Cognitive decision and post purchase behaviour patients perspective at a Multispecialty Hospital, Chennai ABSTRACT Sharanya Paranthaman Sri Ramachandra University, Porur, Chennai, India S.Sheela Rani New College Institute of Management, Royapettah, Chennai, India This paper focuses on the patients cognition, decision process while deciding upon a health care provider. Individual capacities, their thought process plays a vital role in decision making. The study has been conducted with 50 in patients at a multispecialty corporate hospital and methodical analysis was done in order to ascertain, the cognitive decision and its impact on the post purchase behaviour shown by the patients after selecting a health care provider. The entire process happens as a sequence starting from individual determinants of behaviour followed by decision process which further continues to reflect on the post purchase determinants and finally leads to the post purchase behaviour of the patients. Keywords: Patients, Individual Determinants of Behaviour, Decision Process, Post purchase determinants, Post Purchase behaviour, Health care providers, Patients, Patient attender. INTRODUCTION The study is based on Consumer behaviour (patients ) which involves consumer playing crucial roles such as learning or gathering information about the service. Once the consumer gathers information, perception plays a role which impacts on the decision making process. Consumers frame an expectation in their minds about the service they will receive during their transaction with the provider. This expectation is framed in the minds of the consumer as an upshot of their cognition, learning process, the response, views they received from different sources. Then the consumer actually experiences the service. The services can be experienced either by themselves or their dependents. Once the consumer experiences the service they try to compare if it matched well with the expectation they had in their mind. Satisfaction occurs when the perception and expectation matched well during the transaction with the provider. If in case there was a blotch in the process it affects the satisfaction level of the consumers and influences on the post purchase behaviour and repurchase intention. Hence the study focuses on traits which patients look frontward from a provider during the interface. RESEARCH OBJECTIVES 1) To assess the demographic factors and individual determinants of behaviour that influences the patient in choosing a health care provider. 2) To evaluate the decision process of the patients. 3) To assess the post purchase determinants that influences post purchase behaviour of the patient. METHODOLOGY The study follows a Descriptive research design. The following steps discussed in the below table has be carried out for the study: www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 09, January 2015 Page 73
Table 1: Steps in methodology S.NO STEPS IN METHODOLOGY DETAILS 1. Area of Research Multispecialty corporate hospital in Chennai was identified to conduct the study 2. Target Population The target respondents involved in the study are Inpatients 3. Inclusion criteria The patients who gave their consent to participate in the study. Patients above the age group of 18 years and in case of Pediatric wards the respondents will be the mother/ immediate care giver and the patients Patients who have been hospitalized for a period ranging between 3 days - 2 weeks 4. Exclusion criteria Patients who were unconscious were excluded. 5. Sampling technique Systematic random sampling technique was followed 6. Sample Size 50 Inpatients 7. Data Collection Primary data : Questionnaire was used for data collection Secondary data : Journals, Books etc. 8. Data Analysis : Percentage analysis Statistical tools used Weighted average Successively doing an all-embracing literature review and also after several levels of discussions with professionals in the field, the variables for assessing the patients discernment and the items under each category was identified. Table 2: Variables identified for the study S.NO Variables Key factors 1. External environmental variables Demographic factors 2. Individual determinants of Learning and memory Behaviour Motivation and involvement Attitudinal aspects Perception and information processing 3. Decision process Taking medical decisions Decision to choose a particular hospital Choice of hospitals Alternate choice of hospital Decision to choose a particular hospital 4. Post purchase determinants Doctor- Patient relationship Nursing care Overall rating of hospital 5. Post purchase behaviour Overall care & quality of service Affordability of charges Level of satisfaction Expectation about the hospital Recommendation about the hospital Avail the hospital services in the future Patient / attenders future expectation from the hospital www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 09, January 2015 Page 74
RESULTS The study has been analyzed using statistical tools such as percentage analysis and weighted average. The analysis has been done based on the variables identified for the study. The Demographic profile explains the aspects such as demographic variables used, categorization of the respondents details, number of respondents and their relative percentage based the categorization as shown in Table 3. Table 3: Variable 1 - Demographic profile of the Respondents (n= 50) S.No Demographic variables Categories Number of respondents Percentage (%) 1 Category of respondents Patient 28 56.0 Attender 22 44.0 Below 20 years 5 10.0 21 30 years 14 28.0 2 31-40 years 14 28.0 Age 41 50 years 7 14.0 51 60 years 6 12.0 Above 60 years 4 8.0 3 Gender Male 24 48.0 Female 26 52.0 4 Income per month in Rs. Not given 21 42.0 Below 30,000 12 24.0 30,000 40,000 10 20.0 Above 40,000 7 14.0 5 Marital Status 6 Education 7 Occupation 8 Locality 9 Family set up 10 Family size Married 40 80.0 Single 10 20.0 Illiterate 1 2.0 Primary education 7 14.0 High school 10 20.0 Undergraduate 24 48.0 Post Graduate 8 16.0 Business 10 20.0 Government employee 9 18.0 Private employee 10 20.0 House wife 14 28.0 Others 7 14.0 Rural 10 20.0 Urban 33 66.0 Semi urban 7 14.0 Joint 21 42.0 Nuclear 26 52.0 Extended 3 6.0 No. of Children One 13 26.0 Two 20 40.0 Three 12 24.0 >= Four 5 10.0 www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 09, January 2015 Page 75
11 First visit to the hospital 12 Number of the patient visited the hospital No. of Adults Two 31 62.0 Three 3 6.0 Four 14 28.0 Five 2 4.0 Yes 33 66.0 No 17 34.0 First visit 33 66.0 Two times 9 18.0 Three times 8 16.0 Figure 1: Variable 2 - Individual determinants of behaviour - Learning & Memory People who introduced the respondents to the Hospital Figure 1, shows that, 48% of respondents were introduced to the hospital by family members, 30% respondents said that colleagues introduced, 22% of them said that their Doctor/medical personnel introduced them to the hospital, 18% of respondents were introduced by their friends, and remaining 10 % respondents were referred by neighbours and other hospitals. www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 09, January 2015 Page 76
Figure 2: Variable 2 - Individual determinants of behaviour - Learning & Memory Source of awareness about the hospital Figure 2, shows the source of awareness and learning about the hospital among respondents. 76% of respondents learnt or got influenced about the hospital because of word of mouth, 48% of respondents source of awareness was through website, 22% respondents were influenced through brochures, 20% through Pamphlets / Hand bill, 22% of respondents said that they did not get influenced by any of the factors mentioned in the question and none of the respondents were influenced because of Advertisement/ radio. Table 4: Variable 2 - Individual determinants of behaviour - Learning & Memory Learning & Memory aspects in selecting the hospital Weighted average Mode of treatment and availability of modern equipment/multi-specialty facilities in the hospital 3.440 Prompt diagnosis 3.380 Insurance facilities 3.000 Doctor s Educational Qualification 3.800 Well- reputed with brand image 3.200 Hospital is widely accepted as best with minimum number of errors 3.440 Past relationship with the hospital 2.660 Learnt about this hospital from the ranking given by media / reports /magazines 3.340 Sure of the quality of care 3.140 The weightage of each aspect has been shown in Table 4. From the table we can know that, Doctor s educational qualification has been given more weightage by many respondents and a least weightage has been given for past relationship with the hospital. www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 09, January 2015 Page 77
Table 5: Variable 2 - Individual determinants of behaviour - Motivation & Involvement Motivating reasons to choose the hospital Reasons motivating to choose the hospital Weighted average Doctor I know & trust is here 3.660 Patient find it affordable 2.600 Financial constrains such as approved institution by employer or 3.220 insurance Doctors and other medical personnel inspire confidence 3.600 Reception & courtesy of the staff& other personnel 3.120 Ambience & atmosphere in the hospital 3.120 Convenience of transportation & nearness to the residence 2.520 From table 5, we can know the reasons which are motivating the patients to choose the hospital. The highest weightage and lowest weightage have been indicated with the arrow marks accordingly. Table 6: Variable 2 - Individual determinants of behaviour - Attitudinal aspects Attitudinal aspects in choosing the hospital Attitudinal aspects in choosing the hospital Weighted average Best suited for my status 2.40 Frightened of new or unknown hospitals 2.82 Medical personnel listen & understand the patient s problem 3.42 Friends and relatives always come here for treatment 3.06 Doctor s advice felt right 3.40 Doctor knows all about me 3.60 When attitudinal aspects of respondents are taken into consideration we can understand that, criteria such as friends and relatives coming to the hospital for treatment and the doctor knowing the information about the patient has been given more weightage compared to other aspects as shown in the table 6. Table 7: Variable 2 - Individual determinants of behaviour - Perception & information processing Perception & information processing with regard to choosing the hospital Perception & information processing with regard to choosing the Weighted average hospital Transparency in treatment procedures 2.32 Transparency in payment procedures 2.32 Economical even for those who do not have insurance 2.32 Counseling given by the doctor on treatment procedures and methods 3.64 Promptness of service 2.32 Counselling given by the doctor on treatment procedure and methods has gained more weightage when perception and information processing is taken into consideration as shown in the table 7. www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 09, January 2015 Page 78
Figure 3: Variable 3 - Decision process Medical decisions Figure 3, shows the Decision making process of respondents before they make medical decisions. Table 8: Variable 3 - Decision process Basis for deciding to choose the hospital Basis for deciding to choose the hospital Weighted average Chosen the hospital with full awareness 3.00 Chosen this hospital only because of the facilities in the hospital 2.80 Chosen this hospital only because of my doctor 3.34 Preferred hospital by many people 3.20 Hospital brand name 3.18 Location/ accessibility 2.84 Hospital affordable 2.64 Chosen this hospital only on the basis of reference without awareness about the doctor and the facilities 2.82 Table 8, shows the reasons that serves as basis for respondents to choose a hospital. The highest weightage has been given for doctor being the reason to choose the hospital and lowest weightage has been given for affordability. www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 09, January 2015 Page 79
Table 9: Variable 4 - Post purchase determinants Clinical aspects (Doctor- Patient relationship) Table 9, shows the various post purchase determinants with regard to Doctor Patient relationship. It s well understood from the table that respondents have given more weightage for aspects such as empathy, instructions regarding medications after discharge which impacts on the level of satisfaction during the transaction. The contents of Table 9, has been represented in Figure 4 as a bar chart. Figure 4: Variable 4 - Post purchase determinants Clinical aspects (Doctor- Patient relationship) Clinical aspects Doctor- Patient relationship Weighted average The doctor listens patiently and explains the benefits and risks involved in the treatment 3.58 Understood illness much better after seeing this doctor 3.56 Doctor always respects my privacy 3.56 Doctor to be empathetic towards me 3.80 The doctor gave instructions regarding medications and precautions to be taken after discharge 3.80 Totally satisfied with my visit to this doctor 3.80 Table 10: Variable 4 - Post purchase determinants Clinical aspects (Nursing Care) Clinical aspects - Nursing care Weighted average Prompt in responding to needs 3.54 Courteous while attending to the needs 3.68 Concerned to keep me informed about the treatment 3.54 Carries out the medical instructions given by the doctor 3.60 Gives importance to cleanliness and sanitary aspects. 3.54 Gives health education & instructions about medications. 3.60 The nurse indulged in small talks about my family and made me 3.42 www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 09, January 2015 Page 80
comfortable I am totally satisfied with the nursing care provided. 3.54 Table 10, shows the various post purchase determinants with regard to nursing care. It s well understood from the table that more weightage for aspects such as courteousness and indulging in small talks about family makes the respondents feel comfortable. The contents of Table 10, has been represented in Figure 5 as a bar chart. Figure 5: Variable 4 - Post purchase determinants Clinical aspects (Nursing Care) Table 11: Variable 4 - Post purchase determinants Overall rating of hospital Overall rating of hospital Weighted average Availability of equipment for test / investigations 3.22 Performing lab tests and imaging services as per the schedule 3.22 Punctuality in delivering the reports 2.98 Overall rating for the Diagnostic & Imaging services 2.98 Functionality and efficiency in catering to the needs of the patients 2.10 Cafeteria for the patient attenders 2.20 Overall rating for Dietary and Cafeteria 2.10 Functionality and efficiency in catering to the needs of the patients 2.48 Dispensing medicines without delay 2.58 Overall rating for hospital pharmacy 2.68 Cleaning the room & Toilet maintenance 1.82 Changing the sheets,bedding material and linen 1.82 Cleanliness of the linen and bedding material 2.08 Ambience & Cleanliness of the entire hospital 2.02 Overall rating for the housekeeping facilities 1.72 Table 11, shows the various post purchase determinants with regard to overall rating of www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 09, January 2015 Page 81
hospital. It s well understood from the table that respondents were satisfied and have given high weightage for Diagnostic and Imaging services and the housekeeping aspects have been rated with a lesser weightage. The contents of Table 11, has been represented in Figure 6 as a bar chart. Figure 6: Variable 4 - Post purchase determinants Overall rating of hospital Table 12: Variable 4 - Post purchase determinants Respondents experiences in the hospital Respondents Experiences In The Hospital Weighted average Services are provided without unnecessary delay 1.72 Information regarding the delay in service is being conveyed 1.72 Informing patients/ attenders exactly when the service will be provided 1.88 Standard pricing structure 2.38 Transparency in charges and patient-fees 2.20 Patients / Attenders feeling safe in their transactions 2.28 Systems and procedures related to billing are patient friendly 2.48 Have felt safe and secure during the stay in the hospital 2.70 Employees / non- clinical staffs have been consistently 3.00 courteous Good co-ordination & co-operation among the staff 2.60 Neat appearing employees 3.00 Good administrative systems & procedures 2.50 Availability of recreational services such as Newspaper, TV/Radio/ Wi Fi 2.50 Services provided under one roof 2.72 Support & confidence given by staff 3.00 Consideration to patient feedback 1.86 Table 12, shows the various post purchase determinants with regard to respondents experience in the hospital. It s well understood from the table that respondents have given www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 09, January 2015 Page 82
high weightage for employees / non clinical staffs consistently being courteous and aspects such as information regarding the services and related delays and consideration to patient feedback have been rated with a lesser weightage. The contents of Table 12, has been represented in Figure 7 as a bar chart. Figure 7: Variable 4 - Post purchase determinants Respondents experiences in the hospital Table 13: Variable 5 - Post Purchase Behaviour Post purchase Behaviour Weighted Average Overall care & quality of service 2.74 Affordability of charges 2.72 Level of satisfaction with regard to the visit 2.62 Matching of expectation & experience in hospital 2.22 Recommending hospital to others 2.70 Availing hospital service in future 2.34 The post purchase behaviour variable covers aspects, which help to determine how the patient will actually behave after experiencing the service. It takes into contemplation the aspects like how the patients / attenders feel about the overall care and quality of service, affordability of charges, their level of satisfaction, match between expectation and real experience. It also includes the criteria such as, if the patients / attenders will recommend the hospital to others and if they will avail the services in future if required. From the above table 13, it s well understood that, respondents have given highest weightage for overall care and quality of service. The lowest weightage has been given for matching of expectation with the experience they had in the hospital. The contents of Table 5, has been represented in Figure 8, as a bar chart. www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 09, January 2015 Page 83
Figure 8: Variable 5 - Post Purchase Behaviour CONCLUSION The study of patients behaviour is very decisive in the existing scenario. It is significant for the healthcare providers to analyze the key aspects which the patients look forward during the health care service delivery. From the study, we can know the aspects which the patients have considered while choosing a corporate hospital. And it s also understood that patients have acknowledged the quality of care, doctor patient relationship, nursing care, and overall services provided by the hospital. But somewhere during the process or transaction between the patients and providers coordination is loss sight off. Health care professionals can consider the prominence of coordinated care and focus on the aspects which are momentous to provide a co-ordinated care to the patients. Measures can be taken to coordinate with the staffs that provide administrative support to the patients. This helps to accomplish patient delight which is the need for the hour. REFERENCES 1. Anderson, LA. and Zimmerman, MA. 1993. Patient and physician perceptions of their relationship and patient satisfaction: A study of chronic disease management, Patient Education and Counseling, vol. 20, no. 1, pp. 27-36 2. Armstrong, D. 1991 What do patients want?, British Medical Journal, vol. 303, no.6797, pp.261-262. 3. Armstrong, J. 1991. Prediction of Consumer Behavior by Experts and Novices, Journal of Consumer Research, vol.18, no.2, pp. 251 256. 4. Baker, R. 1990. Development of a questionnaire to assess patients' satisfaction with consultations in general practice, British Journal of General Practice, vol. 40, no. 341, pp. 487 490. www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 09, January 2015 Page 84
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