“ROLE OF PHYSICAL EVIDENCE IN QUALITY SERVICE DELIVERY” at

CAREWELL HOSPITAL AND RESEARCH CENTRE PVT.LTD ,KASARAGOD

A PROJECT REPORT

Submitted To:

MANGALORE UNIVERSITY

In Partial Fulfilment of the Requirements for the Award of

MASTER’S DEGREE IN BUSINESS ADMINISTRATION

(MBA)

Submitted By:

HASHIM P V

Reg No. 186873343

Under the valuable guidance of

Mrs. ROSHELLA D’COSTA

Assistant Professor,

A . J Institute of Management

A J INSTITUTE OF MANAGEMENT

KOTTARA CHOWKI, MANGALORE- 575006

2018– 2020
 DECLARATION

I, HASHIM P V hereby declare that this project report titled “ROLE OF PHYSICAL
EVIDENCE IN QUALITY SERVICE DELIVERY at CAREWELL HOSPITAL AND
RESEARCH CENTRE PVT.LTD KASARAGOD. Has been prepared by me under the
supervision of Mrs.ROSHELLA D’COSTA, Assistant professor of A. J INSTITUTE OF
MANAGEMENT (AJIM), affiliated to Mangalore University, in partial fulfillment of the
requirement for the award of the MASTER DEGREE IN BUSINESS
ADMINISTRATION during the year 2018-2020. I also declare that this project report has
not been submitted to any other university for the award of any other degree, fellowship,
associateship, or any other similar title.

Date: Mr. HASIM P V

Place: Reg no: 186873343

 GUIDE CERTIFICATE

This is to certify that the project report titled“ROLE OF PHYSICAL EVIDENCE IN

QUALITY SERVICE DELIVERY at CAREWELL HOSPITAL AND RESEARCH
CENTRE PVT.LTD KASARAGOD. submitted to the MANGALORE UNIVERSITY,
MANGALORE for the award of MASTERS DEGREE IN BUSINESS
ADMINISTRATION is a record of original and independent work carried out by Mr.
HASHIM P V a student of A. J. INSTITUTE OF MANAGEMENT (AJIM) under my
guidance. This project report has not been previously submitted for the award of any degree,
post-graduation degree, or diploma of any other universities.

Date: Mrs. ROSHELLA D’COSTA

Place: Mangalore Assistant professor
A.J. Institute of Management
 CERTIFICATE

This is to certify that HASHIM P V is a bonafide student of M.B.A final semester at A. J

Institute of Management, Kottara Chowki, Ashok Nagar, Mangalore -575006. This project
Report title“ROLE OF PHYSICAL EVIDENCE IN QUALITY SERVICE DELIVERY
at CAREWELL HOSPITAL AND RESEARCH CENTRE PVT.LTD KASARAGOD.
has been prepared by him in partial fulfillment of the requirement for the award of the degree
of MASTER OF BUSINESS ADMINISTRATION under the supervision of ROSHEL
DCOSTA, Assistant Professor of this institute.

Date: Dr. T. Jayaprakash Rao

Place: Mangalore Director
A. J. Institute of Management
 ACKNOWLEDGEMENT

I give glory to the almighty for giving the necessary wisdom for completing this project. This
project work is completed with the immense amount of commitment, advice, encouragement,
and guidance of the people whom I could personally acknowledge.

I would like to express my sincere gratitude to Dr. T. Jayaprakash Rao, Director A. J.

Institute of Management, Mangalore for his active support and guidance during my studies
in the institute and providing me guidance in the successful completion of the project.

I am greatly indebted to my guide Mrs.ROSHELLA D’COSTA, Assistant professor, A. J.

Institute of Management, for her kind cooperation, help, guidance, and encouragement for
preparing this project report.

I would like to thank my family, friends, dear ones, and well-wishers for their encouragement
in completing the project work.

I take this opportunity to extend thanks to all who have helped me and encouraged me
throughout in bringing the best of this project.

CONTENTS
CHAPTER
TITLES PAGE NO
NO
Chapter 1 1.0 INTRODUCTION 1-4
1.1 Background of topic 4-6
1.2 Importance of study 6-8
1.3 objectives of study 8
1.4 Need for study 8
1.5 Statement of problem 8-9
1.6 Current scenario 9-13

1.7 Chaptalization 13
Chapter 2 2.0 RESERCH DESIGN 14

2.1 Review of literature 14-17

2.2 Area of study 18

2.3 Methodology of study 18-19

2.4 Scope of the study 19

2.5 Limitations of study 19

Chapter 3 3.0 INDUSTRY PROFILE 20-37

3.1 COMPANY PROFILE 37-40

Chapter 4 4.0 DATA ANALYSIS AND 41-59

INTERPRETATION

Chapter 5 5.0 CONCLUSION 60-62

5.1 FINDINGS 60-61

5.2 SUGGESTIONS 61

5.3 CONCLUSION 61-62

APPENDIX 1.QUESTIONNAIRE

2.BIBLIOGRAPHY
 LIST OF TABLES
TABLE
TITLES PAGE NO
NO

4.1 Noise level of the hospital 41

4.2 The odor in this hospital is pleasant 42

4.3 The hospital is Hygienic 43

4.4 Eco - Friendly atmosphere 44

4.5 waiting area 45

4.6 Consulting area is overcrowded 46

4.7 The patients admit cards 47

4.8 The layout of the hospital 48

4.9 The structure of the building 49

4.10 color of the building and the physical facility 50

4.11 The business card and the brochures 51

4.12 The nursing staff attitude 52

4.13 staffs look professional and elegant in their 53

uniforms.

4.14 The front office staffs or receptionist is good 54

in giving instructions

4.15 The parking facility is good 55

4.16 The room and wards are spacious. 56

4.17 The Beds are comfortable. 57

4.18 Hospital is giving timely treatment 58

4.19 facilities and the ambiance 59

 LIST OF CHARTS
CHART
TITLES PAGE NO
NO

4.1 Noise level of the hospital 44

4.2 The odor in this hospital is pleasant 42

4.3 The hospital is Hygienic 43

4.4 Eco - Friendly atmosphere 44

4.5 waiting area 45

4.6 Consulting area is overcrowded 46

4.7 The patients admit cards 47

4.8 The layout of the hospital 48

4.9 The structure of the building 49

4.10 color of the building and the physical facility 50

4.11 The business card and the brochures 51

4.12 The nursing staff attitude 52

4.13 staffs look professional and elegant in their 53

uniforms.

4.14 The front office staffs or receptionist is good 54

in giving instructions

4.15 The parking facility is good 55

4.16 The room and wards are spacious. 56

4.17 The Beds are comfortable. 57

4.18 Hospital is giving timely treatment 58

4.19 facilities and the ambiance 59

 Chapter 1
INTRODUCTION
1.0 INTRODUCTION
Physical evidence in any organization is an asset, especially for a service firm. The services
are intangible this intangibility makes the physical evidence more important. The
environment in which the services are delivered is known as physical evidence. In a hospital
physical evidence includes the odor in the hospital, the visiting cards provided to patients,
cleanliness, the structure of the building, etc. the study on physical evidence in St. Sebastian’s
visitation hospital. helps to know more about the physical evidence of the hospital which will
be helpful for the hospital authorities and the patients. .Physical evidence is one of the
marketing mixes in service delivery. The service firms must consciously make efforts to
manage the physical evidence. In the case of a hospital, it is really important in maintaining
attractive physical evidence. Physical Evidence is the environment in which service is
delivered. The services are intangible. Intangibility is the reason for the importance of
physical evidence in the service marketing mix. So physical evidence in the service industry
is really important.Modern hospitals need to create a good ambiance.  Right from the
reception, one finds very cordial and comforting staff.  The ambiance plays an important role
because when a patient walks into the hospital he immediately forms an opinion about the
hospital. The staff follows a dress code to show professionalism and to maintain discipline. 
The staff is trained to be understanding, warm, and comforting because the clientele that goes
to the hospital is usually disturbed or unhappy. A hospital must be well organized and
segregated into different departments.  All the doctors should be offered with a well-equipped
cabin.  The entire hospital requires to be centrally air-conditioned with good lighting. 
Ventilation is taken care of by air-conditioning. Special care should be taken to maintain
hygienic, cleanliness, and the whole hospital must be well lit.  This is taken care of by the
housekeeping department.  A hospital has to keep in mind both the aspects of physical
evidence that is essential and peripheral.  Physical evidence particularly plays an important
role in the hospital where the patients are already depressed or traumatized and a good
atmosphere could make all the difference. Services as we know are largely intangible when
marketing. However, customers tend to rely on physical cues to help them evaluate the
product before they buy it. Therefore marketers develop what we call physical evidence to
replace these physical cues in a service. The role of the marketer is to design and implement
such tangible evidence. Physical evidence is the material part of a service.The physical
evidence of service in the hospital includes all the tangible representation of the service like
hospital physical facility (the servicescape) as well as other forms of tangible communication.

1
Elements of a servicescape that affect patients and their attendants include both exterior
attributes (such as signage, parking, and the landscape) and interior attributes (such as design,
layout, equipment, and décor). Apart from interior decoration, lighting, and ventilation,
attention should also be paid to necessary infrastructures like electricity, water, sewerage,
communication and transportation, security, etc, the certifications and awards won by doctors
of the hospital and the service certificates won the hospital can all be displayed at the
reception to instill confidence in the customers. Further Physical evidence determines service
quality expectations and perceptions in the hospital. For an effective strategy, it must be
linked clearly to the hospital‟s overall goals and vision. So, planners know what those goals
are and then determine how the evidence strategy can support them at a minimum, the basic
service concept must be defined, the target markets identified, and the firm‟s broad vision of
its future known. Because physical evidence decisions are relatively permanent and costly.
Therefore, corporate hospitals should be very, careful about presenting the right kind of
atmosphere, which is both hygienic and relaxing, a large open lawn or garden with a simple
layout and comfortable seating arrangement for patients has become essential for hospitals to
remove the perceived risk of patients .The physical evidence mix in Care hospital can be
described in terms of entrance and lobby area, parking area, main public entrance, public
waiting area, public toilet facilities, signage system, gift, book and florist‟s shops, coffee
shop-cum-snack bar, interior decoration, lighting and ventilation, uninterrupted power
supply, drinking water facilities, sewerage, telephone and communication facilities,
transportation facilities, security and display of awards and certificates won by doctors and
hospital, etc. Physical evidence mix in Care hospital starts from the entrance and lobby area.
Care has recognized that the public areas of a hospital serve as an important reference point
in the context of space and traffic in the facility. Therefore attention is paid while designing
the facilities. In Care, the main lobby is designed to serve as a convenient access route to the
medical and other staff proceeding to administrative and other areas of the hospital. The main
waiting area provided seating for the largest estimated number of people who may occupy it
at a given time. Here Care hospital is not remembered the fact that all patients are usually
accompanied by one or two relatives or attendants. So the researcher has observed that some
people feeling inconvenience for not having seating arrangements. Gift shop, book shop, and
florist‟s shop, and coffee shop-cum snack bar are located off the main lobby but not it is
visible to the visitors. There is a simple and effective signage system in the Care hospital to
find a way by the patients. This hospital is using simple signs and figures for an easy
understanding of patients and visitors. A hospital is a health care institution providing patient
2
treatment with specialized staff and equipment which plays an important role in society.
Hospitals and health clinics can be very different from other work environments. Outpatient
Department (OPD) is a very important wing of the hospital serving as a mirror. OPD is
visited by a large section of the community. It is the first point of contact between patient and
hospital staff. Information technology (IT) has the potential to improve the quality, safety,
and efficiency of health care. Some hospitals have already implemented technology for
automating their workflow and maintain indoor patient information. But those systems are
lacking in crowd management at the OPD section of the Hospital. OPD is considered as the
window to hospital services and a patient's impression of the hospital begins at the OPD. This
impression often influences the patient's sensitivity to the hospital and therefore it is essential
to ensure that OPD services provide an excellent experience for customers. In the OPD
section of the hospital system ensuring efficient and reliable patient flow is a regular
problem. Demand and patient complexity increase can cause a delay in the services of
patients. The overcrowding had become a routine problem in the OPD. Normally, we see
patients coming to the hospital and filling out registration forms and waiting to be called.
Sometimes patient calls in for getting an appointment and waits for the response for an
agreed date. It is the most frustrating part of the OPD section.Health is an important factor in
the formation of human resources development which will play a vital role in improving the
qualities of human beings, who are the active agents of economic development. So any
measure of development achievement in a nation must affect the state of personal wealth in
the nation. Better wealth would contribute to improving the economic status of the poor and
for expanding total output. This demands the sound management of a hospital. Therefore in
this chapter, the researcher has attempted to discuss the meaning of hospital and hospital
management, the evolution of hospitals, changing concept of the hospital, the role of the
hospital administrator, functions of hospital management, hospital services and to present a
picture of several public hospitals and beds in India.The hospital is a specialized body where
patient care is the focal point and about which all activities of the hospital revolve. The
physician who examines and takes care of the patient is in the principal position and special
facilities and trained personnel are provided to him to make his work easy and efficient,
trained personnel includes the technical staff of nurses, dieticians, and pharmacists. From the
organizational and administrative point of view, a hospital is virtually a city within a city.
Within its four walls, it has an operation theatre, a hospital which is in the shape of the
patient's rooms, a dormitory for student nurses, residents, and interns, a school for the
training of nurses, technicians, dietician, laboratories, a pharmacy, food vending operations,
3
laundry, and linen service, delivery service, a post office, massive internal and external
communication system, blood bank, accounting and credit services, a public relation
department, a motor service, and security patrols 9. In short, the hospital is a healthcare
organization.Hospitals, clinics, and community health agencies can be very different from
other work environments. Healthcare systems are complex and there are many things you
need to know about types of hospital systems, patient care, insurance, healthcare providers,
and legal issues. This tutorial will help you learn basic healthcare concepts so you can be
successful on the job and understand the system.

1.1 BACKGROUND OF TOPIC

Physical evidence in any organization is an asset, especially for a service firm. The services
are intangible this intangibility makes the physical evidence more important. The
environment in which the services are delivered is known as physical evidence. In a hospital
physical evidence includes the odor in the hospital the visiting cards provided to patients,
cleanliness, the structure of the building, etc. the study on physical evidence in care well
hospital Kasaragod. helps to know more about the physical evidence of the hospital which
will be helpful for the hospital authorities and the patients. Historically, the principles of
hospital design have been based on Florence Nightingale’s 19th-century observations about
the advantages of natural light, ventilation, and cleanliness.Long open wards of about 30 beds
became the standard inpatient accommodation in hospitals globally. Over the years, clinical
practice and opinions about health care have changed and the suitability of open wards in
modern hospitals has been called into question. In the 1950s, new build hospitals
experimented with ‘racetrack’ wards, where beds are arranged around the periphery with a
corridor or track surrounding the offices and other ancillary areas. More recently, hospital
design has used multi-bedded bays, which usually contain four to six beds. Meanwhile,
private health-care facilities have mainly single rooms. At present, internationally, the case is
being made for more single room accommodation in new hospital designs, and some
researchers argue for the abolition of all shared accommodation. This is largely based on the
belief that patients prefer single rooms and benefit from improved patient outcomes
compared with hospital wards. Hospital designs based on higher proportions of single room
accommodation are likely to impact on patients’ health outcomes, staff, and organizations but
the nature and extent of the impact are as yet unclear. Physical evidence is important when
consumers have little on which to judge the actual quality of service they will rely on these

4
cues, just as they rely on the cues provided by the people and the service process. Physical
evidence cues provide excellent opportunities for the hospital to send consistent and strong
messages to the service utilisers. The physical evidence of service in the hospital includes all
the tangible representation of the service like hospital physical facility (the servicescape) as
well as other forms of tangible communication. Elements of a servicescape that affect
patients and their attendants include both exterior attributes (such as signage, parking, and the
landscape) and interior attributes (such as design, layout, equipment, and décor). Apart from
interior decoration, lighting, and ventilation, attention should also be paid to necessary
infrastructures like electricity, water, sewerage, communication and transportation, security,
etc the certifications and awards won by doctors of the hospital and the service certificates
won the hospital can all be displayed at the reception to instill confidence in the customers.
Further Physical evidence determines service quality expectations and perceptions in the
hospital. For an effective strategy, it must be linked clearly to the hospital's overall goals and
vision. So, planners know what those goals are and then determine how the evidence strategy
can support them at a minimum, the basic service concept must be defined, the target markets
identified, and the firm's broad vision of its future known. Because physical evidence
decisions are relatively permanent and costly. Therefore, corporate hospitals should be very,
careful about presenting the right kind of atmosphere, which is both hygienic and relaxing, a
large open lawn or garden with a simple layout and comfortable seating arrangement for
patients has become essential for hospitals to remove the perceived risk of patients. All these
can be conventionally classified into seven major strategies namely product/service, price,
place promotion, people, physical evidence, and process. The product element of the
hospitals includes diagnosis, treatment provided, the education training provided to nursing
and medical students, and research. Services like facilities for attendants, ambulance, and
pharmacy services, etc., augment the core service. The pricing of services should take into
consideration the operational costs and the paying ability of the patient, apart from the value
provided to the customer. People play a very important role in the marketing of hospital
services. Processes add value to the customer and also improve the efficiency of the
operations of the hospitals. Physical evidence can be provided using a good layout and
maintain hygiene. Supplementary services also help in providing physical evidence to
customers. The future healthcare environment is likely to be characterized by more
competition; tighter margins; more diverse, better informed, and more demanding consumers;
demands for accountability; and growing labor shortages. Marketing may not be a panacea
for this laundry list of challenges, but the judicial use of marketing resources can certainly
5
contribute to their amelioration. Physical evidence is the environment in which the service is
delivered with physical or tangible commodities and where the firm and the customer
interact. Modern hospitals need to create a good ambiance. Write from the reception
ambiance plays a very important role because when a patient walks into the hospital he forms
an opinion about the hospital. It is considered to be important as the patients and their
relatives will already in a depressed or traumatized state. It is observed that in two sample
hospitals from reception onwards they maintain the right ambiance that is creating a positive
feeling in the minds of patients and attendants. Physical evidence reflects the things a
customer can see that impact the overall experience. Think of an entertainment venue like a
baseball game. The physical evidence includes the uniforms, the logos around the ballpark,
and the convenient location of refreshments and other services, among other items. Each of
these physical attributes contributes to the value of the overall experience.In a hospital, a
welcoming environment that includes a car valet and a beautiful entrance is only part of
physical evidence. How well they navigate the labyrinth of a delivery organization and what
they see as they move from location to another also provides physical evidence. Clear and
extensive signage, as well as hallways with pictures rather than sterile walls, also creates
physical evidence. After all, it doesn't matter how well the service was provided if people
struggle to find their way.

1.2 IMPORTANCE OF THE STUDY

Physical evidence is the ability and environment in which the service is delivered. Both
tangible and intangible goods help to communicate and perform the service, experience of the
existing customers, and the ability of the business to relay customer satisfaction to potential
customers. Physical evidence is ‘packaging’ for services, therefore the creation of a service
environment should not be left to chance. physical evidence is very important for service
provider organizations due to the influence that they may have over the reaction of their
target audiences and their resulting behaviors, this study aims to contribute to the knowledge
of the role that physical evidence play in the patients, visitors/caregivers, and hospital
employees overall satisfaction level and their willingness to recommend the services of the
organization.For this purpose, through questionnaire research carried out at the care well
hospital and research center Kasaragod. possible to ascertain that physical evidence
influences the satisfaction of the hospital target audiences as well as their willingness to
recommend the institution to others.This study helps society by the way of making
corrections and giving suggestions to the hospital management for how to improve the

6
facilities of the hospital.The people or patients mostly need a good atmosphere in the hospital
and surroundings.This study helps the people to know about the overall physical
environments of the hospital. This study helps to improve patient and staff outcomes can
target latent conditions for clinicians by using evidence-based designs to decrease
distractions, standardize locations of equipment and supplies, and ensure adequate space for
documentation and work areas. Healthcare is important to society because people get ill,
accidents and emergencies do arise and the hospitals are needed to diagnose, treat, and
manage different types of ailments and diseases. Many of people’s aspirations and desires
cannot be met without longer, healthier, happy lives. The healthcare industry is divided into
several areas to meet the health needs of individuals and the population at large. All over the
world, the healthcare industry would continue to thrive and grow as long as man exists hence
forming an enormous part of any country’s economy. Expectations of patients and their care-
takers on healthcare continue to increase.This demand needs adequate management to
enhance patient outcomes. Understanding these expectations can improve patient satisfaction
levels and provide trustful care. The physical environment and its surroundings have a
tremendous impact on health, healing, and safety. Therefore all healthcare facility plans must
be designed with the explicit goal of enhancing patient comfort This calls for architects to
develop a set of facility planning and design recommendations and principles that guide
hospital facilities.Physical evidence is important when consumers have little on which to
judge the actual quality of service they will rely on these cues, just as they rely on the cues
provided by the people and the service process. Physical evidence cues provide excellent
opportunities for the hospital to send consistent and strong messages to the service utilisers.
The broad objective for which the research has been undertaken is to investigate and compare
the physical evidence in selected super-specialty hospitals and making suitable suggestions
based on a statistical analysis of perceptions collected from Doctors, Nurses, and
administrative personnel. The collected data is analyzed by applying descriptive and
inferential statistical techniques such as Mean and Standard Deviation.Numerous studies
have shown that the provision of high-quality service is directly related to an increase in
profits, market share, and cost savings. competitive pressures and the increasing necessity to
deliver patient satisfaction, the elements of excellent services are a priority.service quality is
a key to financial success and survival. With this effort to improve the service quality in
hospitals, it is an essential part of survival in the health care industry and a means to choose
which facility to use by the public, specifically in the healthcare sector. There is increased
competition for both patients and funders to choose their healthcare facility and it forces the
7
healthcare industry, specifically hospitals to be more market-orientated. They think that the
customer ultimately plays an active role in the provision of services of good quality. The
views of patients are very important in strategic planning. They also mention the strong
demand fluctuations, required excess capacity, and careful planning at the level of the service
provider. Although service quality is that of the customer’s definition of quality, and not the
organization’s, it is still the organization that has to survive in a very competitive
environment. a study to analyze the quality of a professional surgical service. Their findings
show that the relationship dimensions of service quality to be the most important in the
medical context.

1.3 OBJECTIVES OF THE STUDY

1. To measure the quality of physical evidence in care well hospital, Kasaragod

2. To evaluate the importance of physical evidence ineffective service delivery

3. To study the level of consumer satisfaction towards the facility offered at care well hospital
and research centrepvt.ltd.

4. To suggest measures to improve quality physical evidence

1.4 NEED FOR STUDY

The problem is the physical evidence in the hospital with special reference to CAREWELL
hospital and research center private limited. Physical evidence is one of the marketing mixes
in service delivery. The service firms must consciously make efforts to manage the physical
evidence. In the case of the hospital, it is really important in maintaining attractive physical
evidence. Physical Evidence is the environment in which service is delivered. The services
are intangible. Intangibility is the reason for the importance of physical evidence in the
service marketing mix. So physical evidence in the service industry is really important.
Nowadays there are several issues taking place in any hospital regarding the hygiene and
facilities provided. So the topic for the study regarding physical evidence in the hospital is a
need in this current scenario.

1.5 STATEMENT OF THE PROBLEM

The problem is the physical evidence in the hospital with special reference to care well

8
hospital and research center Kasaragod. The key aspect of a hospital is physical evidence.
In the case of the hospital, it is really important in maintaining attractive physical evidence
and the elements like odor, cleanliness, and structure of the building, etc are very important.

1.6 CURRENT SCENARIO

Unlike in top cities having a well-linked chain of private hospitals (besides GHs and
community clinics), the rural and semi-urban areas suffer from abysmal facilities in
healthcare. The overall Indian healthcare market is valued at out of which drug supplies and
medical equipment segment is believed to be only $4.5-5 million, says an estimate. While
hospitals, nursing homes, and diagnostics centers, and pharmaceuticals combine to form 65
percent of the overall healthcare market.

Storing of information in digital form accessible and transferable, wherever and whenever
needed is
essential. Tele-healthcare can be defined as the use of ICT to support the delivery of
healthcare directly to
people outside the conventional care centers such as Hospitals or residence. A telehealthcare
system can
be as simple as providing a patient with the means to alert a remote care provider of their
need for
assistance. European Telecommunication Standards Institute (ETSI) formed a specialist task
force (STF) to
prepare an ETSI guide (EG) designed (Bruno, et.al.) to help telehealthcare delivery. The
guide focused on
trust, privacy, confidentiality, ethics, integrity, safety, reliability, availability keeping in mind
legal aspects
, and satisfaction of end-users. The pressure on the healthcare industry is well known.
Shortage of human
resources, the constraint of the fund, higher sensitivity of patients for health issues, the high
expectation for best quality
treatment at the lowest cost without inconvenience. There has been undue delay in
implementing e-governance
and e-healthcare in developing countries like India due to the following reasons (1) Absence
of competition in
the health sector – for a long time healthcare is handled by Public Health System(PHS) with
no competition. (2)
Weak customer with low bargaining power (3) Non-existence of funding systems like
insurance or social
For consumers, evaluation of a service firm often depends on the evaluation of the "service
encounter" or the period when the customer interacts directly with the firm. Knowledge of the
factors that influence customer evaluations in service encounters is therefore critical,
particularly at a time when general perceptions of service quality are declining. The author
presents a model for understanding service encounter evaluation that synthesizes consumer

9
satisfaction, services marketing, and attribution theories. A portion of the model is tested
experimentally to assess the effects of physical surroundings and employee responses
(explanations and offers to compensate) on attributions and satisfaction in a service failure
context. India, a country with a centuries-old heritage of medical science, first became
familiar with the modern systems of medicine in the 17th century. India became an
independent nation in 1947 and became the Federal Republic in 1950. There have been
various developments in the health sector in the postindependence era. But problems like
higher population density, low socioeconomic status of a significant number of people, and
low literacy rate in some parts of the country, have resulted in poor health indicators

India has a rich, centuries-old heritage of medical and health sciences. The approach of the
ancient Indian medical system was one of the holistic treatment. The history of healthcare in
India can be traced to the Vedic times (5000 BCE), in which a description of the
Dhanwanthari, the Hindu god of medicine, emerged. Atharvaveda, one of the four Vedas, is
considered to have developed into Ayurveda, a traditional Indian form of holistic medicine.
The philosophy of Ayurveda, “Charaka Samhita” (the famous treatise on Medicine compiled
by Charaka), and the surgical skill enunciated by Sushrutha, the father of Indian surgery, bear
testimony to the ancient tradition of scientific healthcare amongst the Indian people.
Historically, the most outstanding hospitals in India were those built by King Ashoka (273-
232 BCE). Medicine based on Indian medical principles was taught in the Universities of
Taxila and Nalanda.

Healthcare Market in the Present Scenario

For the healthcare sector in the 21st century, stakeholders around the globe are looking for
quality of care along with the best outcomes. Innovative and cost-effective ways should be
adopted to deliver patient-centered, technology-enabled smart healthcare. The opportunity to
enter the market is ripe but India spends only 4.69 percent of total GDP on healthcare
services (whereas the US spends 17.9 percent). India’s staggering population lives in rural
areas where there is limited or no access to hospitals and clinics. They can be subject to harm
in the hands of quacks who mislead the poor and maltreat them in the name of medicine and
cure. More often the rural population is dependent on alternative medical sources or
government-aided programs. This needs to be rectified. On budgetary allocation in
healthcare, India spends 4.69 percent of total GDP in healthcare, wherein the government
spends 1.41 percent and the private sector spends 3.48 percent of GDP. The government

10
spends for healthcare financing should be raised to a minimum of 3.5 percent excluding the
private healthcare financing thus meeting the requirements of WHO. A 0.23 percentage-point
decline over 2017–2018 in the Union Budget’s share of funding to the Human Resource
Development (HRD) ministry, makes it the lowest since 2014–2015; a 7 percent cut in
allocation for the Swachh Bharat Mission budget from 2017 to 2018’s revised estimates.
National Health Protection Scheme is the latest avatar of the Rashtriya Swasthya Suraksha
Yojana (RSSY), which was previously the Rashtriya Swasthya Bima Yojana (RSBY) under
the labor ministry. There has only been a 2.7 percent increase in allocations to the health
sector, from `53,198 crores in 2017–2018 (revised estimates) to `54,667 crores (budget
estimate).On planned budgetary allocation for the fiscal year 2018–2019, and proportion
allotted for the procurement of medical equipment and devicesThe SGPGIMS is a pioneer
autonomous medical institution (as deemed university by an act of U.P. assembly) and
tertiary care super-specialty hospital and is known for using modern and innovative
management techniques. The funding of the institute is done by the state government. The
planned budgetary allocation for the fiscal year 2018–2019 for the institute is `71,022.40 lakh
(revenue) and `13,300 lakh (capital) making a total of `84,322.40 lakh. The budget allotted
for the procurement of medical equipment and devices is `7300 lakh (8.65 percent) which
includes equipment for the newly established Apex Trauma Centre and Tertiary Care Cancer
Centre. On the outlook for health and family welfare and challenges, faced establish the most
effective and efficient healthcare delivery system with a sustainable approach and
simultaneously maintains the highest standards of quality-based services shall be the vision
statement of health and family welfare. Healthcare organizations are continually battling
conflicting priorities wherein collaborating hospitals’ policy with external services, the
financial challenges, patient safety, patient satisfaction, hospital security, compliance with
regulatory standards, and fulfilling the demand and supply of health services are the most
common challenges faced during implementation of health services. On monitoring the
quality of private healthcare private medical sector in India remains the primary source of
healthcare for 70 percent of households in urban areas and 63 percent of households in rural
areas. Healthcare generally consists of hospital activities, medical and dental practice
activities, and other human health activities. The last class involves activities of, or under the
supervision of nurses, midwives, physiotherapists, scientific or diagnostic laboratories,
pathology clinics, residential health facilities, patient advocates, or other allied health
professions. The general perception of the private healthcare system is that its sole purpose is
to generate money. This perception is based on massive exploitation done by several private
11
healthcare chains on the common public. Hence, it is of utmost importance to have a proper
nationwide integrated private healthcare monitoring system that can prevent such large-scale
exploitation. This system will have the responsibility to check and assess the quality of all
healthcare services, checking the infrastructure of the centers, verifying the billing
methodology, and getting feedback from both patients and the service provider.

The huge extent of private healthcare prevents such a monitoring system to be independent of
manual intervention. Hence, such a system has to be technology-driven with manual
supervision on the system. For example, it can be mandated that the bills generated by these
centers are valid for payment only if they are verified by an online system. That online
system can do checks on the services and its charges, and if there is any overcharging done
that bill can be canceled or the centers could be asked for the reasons for such high rates.

Further quality of services can be managed by placing feedback devices in the centers where
the patient or the patient’s caretaker is free to report any issue with the center along with a
mandate for these centers to maintain an e-diagnosis which will contain all records of
medications, procedures, etc. done with the patient. That e-diagnosis can be checked on the
online system to red-flag any wrong medication or procedure being done against the disease
and update it to the center. Likewise, many other ways can be devised to ease the monitoring
and cause minimum interference with the daily work of those centers, thereby improving the
quality of service of those centers. On the importance of public-private partnerships in
making healthcare, a successful PPC has been acknowledged for their role and contribution
by enabling the government to collaborate with the private sector in pooling resources to
improve the efficiency of services thereby also providing them the ultimate supervision.
Various successful projects have been initiated through central and state governments which
have successfully helped in improving the healthcare sector like awareness programs wherein
central and state governments and international agencies have partnered with NGOs to
conduct awareness programs in various fields, specifically for HIV-AIDS, family welfare,
MCH, disasters preparedness; medical interventional services – conduct family planning
clinics, HIV testing and counseling services, MCH, provide primary and secondary curative
services; and contracting for maintenance services – cleaning and maintenance of the
buildings, security, waste management, laundry, catering, immunization, counseling, blood
bank, blood donation camps, eye camps, and allied services. On areas where the government

12
should invest to make healthcare available all go: India is undergoing epidemiological and
demographic transition, thus making the domain of public health very dynamic. The
population burden further complicates the situation. Extensive and planned integration of
information technology (IT) is of utmost importance for proper implementation and
regulation of health policies, revolutionizing school health programs, urban and rural
planning for basic healthcare facilities to reach the grass-root level, promote the participation
of public volunteers in spreading health education, and making the population aware of
facilities offered by the government. On policy intervention that the healthcare sector in the
state needs to align with healthcare objectives at the national level or strength and at the same
time challenge of governance in health is the distribution of responsibility between the center
and the states. Better assistance to states should be provided to develop state-specific strategic
plans, through the active involvement of local self-government and community-based
monitoring (CBM) of health outputs. Panchayats should be strengthened to play an enhanced
role at different levels. There is a need for appropriate distribution of doctors, paramedics,
and other staff, especially at borders and other sensitive and remote areas. Human resource
management in the healthcare sector should be dealt with by senior/experienced persons in
the public health management cadre. IT must be integrated into the healthcare sector
effectively and efficiently and all the staff related to healthcare must be trained in utilizing IT
according to their work. Grievance redressal systems must be better implemented especially
at the grass-root level. The legal framework must be improved to check and control flaws in
the implementation of health programs.

1.7 CHAPTALIZATION

CHAPTER 1: INTRODUCTION TO THE STUDY

The chapter classified into different parts they are

• INTRODUCTION

• SCOPE OF THE STUDY

• NEED FOR THE STUDY

• REVIEW OF LITERATURE

• STATEMENT OF THE PROBLEM

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• OBJECTIVES OF THE STUDY

• RESEARCH METHODOLOGY

14
 CHAPTER 2
RESEARCH DESIGN

1
2.0 Research design
A research design is a logical and systematic plan prepared for directing a research plan. A
descriptive research design is concerned with describing the characteristics or dimensions of
the problem studied. Descriptive research studies are those studies which are concerned with
the description of characteristics of a particular individual or group

2.1 Review of literature

1.Edem Maxwell Azila-Gbettor(1990)

This study examines the value of the physical environment in the delivery of quality
healthcare or service in public hospitals in Ghana. Twelve sets of self-administered questions
were designed using Baker’s (1987) typology of servicescape. A descriptive univariate
analysis was applied for the study. Based on 233 usable questionnaires retrieved from
respondents, the study indicates a strong link between the physical environment and quality
healthcare delivery and the choice of the healthcare facility. It is thereby recommended that
improvement in quality service delivery may be better served and improved by improving the
servicescape/physical element in the services mix.

2.VadiveluThusyanthy and SamithambySenthilnatha (2012)

The study attempts to compare and explore the level of customer satisfaction terms of
physical evidence and employee interaction between Earlier EstablishedBanks (EEB)
(before 2008) and Newly Established Banks (NEB) (after 2008) in the northern region of
Batticaloa, Sri Lanka. The results indicate that all the banks have the attribute of high-level
customer satisfaction with the bank service provided in terms of physical evidence and
employee interaction. Further analysis confirms that there is a difference in the service being
provided and the layout of physical evidence between EEBand NEB in creating customer
satisfaction.
3.Mary Jo Bitner (1990)

For consumers, evaluation of a service firm often depends on the evaluation of the "service
encounter" or the period when the customer interacts directly with the firm. Knowledge of the
factors that influence customer evaluations in service encounters is therefore critical,
particularly at a time when general perceptions of service quality are declining. The
author presents a model for understanding service encounter evaluation that synthesizes

14
consumer satisfaction, services marketing, and attribution theories. A portion of the model is
tested experimentally to assess the effects of physical surroundings and employee responses
(explanations and offers to compensate) on attributions and satisfaction in a service failure
context.

4.George Lodorfos, George Lodorfos (2011)

This study focuses on the effectiveness of the Service Delivery System (SDS) and
reexamines its influence on customers’ perceived service quality. In this study, the influence
of four specific indicators of the SDS’ effectiveness (namely front line employees’ role
performance, their adaptability to individual customer needs, the effectiveness of their
coordination, and the effectiveness of the service process’ control) on perceived service
quality is tested. In doing so, a hierarchical approach has been taken integrating both
managers’ and customers’ views. The results confirm the positive influence of three variables
on perceived service quality (role performance, the effectiveness of coordination, and
effectiveness of process’ control). On the contrary, the influence of employees’ adaptability
was not found significant.

5.Leena Nitin key(2014)

The main objective of this paper is to gravely evaluate various service delivery improvement
models and identify hypotheses from the models to analyze whether these models are
significant to the hotel industry or not, based on the critical examination of the literature
review. The paper critically scrutinizes six factors of service delivery which is widely used in
the hotel industry through a detailed literature review. And also through critical review, it
analyzes various models under each factor from different authors to identify the hypothetical
approach of these model's significance in the hotel industry. The review of various service
delivery models under each factor revealed that these models play an important role in
improving service delivery in the hotel industry. Also, this paper provides a new gateway for
upcoming researchers. Due to the time limit, the reviewed models under each factor has
restricted to a certain number. This can be a suggestion to expand this study by including
present and upcoming models for future research and also it provides new direction to service
delivery improvement researchers. This paper discovers new direction in service delivery
improvement research and offers theoretical and practical aid to researchers and practitioners
in providing a direction for service delivery improvement.

15
6.Jessica Santos(2002)

Intangibility is one of the distinctive characteristics of service. However, the literature also
highlights “tangibles” as one of the basic service quality dimensions. Investigates the
importance of tangibles and intangibles in perceptions of service quality as assessed by both
customers and service providers. Selects four service industries to reflect a range from high to
low levels of tangible components and the degree of intangibility in both service process and
output. Based on 400 telephone interviews with consumers, shows that the level of tangible
components has a positive impact on the perceived importance of the tangible dimension in
service quality. However, the second phase of this research, involving a qualitative study with
managers in the studied industries, shows that the tangibles dimension is relatively neglected
in service industries with high tangible involvement. Presents a model of tangibility and
intangibility to aid managers in understanding customers’ perceptions, and to stimulate
further research.

7.Tsietsi Mmutle(2017)

Customer satisfaction and the management of their expectations are a strategic component to
the sustainability of any organization. It is argued that these two strategic components are the
most important features that generate customer allegiance and desired retention. In the
hospitality industry, hotels are attempting to obtain augmented customer satisfaction by
concentrating on the quality of service they provide to guests. The objective of this paper was
to examine the customers’ perception of service quality and its impact on a selected hotel’s
reputation. A qualitative research method was used and data was collected using in-depth
semi-structured interviews with both customers and employees as core stakeholders. The
findings indicate that service quality has an impact on hotel reputation as poor service
provision invariably leads to negative conversations and bad publicity concerning the hotel. It
also emerged that the customers and service providers have more or less similar notions of
what service quality entails. The hotel departments have mechanisms and strategies for
meeting and exceeding customer satisfaction and especially of dealing with customer
complaints and these are important when one desires organizational stability

16
8.SamaanAlmsalam (2014)

The effect of the antecedents of satisfaction on customer satisfaction is an issue still under
debate in the academic literature. Thus, the primary goal of this study is to analyze the
relationship between two of the most important antecedents of customer satisfaction ( namely
customer expectation and perceived service quality ) and customer satisfaction. Data were
collected through a survey, including samples of 250 customers from the 5 Banks in
Damascus, Syria. Spss is used to test the hypotheses. The findings show that customer
expectation and perceived service quality have a positive effect on customer satisfaction.
Bank managers must know how improvement in service quality influences customer
satisfaction and what expectation levels they might consider to increase consumer satisfaction
which ultimately retains valued customers.

9.Dr. Bhanu Prakash

Patient satisfaction is an important and commonly used indicator for measuring quality in
health care. Patient satisfaction affects clinical outcomes, patient retention, and medical
malpractice claims. It affects the timely, efficient, and patient-centered delivery of quality
health care. Patient satisfaction is thus a proxy but a very effective indicator to measure the
success of doctors and hospitals. This article discusses as to how to ensure patient satisfaction
in dermatological practice

10.Rashid al abri and Amina Al Balushi

Over the past 20 years, patient satisfaction surveys have gained increasing attention as
meaningful and essential sources of information for identifying gaps and developing an
effective action plan for quality improvement in healthcare organizations. However, there are
very few published studies reporting of the improvements resulting from feedback
information of patient satisfaction surveys, and in most cases, these studies are contradictory
in their findings. This article investigates in-depth several research studies that critically
discuss the relationship between the dependent and independent influential attributes towards
overall patient satisfaction in addition to its impact on the quality improvement process of
healthcare organizations. The healthcare managers that endeavor to achieve excellence take
patient perception into account when designing the strategies for quality improvement of
care.

17
2.3 AREA OF STUDY
The physical evidence in the hospital is the area of study and it contains many factors such as
the facilities provided by the hospital and how the hospital is to be designed are analyzed.The
elements like odor,clean,convenience,parking,pharmacy,restroom,wards etc. Are also be
analyzed. The area of the study cares well hospital and research center Kasaragod Kerala and
the samples and respondents are nurses, patients, doctors, etc.

2.4 METHODOLOGY OF THE STUDY

DATA COLLECTION METHOD

 PRIMARY DATA COLLECTION

Primary data is the specific data that the researchers collect or observe by themselves such as
conducting a questionnaire and interview. This specific data can be seen as important data
because the data is unique and it is collected and observed according to the specific purpose
draw by researches.

 SECONDARY DATA COLLECTION

Secondary data collection can be seen as the beginning of this research. Firstly, the authors
had studied and reviewed many relevant data to know and understand the area of the
research. Secondly, the authors used secondary data as an indicator to do further research.
Moreover, secondary data provides many benefits to this research such as cost and time
saving with high-quality data. Those are the reasons to support why secondary data was
applied in this research.
 The data collection tools which we used include the interviews designed based on
different questions

SAMPLING TECHNIQUE

I used the techniques of interviews and random sampling from different consumers located in
different places.

TOOLS USED FOR ANALYSIS

The main tools used for data analysis are:

 Percentage method

18
SAMPLE SIZE
The sample size is 100 respondents

2.4 SCOPE OF THE STUDY

The study conducted in CAREWELL HOSPITAL, KASARAGOD tells about the condition
of physical evidence in the hospital. The study was about the quality of physical evidence and
it helps the hospital in many ways to know more about the environment in the hospital and
the acceptance of the physical environment provided by the hospital was recognized. The
study provides a wide scope for the administrators to look into the physical evidence and take
corrective actions.

2.5 LIMITATION OF THE STUDY

 Non-cooperation of respondents
 There is only a short period to complete the project
 The small sample size of respondents may not represent the whole universe
 A busy schedule of respondents will not give exact information
 Irregular respondents or patients may not give the right information

19
 CHAPTER 3

INDUSTRY PROFILE
AND
COMPANY PROFILE

20
3.1 INDUSTRY PROFILE

The healthcare industry (also called the medical industry or health economy) is an
aggregation of sectors within the economic system that provides goods and services to treat
patients with curative, preventive, rehabilitative, and palliative care. It includes the generation
and commercialization of goods and services lending themselves to maintaining and re-
establishing health. The modern healthcare industry is divided into many sectors and depends
on interdisciplinary teams of trained professionals and paraprofessionals to meet the health
needs of individuals and populations. The healthcare industry is one of the world's largest and
fastest-growing industries. Consuming over 10 percent of gross domestic product (GDP) of
most developed nations, health care can form an enormous part of a country's economy.

For purpose of finance and management, the healthcare industry is typically divided into
several areas. As a basic framework for defining the sector, the United Nations International
Standard Industrial Classification (ISIC) categorizes the healthcare industry as generally
consisting of hospital activities; medical and dental practice activities; "other human health
activities"

AYURVEDA IN INDIA.

Ayurveda has the distinction of being the "oldest medical system known to man and the
oldest and most comprehensive spiritual teachings in the world". Ayurveda is based on the
principle of maintaining a balance between the interrelated relationships within the body and
mind. It helps the patient to understand the benefits of knowing their body and mind and to
live in an intimate relationship with nature. Ayurvedic literature has remedies for age-related
diseases like memory loss, osteoporosis, diabetic wounds, etc. for which no efficient
medicine is available in modern therapy. Even though Ayurveda has a sound literature
background, ironically its share in the global medicinal market is very less (0.5%). To
promote Ayurveda in the international market, ayurvedic drugs should be available in a
standardized form, which is the minimum requirement for introducing a product in the
Western market. Ayurvedic formulations should be standardized based on active principle or
major compound(s) along with fingerprints. There as great scope for India to achieve global
leadership of the traditional medicinal market through the export of quality products from the
Ayurvedic medicinal system. principle of ayurvedic therapy, the current status of Ayurveda,
the challenges faced by Ayurveda in the modern world, and the need for science-based
research to overcome its drawbacks. According to Caraka -"The Science of life shall never

20
attain finality. Therefore humility and relentless industry should characterize your endeavor
and your approach to knowledge. The entire world consists of teachers for the wise and
enemies for the fools. Therefore, knowledge, conducive to health, longevity, fame, and
excellence, coming from even an unknown source, should be received, assimilated, and
utilized with earnestness". At the beginning of the first millennium AD, there were mainly
three principal medical systems: Ayurveda, Greek, and Chinese medicine. The fundamental
principle of the relationship between the man and nature was more or less the same in all the
medical systems, but their approach in therapy was different (Subbarayappa, 2001) Among
the three ancient medicinal systems Ayurveda emerged as one of the world's classic medical
practice with the renewed interest in the interaction between religion

HEALTH CARE IN INDIA

Healthcare has become one of India’s largest sectors - both in terms of revenue and
employment. Healthcare comprises hospitals, medical devices, clinical trials, outsourcing,
telemedicine, medical tourism, health insurance, and medical equipment. The Indian
healthcare sector is growing at a brisk pace due to its strengthening coverage, services, and
increasing expenditure by public as well as private players. Indian healthcare delivery system
is categorized into two major components - public and private. The Government, i.e. public
healthcare system comprises limited secondary and tertiary care institutions in key cities and
focuses on providing basic healthcare facilities in the form of primary healthcare centers
(PHCs) in rural areas. The private sector provides the majority of secondary, tertiary, and
quaternary care institutions with a major concentration in metros, tier I, and tier-II cities.

India's competitive advantage lies in its large pool of well-trained medical professionals.
India is also cost-competitive compared to its peers in Asia and Western countries. The cost
of surgery in India is about one-tenth of that in the US or Western Europe.

Market Size

The overall Indian healthcare market today is worth US$ 100 billion and is expected to grow
to US$ 280 billion by 2020, a compound annual growth rate (CAGR) of 22.9 percent.
Healthcare delivery, which includes hospitals, nursing homes, and diagnostics centers, and
pharmaceuticals, constitutes 65 percent of the overall market. There is significant scope for
enhancing healthcare services considering that healthcare spending as a percentage of Gross
Domestic Product (GDP) is rising. Rural India, which accounts for over 70 percent of the
population, is set to emerge as a potential demand source.

21
India requires 600,000 to 700,000 additional beds over the next five to six years, indicative of
an investment opportunity of US$ 25-30 billion. Given this demand for capital, the number of
transactions in the healthcare space is expected to witness an increase shortly. The average
investment size by private equity funds in healthcare chains has already increased to US$ 20-
30 million from US$ 5-15 million, as per PriceWaterhouseCoopers.The Indian medical
tourism industry is pegged at US$ 3 billion per annum, with tourist arrivals estimated at
230,000. The Indian medical tourism industry is expected to reach US$ 6 billion by 2018,
with the number of people arriving in the country for medical treatment set to double over the
next four years. With a greater number of hospitals getting accredited and receiving
recognition and greater awareness on the need to develop its quality to meet international
standards, Kerala aims to become India's healthcare hub in five years.

Investments

The hospital and diagnostic centers attracted Foreign Direct Investment (FDI) worth US$
3.21 billion between April 2000 and September 2015, according to data released by the
Department of Industrial Policy and Promotion (DIPP). Some of the major investments in the
Indian healthcare industry are as follows: American multinational technology and consulting
corporation, IBM has announced that Manipal Hospitals’ corporate and teaching facilities
will adopt ‘Watson for Oncology’, a cognitive computing platform trained by Memorial
Sloan-Kettering that analyses data to identify evidence-based treatment options, helping
oncologists to provide cancer patients with individualized healthcare. Apollo Hospitals
Enterprise (AHL) plans to add another 2,000 beds over the next two financial years, at a cost
of around Rs 1,500 crore (US$ 225.28 million). Malaysia-based IHH Healthcare Berhad has
agreed to buy a 73.4 percent stake in Global Hospitals Group, India's fourth-largest
healthcare network, for Rs 1,284 crore US$ 192.84 million. Temasek Holdings Pte Limited
acquired the entire 17.74 percent stake of Punj Lloyd Limited in Global Health Private
Limited, which owns and operates the Medanta Super Specialty Hospital in Gurgaon.CDC, a
UK based development finance institution, invested US$ 48 million in NarayanaHrudayalaya,
a multi-specialty healthcare provider. With this investment, Narayana Health will expand
affordable treatment in eastern, central, and western India. Apollo Health and Lifestyle
Limited (AHLL), a wholly-owned subsidiary of Apollo Hospitals Enterprise, acquired Nova
Specialty Hospitals at an estimated cost of Rs 135-145 crore (US$ 20.3-21.8 million).IHH
Healthcare Berhad acquired a controlling 51 percent equity stake in Hyderabad-based
Continental Hospitals Limited for about approximately US$ 45.4 million. Sanofi-Synthelabo

22
(India) Limited invested Rs 90 crore (US$ 13.52 million) in Apollo Sugar Clinics Limited
(ASCL), a unit of its subsidiary Apollo Health and Lifestyle Limited. Carlyle Group acquired
a stake in Metropolis Healthcare Limited, an operator of pathology laboratories in India, for
an undisclosed sum. San Francisco-based Fitbit Inc., a fitness-tracking device maker, has
launched its fitness wristbands across 300 towns in India and expects the country to be
among its top five markets in the next two years. Home healthcare service provider Portea
Medical has raised Rs 247 crore (US$ 37.5 million) in Series-B funding from investors
including Accel Partners, International Finance Corporation, Qualcomm Ventures, and
Ventureast. Practo Technologies Pvt. Ltd, India’s largest online doctor discovery company,
has acquired hospital information management solution provider Insta Health Solutions for
US$ 12 million which will help Practo get access to more than 500 hospitals across 15
countries. Attune Technologies Private Limited, a Chennai-based healthcare technology firm,
has raised US$ 10 million in Series B funding from Qualcomm Ventures and Norwest
Venture Partners to expand its digital healthcare solutions from the current 200 hospitals and
laboratories to 25,000 such facilities globally. Pluss, a Gurgaon based on-demand medicine
and healthcare products delivery service start-up, has raised US$ 1 million in pre-Series A
funding from IDG Ventures, India; M & S partners, Singapore and Powerhouse Ventures,
US. The company would use the funding to upgrade its technology and expand its presence in
five cities.

Government Initiatives

India's universal health plan that aims to offer guaranteed benefits to a sixth of the world's
population will cost an estimated Rs 1.6 trillion (US$ 24.03 billion) over the next four years.
Some of the major initiatives taken by the Government of India to promote the Indian
healthcare industry are as follows: A unique initiative for healthcare 'Sehat' (Social
Endeavour for Health and Telemedicine) has been launched at a government-run common
service center (CSC) to empower rural citizens by providing access to information,
knowledge, skills and other services in various sectors through the intervention of digital
technologies and fulfilling the vision of a ‘Digital India’.India and Sweden celebrated five
years of Memorandum of Understanding (MoU). The cooperation in healthcare between
India and Sweden will help in filling gaps in research and innovative technology to aid the
provisioning of quality healthcare.

Mr. J P Nadda, Union Minister for Health & Family Welfare, Government of India has
launched the National Deworming initiative aimed to protect more than 24 crore children in

23
the ages of 1-19 years from intestinal worms, on the eve of the National Deworming Day.
Under the National Health Assurance Mission, Prime Minister Mr. Narendra Modi's
government would provide all citizens with free drugs and diagnostic treatment, as well as
insurance cover to treat serious ailments. All the government hospitals in Andhra Pradesh
would get a facelift with a cost of Rs 45 crore (US$ 6.76 million), besides the establishment
of 1,000 generic medical shops across the State in the next few months.MissionIndradhanush
launched by Mr. JP Nadda aims to immunize children against seven vaccine-preventable
diseases namely diphtheria, whooping cough, tetanus, polio, tuberculosis, measles, and
hepatitis B by 2020. The government has set a target of 95 percent immunization cover by
end of 2016. The E-health initiative, which is a part of the Digital India drive launched by
Prime Minister Mr. Narendra Modi, aims at providing effective and economical healthcare
services to all citizens. The program aims to make use of technology and portals to facilitate
people to maintain health records and book online appointments with various departments of
different hospitals using eKYC data of Aadhaar number.

Road Ahead

India is a land full of opportunities for players in the medical devices industry. The country
has also become one of the leading destinations for high-end diagnostic services with
tremendous capital investment for advanced diagnostic facilities, thus catering to a greater
proportion of the population. Besides, Indian medical service consumers have become more
conscious of their healthcare upkeep. India's competitive advantage also lies in the increased
success rate of Indian companies in getting the Abbreviated New Drug Application (ANDA)
approvals. India also offers vast opportunities in R&D as well as medical tourism. To sum up,
there are vast opportunities for investment in healthcare infrastructure in both urban and rural
India.

This third class involves activities of, or under the supervision of, nurses, midwives,
physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health
facilities, or other allied health professions, e.g. in the field of optometry, hydrotherapy,
medical massage, yoga therapy, music therapy, occupational therapy, speech therapy,
chiropody, homeopathy, chiropractic, acupuncture, etc. The Global Industry Classification
Standard and the Industry Classification Benchmark further distinguish the industry as two
main groups: healthcare equipment and services; and pharmaceuticals, biotechnology, and
related life sciences. The healthcare equipment and services group consists of companies and
entities that provide medical equipment, medical supplies, and healthcare services, such as

24
hospitals, home healthcare providers, and nursing homes. The latter listed industry group
includes companies that produce biotechnology, pharmaceuticals, and miscellaneous
scientific services. Other approaches to defining the scope of the healthcare industry tend to
adopt a broader definition, also including other key actions related to health, such as
education and training of health professionals, regulation and management of health services
delivery, provision of traditional and complementary medicines, and administration of health
insurance.

TRENDS IN HEALTHCARE INDUSTRY

Rural Healthcare

Outside of the largest cities and some suburban hospitals where many health systems have
formed, many patients in the United States receive care from smaller, rural institutions that
offer challenges for patients and providers. According to the American Hospital Association,
“Rural hospitals provide essential health care services to nearly 57 million people.”The
number of people living in rural (nonmetropolitan) counties declined by nearly 200,000
between 2010 and 2016, which is the first recorded period of rural population decline with
government programs in constant danger of financial cost-saving spending cuts, rural
healthcare providers are in crisis. According to the National Rural Hospital Association,
“Currently one in three rural hospitals is in financial risk. At the current rate of closure, 25%
of all rural hospitals will close within less than a decade.”

Consumerism in Healthcare

Healthcare consumerism is defined by the Institute for HealthCare Consumerism's IHC

Forum as, “transforming an employer's health benefit plan into one that puts economic
purchasing power—and decision-making—in the hands of participants. This is best achieved
by supplying employees with the decision-making information and support tools they need,
along with financial incentives, rewards, and other benefits that encourage personal
involvement in altering health and health care purchasing behaviors.”

.Workforce Change

Employment in the United States is undergoing intense changes, and an analysis of

government data from a survey by the Pew Research Center shows that employment in

25
occupations that require more education and training are on the rise, and many workers are
realizing that retraining and upgrading their skills are lifetime commitments.6 The workplace
now encompasses multiple generations representing a wide variation in skills, life
experiences, technical training, and college education. Such a diverse workforce environment
also creates challenges for healthcare.

Administration Transformation: Benefits Strategy and Specialty Drugs

The Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) estimated
that aggregate healthcare spending would grow at a 5.8% average annual rate from 2015 to
2025, or 1.3% higher than the expected annual increase in the gross domestic product.10 This
is causing more interest in new strategies across employers for drugs or administration.

Integrated Care for Population Health

In a typical integrated network, the payers stipulate a framework whereby provider groups
agree to care for a specific patient population to reach or surpass a predetermined set of
quality and cost benchmarks. The integration model encourages healthcare organizations to
deliver value to patients and reduce the overuse of treatments.

Technology Acceleration and Transformative Market Impacts

Wearable sensors are small but crucial components of consumer technology that enables
smart devices to track and monitor several parameters, such as movements, temperature,
speed, muscle activity, and blood pressure. Sensors collect data about the physical and
chemical properties of the body and the local environment, which are used by algorithms to
produce useful information.

Various Types of Hospitals

In the current scenario., you can differentiate hospitals based on a variety of factors that
includes functionality, size, location, ownership, and specialization. Here they are in more
detail:

1. Functionality
Functionality refers to whether the hospitals are general-purpose, teaching hospitals, acute
care facilities, long-term hospitals, community hospitals, research hospitals, or if they provide

26
trauma care for patients. It refers to how the hospitals themselves function within the
communities they serve.

2. Size

There are three primary classifications when it comes to size:

1. Small hospitals: Fewer than 100 beds

2. Medium hospitals: 100 to 499 beds
3. Large hospitals: 500 or more beds

Typically, these sizes are classified by the number of beds they have — although there can be
some variation within these groups of hospitals and medical centers.

3. Location

You can also classify hospitals by their locations. Rural hospitals aid smaller communities
and often have limited access to advanced equipment or specialized procedures and
techniques. Since they also face competition, urban hospitals serve larger metropolitan areas
and must often offer a wide degree of versatility when it comes to treatment options and
patient experience.

4. Ownership

Knowing who owns the hospital will also tell you a great deal about how the hospital will
operate. Some hospitals are part of larger networks that offer a streamlined approach to
management. While some physicians feel this improves efficiency and patient experience,
some feel it removes the emphasis from the patient and makes treatment less personal.
Private hospitals often offer access to the latest technologies and equipment but may under-
served community members who need healthcare the most. Government-supported facilities
operate via grants and other public funds. They have greater restrictions but also reach out to
members of the community who may not otherwise receive healthcare and medical treatment.

5. Specializations

Specialized hospitals appeal to physicians who entered the medical field with plans to treat
people with a specific condition. Most physicians choose specializations due to personal

27
reasons, an area of intense interest, or a desire to provide a comfortable life for themselves
and their families.

The Many Types of Hospitals

Academic Medical Centers

Academic medical centers often serve specific medical schools or universities. Facilities like
this offer a variety of services to treat the general healthcare needs of their communities as
well as specialized services while simultaneously offering educational opportunities to
students in the healthcare field.

Acute Hospitals

Acute hospitals focus solely on the treatment and care of people with short-term needs like
the following:

 Illnesses
 Diseases
 Injuries
 Surgeries
 Surgery recoveries
 Obstetric care
 Postnatal care

They are not equipped to handle chronic or long-term care for patients. According to
EOSCU, approximately 91 percent of hospitals are acute care facilities. Most people who are
treated in acute care hospitals stay for 10 days or fewer.

Ambulatory Surgery Centers

Focusing on same-day surgical care, ambulatory surgery centers offer surgical procedures
without requiring patients to be admitted to hospitals for the operation or recovery. They are
cost-effective options for patients and provide a less stressful surgical environment than many
hospitals can provide.

28
Children’s Hospitals

Children’s hospitals specialize in the care and treatment of children and the conditions that
affect younger patients. It is a type of specialty hospital, which means the staff has received
additional training to aid in the treatment of children for a variety of acute and long-term
medical needs. In addition to offering medical treatment to children, children’s hospitals are
widely praised for the level of psychosocial support they offer the children in their care and
their families — especially in the case of children who require long stays in the hospital.

Clinics

Clinics are typically much smaller than hospitals and operate solely on an outpatient basis.
They aren’t equipped to keep patients overnight for recovery, treatment, diagnosis, or
observation. Government agencies may run clinics or they may operate as private entities and
partnerships among surgeons or private physicians.

Community Hospitals

Non-teaching hospitals serving local communities without federal funding are known as
community hospitals. They can be found in rural or urban settings and provide vital services
to their local populations.

District Hospitals

District hospitals serve as healthcare hubs for their geographic regions. They have more
extensive intensive care facilities and long-term care programs in addition to providing
necessary treatments in fields like obstetrics, general surgery, plastic surgery, and more.

Federal Hospitals

Sometimes referred to as government hospitals, federal hospitals receive funding from the
federal government. In the United States, federally funded hospitals typically handle the
healthcare and medical needs of select populations such as Native Americans and Veterans.

For-Profit Hospitals

For-profit hospitals are investor-owned facilities. This means the profits they earn go to
shareholders who have invested in the facilities rather than back into the hospital for

29
improvements, new services, and medical advancements. Some fifty-eight percent of
hospitals today, according to EOSCU, are not-for-profit hospitals.

Free Hospitals

Free hospitals do not charge patients for the services they provide. They are generally located
in areas that reach out to patients of poor socio-economic classes and frequently operate at a
loss. As a result, they often struggle to provide the amenities and level of services many
physicians strive to offer.

General Services Hospitals

General service hospitals focus on general and necessary services for the community, like:

 Surgery
 OB/GYN services
 Pediatric services
 General medical care

They offer little in the way of specialty services and may not be equipped to provide long-
term care to patients. Most hospitals today are general services hospitals.

Government-Funded Hospitals

State or federal governments provide grants or public funding to government-funded

hospitals to operate. Veterans hospitals are perhaps the most famous of these kinds of
hospitals. EOSCU reports that there are currently 213 federally funded hospitals in the U.S.

Hospitals in a Network

Hospitals in a network operate in connection with one another to deliver a range of services
to a single community or multiple communities. The benefits of becoming affiliated with a
hospital network are mainly economic, as this helps to improve efficiency, eliminate
redundancy in services and ensure the quality of care to all patients — whether in rural
communities or larger cities.

30
Hospitals in a System

Hospital systems are a lot like hospital networks. Larger systems can offer specialty services
as well as general services, though patients may have to travel to a different facility to have
their needs met. This helps reduce costs for the hospitals while offering confidence among
patients that they will receive a certain standard of care from any hospital within that system.

Independent Hospitals

Independent hospitals are becoming increasingly rare as healthcare costs rise and many
hospitals look for the financial benefits network affiliation provides. However, there are still
independent hospitals throughout the country finding great success while meeting the medical
and healthcare needs of their communities.

Large Hospitals

Because they typically have 500 or more beds, large hospitals are capable of serving the
broader needs of the community. Some larger hospitals offer a combination of acute and
long-term care services while also providing research opportunities in some cases and
accommodating a variety of specializations.

Local Hospitals

While once the backbone of healthcare in America, many local hospitals are either facing
closure or being incorporated into larger healthcare systems so that they can continue to
provide necessary services to their communities while meeting the substantial financial
burdens local hospitals experience.

Long-Term Hospitals

Hospitals providing long-term care can meet the needs of patients suffering from chronic
illnesses, requiring psychiatric care, cardiac rehabilitation, or who are going through
extensive rehabilitation after accidents or injuries. This might include hospitals that offer
burn centers, cancer centers, and similar types of care facilities.

Medium Hospitals

Medium hospitals usually have between 100 and 300 beds though some may have as many as
500 beds.

31
Municipal-Funded Hospitals

Municipal-funded hospitals are community hospitals funded, at least in part, by local

governments. They are often small facilities that provide limited acute care services to local
populations.

Non-Community Hospitals

This is another term used to reference federally funded or government hospitals. While
community hospitals exist to serve the short-term acute care needs of the general public, non-
community hospitals often provide for specific groups such as veterans or Native American
populations.

Non-Teaching Hospitals

Non-teaching hospitals are unaffiliated with medical schools and do not provide educational
opportunities for students studying to become doctors, nurses, or other medical professionals.
They provide necessary medical services to the communities they serve and often operate
more cost-effectively, as they do not absorb the many costs associated with educating
medical professionals of the future.

Not-for-Profit Hospitals

Nearly two-thirds of all hospitals located in urban areas are considered to be not-for-profit

hospitals, meaning they are not beholden to shareholders to earn profits. Many of these
nonprofit facilities receive tax benefits that are unavailable to for-profit facilities.

Osteopathic Hospitals

Focusing on diet and the environment to influence health as well as manipulation of the body,
osteopathic hospitals take a holistic approach to healing and patient care. Rather than
treatment, osteopathic hospitals tend to concentrate on preventative measures.

Private Hospitals

Owners and investors — who recover their investments via fees charged to the patients they
assist or their insurance providers — provide funding for private hospitals. Facility owners
and administrators determine the budget, manage finances, and ensure compliance with
various codes and regulations related to medical care. Patients often prefer private hospitals

32
because of the many offered amenities, better doctor-to-patient ratios, and a variety of
services that are unavailable in facilities that have more limited budgets.

Psychiatric Hospitals

Psychiatric hospitals attend to the mental health needs of their patients. The staff who work in
them treat a variety of mental health conditions through the use of medications,
psychotherapy, and behavioral therapies. Some hospitals and treatment centers focus on
short-term treatments while others offer long-term care for psychiatric patients.

Rehabilitation Hospitals

Rehab hospitals and treatment centers focus exclusively on patient rehabilitation for a variety
of illnesses and injuries. Some facilities offer both inpatient and outpatient rehabilitation
services while others focus exclusively on inpatient services and intensive therapy regimens.

Research Hospitals

Research hospitals commit their efforts to research cures for certain conditions in addition to
treating illnesses, diseases, injuries, and various healthcare conditions. St. Jude Children’s
Research Hospital may be one of the most famous research hospitals in the United States, but
there are plenty more.

Rural Hospitals

Usually fitted with 100 or fewer beds, rural hospitals are located outside large urban areas
and operate on small budgets. They generally provide basic care. If needed, they’ll transport
patients in need of more critical care to larger hospitals in their regions. Nearly 72 percent of
all rural hospitals are defined as “critical access” hospitals, meaning they have fewer than 25
beds and are located 35 or more miles from the next-nearest hospital. According to the
American Hospital Association, there were 1,825 rural community hospitals in 2016.

Seniors’ Geriatric Hospitals

Geriatric or seniors’ hospitals exclusively treat aging adults. They focus on diseases and
conditions that impact adults aged 65 and over. According to Psych Central, elderly patients
who receive care in a specialized geriatric facility enjoyed a reduced risk of functional

33
decline at discharge (18 percent lower) and a 30 percent higher likelihood of returning home
upon leaving the hospital than those treated in general hospitals.

Small Hospitals

As the name implies, these are typically small-scale operations with fewer than 100 beds.
Many of them are located in rural communities with no other hospital or medical center
within a short driving range or offer highly specialized treatment options.

Specialty Hospitals

Specialized hospitals are typically affiliated with larger hospitals or healthcare networks and
offer specific treatments. You may find a variety of specialty hospitals within one
community, including:

 Women’s hospitals
 Children’s hospitals
 Cardiac hospitals
 Oncology hospitals
 Psychiatric hospitals
 Trauma centers
 Cancer treatment centers

Specialty facilities typically excel at providing the types of services listed above while
offering limited specialized care, other than the basics, for conditions outside their specialties.

State Hospitals

Many state hospitals are teaching hospitals that offer vital educational experiences to students
while meeting the medical care and treatment needs of their communities. State hospitals
often receive a substantial portion of their funding from the state, though they may also
receive grants and endowments from charitable organizations in the communities they serve.

Super Specialty Hospitals

Super-specialty hospitals offer highly specialized treatments along with a staff that has
received extensive education and training in isolated conditions. They will often have cutting-

34
edge equipment to offer highly sophisticated diagnostic and treatment options to the patients
who visit them.

Specialized hospitals or units within hospitals may have access to treatment options that
aren’t available at other hospitals, such as organ transplants, specialty medical devices, and
medications that require very precise handling and training to administer.

Teaching Hospitals

Typically affiliated with universities, colleges, medical schools, or nursing schools, teaching
hospitals provide medical and healthcare services while teaching and training healers of the
future. The students, interns, and fellows working and learning in these hospitals are all
supervised by qualified physicians, teachers, department chairs, and other medical staff.
Because teaching hospitals exist to provide educational opportunities to students, they often
treat sicker patients, which may result in lower quality scores than non-teaching hospitals —
even if the ranking is somewhat undeserved.

Trauma Center Hospitals

Trauma centers are hospitals specifically equipped to provide care for patients who have
experienced traumatic injuries. These can be from a variety of occurrences, including:

 Falls
 Auto accidents
 Gunshot wounds
 Other life-threatening injuries

The American Trauma Society describes five levels that classify trauma centers.
Requirements for classifications vary from one state to the next and most trauma center
hospitals also have designations or levels assigned to adult trauma and pediatric trauma.

Trust Hospitals

Trust hospitals are either charitable hospitals or semi-charitable, with many charges funded
through trusts. Some trust hospitals, widely used by middle-class patients, are referred to as
“no profit, no loss” hospitals, and they provide subsidized services.

35
Veterans Affairs (VA) Hospitals

Veterans Affairs hospitals are tax-supported hospitals widely utilized by the men and women
who have served their country in any branch of the Armed Forces. Treatment at VA hospitals
is provided free of charge to veterans as thanks from a grateful nation for their service to the
country.

About Health Facilities

Humans in global natural views are dependent on environmental locations, climate, and
power sources of nature. All lives irrespective of rural and urban areas depend on all facilities
of the universe which is available in the form of environmental processing factors, natural
sources, and climate factors, location of residential, life status, earning fields, and feeding
systems. All available systems, as the nervous system and the organic parts of the body,
depending on the health of the person, and health is dependent on the environmental and
global sources and nature. The deficiency in health functions can be due to lack of duties and
responsibility, lack of disciplinary actions, lack of decision making at all levels, and
ineffective communications and changes in primitive health systems. There is poor
coordination, poor physical situations, inadequate infrastructure, and poor maintenance of
records. High technology equipment is inadequate, negligence in deterioration in the
standards of health care, lack of emphasis on patient-centered service, lack of quality, and
supply of food. Lack of in-service education for staff, high cost of technical staff,
unavailability of machines in government hospitals, and high cost of treatment incorporation
hospitals. In India, health care facilities (HCFs) are provided by both private and public
sectors. The nature of services provided by the public sector differs significantly from that of
the private sector. Besides providing curative service, the public sector also provides several
preventive services. It also aims to educate the population towards environmental,
cleanliness, and some preventive measures to combat the certain disease are highly
subsidized by the public sector. Page 20 Corporate sector is more profit-oriented. In such
conditions the responsibility (HCFs) in part of the country is mainly with the public sector,
hence the provision preliminarily concerned with the public (HCFs) availability, accessibility,
and utilization. All health quality resources that are available are called a facility. Health
facility is in general terms are where health care is provided. Health facilities range from
small clinics and doctors’ offices to urgent centers. The large hospitals mainly elaborate
emergency rooms and trauma centers. The number and quality of health facilities in-country

36
or regions are on a common measure of that area's prosperity and quality of many countries.
The health facilities are regulated to some extent by law and licensing by regulatory agencies
is often required before a facility may open for business. Health facilities are owned and
operated for-profit businesses, nonprofit organizations, and government and in some cases by
individuals with varying proportions in the country. India is the second-largest populated
country, 70% Population is living in semi-urban and rural areas. Hospitals and health care
services are vital components and any well-ordered and woman society will indisputably be
the recipients of social resources. Hospitals should be places of safety not only for the patient
but also for the staff and the general public. The World Health Organization defines modern
hospitals, thus: “The modern hospital is an integral part of social and medical organization,
the function of which is to provide for the population complete health care both curative and
preventive and whose outpatient services reach out to the family in its home environment

3.2 COMPANY PROFILE

CAREWELL HOSPITAL AND RESEARCH CENTRE PRIVATE LIMITED,
KASARAGOD, KERALA

Carewell Hospitals And Research Centre Pvt Ltd are a Private incorporated on 29 November
1990. It is classified as a Non-government company and is registered at Registrar of
Companies, Ernakulam. Its authorized share capital is Rs. 17,300,000 and its paid-up capital
is Rs. 13,346,400. It is involved in Human health activities. Carewell Hospitals And Research
Centre Pvt Ltd's Annual General Meeting (AGM) was last held on 30 September 2019 and as
per records from the Ministry of Corporate Affairs (MCA), its balance sheet was last filed on
31 March 2019. Carewell Hospitals And Research Centre Pvt Ltd's Corporate Identification
Number is (CIN) U85110KL1990PTC005876 and its registration number is 5876. Its Email
address is carewelhospital@gmail.com and its registered address is NULLIPPADY
KASARAGOD KASARAGOD KL 671121 IN Current status of Carewell Hospitals And
Research Centre Pvt Ltd is - Active. 

FACILITIES PROVIDED BY CAREWELL HOSPITAL

 Ambulance
 24 Hour Casualty
 Postpartum Sterilisation
 Ventilator

37
COMPANY DETAILS

Company name: CAREWELL HOSPITAL AND RESEARCH CENTRE PVT LTD

Company status: Active

Roc : Roc –Ernakulam

Registration no . : 5876

Company category: Company limited by shares

Company

Subcategory : Non-government company

Class of company : Private

Date of

Incorporation :29 November 1990

Age of company : 30 years

Activity : Human health activities

SHARE CAPITAL

Authorised capital : 17,300,000

Paid up capital : 13,346,400

Listing and annual compliance details

Listing status : Unlisted

Date of last annual general meeting :30 September 2019

Date of the latest balance sheet: 31 March 2019

38
Directors details
Director name appointment date

Mogral arimala Abdulhafeez 29 November 1990

Hameed beefathuma zuhara 25 March 1997

Mogral arimala Mohammed afsal 29 November 1990

Fathima Tahira Ali 07 November 1999

Jayadeva kangila 09 march 2005

Chethanadka Nagaraja 09 march 2005

Mogral arimala ayisha nazeera 29 November 1990

Specialties & Treatments offered by Carewell

Hospital
Diagnostic Centre
ECG

XRAY

Ultrasonography

Clinical Haematology

Critical Care

Eye Care

Pediatrics

Biochemistry

Dental

Dermatology

ENT

39
General Surgery

Intra-Uterine Contraceptive

Neonatology

Other services

Canteen

pharmacy

40
 CHAPTER 4
DATA ANALYSIS AND
INTERPRETATION

20
 The noise level of the hospital

Parameter No of Percentage
respondents

Yes 59 59%

No 41 41%

Total 100 100%

Table no: 4.1: Showing respondents openion towards noise level

yes no

41%

59%

Chart no: 4.1 : Showing respondents openion towards noice level

Interpretation

From the above table and chart it is evident that 41 percent of the respondent accept the noise
level and 59 percent of respondents do not accept with the noise level.Hence the majority of
respondents accept the noise level in the hospital

41
 Odor of the hospital

Parameter No of Percentage
respondents

Yes 72 72%

No 28 28%

Total 100 100%

Table no: 4.2: Showing respondents openion towards odor of the hospital

28% Yes No

72%

Chart no:4.2 : Showing respondents openion towards odor of the hospital

Interpretation

From the above table and chart it is evident that 72 percent of the respondent accept the odor
in the hospital and 28 percent of respondents do not accept with the odor in the
hospital.Hence the majority of respondents accept the odor of the hospital

42
 The highgienicity of hospital

Parameter No of Percentage
Respondents

Strongly Agree 6 6%
Agree 80 80%
Neither agree nor disagree 4 4%
Disagree 10 10%
Strongly disagree 0 0%

Total 100 100%

Table no :4.3 : Showing respondents openion towards higienicity of the hospital

Strongly Agree Neither agree nor diagree

Agree Disagree
Strongly disagree
10% 6% 4%

80%

Chart no :4.3 : Showing respondents openion towards higienicity of the hospital

Interpretation

From the above table and chart it is evident that 80 percent of the respondent agrees the
higienicity in the hospital and 10 percent of respondents disagree with the higienicity of the
hospital.Hence the majority of respondents agree the highgienicity of the hospital

43
 Eco-friendly atmosphere of the hospital

Parameter No of Respondents Percentage

Strongly Agree 80 80%

Agree 18 18%

Neither agree nor 0 0%

disagree
Disagree 2 2%
Strongly disagree 0 0%

Total 100 100%

Table no:4.4: Showing respondents openion towards eco friendly atmosphere of the
hospital
90
80
80
70
60
50
40
30
20 18
10 2
0 0
0
Strongly Agree Neither agree Agree Disagree Strongly
nor disagree disagree

Chart no 4.4 : Showing respondents openion towards eco friendly atmosphere of the
hospital

Interpretation

From the above table and chart it is evident that 80 percent of the respondent agrees the eco
friendly atmosphere in the hospital and 2 percent of respondents disagree with the eco
friendly atmosphere of the hospital.Hence the majority of respondents agree the eco friendly
atmosphere of the hospital

44
 Waiting area provided to patients

Parameter No of Percentage
Respondents

Strongly Agree 10 10%

Agree 89 89%
Neither agree nor disagree 1 1%
Disagree 0 0%
Strongly disagree 0 0%

Total 100 100%

Table no:4.5: Showing respondents openion towards waiting area provided to patients in
the hospital

Strongly Agree Neither agree nor disagree

Agree Disagree
Strongly disagree

10% 1%

89%

Chart no:4.5: Showing respondents openion towards waiting area provided to patients in
the hospital

Interpretation

From the above table and chart it is evident that 89 percent of the respondent agrees the
statement that waiting area provided to patients in the hospital is good and 0 percent of
respondents disagree with the statement that waiting area provided to patients in the hospital
is good.Hence the majority of respondents agree the waiting area provided to patients the of
the hospital

45
 Consulting area is overcrowded at times
Criteria No of Percentage
Respondents

Strongly Agree 0 0%

Agree 1 1%

Neither agree nor disagree 0 0%

Disagree 90 90%
Strongly disagree 9 9%

Total 100 100%

Table 4.6 : Showing respondents openion towards consulting area is overcrowded at times

Strongly Agree Neither agree nor disagree

Agree Disagree
Strongly disagree

9% 1%

90%

Chart 4.6 : Showing respondents openion towards consulting area is overcro wded at times

Interpretation

From the above table and chart it is evident that 90 percent of the respondent agrees the
statement that consulting area is overcrowded at times in the hospital and 9 percent of
respondents disagree with the statement that consulting area is overcro wded at times .Hence
the majority of respondents agree the consulting area is overcrowded at times at the hospital

46
 patients admit cards are standard and it is attractive

Criteria No of Percentage
respondents

Strongly Agree 24 24%

Agree 70 70%

Neither agree nor disagree 0 0%

Disagree 6 6%
Strongly disagree 0 0%

Total 100 100%

Table no :4.7 : Showing respondents openion towards patients admit cards are standard
and it is attractive

Percentage of Respondents
Strongly Agree Neither agree nor disagree
Agree Disagree
Strongly disagree
6
24

70

Chart no :4.7 : Showing respondents openion towards patients admit cards are standard
and it is attractive

Interpretation

From the above table and chart it is evident that 70 percent of the respondent agrees the
statement that patients admit cards are standard and it is attractive in the hospital and 6
percent of respondents disagree with the statement that patients admit cards are standard and
it is attractive .Hence the majority of respondents agree the patients admit cards are standard
and it is attractive.

47
Layout of the hospital is well planned in terms of grassing, flowering, and
lighting.

Parameter No of erspondents Percentage

Strongly Agree 91 91%

Agree 7 7%
Neither agree nor disagree 2 2%
Disagree 0 0%
Strongly disagree 0 0%

Total 100 100%

Table no :4.8 : Showing respondents openion towards layout of the hospital is well planned
in terms of grassing ,flowering and lighting

91
90
60
30 7
2 0 0
0

Chart no :4.8 : Showing respondents openion towards layout of the hospital is well planned
in terms of grassing ,flowering and lighting

Interpretation

From the above table and chart it is evident that 91 percent of the respondent agrees the
statement that layout of the hospital is well planned in terms of grassing ,flowering and
lighting in the hospital and 0 percent of respondents disagree with the statement that layout
of the hospital is well planned in terms of grassing ,flowering and lighting .Hence the
majority of respondents agree the statement that layout of the hospital is well planned in
terms of grassing ,flowering and lighting.

48
structure of the building is attractive and convenient.
Parameter No of Percentage
Respondents

Strongly Agree 1 1%
Agree 49 49%
Neither agree nor disagree 0 0%
Disagree 43 43%
Strongly disagree 7 7%

Total 100 100%

Table no :4.9 : Showing respondents openion towards structure of the building is attractive

and convenient
60
49
50
43
40

30

20

10 7
1 0
0
Strongly Neither agree Agree Disagree Strongly
Agree nor disagree disagree

Chart no :4.9 : Showing respondents openion towards structure of the building is attractive

and convenient

Interpretation

From the above table and chart it is evident that 49 percent of the respondent agrees the
statement that structure of the building is attractive and convenient in the hospital and 43
percent of respondents disagree with the statement that structure of the building is attractive
and convenient .Hence the majority of respondents agree the statement structure of the
building is attractiveand convenient

49
Color of the building and the physical facility is good
Parameter No of Percentage
Respondents

Strongly Agree 0 0%
Agree 24 24%
Neither agree nor disagree 0 0%
Disagree 26 26%
Strongly disagree 40 40%

Total 100 100%

Table no :4.10 : Showing respondents openion towards color of the building and the
physical facility is good

Strongly Agree Neither agree nor disagree

Agree Disagree
Strongly disagree

27%

44%

29%

Chart no :4.10 : Showing respondents openion towards color of the building and the
physical facility is good

Interpretation

From the above table and chart it is evident that 44 percent of the respondent dtrongly dis
agrees the statement that towards color of the building and the physical facility is good in
the hospital and 29 percent of respondents disagree with the statement that color of the
building and the physical facility is good .Hence the majority of respondents strongly dis
agree with the statement towards color of the building and the physical facility is good.

50
Business card and brochures are provided by the hospital
Parameter No of Percentage
Respondents

Strongly Agree 0 0%
Agree 0 0%
Neither agree nor disagree 6 6%
Disagree 5 5%
Strongly disagree 89 89%

Total 100 100%

Table no :4.11 : Showing respondents openion towards business card and brochures are
provided by the hospital

Strongly Agree Neither agree nor disagree

Agree Disagree
Strongly disagree

6% 5%

89%

Chart no :4.11 : Showing respondents openion towards business card and brochures are
provided by the hospital

Interpretation

From the above table and chart it is evident that 89 percent of the respondent agrees the
statement that business card and brochures are provided by the hospital and 5 percent of
respondents disagree with the statement that business card and brochures are provided by the
hospital .Hence the majority of respondents agree the statement that business card and
brochures are provided by the hospital.

51
The nursing staff understood your needs and have shown commitment and
a positive attitude towards satisfying your needs.
Parameter No of Percentage
Respondents

Strongly Agree 23 23%

Agree 63 63%
Neither agree nor 0 0%
disagree
Disagree 14 14%
Strongly disagree 0 0%
Total 100 100%

Table no :4.12 : Showing respondents openion towards the nursing staff understood your
needs and have shown commitment and a positive attitude towards satisfying your needs.

Strongly Agree
Neither agree nor dis agree
Agree

14% 23%

63%

Table no :4.12 : Showing respondents openion towards the nursing staff understood your
needs and have shown commitment and a positive attitude towards satisfying your needs.

Interpretation

From the above table and chart it is evident that 63 percent of the respondent agrees the
statement that the nursing staff understood your needs and have shown commitment and a
positive attitude towards satisfying your needs and 14 percent of respondents disagree with
the statement that the nursing staff understood your needs and have shown commitment and a
positive attitude towards satisfying your needs in the hospital .Hence the majority of
respondents agree the statement that the nursing staff understood your needs and have shown
commitment and a positive attitude towards satisfying your needs

52
Staff look professional and elegant in their uniforms
Parameter No of Percentage
Respondents

Strongly Agree 20 20%

Agree 71 71%
Neither agree nor 1 1%
disagree
Disagree 8 8%
Strongly disagree 0 0%
Total 100 100%

Table no :4.13 : Showing respondents openion towards staff look professional and elegant
in their uniforms

90%
60% 20 1 71 8
30%
0
0%
ee re
e ee re
e
re
e
gr g gr g g
y
A isa A isa di
sa
gl rd D y
n no gl
S tro ee ro
n
r St
r ag
ithe
e
N

Chart no :4.13 : Showing respondents openion towars staff look professional and elegant
in their uniforms

Interpretation

From the above table and chart it is evident that 71 percent of the respondent agrees the
statement that staff look professional and elegant in their uniforms in the hospital and 8
percent of respondents disagree with the statement that staff look professional and elegant in
their uniforms in the hospital .Hence the majority of respondents agree the statement that
staff look professional and elegant in their uniforms

53
Front office staff and receptionists are good at giving instructions
Parameter No of Percentage
Respondents

Strongly Agree 31 31%

Agree 40 40%
Neither agree nor disagree 0 0%
Disagree 21 21%
Strongly disagree 8 8%

Total 100 100%

Table no :4.14 : Showing respondents openion towards front office staff and receptionists
are good at giving instructions

Strongly Agree Neither agree nor disagree

Agree Disagree
Strongly disagree
8% 31%
21%

40%

Chart no :4.14 : Showing respondents openion towards front office staff and receptionists
are good at giving instructions

Interpretation

From the above table and chart it is evident that 40 percent of the respondent agrees the
statement that towards front office staff and receptionists are good at giving instructions in
the hospital and 21 percent of respondents disagree with the statement that front office staff
and receptionists are good at giving instructions in the hospital .Hence the majority of
respondents agree the statement that towards front office staff and receptionists are good at
giving instructions

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 parking facility

Parameter No of Percentage
Respondents

Strongly Agree 13 13%

Agree 81 81%
Neither agree nor 2 2%
disagree
Disagree 4 4%
Strongly disagree 0 0%
Total 100 100%

Table no :4.15 : Showing respondents openion towards parking facility

Strongly Agree Neither agree nor disagree

Agree Disagree
Strongly disagree

4% 13%
2%

81%

Chart no :4.15 : Showing respondents openion towards parking facility

Interpretation

From the above table and chart it is evident that 81 percent of the respondent agrees the
statement that parking facility is good in the hospital and 4 percent of respondents disagree
with the statement that parking facility is good in the hospital .Hence the majority of
respondents agree the statement that parking facility is good.

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Room and wards are spacious.
Parameter No of Percentage
Respondents

Strongly Agree 0 0%
Agree 36 36%
Neither agree nor 0 0%
disagree
Disagree 43 43%
Strongly disagree 21 21%

Total 100 100%

Table no :4.16 : Showing respondents openion towards room and wards are spacious

Strongly Agree Neither agree nor disagree

Agree Disagree
Strongly disagree
21%
36%

43%

Chart no :4.16 : Showing respondents openion towards room and wards are spacious

Interpretation

From the above table and chart it is evident that 43 percent of the respondent disagrees the
statement that room and wards are spacious in the hospital and 21 percent of respondents
strongly disagree with the statement that room and wards are spacious in the hospital .Hence
the majority of respondents strongly disagree with the statement that room and wards are
spacious

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 Beds are comfortable
Parameter No of Percentage
Respondents

Strongly Agree 0 0%

Agree 54 54%

Neither agree nor 0 0%

disagree
Disagree 36 36%

Strongly disagree 10 10%

Total 100 100%

Table no :4.17 : Showing respondents openion towards beds are comfortable

Strongly Agree Neither agree nor disagree

Agree Disagree
Strongly disagree
10%

54%
36%

Chart no :4.17 : Showing respondents openion towards beds are comfortable

Interpretation

From the above table and chart it is evident that 54 percent of the respondent agrees the
statement that beds are comfortable in the hospital and 36 percent of respondents disagree
with the statement that beds are comfortable in the hospital .Hence the majority of
respondents agree the statement that beds are comfortable.

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Hospital is providing timely treatment
Parameter No of Percentage
Respondents

Strongly Agree 13 13%

Agree 81 81%
Neither agree nor 0 0%
disagree
Disagree 6 6%
Strongly disagree 0 0%

Total 100 100%

Table no :4.18 : Showing respondents openion towards hospital is providing timely

treatment

Strongly Agree Agree

Neither agree nor disagree Disagree
Strongly disagree

6%
13%

81%

Chart no :4.18 : Showing respondents openion towards hospital is providing timely

treatment

Interpretation

From the above table and chart it is evident that 81 percent of the respondent agrees the
statement that hospital is providing timely treatment in the hospital and 6 percent of
respondents disagree with the statement that hospital is providing timely treatment in the
hospital .Hence the majority of respondents agree the statement that hospital providing
timely treatment.

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 visiting the hospital because of the facilities and the ambiance provided by
the hospital
Parameter No of Percentage
Respondents

Yes 91 91%

No 9 9%

Total 100 100

Table no :4.19 : Showing respondents openion towards visiting the hospital because of the
facilities and the ambiance provided by the hospital

Yes No

9%

91%

Chart no :4.19 : Showing respondents openion towards visiting the hospital because of the
facilities and the ambiance provided by the hospital

Interpretation

From the above table and chart it is evident that 91 percent of the respondent accept the noise
the facilities and ambience and 9 percent of respondents do not accept with the facilities and
ambience.Hence the majority of respondents accept the facilities and ambience

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CHAPTER 5
CONCLUSION

41
5.1FINDINGS
 It is found that the noise level of the hospital is acceptable because 41% say no and 59% say
yes with the statement.
 It is found that the odor in the hospital is pleasant because 72% says yes and 28% says no to
the statement
 It is found that the hospital is hygienic because 6% strongly agrees and 80% agrees with the
statement
 It is found that the hospital provides an eco-friendly atmosphere because 80% strongly
agrees and 18% agrees with the statement
 it is understood that the waiting area provided to patients and visitors are good because 10%
strongly agrees and 89% agrees with the statement
 it is understood that the Consulting area is not overcrowded because 9% strongly Disagrees
and 90 % Disagrees with the statement
 it is understood that the patients admit cards are standard and it is attractive because 24%
strongly agrees and 70% agrees with the statement
 it is understood that the layout of the hospital is well planned in terms of grassing, flowering
and lighting because 91% strongly agrees and 7% agrees with the statement.
 it is understood that the structure of the building is partially attractive and convenient because
1% strongly agrees, 49% agree,43% Disagree and 7%Strongly disagree with the statement.
 it is understood that the color of the building and the physical facility is not good and it
doesn’t suit the hospital’s ambiance. Because 26%disagree and40%strongly disagrees with
the statement.
 it is understood that business cards and brochures are not provided by the hospital. Because
5%disagree and 89%strongly disagree with the statement
 it is understood that nursing staff understood the patient’s needs and has shown commitment
and a positive attitude towards satisfying their needs. Because23 % strongly agree, 63% agree
with the statement.
 it is understood that the staff looks professional and elegant in their uniforms. Because20 %
strongly agree,71% agree with the statement
 it is understood that the front office staff and receptionist are good at giving instructions.
They give the right guidance and provide answers to all queries of visitors Because31 %
strongly agree,40% agree with the statement

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  it is understood that the parking facility is good Because13 %strongly agree,81% agree with
the statement.
 it is understood that room and wards are not spacious Because43 % Disagree,21%Strongly
disagree
 it is understood that the beds are comfortable because 54% agrees with the statement and
36% disagrees with the statement
 It is understood that the hospital providing timely treatment because 81% agrees with the
statement and 13% strongly agrees with the statement
 it is understood that patients are visiting the hospital because of the facilities and the
ambiance provided by the hospital because.91% say yes to the statement.

5.2 SUGGESTIONS
 The hospital should take appropriate actions to reduce the noise
 The hospital has to ensure that there is a brochure that helps the outsiders to know more about
the hospital.
 The structure of the building and color has to be best suited for the hospital.
 The hospital should make the beds comfortable
 Wards and rooms in the hospital can be more spacious.

5.3 CONCLUSION

From the research, it is concluded that the physical evidence in the hospital is good. But in
some aspects like having a brochure or the problem regarding the space inside the rooms
wards should be considered by the hospital. Physical evidence is the environment in which
the service is delivered with physical or tangible commodities and where the firm and the
customer interact. Modern hospitals need to create a good ambiance. Right from the
reception, one finds very cordial and comforting staff. The ambiance plays an important role
because when a patient walks into the hospital he immediately forms an opinion about the
hospital. The staff follows a dress code to show professionalism and to maintain discipline.
The staff is trained to be understanding, warm, and comforting because the clientele that goes
to the hospital is usually disturbed or unhappy. The entire hospital needs to be centrally air-
conditioned with good lighting. Ventilation is taken care of by air-conditioning. Special care
should be taken to maintain hygiene, cleanliness in the whole hospital. A hospital has to keep
in mind both the aspects of physical evidence that is essential and peripheral. Physical

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evidence plays an important role in the hospital where the patients are already depressed or
traumatized and a good atmosphere could make all the difference. As the primary objective
of the study is to examine service marketing as applied to the healthcare industry, a simple
methodology was set for this study. The significance of developing a consumer [patient]
oriented approach in the healthcare industry is being increasingly realized. But the service
providers in this industry remain docile to translate this realization into a concrete strategy

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APPENDIX

63
Questionnaire

Dear Respondent,
I, HASHIM.P.V2nd year MBA student of A J Institute of management
Mangalore, Affiliated to Mangalore University is undertaking a project study on the “ROLE
OF PHYSICAL EVIDENCE IN QUALITY SERVICE DELIVERY” at Carewell
hospital and research center PVT ltd, Kasaragod. I request you Sir/Madam to kindly spend
your precious time and fill these questionnaires and help me in completing my project. All
the information provided by you will be kept confidential

Name:..................................................

Gender: Male Female

Age :

Below 20 20-35

35-60 above 60

1. The noise level of the Hospital is acceptable.

Yes No

2. The odor in this hospital is pleasant.

Yes No

3. The hospital is Hygienic.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

4. The hospital provides an Eco - Friendly atmosphere.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

5. The waiting area provided to patients and visitors is good.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

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6. The Consulting area is overcrowded at times.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

7. The patients admit cards are standard and it is attractive.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

8. The layout of the hospital is well planned in terms of grassing flowering and lighting.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

9. The structure of the building is attractive and convenient.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

10. The color of the building and the physical facility is good and it suits the
hospital’sAmbiance.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

11. The business card and the brochures are provided by the hospital

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

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12. The nursing staff understood your needs and have shown commitment and a positive
attitude towards satisfying your needs.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

13. The staffs look professional and elegant in their uniforms.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

14. The front office staff or receptionist is good at giving instructions. They give the right
guidance and provide answers to all your queries.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

15. The parking facility is good.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

16. The room and wards are spacious.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

17. The Beds are comfortable.

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

18.the hospital is giving timely treatment

Strongly Agree Agree

Neither agree nor disagree Disagree Strongly Disagree

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19. Are you visiting the hospital because of the facilities and the ambiance provided by the
hospital?

YES NO NO
        

20.Any suggestion?

..................................................................................................................

BIBLIOGRAPHY
BOOKS

1. C.R Kothari – Research methodology

2. R Srinivasan – Services marketing The Indian context

3. SM Jha – Services marketing

4. Govind Apt – Services marketing

WEBSITES

http://www.grupomio.org/?attachment_id=393

https://www.researchgate.net/publication/326773897_Does_the_Physical_Evidence_in_Emer
gency_Department_Affect_the_Loyalty_of_the_Beneficiaries_in_Jordanian_Healthcare_Org
anizations

www.wikipedia.org

www.heapol.oxfordjournals.org

www.academia.edu

www.learnmarketing.net

www.marketing91.com

www.studymode.com

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