn from hospital personnel interviews
1.) Hospitals have not been taking into consideration patients’ complaints and
grievances seriously and are not appreciating importance of CRM in resolving them
within stipulated time.

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2.) Large private hospitals have realized the importance of technology in CRM and
have started using it to some extent. Small and medium private hospitals have not
realized importance of technology in CRM .Large government hospitals have still not
realized the importance of technology in customer relationship management.
3.) Large private hospitals and small-medium private hospitals have realized the
importance of CRM department to improve the service quality. Large government
hospitals have not realized the importance of CRM department to improve the service
quality. There is a difference between the perception of patients and hospital
personnel regarding the satisfaction with the services provided by the hospital.
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C.) Conclusions from Secondary data:
The conclusions for secondary data are drawn from the analysis of hospital profiles,
case study; medico-legal cases and patients’ grievances are as follows:
1.) The patients of large private hospitals are satisfied due to better infrastructure and
facilities than small-medium private hospital. Large government hospitals have not
been able to satisfy patients on account of infrastructure and facilities.
2.) The large private hospitals have more tie-ups with insurance companies and
cashless payment providers thus being able to offer such services on a wider scale
than small-medium private hospitals. The large government hospitals services are
restricted to government schemes.
3.) The large private hospitals realize the importance of continuous upgradation of
personnel skill in providing better services to patients and thus support various
training programs. The small-medium hospitals are not so active in such training
programs whereas large government hospitals are not involved in such programs.
4.) The large private hospitals realize importance of technology in CRM using
specialized software for the same. The small-medium private hospitals and large
government hospitals have yet to realize importance of the same.
5.) Most of the large private hospitals have realized the need to use feedback forms
printed in English and Marathi to collect patient feedback whereas small-medium
private hospitals rarely have availability of printed feedback forms with most of them
relying on the use of suggestion box. Large government hospitals do not use a defined
feedback facility.
6.) Most of the hospitals except large government hospitals use patient registration
records and other supportive media for the collection of data for CRM.

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7.) Most hospitals support health and social campaigns either supported by corporates
or with help of government initiatives and NGO’s.
16. Recommendations:
Common and specific recommendation were given to hospitals-
Part One.) General recommendations for hospitals:
1.) The hospitals should simplify the admission process and maintain a permanent
patient record for easy retrieval and accessibility of patient information. Parking
facilities should be improved and separate allotments should be made for visitors.
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2.) Hospitals should improve their communication skills and inform patients about
treatments, services and facilities, cost of treatment and rules and regulations of the
hospital. Additionally hospitals should improve the intra and inter departmental
coordination and should also make provision for tele medicine and tele diagnostic
facilities.
3.) The hospitals supervisory staff should periodically inspect the internal
passageways and premises of the hospital physically and with help of surveillance
cameras in order to make sure the hygiene standards are maintained.
4.) Hospitals should upgrade the treatment facilities and procedures by making latest
treatment facilities available. The doctors and nursing staff should be encouraged and
also helped in training and acquiring skills related to latest treatment procedures and
facilities.
5.) Hospitals should improvise on patient convenience by ensuring correct prescribed
diet reaches the patient, this can be achieved by computerized name labels and bar
coding as soon as patient is admitted in the hospital. In addition to this the hospitals
should make provision for cafeterias. ATM’s, communication and photo-copying
centre, etc. which can be used by patients relatives and OPD patients.
6.) Hospitals should invest in CRM technology upgradation which will lead to
improving efficiency and thus lead to patient satisfaction. Hospitals should also invest
in interactive self-help and convenience technologies like computerized kiosks, smart-
phone based apps useful for both staff and patients in communication.
7.) Hospitals should introduce training programmes for staff for improving their
communication skills for better interaction and responsiveness while dealing with
patients.

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8.) Hospitals should work on improving the response time efficiency of nursing and
other staff while providing services to patients. Evaluation of the same should be done
on the basis of time and motion study with regard to specific tasks.
9.) Hospitals should take customer feedback seriously and process it efficiently
understanding the nature of the complaint. Hospitals should utilize CRM practices for
resolving patient.
10.) Hospitals should improve efficiency in discharge process completing it in a
stipulated time frame. Insurance processing should be completed efficiently, separate
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and multiple billing, payment, cashless payment counters should be introduced avoid
confusion.
11.) Hospitals should improve their security and safety measures by having security
personnel and every entry and exit point, surveillance cameras at all transit areas,
colour coded security cards should be provided to differentiate between patient and
relatives. Separate cards should be provided to visitors. The safety precautions include
well maintained firefighting equipment installed in the hospital premises, fireproof
visible directions pointing towards fire exits, safety nets near open atrium areas on the
upper floors of the hospital premises, etc.
Part Two.) Recommendation for large private hospitals: Large private hospitals
should have a more patient friendly approach from hospital staff, be more specific
while estimating the cost of treatment, improve on response time while taking the
patient to the room during admission process, pay more attention to discharge and
feedback procedure, improve efficiency in response time for processing insurance and
improve on processing of complaints and redressal of the same.
Part Three.) Recommendations for small-medium hospitals: Small-medium
private hospitals should improve on accessibility and friendly approach, improve on
patient comfort and hygiene, improve on nursing staff response time, patient
friendliness and personalized attention, improve on diagnostic, clinical and treatment
facilities available with them and also need to improve on discharge process feedback
processing and complaint redressal.
Part Four.) Recommendations for government hospitals: Large government
hospitals should improve on accessibility and friendly approach, on patient comfort
and hygiene, on nursing staff response time, patient friendliness and personalized
attention, on diagnostic, clinical and treatment facilities available with them and also
need to improve on discharge process feedback processing and complaint redressal.

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17. Future Scope of the study:
1.) Research on marketing practices implemented by large hospitals through family
physicians, private medical practitioners and small healthcare establishments to
inform about facilities and services available with the hospital.
2.) Research on comparison between CRM practices of hospitals of urban and rural
areas.
3.) Research on marketing practices in different types of healthcare establishments.
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4.) Research on effect of CRM practices in hospitals on profitability.
5.) Research on role and effectiveness of internal customers in CRM in hospitals.
6.) Research on CRM practices in single specialty hospitals.

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CHAPTER ONE – INTRODUCTION AND RESEARCH METHODOLOGY.
_____________________________________________________________________
1.1 Introduction:
We often receive mails or phone calls from banks, our favorite hotels informing us about
their new services or even wishing us on our birthday. Such exercises are part of
Customer Relationship Management (CRM) strategies, a process or methodology used to
develop long term relationships with them.
In the current era there has been increase in the competition in all fields with
organizations and individuals struggling to sustain in this environment by investing
precious resources like time and money to gain a significant share in the market to
increase their customer base.1 The increased competition has led to more choices for
customers who have become more demanding and are also well informed of the available
choices for a particular product or service. For example Life Insurance Corporation of
India (LIC) which did enjoy a large share in the life insurance market a few decades ago,
has to face severe competition at present from many new insurance companies like Bajaj,
Aviva, etc. as customers today do compare available choices before they purchase an
insurance policy.
In the last few years worldwide service sector has been growing fast. India is also
experiencing a boom with the service sector contributing to around 55% of India's GDP
and employing around 45% of the total labour force.2 The service industry has grown

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exponentially with availability of high quality products universally leading to a change in
customer expectations and behavior. The service sector started to focus on quality much
later than the manufacturing sector because of the intangible nature of services which was
not easy to conceptualize and measure as objectively as tangible goods. In contrast to the
past decades, present day brands alone are no longer enough to satisfy customers who
demand higher quality and service. Therefore many public and private organizations are
undergoing changes by implementing customer-oriented initiatives.
Specifically, a new focus has emerged in the service industry on the creation of
‘relationships’ with customers. The use of customer information has helped in cementing
relationships with customers and thereby in the course helps organizations improve the
return on their investments. This scenario has led to organizations
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realizing the fact that only investing in marketing to increase customers is less
beneficial in the long term as compared to being able to retain the existing customer
base by achieving customer satisfaction and even customer delight.
In India the service sector consumers have been included under the protection of the
Consumer Protection Act and therefore have the right to initiate legal action against a
service providing organization for provision of negligent or incomplete services.
A case example where Consumer Protection Act has helped consumers obtain justice
is the Kesari Tours Compensation case. In 2011, a Pune based couple Sachin and Uma
Agrawal decided to go on a European tour and selected a package by Kesari Tours,
but after booking the tickets and receiving confirmation from the firm, they were
informed by the firm a few days later that Uma’s passport was lost postponing their
trip indefinitely. Finally when a new passport was issued to Uma and new travel
arrangements made by the firm, the couple expressed their inability to travel due to
personal reasons thus asking the firm to refund their trip expenses. The firm refused to
refund and the couple had to forcibly take the trip. After returning back the couple
initiated legal action against the firm for negligence in providing service under
Consumer Protection Act. The Central Mumbai Consumer Redressal Forum had
penalized Kesari Tours and its city-based sales agents for causing mental agony to the
Pune-based couple and directed the company to pay Rs.55,000 as compensation
including the litigation cost.3
Healthcare which is a part of the service sector is no exception to this scenario.
Hospitals which come under healthcare have to confront the essential issue which is
how to utilize Customer Relationship Management to improve healthcare services
quality.
Thus due to the above reasons the importance of implementation of Customer
Relationship Management or CRM has become an important aspect in all types of
organizations including healthcare under the service sector.

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1.2 Evolution of healthcare sector in India:
The evolution of healthcare sector in India can be historically divided in three
different eras -
a.) Healthcare in Ancient India:
This is the phase when healthcare was dominated by the Indian Medicine system. In
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Figure 1.1 : A discovered ancient site of a 6th
century hospital located at Sirpur-
Chattisgarh on the banks of Mahanadi River in the Bar-Nawapura wildlife
sanctuary where at least ten patients could stay with medical personnel to attend
to them and equipped with surgical tools and stone pots to make ayurvedic
medicines.4
ancient India healthcare practices involved presence of public healthcare systems
established in the times of ‘Buddha’ and ‘Ashoka’ in Northern and Central India.
Similarly there is evidence of ancient hospitals in South India in the ‘Chola’ and
‘Malakapuram’ edicts.
The Indian medicine system of ‘Ayurveda’ was used based on the teachings of
‘Sushruta’ – a famous surgeon of 6th century BC and ‘Charaka’ – a famous physician

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present around 200 AD. ‘Ayurveda’ was practiced by ‘Vaidyas’ who gained
knowledge at the famous ancient ‘Universities of Taxilla’ and ‘Nalanda’.
There were hospital specifications for medical infrastructure and equipment, hospital
personnel qualification criteria, determined hygiene standards, medical diet written by
‘Charake Suthrasthanum’ in ‘Upakalpa-niyam Adhyayam’ which served as a
guideline for healthcare services in ancient India.
In the 10th century after the Mohammedian invasion the Greek system of ‘Yunani’
medicine practiced by ‘Hakims’ came to India resulting in the decline of ‘Ayurveda’
as a dominant healthcare system.5
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b.) Healthcare in Pre-Independence period:
Figure 1.2: Left side – aerial view of Madras Medical College and General
Hospital in 1930’s; Right side – present day picture of the same.6
This period in Indian Healthcare is marked pre-dominantly by the arrival of European
settlers and invaders particularly the British who brought along with them the western
or the allopathic system of medicine.
The establishment of allopathic healthcare services in India dates back to 1600 A.D.
when the British East India Company brought their first medical officers to India. The
first hospital in India was the Madras General Hospital in 1664.

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In 1764 the East India Company established a medical department in Bengal for
providing services to its troops and servants. Throughout the next century the
Company established many more medical departments spread across Bengal, Madras
and Bombay presidencies which were amalgamated in 1896 to form the Indian
Medical Services.7
The central government controlled all the medical departments till 1919 when the
Montgomery-Chelmsford Constitutional Reforms led to the transfer of public health,
sanitation, and vital statistics to the provinces. In 1920-21, Municipality and Local
Board Acts were passed containing legal provisions for the advancement of public
health in provinces. The Government of India Act 1935 gave further autonomy to
provincial governments. In 1939, the Madras Public Health Act was passed which
helped further reforms.8 The Bhore Committee submitted its report in 1946 and the
health of the nation was reviewed for Public Health, Medical Relief, Professional
Education, Medical Research, and International Health.9
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c.) Healthcare in Post-Independence period:
Figure 1.3: All India Institute of Medical Sciences (AIIMS), New Delhi.
This phase in Indian Healthcare started after India gained independence in 1947 and
dates to present times.
After independence the Planning Commission was established in 1950 and the Indian
government has been implementing specifically formulated programmes involving

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building of healthcare related infrastructure, healthcare man power training and
development such as doctors, nursing personnel, para-medical personnel, etc.
In 1951 there were 8,600 hospitals and dispensaries in the country with about
1,13,000 beds and 70,000 qualified doctors.10 In 2014 the total number of doctors
registered with MCI in the country was 9,18,889.11 The total number of hospitals by
2015 was estimated to be around 55,000 with an availability of 16,00,000 beds.12
1.3 Types of Healthcare services:
The present Indian health care service is based around two different classifications
– a) Depending on ownership:
The healthcare services are differentiated on basis of ownership of the service
providing establishment.
1.) Government Ownership:
These are non-profit organizations providing free medical treatment which are owned
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Figure 1.4: Classification of Indian Healthcare System.13
by government bodies under Ministry of Health and Family Welfare. Example
includes general hospital such as Sassoon hospital, etc.
2.) Private Ownership:
These are privately owned organizations and are either owned individually or a group
of associates and are mostly profit run entities although some may be non-profit
organizations. Example includes large hospitals such as Apollo hospitals, etc.
(b) Depending on the System of Medicine:
The healthcare services are differentiated on the basis of the system of medicine
which is used to provide the medical services.
1.) Allopathic System:
The ‘Allopathic’ medical system is the ‘Modern’ system of medical treatment also

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known as the ‘Western’ system of medical treatment. Example includes Jehangir
hospital.
2.) Indian System of Medicine:
The Indian System of Medicine includes ‘AYUSH’ which includes traditional
medical systems like Ayurveda, Yoga, Unani, Siddha and Homeopathy, example
includes Sheth Tarachand hospital.
1.4 Reasonfor choosing the specific topic:
Globally as well as in India healthcare sector forms an important part of the service
sector. Healthcare industry in India has been emerging as one of the biggest service
sectors. It constitutes 5% of GDP and its revenue is estimated around $ 30 billion.
According to Investment Commission of India, the sector has witnessed a
phenomenal expansion in the last four years growing at over 12% per annum. As per
a CII-McKinsey report, the growth of this sector can contribute to 6-7% of GDP.14
The Indian healthcare provider needs to be benchmarked to international quality and
efficiency standards to provide the quality services to the patients to meet their
expectations.
Healthcare is one of India’s largest sectors, in terms of revenue and employment, and
one can very well witness the sector to expand rapidly. The healthcare scenario in
India has changed with increasing competition along with the presence of different
types of hospitals having availability of the latest world class treatment facilities. With
the fast growing purchasing power, Indian patients are willing to pay more to avail
health care services of international standard and therefore expect the best treatment
experience at hospitals. The result of these high expectation standards from patients
has led to increased number of patient complaints if they are not satisfied with the
treatment. In the era of globalization and heightened competition, it has been observed

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that delivery of quality service is imperative for Indian healthcare providers to satisfy
their in-patients as well as out-patients. Health care being typical service other
promotional measures have limitations except word of mouth and patient satisfaction,
which are important pillars of business. A cured patient may not come back to the
hospital for treatment but will spread word about availability of good treatment at that
particular hospital. Hence, it is essential to be aware of how the patients and patient
parties evaluate the quality of health care services.15 Thus this
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scenario has made healthcare service providers realize the importance of CRM while
providing medical services.
1.5 Needof CRM in Indian hospitals:
It has been observed that globally as well as in India major changes in healthcare
sector have taken place which has necessitated the entry of CRM practices in the
medical sector including hospitals. The reasons for this need for CRM in hospitals are
enumerated below–
a.) Technological advancement:
There is an increased use of advanced technology in healthcare sector and it keeps
changing fast due to continuous research.
b.) Huge Investments:
The rapid changes in technology has created a need for continuous up gradation
leading to huge investments. Examples are like in diagnostic aids the health industry
has promoted from a simple X-ray to a MRI Scan which is a very big investment.
This scenario makes it necessary to have good bed occupancy in the hospitals along
with utilization of its facilities.
c.) Health Insurance and Cashless payment facilities:
There has been an increase in the number of patients who are opting for medical
health insurance and cashless insurance policies to help cover their medical treatment
expenses. Hospitals have to co-ordinate between patients and the insurance companies

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to ensure the efficient processing of medical insurance claims and cashless payment
options.
For example, in March 2015, 10 large hospitals in Pune agreed to continue providing
cashless treatment option to patients while 28 more large hospitals are in the process
for the same. However 100 small hospitals in Pune have decided to permanently stop
providing cashless treatment option to patients.16
d.) Increased Medical Tourism:
According to a study by Assocham, medical tourism in India has been on a
continuous rise and is set to grow into a Rupees 12,000-crore industry by 2015 with
more than 45 lakh people expected to visit the country.17 Low cost and world class
treatment at the earliest is the main reason for increase in medical tourism in India.
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Many of the hospitals in India are opening dedicated international patients department
to gain benefit from increased medical tourism.
The table below gives a cost comparison for medical treatment procedures in different
countries around the world –
Treatment Cost Comparison. (All rates in US dollars - $).
Procedures US
Costa
India
South
Mexico Thailand Malaysia
Rica Korea
Heart Bypass 144,000 25,000 5,200 28,900 27,000 15,121 11,430
Angioplasty 57,000 13,000 3,300 15,200 12,500 3,788 5,430
Heart Valve
170,000 30,000 5,500 43,500 18,000 21,212 10,580
Replacement
Hip Replacement 50,000 12,500 7,000 14,120 13,000 7,879 7,500
Knee Replacement 50,000 11,500 6,200 19,800 12,000 12,297 7,000
Lasik (both eyes) 4,400 1,800 500 6,000 1,995 1,818 477

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Table 1.1: Comparative cost of various medical treatment procedures between
India and different countries around the world.18
India's decision to provide immediate medical visa for patients from SAARC
countries with provisions such as 90 days visa to Maldivian nationals19 coming for
medical treatment to India, lifting of restrictions on 60-days gap between two entries
for foreign medical tourists has further strengthened its position as a preferred
medical treatment destination.20
In addition to this, initiatives by corporates such as the one by healthcare major Prime
India which launched the International Wellness Card facilitating easy medical access
to patients from abroad while also enabling them to gain access to a host of e-health
services, medical tourism educational kits and discounted rates on medical services
and products has further given a boost to medical tourism in India.21
(e) Corporatization:
Hospitals require a huge investment to set up world class infrastructure which is
possible due to advent of corporate houses in hospital setups. Many corporate like the
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Wockhart group, Escort group, etc. are setting large corporate based multispecialty
and super specialty hospitals.
(f) Increased Patient Awareness:
Over the years life expectancy has increased and income has also increased leading to
an increase in the number of middle class patients who are ready to pay more for
quality treatment and are aware of available treatment options.
(g) Strong Competition:
The competition in the healthcare sector is increasing due to more number of hospitals
being set up compounded with the help from increased availability of trained
healthcare professionals.
(h) Legal Rights:
There is an increased awareness amongst patients about their rights and they do not
hesitate to take hospitals and medical personnel to court under Consumer Protection
Act.
(i) Ethical Restrictions:
Although there is increased competition hospitals cannot implement marketing due to
ethical restrictions like the code of conduct guidelines 6.1 and 7.11 to 7.14 imposed
by Medical Council of India.22
(j) Utilization of Hospital Services:

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The total bed strength of public and private hospitals in Pune is around 8,000 of
which the private hospitals provide 5,500 beds, state-run hospitals provide 1,400 and
PMC 1,200 beds.23
Although the hospital capacity is large the utilization of hospital services including
occupancy of beds is on a fluctuating basis with respect to time. Thus hospitals today
have to take extra effort to ensure patients are satisfied which will add to a loyal
patient base for the hospital.
Patients visit hospitals for curing illness rather than for pleasure which is an
interesting aspect in view of CRM application. The typical nature of medical services
where the theory satisfied customer comes back does not hold good. A fully cured
patient will not come back and will also not like memories of illness, but if satisfied
will be source of word of mouth publicity. Thus CRM is not just a ‘necessity’ but a
‘must’ in hospitals and Pune is no exception to this trend in the country. In relation to
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the city of Pune CRM in hospitals was first implemented around in the late 90’s and is
still in very nascent stage but has been improving with time as per the pilot study. The
hospitals facing with competition and managerial challenges have realized the
importance of CRM and most of them have established separate departments to
implement the same. Also with entry of large hospital chains like ‘Sahyadri
Hospitals’, ‘Columbia Asia Hospitals’ and many others Pune is no exception to
current medical scene, in view of this it will be interesting to study CRM with
reference to patient behavior and services offered by hospitals.
In the last two decades there has been an increase in the number of patients in Pune
due to increased population and also due to medical tourism. To provide healthcare
service to this increased population there has been an increase in the number of
hospitals and are estimated to be more than 500 hospitals24 in Pune.
The hospitals in Pune region are undergoing a complete change to provide services to
a wider range of patients causing set up of world class infrastructure which requires a
huge investment as there has also been an increase in the cost of living in Pune. These
huge investments increase in hospitals are possible due to advent of corporate houses
in hospital setups. Many corporate like the Apollo group, Aditya-Birla group,
Sahyadri group, Cipla, Columbia Asia, etc. are setting large corporate based hospitals
in Pune. Also CRM requires huge database which already exists in most hospitals of
Pune as was observed in the pilot study.
In view of the above reasons it is clear that CRM is an important tool in achieving
customer satisfaction and staying in the competition which made it interesting to
study CRM practices whether formal or informal in relation to Pune. The researcher
who is a doctor by profession realized these factors in the pilot study which helped
him to select this topic for research.
1.6 Type of Research:

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The conducted research is exploratory, descriptive and qualitative type of research.
a.) Exploratory research:
Exploratory research is a research conducted to find the extent to which a particular
event has occurred while getting an initial idea of the same so as to check the
feasibility for carrying out further extensive research.25
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The objective of conducting exploratory research was to collect information and
identify problems related to the research topic, helping for suggestion of hypothesis.
This research was used to collect qualitative data using methods of exploratory
research which included literature searches of past research on the topic which
included information available in libraries, online sources, in commercial data bases,
popular press like newspapers, magazines, etc., trade literature, academic literature,
published statistics from research firms or governmental agencies. The exploratory
research also included interviews of patients and hospital personnel, focus group
discussions with patients, and case analyses by benchmarking of select hospitals.
These methods were helpful to the researcher to gain knowledge with respect to the
CRM practices implemented by hospitals and patient perception as well as actual
experience about the same. The exploratory research was also used to find out the
orientation and success of CRM practices in different hospital set-ups.
b.) Descriptive research:
Descriptive research is directed at making careful observations and detailed
documentation of a phenomenon or population of interest using scientific method of
observations which must be replicable, precise and reliable.26 The research is
conducted to answer the questions about who, what, when, where and why a
particular event occurred.27
The objective of conducting descriptive research was to understand the knowledge of
how CRM is being used by hospitals to improve patient satisfaction and help in
patient retention while also finding out which hospitals are actively implementing
CRM and by use of what methods. The research also describes patient’s satisfaction
levels with different CRM initiatives.
The researcher has used descriptive research with help of cross-sectional study design
through use of primary and secondary data for describing the answers for the above
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c.) Qualitative research:
Qualitative research consists of a scientific investigation that seeks answers to a
question using systematically predefined set of procedures for collecting evidence and
producing findings that were not determined in advance and are applicable beyond the
immediate boundaries of the study. It also understands a given research problem or
topic from the perspectives of the involved local population. Qualitative research is
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especially effective in obtaining culturally specific information about the values,
opinions, behaviors, and social contexts of a particular population.28
This research is qualitative in nature as it provides information of how patients define
their experience towards hospital implemented CRM initiatives while taking into
consideration intangible factors, such as human behavior, social norms,
socioeconomic status, gender roles, ethnicity, and religion to interpret and better
understand the same.
The data was collected using participant observation, in-depth interviews, and focus
groups. The collected data included primary data which included questionnaires,
interviews, etc. The secondary data included opinions and complaints of patients
collected through electronic media, print media, etc.
1.7 Objectives and hypotheses of the study:
The initial pilot study has helped to form an outline of the study objectives and
hypotheses for the research which are as follows-
a.) Objectives of the study:
The objectives of the study are divided into primary objectives and secondary
objectives.
<> Primary Objectives:
1.) To study the CRM practices of hospitals in Pune.
2.) To compare the practices of small, medium and large hospitals of Pune.

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3.) To study the CRM factors which affect the patient satisfaction criteria such as
patient care, patient cure, patient communication, patient comfort in hospitals of Pune.
4.) To identify the factors affecting the choice of hospitals.
5.) To find out whether the huge available database in hospitals of Pune is used for
CRM practices.
6.) To suggest a suitable CRM model for hospitals in Pune.
<> Secondary Objectives:
1.) To find if CRM software is used in hospitals in Pune.
2.) To study if the CRM software is utilized in hospitals to process feedback about
hospital services received from the patients and improving the CRM practices.
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b.) Hypotheses of the study:
Hypothesis no. 1:
The existence of Formal CRM Department depends on the size of Hospital.
Hypothesis no. 2:
CRM practices and their implementation depend on the type of hospital.
Hypothesis no. 3:
There is a difference between the perception of patient and hospital personnel
regarding service quality parameters.
Hypothesis no. 4:
All the listed reasons influencing choice of hospital are equally important to patients.
(Note: The researcher on the basis of the pilot study has listed certain factors
influencing choice of the hospital such as facilities, well known doctors, insurance,
etc.
There may be other reasons apart from the listed reasons, which are excluded, as they
are too specific to the hospital such as staff behaviour with patients, staff behaviour
with each other, general hygiene of the hospital, personal hygiene of staff, etc.).
Hypothesis no. 5:
Five Dimensions of perceived service quality affect customer satisfaction.

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1.8 Period of the study:
The researcher has included in the study the CRM practices in hospitals in Pune after
year 2006 onwards as it was found in the pilot study that most large hospitals have
been set up or have been upgraded after this year with notably among them being
Sahyadri hospital, Pandit Deenanath Mangeshkar hospital, Aditya Birla hospital,
Joshi hospital, Columbia Asia hospital, etc.
1.9 Scope of the study
a.) Hospitals which are included in the study:
The study was conducted in Pune and included allopathic that is modern medical
science hospitals. The study included multi-specialty and general hospitals with
treatment facilities available for various branches of medicine and surgery. The
hospitals covered in the study included secondary, tertiary and quaternary level
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hospitals with different treatments being provided in the hospital premises. The study
included small and medium private allopathic hospitals with between 1 to 99 beds
intake capacity and large allopathic private and government hospitals with 100 beds
and above intake capacity with presence of both IPD and OPD facilities.
b.) Hospitals which are not included in the study:
The study excluded purely ayurvedic, homeopathic, Unani, Electropathy practicing
hospitals for lack of well documented available data as was observed in the pilot
study. The study excluded stand-alone or single pure specialty and super specialty
hospitals like maternity and nursing homes, orthopedic hospitals, cancer hospitals,
chest hospitals, cardiac hospitals, neuro hospitals, etc. The study also excluded
pathology labs, diagnostic centres’ – including radiography; ultrasound sonography;
CT scan; MRI scan centres, medical and dental clinics and outpatient treatment
centres, physiotherapy centres, rehabilitation and deaddiction centres, diet and health
counseling centres which are not attached or included in the infrastructure facilities of
hospitals as these do not fit as per the norms for the definition of hospitals.
c.) Patients who are included in the study:
The study was limited to Indian patients that is Indian nationals who were citizens of
the Republic of India and have utilized the services of any of the hospitals included in
the area and scope of the study. The study included patients who were above 18 years
of age and were mentally and physically in a condition to respond to the questionnaire
and answer the personal interview.
d.) Patients who are not included in the study:
Patients who were foreign nationals were not included in the study. Patients who were
below 18 years of age and also those who were not mentally and physically fit to

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respond to questionnaires and answer the personal interview were excluded from the
study Relatives of patients have not been included in the study.
1.10 Area of the study:
The area of research was Pune city the eighth largest city in India with an area of
1,109.69 sq.km and population of 56,95,000 and Pimpri-Chinchwad area which is one
of the biggest industrial zones in Asia with a population of 1,012,472 and area of
171.51 sq.km.29
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Figure 1.5: Pune – Developing towards the future (Left: Traditional Mandai-
market; Right: Modern Day Mall).
Pune has a growing industrial and information technology sector with good
infrastructure facilities attracting migrants and tourists from all over India and also
attracts foreign students and business professionals from around the globe. To provide
health facilities to all this cosmopolitan population and medical tourists there are
more than 500 hospitals of different sizes and specialties in Pune.30

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A study by Noida-based RNCOS, a market research and information analysis
company, estimated India's share in the global medical tourism industry was around
2.4 percent in the year 201231and is expected to grow by a CAGR of 30 percent
between 2014 and 201932. According to medical experts Pune has gained from this
boost in medical tourism due to the existence of a wide variety of hospitals,
reasonable efficiency in healthcare, comparatively low treatment costs with state of
the art hospitals and also pleasant hospitality along with other feel-good factors
placing the city among the top destinations for medical tourism. Also many of the
hospitals in Pune have opened a separate international patients department entirely
dedicated to foreign nationals for assisting them in their treatment and other needs
such as providing translators to non-English speaking patients for communication,
helping in arranging accommodation, arranging of local transportation facilities, etc.
during their stay in Pune. Hospitals in Pune like Apollo – Jehangir hospital, Ruby
Hall Clinic, Joshi hospital, Ratna Memorial hospital, Sahyadri hospital, Columbia
Asia hospital, etc. are some of the best available in the country and have the latest
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equipment for treating patients with some of the famous doctors of India associated
with them. Thus, due to all the above reasons Pune provides an ideal field of research
for the subject.
1.11 Population:
a.) Patients:
The population sample was heterogeneous in nature and included responses of
patients from different age groups, gender groups and socio-economic groups from
the research area covering the city of Pune and Pimpri-Chinchwad area.
b.) Hospital Personnel:
The different sizes and types of hospitals which included small hospitals up to 25
beds, medium hospitals from 26 beds up to 99 beds and large hospitals from 100 beds
and above. The research also included both private and government hospitals.
1.12 Sampling technique:
a.) Non-probability purposive convenience sampling technique was used for
collecting patients’ responses.
b.) Non-probability judgment sampling technique was used for collecting hospital
personnel responses.
1.13 Sample size:

208004
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a.) Patients sample size:
The population for number of patients is large though not infinite, hence for practical
purposes the population is considered as infinite.33
The data is categorical data. Hence the Cochran’s sample size formula for categorical
data is used.34, 35
The minimum sample size is given by,
n0 
Z
2 / 2 s2
d
2
Where Z value at half alpha level can be obtained from statistical table; s is estimate
of standard deviation in the population that is estimate of standard deviation for 5
point scale & d is the acceptable margin of error the researcher is willing to expect.
Here the error d decided is 5*0.01 i.e. 5% for 5 point scale.
17

208004
Phone: 0512-2328181
Mobile: 7753818181, 9838033084
Std = 0.945 (Standard deviation of all five point scales which is evaluated from the
data collected for pilot study) & s = 5*std/6 = 0.7875
Z 0.025 = 1.96 [from statistical table].
n  1.962
*
0.78752
0 (5*0.01)2
n0  952.96
Hence minimum sample size for the study is 953 with 95% level of confidence.
Thus considering the population size to be infinite, sample size was taken 1000
patients including 500 IPD patients and 500 OPD patients.
b.) Personnel sample size:
The population for number of hospitals is finite hence sample size for hospital
personnel was taken as 100 for hospital personnel including 35 large hospital
personnel and 65 small and medium hospital personnel.
1.14 Data Collection:
The research has been conducted on the basis of primary and secondary data –
A.) Primary data:
The primary data was collected as follows -

208004
Phone: 0512-2328181
Mobile: 7753818181, 9838033084
a.) Questionnaire for patients:
The IPD questionnaire included 8 different sections under which 38 questions were
included. The 38 questions included 3 structured open ended questions, 9 structured
closed ended questions with alternatives and 26 structured closed ended questions
with five point rating Likert's scale.
The OPD questionnaire included 2 different sections under which 27 questions were
included. The 27 questions included 4 structured open ended questions, 4 structured
closed ended questions with alternatives and 19 structured closed ended questions
with five point rating Likert's scale. The questionnaire was administered with the
objective to find out patients’ satisfaction levels with the services provided by
hospitals and also to measure the service quality of hospitals as was experienced by
the patients. The questionnaire also helped to find whether the above factors affected
the patients in choosing a particular hospital for future healthcare needs for
18

208004
Phone: 0512-2328181
Mobile: 7753818181, 9838033084
themselves and their relatives and friends. The questionnaire also included questions
about patients views with respect to the different outreach activities carried out by the
hospitals and the level of success that was achieved for the same.
The questionnaires were distributed to patients outside hospitals, in their houses and
offices and outside hospital premises. The answered questionnaires were returned to
the researcher at the same time or after a few days.
The total questionnaires which were distributed were 1,060, out of which 1,033 were
returned and 1,000 were usable.
b.) Questionnaire for healthcare personnel:
The questionnaire for hospital personnel included questions for both IPD and OPD in
a single questionnaire and was divided in 4 different sections with total inclusion of
29 questions. The 29 questions included 4 structured open ended questions, 9
structured closed ended questions with five point rating Likert's scale, 11 structured
closed ended questions with alternatives and 5 structured closed ended questions with
alternatives and sub-alternatives. The questionnaires were administered to hospital
personnel with the objective to find out their view with respect to patient satisfaction
with the services provided by them and also the quality of the hospitals provided
services. The questionnaire also tries to find out what CRM practices are used by
them, the feedback system used to know patient views about the hospital and the
mechanism set up to resolve patient grievances with respect to the hospital services.
The researcher collected 100 questionnaires from hospital personnel who were either
PRO or CRM staff heads to find out their perception with regards to services provided
to patients by their respective hospitals. The questionnaires were collected from 65
small and medium hospital personnel and 35 large hospital personnel. The
questionnaires of personnel were mailed and also collected with help of
representatives from their offices located within the hospital premises.

208004
Phone: 0512-2328181
Mobile: 7753818181, 9838033084
c.) Personal Interviews of Patients:
The objective was to find about patients’ experience with services provided by
hospitals and how they rated the quality of the same. The interviews also helped to
find about patients’ behavior and expectations from hospital service providers. The
data was collected by conducting personal structured interviews of the patients using
formal and informal methods by direct personal investigation. The interviews were
conducted in the hospital premises with fifty number of patients were interviewed.
19

208004
Phone: 0512-2328181
Mobile: 7753818181, 9838033084
d.) Personal Interviews of Hospital Personnel:
The objective was to find how CRM practices were used in the hospitals to help
achieve patient satisfaction with the services provided by them. The interviews also
helped to find the perception of personnel regarding the quality of services provided
by them. The data was collected by conducting personal structured interviews of the
hospital personnel using formal and informal methods by direct personal
investigation. The interviews were conducted in the hospital premises with twenty
number of hospital personnel were interviewed.
e.) Focused Group discussions with Patients:
The researcher conducted four focus group discussions which included patients
having grievances towards hospitals and were not satisfied with the quality of services
that were provided. The focused group discussion was carried out with the
participating patients in the hospital premises.
f.) Observation method:
The researcher used the personal observation method during the entire period of the
study to observe how CRM is practiced in hospitals of Pune. The personal
observation method used was non-participant observation using narrative and the
scales technique. This method also helped in better understanding of patient – hospital
personnel interaction from the time the patient enters the hospital till the point where
he gets discharged from the hospital.
B) Secondary Data:
The study utilized data from various books on management, marketing management,
services marketing, CRM, CRM in hospitals and hospital management. The study was

208004
Phone: 0512-2328181
Mobile: 7753818181, 9838033084
conducted by using data from government publications – journals and reports
including MoHFW, PMC and PCMC reports, hospital publications (monthly,
quarterly, annual) medical journals and hospital reports, earlier research articles and
case studies from newspapers and other sources, publicized service records of
hospitals, publicized legal records of judicial cases, internet websites of hospitals,
blogs of patients, etc. The researcher also used library facilities at HNIMRW and
Pune University to collect secondary data.
20

208004
Phone: 0512-2328181
Mobile: 7753818181, 9838033084
1.15 Reliability of the questionnaire:
The reliability of the questionnaires was checked statistically and the following results
were obtained:
a.) Reliability of the questionnaire for IPD patients:
There are total 38 questions related to study. The reliability of the questionnaire i.e.
the Cronbach alpha is calculated as 0.869 for 38 questions. Hence the Cronbach alpha
and reliability of the questionnaire is good.
If the reliability alpha (if the question deleted) is less than 0.869, then the
corresponding question is important (must be kept in questionnaire). If the reliability
alpha (if the question deleted) is greater than 0.869, then the corresponding question is
unnecessary (must be removed from questionnaire).
Since there is no high variation of the reliability alpha (if the question deleted) from
the Cronbach alpha, which is 0.869; all the questions are equally important.
b.) Reliability of the questionnaire for OPD patients:
There are total 27 questions related to study. The reliability of the questionnaire i.e.
the Cronbach alpha is calculated as 0.868 for 27 questions. Hence the Cronbach alpha
and reliability of the questionnaire is good.
If the reliability alpha (if the question deleted) is less than 0.868, then the
corresponding question is important (must be kept in questionnaire). If the reliability
alpha (if the question deleted) is greater than 0.868, then the corresponding question is
unnecessary (must be removed from questionnaire).
Since there is no high variation of the reliability alpha (if the question deleted) from
the Cronbach alpha, which is 0.868; all the questions are equally important.

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