Analysis on Emotional Touch Points as a Predictor of Service Quality in a Multispeciality Hospital, Chennai

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1 Analysis on Emotional Touch Points as a Predictor of Service Quality in a Multispeciality Hospital, Chennai Ms.M.Kalaiselvi Management Trainee, Sri Ramachandra Medical Centre, Chennai. Dr.D.Anantharajan Assistant Professor, Sri Ramachandra College of Management, Sri Ramachandra University, Chennai. ABSTRACT The study provides an attempt to identify and analyse the various patients emotional touch points in the course of their journey in a multispecialty hospital, where the literature failed to explain. Touch point analysis is a new potent tool to bridge the gap of relationships between the healthcare providers and patients, thus the objective of the study was to evaluate the concept, map and prioritise the various emotional touch points of both the patients and employees of the inpatients and outpatients of a multispecialty hospital. A pure, descriptive and fundamental research had been carried out in Nephrology, Orthopaedics, Oncology, Obstetrics and Gynaecology departments of the hospital by Non Probability Convenient Sampling and Simple Random Sampling technique through Hospital consumer assessment of healthcare providers and systems and MSCEIT closed ended questionnaire for patients and employees respectively. The data has been evaluated by using both the statistical and quality tools such as percentage analysis, weighted average, Pearson s coefficient correlation, gap analysis, chi-square, cause and effect and Pareto to determine the outcomes of the study. Key words: Emotional Touch points, Emotional Intelligence, Moments Of Truth, Patients Journey and Service Quality INTRODUCTION The Indian economy is persistently facing an increase in the domestic and international demand from the medical tourism and private equity investment which created a higher foreign direct investment in the health care industry.the IBEF November 2010 statistics reveals that the estimated value of the Health care industry in India is about USD 40 billion, and it may grow to USD 79 Billion by 2012 and ~ USD 280 Billion by 2020 with the average CAGR growth percentage of 21 within next 10years of period. According to the 2012 statistics the Joint Commission of International has given accreditation for 17 Indian hospitals and over 700 Indian hospitals had been applied for NABH accreditation due to the rapid increase in the customer centric approach in the hospitals all over India. There has been an increased trend towards the customer centric approach made the health care consumers to focus and value on the functional aspects of the service provider than the technical ones which were once a competitive advantage and can be easily replicated by others. The major functional component in the healthcare services is touch points or moments of truth which has been identified in the study by personnel observation of the researcher and the experts opinions from the healthcare sector, who were associated with the organisation for more than 10 years and have a rich clinical and administrative experience in the sector. The various emotional touch points in patient journey during their visit to the hospital are enlisted in the Figure 1 and Figure 2. NEED OF STUDY IRJBM ( ) Volume No VII August Issue 8 Page 21

2 Touch points are the basis for every interaction that patients experience during their visits to the hospital. The constantly changing space between the health care providers and patients is comprised of the points, where the healthcare providers such as doctors, nurses, paramedical staffs, receptionist and securities come into contact with the patients and attenders in the journey of their customer relationship cycle in the hospitals. They are the foundation of customer experiences and relationships. The literature failed to prioritise the touch point in the health care process, thereby investments made by organisation to increase the customer satisfaction becomes an additional burden to the organisation. The study focuses on mapping and prioritising the emotional touch points of patients and assessing the emotional intelligence of employees at the patients emotional touch points in the course of their treatment in hospitals. Thus the faded relationship between the healthcare providers and the consumers can be increased by focusing on the various emotional touch points thus the performance outcomes can be drastically improved. OBJECTIVES OF STUDY The major objectives of the study are 1. To study the concept of patient emotional touch points in the course of their treatment in hospitals. 2. To determine the patients experience at various emotional touch points on outpatient and inpatient department of the hospital. 3. To determine the gap between the perception of emotional touch points in patients and employees of outpatient and inpatient department. 4. To map and prioritise the emotional touch points of a patient in the course of their treatment in the hospitals. 5. To provide the measures and suggestions for an improved care at the patients emotional touch points. RESEARCH METHODOLOGY The research design of the study was a pure, descriptive and fundamental research design, about the various emotional touch points in the process of health care services, the study was confined to Nephrology, Orthopaedics, Oncology, Obstetrics and Gynaecology departments in private multispeciality hospital Chennai, for a study period of four month, from 2 nd February 2013 to 2 nd May The study was based on both primary data and secondary data. The primary data is collected through Hospital consumer assessment of healthcare providers and systems closed ended questionnaire for assessing the patients experience in the emotional touch points during their treatment in the hospital. The emotional intelligence of healthcare providers at the emotional touch points is collected through MSCEIT closed ended questionnaire. The secondary data is collected from the Hospital records maintained by the Quality department and medical records department in Sri Ramachandra Medical centre, Porur, Chennai, for a period of one year.non Probability Convenient Sampling and Simple Random Sampling technique has been used for the patients and employees respectively. The sample sizes of the study for each variable were as follows: 1. OUTPATIENT DEPARTMENT: The distribution of 80 outpatient department patient samples in various clinical department of Sri Ramachandra Medical Centre are as follows Nephrology department: 20 samples Orthopaedics department: 20 samples Oncology department: 20 samples Obstetrics and gynaecology department: 20 samples IRJBM ( ) Volume No VII August Issue 8 Page 22

3 Outpatient department health care providers: 40 samples 2. INPATIENT DEPARTMENT: The distribution of 80 inpatient department patient samples in various clinical department of Sri Ramachandra Medical Centre are as follows Nephrology department: 20 samples Orthopaedics department: 20 samples Oncology department: 20 samples Obstetrics and gynaecology department: 20 samples The data has been evaluated by using the statistical tools such as percentage analysis, weighted average, Pearson s coefficient correlation, gap analysis, chi-square and quality tools such as cause and effect relationship diagram and Pareto to determine the various outcomes of the study. RESULTS AND DISCUSSIONS DEMOGRAPHIC DETAILS: The results of the various demographic details of both the inpatient and outpatient department patient are given below TABLE 1 AGE AND GENDER DISTRIBUTION OF OP & IP PATIENTS OP PATIENTS IP PATIENTS AGE Male Female Male Female <20 YRS YRS YRS YRS >80 YRS TOTAL The table 1 shows that 35 percentage of targetpatients fall under the age group of 60 to 79 years, followed by 32.5 percentage of patients were in the age group of 40 to 59 years. TABLE 2 DISTRIBUTIONS OF OP & IP EMPLOYEES AGE OP IP Male Female Male Female <20 YRS YRS YRS YRS TOTAL The table 2 shows that per cent of employees are found under the range of 20 to 39 years, followed by 7.5 per cent of employees are the age group of 20 years TABLE 3EMOTIONS OF OP & IP PATIENTS DURING THE HOSPITAL VISIT ARISES EXPERIENCE OP PATIENTS IP PATIENTS TOTALLY RELAXED RELAXED ACCEPT AS INEVITABLE UPSET TOTALLY TENSED IRJBM ( ) Volume No VII August Issue 8 Page 23

4 The table 3 shows that 42.5 per cent of OP patients and per cent of IP patients were found that when the hospital visit arises they accept as inevitable. TABLE 4 EMOTIONS OF PATIENTS DURING THE HOSPITAL VISIT ANXIETY UNCERTAINITY HELPLESSNESS FEAR STRESS OP IP OP IP OP IP OP IP OP IP No Emotions Slight Intensity Medium Intensity High Intensity Extreme Intensity AVERAGE The table 4 shows infers that the weighted average of stress is 3.10 and 2.8in OP and IP patients respectively followed by 2.95 and 2.9 is found in anxiety level in OP and IP patients respectively. CHART 1 PARETO ANAYSIS PATIENT GRIEVANCES The Chart 1 depicts the major 20 per cent of causes leading to 80 per cent of problems in the patient satisfaction process IRJBM ( ) Volume No VII August Issue 8 Page 24

5 CHART 2 CAUSE AND EFFECT DIAGRAM FOR HIGHER PERCEPTIONGAPS INFORMATION WORK FLOW Difference of opinions between staffs Absence of T and Unexplained billing Poor appointment FACILITY Lack of pre and post purchase touch points Support services \ are under Strict norms and procedures Inadequate manpower Poor etiquette of staff Inner Processing time Poor co-ordination among departments PEOPLE HIGHER PERCEP TION GAPS Lack of competent skills Higher perception TABLE 5 EMPLOYEE EMOTIONAL INTELLIGENCE OVERALL SCORE TOTAL SCORE FREQUENCY PERCENTAGE LESS THAN ABOVE TOTAL The table 5 infers that per cent of employees had scored in the range of 161 to 180 followed by per cent of employees had scored above 180 in the emotional intelligence score. IRJBM ( ) Volume No VII August Issue 8 Page 25

6 TABLE 6 EMPLOYEE EMOTIONAL INTELLIGENCE SCORES IN FOUR CATEGORIES SCORES AWARENESS OF EMPLOYEES EMOTIONS MANAGEMENT OF EMPLOYEES EMOTIONS AWARENESS OF PATIENT EMOTIONS MANAGEMENT OF PATIENT EMOTIONS IP OP IP OP IP OP IP OP LESS THAN TO TO TO TO TOTAL The table 6 shows that 75 employees had higher emotional intelligence score in awareness of patient s emotions and 69 employees had scored higher in management of patients emotions. PERCEPTION GAP ANALYSIS The perception gap between the patients and employees in both the inpatient and outpatient department at various emotional touch points in the patients journey in the hospital has been evaluated below TABLE 7 GAP ON EMOTIONAL TOUCH POINTS PERCEPTION OF OP EMPLOYEES AND OP PATIENTS CONDITION OP PATIENTS OP EMPLOYEES GAP Received with dignity and respect Greeted by staff with smile Guidance for patients needs Listening to grievances of patients Employees punctual and responsiveness The table7 reveals that highest gap is found in employees punctual and responsiveness towards care of patients and least gap of is found in listening to patient s grievances. TABLE 8 GAP ON EMOTIONAL TOUCH POINTS PERCEPTION OF IP EMPLOYEES AND IP PATIENTS CONDITION IP EMPLOYEES IP PATIENTS GAP Received with dignity and respect Greeted by staff with smile Guidance for patients needs Listening to grievances of patients Employees punctual and responsiveness IRJBM ( ) Volume No VII August Issue 8 Page 26

7 The table 8 shows that highest gap is found in greeted by staff with smile and least gap of is found in guidance to patient s needs. TABLE 9 GAP ON EMOTIONAL TOUCHPOINTS PERCEPTION OF OP EMPLOYEES AND OP PATIENTS CONDITION OP PATIENT OP EMPLOYEES GAP Eye contact during communication Biased communication Unwanted personnel communication Co-ordinated care between departments Consistent courtesy level of employees The table 9 infers that highest gap is found in employees unwanted personnel communication and least gap of is found in co-ordinated care between departments. TABLE 10 GAP ON EMOTIONAL TOUCH POINTS PERCEPTION OF IP EMPLOYEES AND IP PATIENTS CONDITION IP EMPLOYEES IP PATIENTS GAP Eye contact during communication Biased communication Unwanted personnel communication Co-ordinated care between departments Consistent courtesy level of employees The table 10 depicts that highest gap is found in employees eye contact during communication with patients and least gap of is found in co-ordinated care between departments. TABLE 11 GAP ON EMOTIONAL TOUCH POINTS PERCEPTION OF OP EMPLOYEES AND OP PATIENTS CONDITION OP PATIENTS OP EMPLOYEES GAP Patience of employees Introduction of staff Privacy during treatment Employees discussion in elevators Support given by staff during financial crisis The table 11 shows that highest gap is found in employees unwanted discussion in elevators and least gap of is found in introduction of staff to the patients IRJBM ( ) Volume No VII August Issue 8 Page 27

8 TABLE 12 GAP ON EMOTIONAL TOUCH POINTS PERCEPTION OF IP EMPLOYEES AND IP PATIENTS CONDITION IP EMPLOYEES IP PATIENTS GAP Patience of employees Introduction of staff Privacy during treatment Employees discussion in elevators Support given by staff during financial crisis The table 12 reveals that highest gap is found in employees introduction to staff and least gap of is found in employees unwanted discussion in elevators and corridors. SUMMARY AND SUGGESTIONS The healthcare providers and the customers of the healthcare industry are thetwo major stakeholders, whose emotional instability affects the both the groups leading to the poor service by the organisation in particular healthcare provider s emotional instability affects patients, caregivers, and peers group of employees. Thus the emotional touch point analysis focuses on two aspects of emotions - the analysis of emotional touch point in patients and assessing the emotional intelligence of employees. PATIENTS EXPERIENCE AT EMOTIONAL TOUCHPOINT The pre and post exposure touch point in the hospital system has been in rudiment position. A well-structured pre exposure touch points such as standard appointment system, regular updating in the social networking sites which are the major technology related touch points in today s developing world shall be developed with good IT department. The major post exposure touch points such as post discharge tracking system, good and bad news communication process, revisiting tracking system shall help the hospital to establish better commitments towards patients. The patients experience at the emotional touch points shall be captured regularly by taking following measures Arranging interviews and discussion meetings with patients Capturing increased level of testimonials by direct supervision of top management Building of customer champion cultures can be made with long standing customers of the organisation. Additional feedback of the customers about the corrective actions that the organisation has taken, whereby the real expectation of the patients can be identified and provided at the right rate. Application of balanced scorecard system in the hospital increases the organisational productivity at critical points of care. Patient involvement, patient responsibility and empowerment, a sense of community and a close connection between their experiences makes better improvement in the hospital management. IRJBM ( ) Volume No VII August Issue 8 Page 28

9 PATIENTS GRIEVANCES ANALYSIS The system in the hospital is imbibed with strong norms and procedures towards processing the patients grievances. The system shall be improved by Developing tracking system of patients grievances Feedback system to the patients, increases their loyalty towards the hospitals Developing quality indicator checks such as Periodical analysis of number of grievances per month Grievances progress status. Frequent surprise checks by the top management. Post discharge care from the clinical sound person. Imbibing professionalism in contract employees through training. EMPLOYEES EMOTIONAL INTELLIGENCE The major focus of assessing the emotional intelligence in healthcare providers is to provide the staff with customer-care training, interpersonal skills, knowledge and values based performance tool which can improve patients experience. Self-awareness, emotional management, emotional connection and inspiring peer group employees can be considered in developing a standard emotional training module CONCLUSION Thus emotional touch points helps to emotionally engage with patients and families and to understand experience at a deep level, provide a realistic way in which patients and families can be involved in service design, and helps to uncover aspects of compassionate caring practice that are not easy to define. The study can be enhanced by focused research on the key health care concept of customer relationship management and emotional touch points of patients in specific clinical and support service departments of the hospital, customer communication process, touch points in international patients, accreditation of the hospitals with reference to various touch point in the hospital. REFERENCES BOOKS: 1. D.K. Sharma, Hospital administration and human resource management, PHI learning private limited publication, fifth edition,p Douglas TouchPoints: Creating Powerful Leadership Connections in the Smallest of Moments, jossy bass publications, first edition. JOURNALS: 1. Amy Feirn. The Patient Experience: Strategies and Approaches for Providers to Achieve and Maintain a Competitive Advantage, Deloitte s 2008 Survey of Health Care Consumers, P Enhancing service orientation through emotional intelligence amongst health care professionals: a case study of government hospital in Delhi, India, 3. Singh Dalip Emotional intelligence at work, a professional guide, Response book publications, 2002, pp IRJBM ( ) Volume No VII August Issue 8 Page 29