RECENT ADVANCES IN HEALTH CARE

COGNITIVE PROCESS AND CONSUMER BEHAVIOUR IN HEALTHCARE

SECTOR
INTRODUCTION- Cognition is a thought process and it is responsible for a persons
attitude , perception, thinking and the ultimately opinion and behavior of an
individual. In the context of a healthcare centre/hospital this process of cognition is
applicable on the part of the patients coming to the hospital with certain
expectations and their degree of satisfaction after they have been delivered the
service. They may have a positive feedback for the hospital and there may be a
negative opinion also. Both these processes of how the patient thinks of the
services and facilities provided by the hospital and what type of service is being
received constitute the cognitive process.

The basic relation of cognition with the healthcare sector lies in patient
satisfaction/dissatisfaction towards the hospital, the quality of healthcare provided,
the effectiveness of the hospital strategy and finally add up to the success stories of
the hospital. This cognitive process of the customers/patients can be investigated
and judged through using some research tools like questionnaires comprising of all
the factors/variables in determining the thought process and customer perception
towards the organization. These questionnaires cover all the important
attributes/dimensions governing patients expectations and perceptions at different
levels to determine the GAPS in the service model of a hospital. These GAPS control
the overall cognitive process of the customers which is measured using the service
quality dimensions scale. Measurement of patients satisfaction with services provided by the
concerned hospital is important from two angles. Firstly patients constitute the hospitals direct
clientele and secondly it provides an indirect measure of other dimensions like technical quality
of medical care and effectiveness of the treatment.

One more thing which is very important is that this cognitive process is a dynamic
process and it starts right from when the customers hear about the hospital ;
continue throughout the complete hospital process and remains after the service
has been delivered.

1. Pre hospital Cognition – it starts from when the customer have heard about
the hospital. The patients thought process basically lies in the prior
perception through ads, word of mouth etc and is carried along as his/her
perceptions.

2. Hospital cognition- at this stage the patient encounters with the hospital,
avails its services and judge them on the basis of various parameters of his
own and develops a thought of either belief or disbelief, good or bad etc. . He
compares the services actually rendered and the service quality he did
thought of. Here comes the role of GAP analysis.

SERVICE GAP MODEL-

 Customer expectations

G1

G5

Customer perception

G4
Service delivery External communication

G3
Service design and standards

G2

Hospital perception of customer

expectations

3.Post hospital cognition- it is basically about the perception carried along by

the patient after being to the hospital.
Q. how the cognitive process affect the customer behavior?

A. The process--

patient became aware of the hospital approaches with certain

expectations (thought) receive the services note the
problems (thought) satisfaction/ dissatisfaction perception
(thought) want to be repeat customer or not

hospital strategy service quality

hospital goodwill

example --

I would like to share an example of the patient satisfaction survey conducted by the
Andhra Pradesh government in the year 1999 in 25 district and area hospitals. A
total of 1179 patients were included out of which 942 were able to answer the
interview directly while 237 responses were taken from the relatives. Based on the
responses following findings were obtained—

Maximum
Number Actual Level of
Service component possible
of items score Satisfaction
score
Composite score 47 235 153 65%
Accress availability and convenience 9 45 33 73%
Communications 5 25 19 76%
Financial aspects 6 30 20 67%
General satisfaction 8 40 18 45%
Interpersonal aspects 10 50 36 72%
Technical quality 7 35 22 63%
Time spent with doctor 2 10 6 60%

Area of concerns Frequency Percentage

Corruption by hosptial staff (Corrptn) 126 20%
Utilities like water supply, fan, light, etc, (utlts) 109 17%
Toilet and cleanliness (Toilets) 108 17%
Communication and interpersonal skills (ComIP) 73 12%
Supply of drugs (Drugs) 55 9%
Food supply (Food) 51 8%
Linen availability and cleanliness (Linen) 34 5%
Staff shortage (Staff) 11 2%
Diagnostic and General facilities (D&GF) 9 2%
Miscellaneous (Misc) 53 8%
All aderse remarks (All) 629 100%

This study reveals the patient satisfaction level towards the public hospital. It shows
depressing results and therefore the government decided to implement managerial
interventions to plan the strategies.

There are two types of standards to be looked upon by the hospitals----

1.Patient care standards----------------Access to care and continuity of care

Assessment of patient

Care of patient

Patient and family rights

Patient and family education

2.Healthcare organization management standards-------quality improvement

and patient safety.

Prevention and
control of infection

Governance
,leadership and direction

Facility
management and safety

Staff
qualification and management

Management of
information.
Managerial strategy------ To render the service effectively and efficiently in
a hospital the hospital have to opt for a customer centered approach.

I believe that there are SIX basic principles to supersede patient

expectations and to provide them desirable satisfaction. These are-

service/ type of facility

technical requirements/EQUIPMENTS

Cost/ price of the service.

Staff

Availability of Material

Communication with the patients

Any strategy to be prepared should focus upon these principles. It will lead
to a patient centered approach. Now I will discuss them one by one to
explain my strategy. The

1.Staff-

Required qualities are-- qualified and competent.

Strategy component to be implemented- staff is a major component of a

hospital and it is covered under the HR policies of the hospital.

The primary motive of the hospital should be to recruit the right people with
necessary technical, conceptual and human skills.
 After recruitment there should be employee development programs so as to
hone up their skills followed by certain appraisals to motivate them under
an effective evaluative plan.

The next step in this context will be employee retention i.e. organization tries
to keep their competent employees intact.

OPTIMUM WORKLOAD
Technic DISTRIBUTION
ally

compet Appraisal
ent
Qualified

Support

system

staff Adequate
no.

Employee Retention—
SALARY HIKE,
PROMOTION ETC.

Employee

Development

programs
2.Equipment-
Patient safety

LATEST with

Reqd.
specifications FAST N EASY

TO HANDLE

EQUIPMENT

COST

TECHNICAL
STAFF MAINTENANCE

3.Facility--- Infection
QUALITY CARE REDUCED
3.Facility--- control TURN
Patient
handling OVER TIME
Design

Facilitate
pt.
SPECIALIZED
flow STAFF

CONTINUE and
FACILITY/SERVI appropriate
CE treatment
LOCATION/

ACCESSIBILIT
COST
Y

Reduce waiting
times
4.Cost/price----

optimum Schemes

discounts

Quality Cost Consistent

with
uncomprom
ised facility

Easy collection

5.Availability of material---

It requires an efficient material management strategy which will ensure the

uninterrupted supply of all the materials including drugs etc to the hospital. There
are various concepts in this strategy and are explained in the previous assignment.

PURCHASE AND
RECEIVING AND
NEGOTIATION
STORAGE

DEMAND AND

SUPPLY
FORECAST
QUALITY ASSURANCE
MM
 ISSUING AND
QUALITY
DISTRIBUTION CONTROL

6.Communication with the patients-

Inquiry and Grevience and

PR
helpdesk readressal

documentatio
communication n

Staff
behaviour

ETHICAL
With the implementation of an appropriate patient oriented strategy a hospital can
RESPONSIBILITIES
PT. ASSISTANCE
successfully increase its utilization and in turn its revenues are increased.
Ultimately hospital services are utilized more and it can be evident from certain
performance indicators. A high value of these indicators prove the patient
satisfaction and reliability over the hospital and demonstrates a positive cognition
resulting in a favorable customer behavior.

Hospital performance indicators-

1. BOR: Bed Occupancy Rate which reflects the popularity of the hospital in terms of
inpatients.
2. TOR : Turn Over Rate indicates the speed with which patients on any bed are rotated,
complicates cases => smaller TOR
3. Small treatment diseases => Larger TOR
4. AVLS: Average Length Of stay indicates the time the patient is retained in the hospital.
5. OP/ IP Outpatient/Inpatient Ratio: Indicator of the manner in which inpatient services
are being utilized in the hospital.
6. Surgeries: Numbers of Surgeries indicate the provision and utilization of surgical
operation facilities.
7. Number of Deliveries: another parameter to judge the functioning of a hospital
8. Number of X-rays Scans: Utilization of X-rays and scanning machines provides a good
indicator of how the hospital is functioning.
 9. Number of Lab Tests indicates the availability and efficiency of diagnostic facilities in a
hospital.
10. Total admissions/year and total yearly attendances.

Thank you.