Service Operations Management

E-Healthcare Services

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Contents Introduction .................................................................................................................................................. 3

MediAngels ............................................................................................................................................... 3

Service offerings of Mediangels ................................................................................................................ 4

Service Classification ..................................................................................................................................... 6

Role of technology in the Service encounter ................................................................................................ 6

Current Service Flowchart............................................................................................................................. 7

Service Blueprint ........................................................................................................................................... 8

Qualitative Research ................................................................................................................................... 10

Quantitative research ................................................................................................................................. 10

Research findings ........................................................................................................................................ 13

Service Quality Gap Model ......................................................................................................................... 13

Cause and Effect Analysis............................................................................................................................ 15

Future Challenges ....................................................................................................................................... 16

Recommendations ...................................................................................................................................... 16

References .................................................................................................................................................. 17

Appendix ..................................................................................................................................................... 18

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Introduction

E-health - any electronic exchange of healthcare data or information across organizations reflects an

industry in transition. Even as its form and structure continue to emerge, e-health is being used to

change business and medical practices, affecting every facet of the health experience. Business, medical,

social, and technological factors are converging to make wide-scale, continuum-based care functionally

achievable perhaps for the first time. The Internet clearly drives the development and adoption of e-

health applications; standing alone, it has the reach, the infrastructure, and the acceptance to achieve

widespread change. As the public grows increasingly Internet-enabled, healthcare organizations have an

opportunity to cost-effectively reach a large part of the Indian population. The sheer breadth of e-

health, the many options available to healthcare organizations, and the relative immaturity of the

applications in most areas make navigating the spectrum of possibilities a clear healthcare management

challenge. Deciding how to incorporate the demand for e-health has extensive technological,

organizational, managerial, and ethical implications.

MediAngels

MediAngels is providing the service of a Global eHospital that revolutionizes the way we look at

healthcare and takes away the hassles of hospital visits. An entire team of qualified and experienced

medical specialists, carefully handpicked from across the globe, are all geared to deliver world-class

healthcare at the click of a button. It makes possible to consult a super-specialist for any ailment,

anytime of the day from anywhere in the world. The credentials of each specialist can be verified to

ensure that customer get to choose from only the genuine and the best. The consumer has to logon to

the Mediangels websit and then choose the doctor to forward his query.

The major advantages of the service are:

No queuing up at the doctors.

No shuttling between clinics.

No appointment hassles.

No traveling stress.

The main features of the Mediangels services are :

300 medical experts from more than 85 specialties and sub specialties

World-class infrastructural support through hospital tie-ups

Security systems to safeguard your private data

Online storage space for medical documents and reports

Live-chat feature for one-on-one communication with your doctor(s)

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Service offerings of Mediangels

1. eQuery

eQuery service allows you to ask basic questions only and text is limited to 60 words. This

service allows the customer to ask specific queries related to a medical problem. Customer can’t

interact with medical expert in real time. This service is not meant for elaborate diagnosis so

customer can’t upload his medical reports and previous diagnosis.

2. eConsult

The MediAngels eConsult allows entering comprehensive details of your medical history and

uploading relevant medical reports, CT scans, photographs, images or any other material that

may help your doctor assist you better. It is possible to create different user profiles under same

login profile to seek opinions for patient’s family members in case they are unable to do so

independently. This facility is the first step to organize and maintain the entire family’s health

records online for easy reference.

MediAngels eConsult is ideal for those who seek:

A correct diagnosis for their health problem.

A second opinion before making a decision.

The best course for treatment for a specific disease/disorder.

Specialized healthcare facilities that is not available locally. Opinions from world-known authorities on a particular disease.

3. Video Consultation

MediAngels provides Video Consultation facility (on request) i.e. Online face to face consultation

with the Specialist doctor from anywhere across the globe. Video Consultation facilitates patient

- physician live interaction (via webcam chat) to resolve the endless concerns specific to your

medical condition. This eliminates the need to wait for days to get the Specialist Doctor's

appointment.

4. eInvestigation – Blood test

MediAngels eInvestigation allows customer to get diagnostic tests done from the comfort of

his/her home. MediAngels has tie-ups with diagnostic centres at almost every conceivable

location in India. All labs have been specially accredited by MediAngels using stringent quality

assurance criteria. The samples are collected by MediAngels from customers home. The reports

of the tests are uploaded on the profile of the customer. Uploaded reports can be instantly

viewed and commented upon by your MediAngels doctor.

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5. MediAngels Annual Health Check up (H40)

The main features of H40 are:

Complete, Credible, Convenient Health Screening

40 essential blood tests to check functions of all vital organs of body

Interpretation of the H40 Blood tests by Top Most MD Doctor

Free home collection of Blood Samples, Store Reports Online

Free Telephonic Discussion on Test Reports with Doctor

A must for everyone above 25 years of age to keep track of health

Tests Included in MediAngels H40

Test Remarks

Lipid Profile (7 tests)

Useful to screen risk of coronary heart disease, heart attack or stroke, to evaluate the success of lipid-lowering drugs/lifestyle changes such as diet and exercise.

Liver Profile (10 tests)

Useful to assess liver function, to screen for or detect liver diseases, injury or infection

Iron Profile (3 tests)

Useful to diagnose iron deficiency like Anemia and iron excess like hemochromatosis and to monitor response to therapy, e.g., oral or parenteral iron, ascorbic acid and erythropoietin.

Thyroid profile (1 test)

Useful to evaluate thyroid gland function and to diagnose thyroid disorders and also to monitor treatment of thyroid disease.

Complete Blood Count (14 parameters)

Screening test to evaluate person's general health status and as a check for anemia, infection, leukemia, allergy, asthma and many other diseases.

Renal Profile (5 test)

Useful to detect kidney problems and kidney function.

MD Doctor Interpretation

H40 includes interpretation of the test reports by an expert MD Doctor, delivered to you along with the test reports.

MediAngels doctors panel

The doctors panel for Mediangels service consist of following speciality areas:

Adult specialities

Pediatric specialities

Cancer specialities

Eye specialities

Dental specialities

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Service Classification To better understand the services provided by MediAngels, service process matrix can be used to

examine the factors which affect the character of service delivery process. In this matrix , services are

classified across two dimensions namely, vertical dimension which measures the degree of labour

intensity (ratio of labour cost to capital cost) and horizontal dimension which measures the degree of

customer interaction and customization (ability of customer to affect personally the nature of service).

Service Factory

Service Shop

Mass Service Professional Service

MediAngels service is a mix of professional (medical) advice and pathological tests. Degree of

customisation and degree of labour intensity is high in the case of professional advice but degree of

labour intensity being lower in case of pathological test case. Based on this analysis services provided by

MediAngles finds a place in between service shop and professional service.

Implications

High degree of labour intensity and customisation in the case of professional service calls for

personal engagement with customer based on customer’s requirement to create a positive

perception about service delivery

Role of technology in the Service encounter Development in communications and information technology has influenced the way customer interacts

with service providers. Based on five modes of technology’s contribution to the service encounter

proposed by Craig M. Froehle and Aleda V. Roth services provided by Mediangels can be termed as

Technology-Mediated-Service encounter.

Mediangels

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In this case internet and telephone serve as a medium of interaction between customer and service

provider where there is no face-to-face contact.

Current Service Flowchart

Based on our analysis of the flow of service provided by MediAngels we have prepared a service

flowchart.

The service provided by MediAngels can be broadly divided in two parts namely professional advice and

pathological tests. E-Query and E-consulting service is part of professional service while E-Investigation

and H-40 tests constitute pathological test service part.

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The process starts with customer creating profile on the webpage of MediAngels by providing personal

details. Then the customer chooses the service which gets processed with the help of internal family

physician. Based on customer’s requirement a specialist is chosen for consultation that checks all the

relevant information provided by the customer and advises accordingly. The family physician helps out

the customer if a customer has certain queries after availing the service.

Key Observations

Role of family physician is crucial in the service flow part of professional service as he is the first

human contact for the customer. The family physician helps in choosing the specialist as well as

simplifying the complex diagnosis to be understood by layman customer who is not

sophisticated to understand medical terminologies

Lab personnel collecting samples from customer’s home also plays an important role in

developing favourable perception about the service as he is the human contact for the

customer. This implies that lab personnel must be properly trained in professional as well as

inter-personal aspects of service

Service Blueprint

The service blueprint provides a framework to understand how the customer and service provider

interact through five components namely physical evidence, customer actions, visible contacts, invisible

contact and support processes. Three lines are also employed to divide the layers of contact between

customer and service provider. This blueprint helps in designing the service delivery by ascertaining the

specifications needed for developing the service.

In this case physical evidence for the customer is web-page of the company which influences the

customer to develop certain perceptions about the service even before availing the service, hence the

service provider needs to ensure that the physical evidence is consistent with customer’s expectations

and service’s image evident from the web-page.

Activities above line interaction are customer initiated steps, choices, and interactions the customer

performs in the process of availing the service.

The line of interaction shows direct contact between the customer and the service provider. Here the

personnel interacting with customer need to be well-trained to understand the customer’s need and

show empathy. Similarly it should be examined that what skill-set is required to serve the customer in a

better way.

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Below the line visibility the customer can’t see the processes involved in delivering the service but if

these processes are not properly planned then may affect the whole delivery process negatively and

may result in a dissatisfied customer. Hence, the back-office system should be robust to ensure error-

free service delivery.

Hence this blueprint comes handy in testing the service concept before making any serious commitment

towards the service offering. Potential problem can be identified at this stage by pinpointing potential

failures and highlighting opportunities to enhance customer’s perceptions of the service.

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Qualitative Research In order to design the online format of the medical service, it is very important to know about the

consumer preferences and attitudes towards the service. Therefore we conducted the in depth

interview of thirteen people to get idea about the perception of the people about the general as well as

online medical service. The interview consisted of around thirty two questions on different aspects

related to online as well as general medical service. The interview help us know the decision maker of

the family, motivation behind the use of service, satisfaction level of the consumers from the service,

their consumption experience and the factors which are important in making the decision.

The major factors identified by the qualitative research are:

Reliability – This is one of the most important factors considered by the people who are more health conscious. Such people give more preference to quality of the service and credibility of the doctors to the cost of the service.

Ease of use – It includes the service provided by the hospital or clinic, that how user friendly is the service to the consumer. This includes waiting time, technology used for interaction with doctors or technicians etc.

Location convenience – If the location of the consumer is far away from the hospital, it is difficult for him to get the service. This happens when a person is located in rural areas or sub urban areas. In this case the service like home collection of samples and talking to the doctor online becomes very easy and convenient.

Time convenience – Due to the changing work culture, the people are facing shortage of time and it becomes difficult for them to get appointments from doctors at their convenient timings. Online medical service provides them the opportunity to get the required service at their convenient timings.

Instant Diagnosis – If someone feels some health problem, then his first is priority to know the cause of the symptoms. Online medical service allows getting the initial diagnosis instantly.

Cost – Cost is also one of the major factors in choosing the medical service. But the cost consideration depends on the kind of disease.

Multispecialty services – It means that different specialized medical services availability at a single location. In order to diagnose the problem, it is easy to find the disease in case of multispecialty hospitals because all the specialized doctors are available at a single place.

Quantitative research After identifying the major factors, the quantitative research was done to identify the importance of

each of the factors in choosing the online healthcare service. A questionnaire was floated which

consisted of thirty two questions starting with the demographic profile of the person. Reliability was

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found the most important parameter followed by time convenience and location convenience. The

breakup of all the factors is given in the figure below.

Figure: Important parameters in choosing the online healthcare services

The three major reasons for which people go for online healthcare services are

Second opinion – Before making a major decision while going for medical service or due to dissatisfaction, lack of trust on doctors, people take second opinion in order to make their deciosn making process more reliable. Through online medical service, one can get the second opinion easily from the doctors of their choice.

Specialist diagnosis – In rural areas and semi urban areas, the doctors are not highly qualified. Due to the lack of specialist doctor in the area, people seek for specialist advice from more qualified doctors in other cities or through online healthcare services. Online healthcare services help such consumers to get the specialist advice from highly qualified doctors all over the world.

Initial diagnosis – If the consumer identify the symptoms of some disease, the he go for the healthcare service and if due to some reason like location, time etc. someone is not able to get the service then he can go for online healthcare services for the initial diagnosis.

Out of these three, most important reason is the second opinion followed by specialist diagnosis and

initial diagnosis. The breakup is shown in the figure below.

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Figure: The reason for choosing online healthcare services

The choice of taking second opinion depends upon following factors:

1. Decision on major surgeries 2. Lack of trust on doctors 3. Dissatisfaction with present treatment 4. Unavailability of specialized doctors

The break up is given below.

Figure: The reason for second opinion

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Research findings • In medical services, people give more importance to reliability than convenience.

• The people who use internet for online transactions are more comfortable with using online

healthcare services.

• Innovators are more likely to go for online healthcare services.

• Around 35% people have heard of online healthcare services.

• Only 15% of people (or their closed ones) have used some kind of online healthcare service.

• Most of the people find it difficult to access online healthcare service.

• Satisfaction level with the current online medical service is average.

• People prefer to refer peers than family, business groups or other sources.

People refer peers due to credibility of the source of information.

Service Quality Gap Model

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Measuring the gap between expected service and perceived service is routine customer feedback

process and is practiced by leading service companies. In the above figure we identified some gaps as

follows:-

Gap 1- This gap arises from management’s lack of full understanding about how customers formulate their expectations on the basis of a number of sources like advertising, past experience etc. As our research findings suggests that in healthcare sector people give more importance to reliability than convenience. When Mediangels was launched its primary aim was to provide convenience to people. Management did not put any effort to communicate the reliability of the services. Hence, here we see a gap between customer expectations and Management’s perception of customer’s expectations.

Gap 2- It results from lack of management commitment to service quality or a perception of the unfeasibility of meeting customer’s expectations. Mediangels was launched keeping in mind to provide convenience to customers but the scanning of diagnostic reports may cause inconvenience to patients. Also, there are chances that the scanned quality of the reports sent are not good .

Gap 3- This Gap arises due to the difference between the service standards set by the management and service delivery. Mediangels has collaboration with various labs, but still they do not have a standardized process or operations followed in each of the labs. So, there is a difference between the expected service standards and service delivery due to lack of standardization of lab operations.

Gap 4- It arises due to difference between Service Delivery and Customer Perception. As Mediangels are new to the market, we couldn’t find any substantial evidence of this gap but Mediangels are not sending any physical reports or prescription to the customers, so there are chances of communication gap.

Gap 5- The gap between customer expectations and perceptions is defined as Gap 5 and is dependent on minimizing the four gaps that are associated with the delivery of service as mentioned above. If Mediangels focuses on minimizing the above four gaps, then this gap would automatically be minimized.

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Cause and Effect Analysis

In the above fishbone diagram, we tried to list out various causes which will lead to unsatisfied

customers. We broadly divide them into four categories:

1) People – In e-query, patients are not getting a chance to directly interact with the physician, so there are chances of communication gap. Also, if the patient wants further clarifications, he/she needs to repeat the whole process again. Also, due to the different nationalities of patients and doctors, there are chances of time mismatch as patient couldn’t find the appointment at his/her convenient time. All this lead to unsatisfied customers.

2) Technology- The quality of scanned reports would always be a problem as well as in developing countries like India, Internet connectivity issues will lead to unsatisfied customers. Also, some of the reports like X-Ray Report cannot be scanned.

3) Information- If misleading information is provided by patients to doctors, and then the treatment would not be that effective. Also, because of no physical interaction between patients and doctors, there are fair chances of information misinterpretation.

4) Procedures- If patient needs further clarification in case of e-query, he/she needs to follow the whole procedure again and again he/she needs to wait for 2-3

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days for getting a response. Also, there are chances that the medicines prescribed by Mediangels doctors are not available at local shops. All this lead to unsatisfied customers.

Future Challenges

As the customer base is increasing, there will be concerns about the privacy and confidentiality of patient’s data.

Mediangels has limited reach due to the low internet penetration in developing countries

Most of the people in tier-3 cities are reluctant to use credit/debit cards online due to security concerns.

Mediangels have to create extensive test lab network in order to cater to the increasing demand and should focus on effectively managing supply and demand.

Recommendations

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We included blue boxes to show that the how we can improve that particular step in current service

flowchart to make the services more effective.

Mediangels can include IVRS Registration i.e. accepting registration and payment through mobiles to facilitate the registration process.

Mediangels can issue a checklist to different labs so as to avoid any mistakes in service delivery (mistake proofing).

Mediangels can tie up with different pharmacies so that patients can order the medicines online in case of non-availability of medicines in local shops.

Mediangels can look forward to open consultancy services for doctors i.e. doctors can register and interact with various renowned doctors in case of any clarifications needed.

Mediangels can tie- up with different couriers in order to facilitate customers in sending and receiving their medical reports.

There should be an effective feedback system in place in order to minimize the gap between customer perceptions and customer expectations.

References

Rucha Kavathe, 2009.”Patterns of access and use of online health information among internet

users: A case study”

Lawrance John, 2010.”Determinants of online health information seeking:Extending Andersen’s

healthcare model to examine choices made about health information sources”

Fitzsimmons James, Fitzsimmons Mona. “Service Management- Operations, Strategy,

Information Technology”, Tata Mcgraw- Hill ( fifth edition)

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Appendix

Quantitative Research

Questionnaire:

1 Name

2 Location

[1-Metro | 2-City | 3-Town | 4-Small town]

3 Address

4 Age

5 Education

[1-Illiterate | 2-Primary | 3-Sec/HS |5-Grad. | 6-PG | 7-Diploma]

6 Occupation [1-Govt|2-Private|3-HW|4-Stud.|5-Ret.|6-Business|7-Labourer|8-

Unemployed]

7 Marital status [1-Married | 2-Unmarried]

8 No. of family members

Adult Male

Adult Female

Children

9 No. of Working members

Male

Female

10 Monthly family income

11 Have you ever used online transactions?

Yes No

12 If yes, how many transactions per month?

1 2 3 4 More than 5

13 How often are you referred to specialized medical center?

Weekly Monthly Quarterly Yearly More than a year

14 How easy do you find to access special medical services? (rate: 1 easy, 7 difficult)

1 2 3 4 5 6 7

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15 How important are the following criteria while choosing medical services? (rate: 1 High, 7 Low)

Convenience 1 2 3 4 5

Reliability 1 2 3 4 5

16 Rate your preference for reliability vs. convenience

Reliability 1

2

3

4

5

6

Convenience 7

17 Have you ever heard of online medical services?

yes no

18 Have you ever used of online medical services?

yes no

19 If yes rate your experience:

Satisfied 1

2

3

4

5

6

Dissatisfied 7

20 Rate the following parameters with respect to their importance while evaluating online medical services:

Location Convenience 1 2 3 4 5 6 7

Time Convenience

Reliability

Ease of use

Multispecialty Service

Cost

Instant Diagnosis

21 Which will be the most important reason if you consider using online medical service?

Initial Diagnosis Second Opinion Specialist Diagnosis

22 Rate the following parameters on scale of 1(Highest) to 7(Lowest)

Initial Diagnosis 1 2 3 4 5 6 7

Second Opinion 1 2 3 4 5 6 7

Specialist Diagnosis 1 2 3 4 5 6 7

22a What is the reason for taking Second opinion for medical services?

Lack of trust 1 2 3 4 5 6 7

Availability 1 2 3 4 5 6 7

Specialist advice 1 2 3 4 5 6 7

Avoid major operations 1 2 3 4 5 6 7

23 How important is the face to face interactions with doctor in medical services?

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(1: High, 7: Low)

1 2 3 4 5 6 7

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Rate the following parameters on scale of 1(Highest) to 7(Lowest)

Family Doctor 1 2 3 4 5 6 7

25 Peer Recommendation 1 2 3 4 5 6 7

26 Rate your importance for family doctors vs. peers recommendation

Family Doctor 1

2

3

4

5

6

Peer 7

27 Evaluation of medical services: (Ei) (From High to Low importance)

1 2 3 4 5 6 7

Waiting time for Medical services

Availability of specialist Doctors (e.g. Orthopedic, Cardiology and Physiotherapist etc.)

Cost of Medical services

Reliability and quality of services

Recommendation from family, friends or family doctor

Past experience with medical service provider

Brand name of the health service provider

28 Beliefs of customers about normal (offline) medical services: (Bi) From (Agree to Disagree on 7-scale)

1 2 3 4 5 6 7

Waiting time for normal medical services is high

Specialist doctors are not readily available in all hospitals

Normal medical services are not much costly

I verify reliability of a doctor before considering his/her suggestions

I prefer recommendations from family, friends or family doctor before choosing medical services

Past experience with medical service provider matter a lot for me

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I don’t consider a established brand name of hospital for taking medical service

29 Who do you refer to while using online health services?

Business Groups Family Peers Relatives Others

30 Why do you refer from the above? For what purpose?

Expert Advice Opinion Credibility Experience Others

31 Is the decision regarding online health services are made jointly in the family?

Yes No

32 Who is the major decision maker in the family?

Father Mother Self Wife Childern