Quality of health care in Coimbatore district: a swot perspective leveraging user insights

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Susruta an Indian who lived in the 6th century BC has been globally acclaimed as the father of plastic surgery and his book Susruta Samhita talks on holistic care in ancient India.

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International Journal of Management (IJM) Volume 7, Issue 3, March-April 2016, pp.259–265, Article ID: IJM_07_03_024 Available online at http://www.iaeme.com/IJM/issues.asp?JType=IJM&VType=7&IType=3 Journal Impact Factor (2016): 8.1920 (Calculated by GISI) www.jifactor.com ISSN Print: 0976-6502 and ISSN Online: 0976-6510 © IAEME Publication QUALITY OF HEALTH CARE IN COIMBATORE DISTRICT: A SWOT PERSPECTIVE LEVERAGING USER INSIGHTS Dr. D. Padmanaban Director, Centre for Research in Social Sciences, Technology and Culture, Coimbatore–641037 Dr. B. Prasanna Soundari Assistant Professor, G R Damodaran Academy of Management, Coimbatore–641062 ABSTRACT Susruta an Indian who lived in the 6th century BC has been globally acclaimed as the father of plastic surgery and his book Susruta Samhita talks on holistic care in ancient India .The golden era of Indian health care is history and even after 68 years of independence universal health as declared by Alma Aata has not been achieved7.The scientific temper of India cannot be questioned, rather the management issues has created a cluttered environment. Fortunately the National Health Bill 2009 has placed the obligation on the Government to ensure protection and fulfilment of the right to health for all. The Indian health care system is at an inflection point and is poised to grow to USD 280 Billion by 2020. The nationwide environment signals that the market oriented approach has set in and it is imperative that one understands the system in which an organisation exist to formulate winning strategies. Strategic formulation without SWOT analysis are inadequate and consequently the tool is applied to dissect the quality of health care in Coimbatore district a renowned health city in the state of Tamilnadu in South India. Key words: Driving Forces, Quality of Care, Restraining Forces, SWOT Analysis, and User Perspective Cite this Article: Dr. D. Padmanaban and Ms. B. Prasanna Soundari. Quality of Health Care In Coimbatore District: A Swot Perspective Leveraging User Insights. International Journal of Management, 7(2), 2016, pp. 259–265. http://www.iaeme.com/IJM/issues.asp?JType=IJM&VType=7&IType=3 http://www.iaeme.com/IJM/index.asp 259 editor@iaeme.com
Dr. D. Padmanaban and Ms. B. Prasanna Soundari 1. INTRODUCTION Patient perception relates to how the patient feels after the treatment. In a health care set up quality of care should incorporate at least in part, components of patients' perceptions (Davies, Ware & John, 1988) 1. Globally patient centric approach has become the norm and marketing of health care has seeped to the developing nations from the developed nations in the era of open economy. Particularly in India the health care sector is in the center of transition and has experienced remarkable growth of 12% per year during the previous six years according to the Investment Commission of India. After globalisation corporate hospitals have made it big. FDI is permitted up to 100 percent under the automatic route, the medical device market is currently esteemed to be at $2.5 billion while the health insurance is projected to grow to US $280 billion by 2020. Indian medical visa, or the M visa, promotes travelling to India for the sole purpose of undergoing medical treatment. The patients of today have better awareness and are willing to be involved in decision making related to their health (Kaba & Sooriakumar, 2007) 4. The National Board for Hospitals and Health care providers an accrediting body founded by the Government of India at 2006 to set quality standards, signals India’s focus on quality. The state administered health care system prevails in India. The country’s health care in the current millennium progressed in a slow pace until Tamilnadu displayed accomplishments through effective and well-organised public health service. Chennai, Vellore, Coimbatore and Madurai are the backbone of Tamilnadu health care, with Coimbatore being frequently recognised for cost effectiveness in healthcare. Health Panel- Confederations of Indian Industry- Coimbatore has taken up an agenda to shape Coimbatore as a model city for health care. Impediments are never far away and the Confederation of Indian Industry –Tamilnadu has pointed that pocket of excellence are evident but queries on access and quality plagues (Challenges Faced, 2011)7. Solution to the queries can be traced by help of SWOT analysis concerning Coimbatore’s health care scenario. Further the SWOT analysis draws on patient feedback as user involvement is a significant factor in advancing the overall quality of health care provision.( Gott, Stevens, Small & Ahmedzai, 2002) 2. 2. SWOT ANALYSIS: A PRELIMINARY STEP TO WINNING STRATEGIES SWOT is an acronym for Strength, Weakness, Opportunities and Threats. The analysis categorise issues into strength, weakness, opportunities and threats and provides insights on business performance and prospects. The literature review identifies that the term SWOT was first mentioned by Urick and Orr in a seminar on “Long range planning” held in Zurich during 1964 (Thakur,2010)8. The evolution of strategic management has sculpted SWOT as a forerunner to the strategic planning process. The analysis has been extended beyond companies to counties and industries (Helms & Nixon, 2010)3. It is more of a marketing update that consolidates information in to manageable chunks and has to be concluded with caution to formulate a winning decision. Strength and weakness are internal factors as they are associated with an individual establishment unlike opportunities and threats that are linked with the industry or service sector and establishes itself as external factors. Having understood the need for continual adjustments to maintain the maximum functionality the health care sector has finally caught up with SWOT analysis as an action research to improve service provided (Toivanen, Lahti & Kilpi, 1999) 5. The http://www.iaeme.com/IJM/index.asp 260 editor@iaeme.com
Quality of Health Care In Coimbatore District: A Swot Perspective Leveraging User Insights cues from the health care studies has directed the current SWOT analysis to decipher the user information as directional change to realise the metro’s vision. 3. RESEARCH METHODOLOGY A descriptive study was undertaken to understand the quality of care in Coimbatore. The SWOT analysis is a part of a large research regarding the scenario of allopathic care in Coimbatore district. After a systematic review the health of allopathic care was examined by administering a structured questionnaire (English/Vernacular language) to the patients. As the SWOT is applied on a district the user insight carefully recorded during the pilot study was given due importance with reference to the factors considered as opportunities, threats, satisfaction and dissatisfaction. The pilot study conducted by selecting 50 rural and 50 urban respondents revealed a Cronbach’s alpha score of 0.682, which is more than 0.6 required for reliability of the data. The data drawn for the SWOT analysis involve the ranks awarded by the patients concerning the strength, weakness, opportunities and threats. 3.1. SAMPLING PROCESS 3.1.1. POPULATION Elements : Patients Sampling Units : Hospitals, then Patients Extent : Coimbatore District 3.1.2. SAMPLING FRAME: Indian Medical Association-Coimbatore Branch Register, Primary Health Center – Coimbatore District list and Coimbatore Corporation Urban Post/ Dispensary list. 3.1.3. SAMPLE SIZE: 350 respondents comprising of 175 samples from urban Coimbatore and the remaining 175 samples from rural Coimbatore. 3.1.4. SAMPLING METHOD: A two stage sampling with stratification was adopted. The sampling frame identified 280 hospitals out of which 131 was located within the city and treated as urban hospitals. The remaining 149 hospitals were representative of rural Coimbatore .i.e. outside city limits. 35 hospitals each from urban and rural stratum was selected at the first stage and from these 70 hospitals, 5 respondents were selected for exit interview based on judgment of care providers to generate 350 samples. 4. ANALYSIS AND DISCUSSION The primary data collected by way of administering questionnaire has been explored using the relevant statistical and management tool. The SWOT analysis a strategic tool has been employed on the consolidated data i.e. 350 patients allowing for the fact that the corporate hospitals as a united front are voicing their interest to brand Coimbatore and avidly seek help from the Government (Health care industry, 2010) 6. The insights of the 350 patients regarding their outlook towards the strength, weakness, opportunities and threats are examined using weighted average. http://www.iaeme.com/IJM/index.asp 261 editor@iaeme.com
Dr. D. Padmanaban and Ms. B. Prasanna Soundari Table 1 The ranks of the satisfaction/strength factors as perceived by the respondents by employing weighted average Final Rank Rank 1 Rank 2 Rank 3 Rank 4 Rank 5 Rank 6 Rank 7 WA* Rank Strength Weights - - (7) (6) (5) (4) (3) (2) (1) Price Frequency 93 93 83 44 11 10 16 - - Scores 651 558 415 176 33 20 16 5.34 1 Doctor Frequency 97 76 61 48 29 12 27 - - Scores 679 456 305 192 87 24 27 5.05 3 Quality of Care Frequency 125 47 59 65 14 11 29 - - Scores 875 282 295 260 42 22 29 5.15 2 Modern Frequency 31 13 22 33 62 88 101 - - Equipment Scores 217 78 110 132 186 176 101 2.85 7 Location Frequency 72 80 47 40 31 46 34 - - Scores 504 480 235 160 93 92 34 4.56 4 Drugs Frequency 34 65 50 48 63 61 29 - - Scores 238 390 250 192 189 122 29 4.02 5 Hygiene Frequency 32 45 49 44 91 76 13 - - Scores 224 270 245 176 273 152 13 3.86 6  WA*-Weighted Average. It is understood that price, quality of care, doctor and location are the factors that add to the strength of the health care establishment a patient visits. Price and quality of care are the top factors as they are awarded first and second rank respectively and are inferred as key helping factors. The factors location/proximity, drugs, hygiene and modern equipment’s are ranked fourth, fifth, sixth and seventh as indicated in the final rank column. Table 2 The ranks of the dissatisfaction/weakness factors as perceived by the respondents by employing weighted average Rank Rank Rank Rank Rank Rank Rank Rank Final Rank WA* 1 2 3 4 5 6 7 8 Rank Weakness Weights (8) (7) (6) (5) (4) (3) (2) (1) - - Frequency 119 55 65 33 43 16 4 15 - - Lack of Critical Staff Scores 952 385 390 165 172 48 8 15 6.10 1 Frequency 55 103 38 17 21 37 78 1 - - Quality of Care Scores 440 721 228 85 84 111 156 1 5.21 2 Frequency 65 58 61 28 37 36 15 50 - - Location Scores 520 406 366 140 148 108 30 50 5.05 3 Frequency 69 60 33 88 10 4 16 70 - - Individual Attention Scores 552 420 198 440 40 12 32 70 5.04 4 Frequency 39 46 81 24 44 42 54 20 - - Delayed Treatment Scores 312 322 486 120 176 126 108 20 4.77 5 Frequency 41 29 31 55 71 31 52 40 - - Hygiene Scores 328 203 186 275 284 93 104 40 4.32 7 http://www.iaeme.com/IJM/index.asp 262 editor@iaeme.com
Quality of Health Care In Coimbatore District: A Swot Perspective Leveraging User Insights Rank Rank Rank Rank Rank Rank Rank Rank Final Rank WA* 1 2 3 4 5 6 7 8 Rank Weakness Weights (8) (7) (6) (5) (4) (3) (2) (1) - - Frequency 25 27 22 43 67 27 46 93 - - Corruption Scores 200 189 132 215 268 81 92 93 3.62 8 Frequency 47 53 45 45 32 26 14 88 - - Crowded Scores 376 371 270 225 128 78 28 88 4.46 6  WA* -Weighted Average. The lack of critical staff is the weakness that is ranked first. It is observed that the factor quality of care is the second most cited weakness making one realise that this entity that adds to the strength of some health care establishment are considered as a dissatisfaction factor in various other organisations. Location and lack of individual attention are the other foremost aspects that are attributed to the cause of dissatisfaction as they are ranked as third and fourth respectively. The factors delayed treatment and crowd are not given much importance, as dissatisfaction regarding these aspects are relatively low. It is interesting to note that the aspect corruption which is prevalent in India is assigned the last rank. Table 3 The ranks of the opportunities as perceived by the respondents by employing weighted average. WA* Final Rank Rank 1 Rank 2 Rank 3 Rank 4 Rank 5 Rank Opportunities Weights (5) (4) (3) (2) (1) - - Government Schemes Frequency 174 53 69 35 19 - - (Insurance - Price) Scores 870 212 207 70 19 3.93 1 Frequency 58 108 87 59 38 - - Health Consciousness Scores 290 432 261 118 38 3.25 2 Advancement of Frequency 83 108 96 47 16 - - Technology Scores 415 432 288 94 16 3.55 3 High no. of Hospital Frequency 26 70 56 150 48 - - Scores 130 280 168 300 48 2.64 4 Private Insurance Frequency 26 36 42 27 219 - - Scores 130 144 126 54 219 1.92 5  WA* - Weighted Average The Government schemes and the increased awareness regarding personal health are the major opportunities as perceived by the respondents as they are awarded first and second rank. They are the driving forces of Coimbatore health care sector. The Government insurance is a price factor as the cost burden is reduced. Advancement of technology, increasing number of hospitals and private insurance are relatively less significant. http://www.iaeme.com/IJM/index.asp 263 editor@iaeme.com
Dr. D. Padmanaban and Ms. B. Prasanna Soundari Table No. 4: The ranks of the threats as perceived by the respondents by employing weighted average. Final Rank Rank 1 Rank 2 Rank 3 Rank 4 WA* Rank Threats Weights - - (4) (3) (2) (1) Private Clinic Frequency 57 44 92 157 - - Scores 228 132 184 157 2.00 3 Lack of Critical Frequency 89 99 126 36 - - Staff Scores 356 297 252 36 2.68 2 Lack of Preventive Frequency 151 94 72 33 - - Care Scores 3.03 1 604 282 144 33 Corruption Frequency 63 109 69 109 - - Scores 252 327 138 109 2.36 4  WA*-Weighted Average. Lack of preventive care and critical staff are the major threats as understood from the final rank column of TABLE No. 4 based on weighted average. These attributes are the restraining forces of Coimbatore health care sector. Private clinics is not much of a threat according to the patients of Coimbatore and once again as in the case of weakness (TABLE No.2) corruption is awarded the last rank. Figure 1 The Driving and Restraining Forces of Coimbatore Health Care Sector. The SWOT is visually represented in “Fig No.1”. It indicates how the Coimbatore District perceive the existing senario. The ranks awarded by using weighted average are diagramatically represented and hence the smaller the length of the bar the more influential the factor is. The driving factor or the key leverage http://www.iaeme.com/IJM/index.asp 264 editor@iaeme.com
Quality of Health Care In Coimbatore District: A Swot Perspective Leveraging User Insights factors of Coimbatore is price as TABLE No.1 and TABLE No.3 specifies that the first rank is awarded to price in both cases i.e.when perceived as strength and as an opportunity. TABLE No.2 and TABLE No.4 pins lack of critical staff as the restraining factor or the key vulnerable factor of the Coimbatore health care sector as it is ranked first when perceived as dissatisfaction factor and ranked second when perceived as a threat. More over corruption is ranked last when perceived as weakness and as a threat. 5.CONCLUSION Strategies that use strength to maximize opportunities are called Maxi-Maxi strategies in management parlance and can be employed on the price aspect. Coimbatore can be branded as a medical destination that is cost effective a case of reinforcing the existing image. Similarly Min-Mini strategy are actions that minimize weakness and avoid threats and can be employed on the factor lack of critical staff. Investment of health care training institutes can be an alternative to think about. The restraining factors are to be transformed as driving factors by observing stringent quality initiatives as in health care life is at stake. The analysis is limited to understanding the most influencing factors of the health care sectors but dosent prioritise the issues. Gap analysis is the next step to improvise on the SWOT results. REFERENCE [1] Davies, A. R., and Ware, John E, Jr. (1988). Involving consumers in quality of care assessment. Health Affairs, 7(1), 33-48. [2] Gott, M., Stevens, T., Small, N., and Ahmedzai, S. H. (2002). Involving users, improving services: The example of cancer. British Journal of Clinical Governance, 7(2), 81-85. [3] Helms, M.M., and Nixon,J, 2010, Exploring SWOT analysis – where are we now?: A review of academic research from the last decade, Journal of Strategy and Management, 3(2), 215 – 251. [4] Kaba, R. and Sooriakumar, P. (2007). The evolution of doctor patient relationship. International Journal of surgery. 5(1):57-65. [5] Toivanen, T., Lahti, S., and Leino–Kilpi H. (1999), Applicability of SWOT analysis for measuring quality of public oral health services as perceived by adult patients in Finland. Strengths, weaknesses, opportunities and threats, Community Dent Oral Epidemiol, 27(5):386-91. [6] States: Health care industry in Coimbatore has huge potential, (2010), Business line, Retrieved from http://search.proquest.com/docview / 749790927?accountid=38609 [7] Managing Risk in Software Projects S Ravichandran, PM Shareef, Indian Management 40, 56-62, 2001. [8] Special Correspondent. (2011, April 30), Challenges faced by healthcare sector discussed, The Hindu, Retrieved from www.thehindhu.com [9] Dr. A Thimmana Gouda, Veerabhadrappa Algur and R G Vani. Development of Strategic Plan in A Technical Educational Institution Through Swot Analysis. International Journal of Industrial Engineering Research and Development, 7(2), 2016, pp. 259–265. [10] Thakur S, (2010, Dec 16), History of the SWOT analysis, retrieved from http://www.brighthubpm.com/methods-strategies/99629-history-of-the-swot- analysis/ http://www.iaeme.com/IJM/index.asp 265 editor@iaeme.com