Review of literatureA growing Healthcare sector

Healthcare is one of India’s largest sectors, in terms of revenue and employment, and the sector is expanding rapidly. During the 1990s, Indian healthcare grew at a compound annual rate of 16%. Today the total value of the sector is more than $34 billion. This translates to roughly 6% of GDP. By 2012, India’s healthcare sector is projected to grow to nearly $40 billion. The private sector accounts for more than 80% of total healthcare spending in India. Unless there is a decline in the combined federal and state government deficit, which currently stands at roughly 9%, theopportunity for significantly higher public health spending will be limited. The growing elderly population will place an enormous burden on India’s healthcare infrastructure. However, India’s thriving economy is driving urbanization and creating an expanding middle class, with more disposable income to spend on healthcare.

Health service’s nature and value

Like quality in most services, healthcare quality is difficult to measure owing to inherent intangibility, heterogeneity and inseparability features that patients participating in production, performance and quality evaluations are affected by their actions, moods and cooperativeness. Healthcare is dynamic – considerable customer changes have taken place and competition is increasing. Consequently, healthcare quality evaluations raise problems owing to service size, complexity, specialization and expertise within healthcare organizations.

Patient satisfaction and its dimensions

Patient satisfaction is defined as an evaluation of distinct healthcare dimensions. It may be considered as one of the desired outcomes of care and so patient satisfaction information should be indispensable to quality assessments for designing and managing healthcare. Patient satisfaction is a multi-dimensional healthcare construct affected by many variables. Healthcare quality affects patient satisfaction, which in turn influences positive patient behaviors such as loyalty. Patient satisfaction is predicted by factors relating to caring, empathy, reliability and responsiveness. Primary patient satisfaction determinants:

1. evaluations of physicians conduct, 2. service availability, 3. continuity, 4. confidence,5. efficiency,6. core services,7. customization, 8. professional credibility,9. competence,10.communications,11.admissions,12.discharge,13.nursing care,14. food,15.housekeeping and 16. technical services.

Patients’ perceptions, notably about physician communication skills are also significant satisfaction determinants. Two dimensions study explained 66 percent of the variance in patients’ service quality perceptions:

1. facility quality2. staff performance

Health service availability (service is available when it is required), and is operationally defined as the number of patient-physician contacts , waiting times, convenience and availability associated with healthcare experiences. Communication is the degree to which the patient is heard, kept informed through understandable terms, afforded social interaction and time during consultation and provided psychological and non-technical information . If communication is good, which includes information from the service provider to the patient on the type of care he or she will receive, thereby alleviating

uncertainty that increases his or her awareness and sensitivity about what to expect,then patient satisfaction is higher.If the service provider’s competence is perceived high then levels of satisfaction also increase.Staff demeanour also has a significant impact on customer satisfaction. The manner in which staff interacts with the patient and staff sensitivity to the patient’s personal experience seems to be important. Studies show that if hospital costs are perceived high then patient satisfaction is lower.If

physical facilities, including: cleanliness; modern equipment and the general feeling that the hospital is in a good physical condition, are well perceived then patient satisfaction increases. Other dimensions that affect patient evaluations are:

reliability (competence); responsiveness (communication); tangibles (physical facilities); and

empathy (staff demeanor).

Satisfaction with specific service dimensions such as nursing staff, fees and meals were found to exert positive influence on cumulative patient satisfaction – the strongest being satisfaction with nursing staff and administration.

Healthcare quality and satisfactionQuality is positively correlated with satisfaction and operational quality definitions are based on values, perceptions and attitudes. Healthcare quality can be categorized in three ways :

1. Technical aspects – how well clinicians diagnose and treat problems.2. Interpersonal component – provider responsiveness, friendliness and attentiveness.3. Amenities – health care facility appeal and comfort.

Individual healthcare quality measures include:

1. Structure – the medical delivery system’s fixed characteristics such as staff number, types, qualifications and facilities.

2. Process – what is done to and for the patient such as treatment.3. Outcomes – changes in the patients’ current and future health attributed to antecedent

medical care.