APPENDIX I

PROFILES OF THE SELECTED HOSPITALS

1. APOLLO HOSPITALS ENTERPRISE LIMITED
Hospital Overview

Apollo Hospitals Enterprise Limited (AHEL) a part of Apollo Hospitals Group, is a private sector healthcare provider. The company owns and manages a network of specialty hospitals and clinics and a chain of pharmacy retail outlets. It also provides consultancy services for commissioning and managing the specialty hospitals. The company operates primarily in India. It is headquartered in Chennai, India.

The company recorded revenues of INR 9,566 million (approximately $212 million) during the fiscal year ended March 2007, an increase of 24.4% over 2006. The operating profit of the company was INR 1,495 million (approximately $33.1 million) during fiscal year 2007, an increase of 63% over 2006. The net profit was INR 954 million (approximately $21.1 million) in fiscal year 2007, an increase of 83.5% over 2006.

Business Description Apollo Hospitals Enterprise (AHEL) is the private sector healthcare provider in Asia. AHEL operates through two business divisions: chain of owned and managed hospitals and management consultancy services. Through the chain of owned and managed hospitals division, the group operates over 26 hospitals of which 14 are client hospitals, managed by professionals deputed from Apollo Hospitals group.

The groups consultancy division provides management consultancy services. The division offers project and operations management consultancy services to clients varying from conceptualization to commissioning of a range i

of healthcare models. The group is also engaged in providing hospital care and healthcare delivery services. It provides nursing and hospital

management colleges, pharmacies, diagnostic clinics, medical transcription services, third-party administration and telemedicine.

AHEL provides healthcare services and programs including, health checkup, complementary and alternative medicine, corporate health

programmes, Apollo life magazine, disease management, understanding medical investigations and Apollo clinics. Apollo Hospitals operates hospitals in Chennai, Delhi, Hyderabad, Kolkata, Ahmedabad, Bangalore, Bilaspur, Madurai, Visakhapatnam and Kakinada. AHEL has international operations in Srilanka, Muscat, Dubai, India, Nepal, Tanzania, and Bangladesh.

History Apollo Hospitals Enterprise Limited was incorporated as a public limited company in 1979. The group negotiated with British American Investment for association in a joint venture for setting up a multi-specialty hospital on a state land provided by Government of Mauritius, in August 2007.

Major Products & Services Apollo Hospitals is an Indian-based healthcare company. The companys key services include Chain of owned and managed hospitals and Management consultancy services.

Apollo Hospitals is a leading player in the high-growth healthcare sector. It currently has a network of 18 owned hospitals and 8 hospitals through subsidiaries / JV / associates totaling to more than 4,000 beds. The company also has 12 hospitals under management contracts which increases its spread and raises its total bed count to more than 6,800. Apollo has presence across the healthcare delivery value chain with 420 pharmacy outlets. Its integrated business model, scale, national footprint and presence across multiple disease and delivery segments make it one of the best plays on the sector.

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Hospital Background

Apollo Hospitals Enterprises Ltd (AHEL) was incorporated as a public limited company in 1979. Promoted by Dr Prathap C Reddy, it is the first group of hospitals that pioneered the concept of corporate healthcare delivery in India. AHEL today is the leading private sector healthcare provider in Asia and owns and manages a network of specialty hospitals and clinics, a chain of pharmacy retail outlets across the country, and provides consultancy services for commissioning and managing hospitals. With nursing and hospital management colleges, pharmacies, diagnostic clinics, medical transcription services, third-party administration and telemedicine, Apollo's leadership extends to all aspects of the healthcare spectrum.

The consultancy division of AHEL offers project and operations management consultancy services to clients varying from to commissioning of a wide range of healthcare models. Over the years, Apollo Hospitals has founded various group companies to empower its flagship company, Apollo Hospitals Enterprise Ltd, to create a healthcare powerhouse that has a leadership position in every sphere of healthcare.

Medical Specialties offered Apollo has established centers of excellence in a variety of medical disciplines cardiology, oncology, orthopaedics, cosmetic and plastic surgery, critical care medicine and emergency and trauma care through their multispecialty and super-specialty tertiary care hospitals which offer highly specialized and sophisticated medical care and surgical procedures in a primarily inpatient setting. CRIS-INFAC estimates that expenditure on tertiary care hospitals comprised approximately 15-20% of the total Rs 125,300 crore spending for healthcare delivery in India in 2006.

According to CRIS-INFAC, this segment is expected to grow faster than the primary or secondary care segments because of an expected rise in complex lifestyles. Apollo hospitals have around 3800 super-specialty and multi-specialty beds owned by self or subsidiary/associate/ JV, which are iii

spread in metros, tier-I and tier-II cities, stand to gain the most with the expected increased demand in healthcare delivery market in India.

2. CARE HOSPITAL
Care Hospitals is one of the fastest growing chains of hospitals in India, engaged in providing primary as well as tertiary healthcare services, with a difference. It is a hospital chain that is founded and managed by professionals with a mission and a passion for providing healthcare for the needy. At CARE, the growth has been phenomenal. From a 100-bed single specialty Heart Institute facility focusing on cardiac care in Nampally (Hyderabad), CARE has become a multi-specialty hospital chain comprising of 1400 beds across 12 hospitals.

Cares reputation for its humanitarian and selfless service has ranked this esteemed institution as the fourth largest healthcare provider in India (CRIS-INFAC report, 2006). The effort to provide quality health care with compassion has rewarded with the honor of being the top healthcare provider in Andhra Pradesh. With the service-oriented Healthcare delivery model, CARE is geared to provide cost effective and user friendly medication. Despite the intense competition and intense marketing tactics employed by multiple commercial corporate organizations, CARE has carved a niche for itself by garnering the best reputation amongst the local masses. Armed with the best of the facilities in areas of Education, Research, patient care and highly qualified professionals, CARE endeavors to match global benchmarks and conquer healthcare market in the second decade of its establishment. CARE aims at providing a holistic approach to healthcare. The logo has been crafted with this thought in mind. Through the explanation of the logo and identity, endeavor to help partners, branch organizations, shareholders and esteemed patients understand CARE and its entity better. Brand Identity and Name are largely dependent on the Logo. People identify an organization with its Logo. It is a Logo that states in part the organizations ethics and values. iv

History A movement called CARE took birth in the year 1997, when Padmashri Dr. B. Soma Raju led a team of medical professionals to set up the first CARE Hospital. It opened a new chapter in the history of health care. The driving force of Compassion, Concern, Care, coupled with single minded objective the recovery of the patient is been the fountainhead of inspiration. Today, within a span of 13 years, CARE has emerged as the leading name in health care and has earned a reputation for humanitarian and self less service. But, most importantly, CARE has the undivided faith of millions. The origins of CARE can be traced to 1983 when a team of cardiologists, under the leadership of Padmashri Dr. B Soma Raju, set up a synergy for professional excellence in the cardiology department of the Nizams Institute of Medical Sciences (NIMS) in Hyderabad. The idea was to propel the cardiology department into one of the top centers in the country. The synergy gave momentum to the purpose and accelerated the birth of CARE 13 years later. The team collaborated with scientists to make healthcare affordable through the development of indigenous medical technologies. It was the development of Indias first coronary stent (KalamRaju stent) that inspired the creation of CARE Hospital in 1997 to nurture a model that makes quality medical care affordable and accessible.

At the outset, CARE earned accolades and appreciation from one and all for its expertise in heart care. It continues to set new benchmarks not only in heart care, but also expanded its horizons by becoming a leading Multi-specialty Health Care Provider.

Accreditations The following shows the accreditations CARE has enjoyed from reputable sources.

CARE laboratories at CARE (Banjara) enjoy the accreditation from the National Accreditation Board for Testing and Calibration Laboratories and are awaiting inspection for ISO certification.

CARE Foundations courses are accredited by National Accreditation Boards like the Indira Gandhi National Open University (IGNOU), Netaji Subhash Open University (NSOU), and the National Board of Examination.

A Physician Assistants (PA) program that commenced in 2003 received an accreditation from the NSOU

Management Governance & Leadership Every organization or Groups growth and prosperity is largely dependent on the leadership of the organization. It is an indisputable fact that CARE Group of Hospitals has grown in reputation and profits primarily because of the governance and leadership. Cares

governance and leadership team has been undoubtedly responsible for the growth of CARE as a Hospital Group. The following are the team of people responsible for CARE governance and leadership: Operations CARE has accomplished growth in many facets but its the growth in the number of patients that stands testimony to widening network of operations. The trust the people have placed has further motivated in furthering contribution to the patient care. 18% growth in OP registration to 31523 lakh in 2005-06 11% growth in IP admissions to 3486 lakh in 2005-06 11.09% increase in the number of surgeries performed in 2005-06. A 500 basis point increase in the average occupancy to about 70% in 2005-06. Specialists number increased from 20 to 100. Clinical and procedural outcomes on par with US Norms. vi

Control the cost components of patient care such as drugs disposables and consumables account for nearly 50% of the total expenses, the highest cost element in a hospital to provide a superior value to patients. Providing qualitative medical care has resulted in increase in patients preferring CARE. This fact is reflected in the consistent growth in the bypass surgeries, growing at a CAGR of 30% over the last nine year

3. NIZAMS INSTITUTE OF MEDICAL SCIENCES

About NIMS Nizams Institute of Medical Science was established (NIMS) in 1964 and has grown into a University in Hyderabad A.P. India and is one of the pioneer and major referral medical center with about 100 beds with staff around 2000. In 2005 bed occupancy rate was 83%, total admissions 30,481, total hospital days 2,88,002, total operations are 18, 111 and average length of stay 9.5 days.

NIZAMS INSTITUTE OF MEDICAL SCIENCES (NIMS), Hyderabad, is a University established under the Act of Andhra Pradesh State Legislature.

Inspired by the objectives, the Medical and Management professionals of NIMS are striving for excellence. As part of it, several courses have been organized under different disciplines. NIMS is recognized by University Grants Commission and Medical Council of India.

The administration of NIMS is carried out under the supervision of Governing Council, Executive Board, Director and other statutory bodies.

NIMS is located at the prime centre of the twin cities of Hyderabad and Secunderabad, and spread over an area of about 23 acres. It has the constructed area of more than six lakh sq.ft. The recently constructed giant vii

structure, i.e., Millennium Block, itself has added an area of about one sixth of the total space. This Institute extends its services through 28 Departments. Out of them, 16 are super and Broad Specialties and others are Supporting Departments.

The Institute has bed strength of 985 beds, out of which 684 are in General Wards, 117 in private rooms and 184 in emergency and post operative care. The average number of out-patients visiting the hospital per day is about 1275, and the number of in-patients admitted per day is about 80. The average bed occupancy is over 89%.

Subsequently this University has raised to a cadre strength of about 2219 staff members, which includes Faculty-139, Residents (students)-172, Junior and Senior Residents-43, Medical Officers & Senior Medical Officers14, College of Nursing & School of Nursing-6, College of Physiotheraphy-6, Offcers-14, Ministerial-149, Paramedical-304, Nursing-426, Class IV-115, Consolidated Staff-21, other workers about 810 and the remaining for other categories. Interestingly NIMS has been consistently maintaining a very good patient doctor ratio of about 3:1. The Origin of NIMS The Genesis of NIMS dates back to the year 1961. The Nizam's Charitable Trust thought of starting a specialty Hospital for orthopedic patients with an initial investment of Rs.55 Lakhs. The foundation stone was laid on 16.07.1961 by Sri Morarji Desai, Minister for Finance, in the cabinet of Sri Jawaharlal Nehru, the first Prime Minister of India.

As per the Act, NIMS has a Governing Council as its supreme authority. The Chief Minister of Andhra Pradesh is the President and the Health Minister, the Vice President. This helps to have close contacts with the authorities in developing NIMS. For a close supervision of the activities during shorter spells, NIMS has an Executive Board with seven members presided by Health Minister of Andhra Pradesh. In addition NIMS has an viii

Academic Council with strength of 35 members for advising and approving the Academic Programmes of this Institute. Departments Clinical Departments 1. Anaesthesiology and Intensive Care 2. Cardiology 3. Cardio Thoracic Surgery 4. Clinical Pharmacology & Therapeutics 5. Chest Clinic 6. Dental 7. Dermatology 8. Endocrinology and Metabolism 9. Gastroenterology 10. General Medicine 11. Gynaecology 12. Medical Oncology 13. Nephrology 14. Neurology 15. Neuro Surgery 16. Orthopaedics 17. Paediatrics 18. Physio Therapy 19. Plastic Surgery 20. Radiation Oncology 21. Rheumatology 22. Surgical Gastroenterology 23. Surgical Oncology 24. Urology 25. Vascular Surgery

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Diagnostic Departments 1. Biochemistry 2. Microbiology 3. Nuclear Medicine 4. Pathology 5. Radiology & Imageology 6. Transfusion Medicine Supporting Departments 1. Biomedical Engineering 2. Civil 3. Computer Division 4. Electrical 5. Hospital Administration 6. Medical Records 7. College of Nursing Other Departments In an addition to the above, departments the Gas Room, Stores (Medical, Surgical, Stationary, Linen) extend their services for Maintenance of the Institute.

Academic Courses On the Academic front the Institute conducts several courses recognized by Medical Council of India. It offers about 40 disciplines. NIMS conducts 8 super specialty courses in DM and M.Ch. in the Departments like Cardiology, Cardiothoracic Surgery, Neurology, Neurosurgery, Nephrology, Plastic Surgery, Urology and CP&T.

Similarly NIMS conducts 6 broad specialty courses of MD, MS and DMRD in the Departments like General Medicine, Pathology, Orthopaedics, Anesthesiology, Radiology and Hospital Administration. College of Nursing x

started on 2nd October 1991 and 209 students have completed B.Sc (Nursing) till 2004. This is recognized by Indian Nursing Council.

Hospital Services The performance of the Institute as a hospital is measured with the parameters of number of beds, number of Out-patients, number of Inpatients, number of Surgeries, bed occupancy rate, average length of stay, mortality rate and revenue generation. Presently the hospital has 985 beds compared to 246 beds of 1986. Out of these 985 beds, 684 are in general wards, 117 in private rooms and 184 in emergency and post operative care. The average number of out patients visiting the hospital per month is about 32,000 and the number of inpatients admitted per month is about 2,600. It is gratifying to note that NIMS is a referral Hospital with a clientele of more than 250 organizations. During the year 2008, the number of outpatients has recorded a figure of 4.12 lakhs, which may be compared with 1.09 lakhs in 1986. Similarly the number of in-patients has increased from about 6,758 to 31,295 during the same period. Presently the average bed occupancy is about 89%.

While the average length of stay is 11 days during the year 2008, the mortality rate is about 2% leaving the well being at 98%. Interestingly NIMS is consistently maintaining a very good ratio of about 3:1 for the patient to the Doctors. All these figures under different heads speak out ultimately the services rendered by NIMS to the patients, quantitatively.

The number of surgeries is almost maintained at about 27,767 in the year 2008. Out of them 8,701 are major operations, 16,248 are minor operations and 2,818 are emergency operations.

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5. GANDHI HOSPITAL
History Gandhi Medical College came into operations on 14th September 1954 AD. This was the second medical college in the erstwhile state of Hyderabad. The Osmania Medical College was the first medical college in the Hyderabad state having started as a medical school in 1846 and made a college in 1926. Gandhi Medical College was the second in Hyderabad State, fourth in Andhra Pradesh and 29th in the country. Average annual outpatient consultations are about 80000 and there were about 42000 inpatient admissions.11000 major operations and about 15000 minor operations are performed each year at Gandhi hospital. Hospital has 27 departments namely: general medicine, general leprosy, surgery, sexually pediatrics, orthopedics, disease, cardiology,

anesthesia,

dermatology, E.N.T.,

transmitted blood bank,

ophthalmology,

radiology,

Casuality,

neurology, nephrology, gastroenterology, endocrinology, Cardio-thoracic surgery, neurosurgery, pediatric surgery, plastic surgery, urology, TB clinic, dental, obgyn, psychiatry and hospital administration. During the 50 years i.e. 1954-2003 a total of 6090 students were admitted to the MBBS course. The number of students admitted ranged between a minimum of 42 in 1954 to a maximum of 224 in 1968. In one-year i.e. 1970 there were no admissions. In recent years the admissions are around 150 per year. There are some students who may have been transferred from other medical colleges to Gandhi and very few left medical studies to pursue other avenues in life. As of now, the Rs 100-crore, 1600-bed Gandhi Hospital and Medical College buildings complex, located in a 30-acre site, was created in a record time. The 152-year-old hospital has about a million sq ft of built-up space, hosting some 29 specialties. This hospital was created in 1851 to look after the British residents of Secunderabad hosting a general, maternity and a ward for paupers. xii

The hospital project was executed by the Andhra Pradesh Health and Medical Housing and Infrastructure Development Corporation. The Gandhi Hospital lacks proper equipment in many departments, including neurology, nephrology, cardiology and gastroenterology as most of them need replacement and are out-dated. As a result, patients coming for routine checkups have to be referred to other hospitals.

Moreover, the hospital that has 1,012 beds and caters to over 900 outpatients daily, has not more than Rs 30 lakh in the Hospital Development Society Funds for replacement of equipment and has to depend on government support that is not forthcoming.

The

cardiology,

neurology,

nephrology

and

gastroenterology

departments are the wings that need urgent replacement of equipment. However, the heads of department (HOD) have requested the government to sanction Rs 40 crore to buy new machinery.

According to doctors at the hospital, though many patients come for simple tests and scans, they have to be referred private hospitals where charges are higher and to other better equipped government hospitals like Osmania General Hospital due to lack of equipment.

The hospital also needs dialysis machines, as most of the machines are very old. Even ventilators also need to be replaced. Moreover, the hospital does not have a CT scan machine that is essential for investigations in most departments. Among the list that has been forwarded by the hospital

management for replacement are half-a-dozen ventilators, 16 fully equipped surgical operation theatres, six dialysis machines and video endoscopes and a CT scan machine.

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6. OSMANIA GENERAL HOSPITAL

Osmania General Hospital is a multi specialty quaternary care hospital with advanced training in every sub-specialty of Medicine, Surgery, Radiology, Anesthesiology, Orthopedic surgery, Neurosurgery, Neurology. This hospital has approximately 3800 beds, with patients overfilling the beds and wards. It has one of the busiest Out-Patient clinics in all specialties in India, particularly on Monday mornings. By the end of the year 2008, Osmania General Hospital has become a multi-specialty quaternary care hospital in Hyderabad, offering 3800 beds with all necessary facilities & amenities. It has one of the busiest Out-Patient clinics in all specialties in India. Osmania Medical College is a medical school in Hyderabad, Andhra Pradesh, India. It was founded in 1846 as the Hyderabad Medical School making it one of the oldest medical schools in the world. It is presently affiliated to the NTR University of Health Sciences. The College was originally affiliated to the Osmania University of Hyderabad. The Main Undergraduate course offered at the School is an MBBS (Bachelor of Medicine, Bachelor of Surgery) course. In addition the college also offers other undergraduate courses and many Postgraduate (graduate) courses. It also offers many Super specialty courses. The College campus is situated in Koti, which is at the heart of the city of Hyderabad. Osmania Medical College has long been a government institution in Andhra Pradesh. It is the oldest medical school in India and perhaps Asia. Osmania has a rich history of pioneering medical innovations. For the first time, chloroform was used as an anesthetic in Osmania. The causative agent of malaria was elucidated by Sir Ronald Ross who has been immortalized by the Sir Ronald Ross Institute of Tropical and Communicable Diseases (popular by name Fever Hospital) affiliated to Osmania.

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OGH is the only medical college in India (and perhaps the world), where each medical specialty has a separate training hospital. It is also the only medical college in south India to offer a postgraduate course in endocrinology. Conclusion on Profiles of Hospitals All these five hospitals though vary in the intensity of level of implementation, varies in usage of management techniques in bringing the quality for patient satisfaction or the implementation of quality initiatives but comparably comes close in the efforts to strive towards providing better healthcare deliverables to patients. There are few areas present in all most all these 5 hospitals which show significant efforts to avoid patient injury occurring in hospitals, reduce the risk of adverse outcomes and lower costs. They all know that poor health service quality wastes resources that could be used to treat more patients, and the public is becoming more critical of the quality of hospital care. Most of them quite aware that ensuring safety for patients and personnel and improving quality are national objectives for health systems in both developed and developing countries, in response to research highlighting poor quality, increasing patient expectations, media coverage, and a belief that there are effective methods to improve quality and safety. Further, it is an open thought that health care organizations are increasingly expected by governments and funders to introduce quality systems and strategies. Some health care managers and practitioners also believe that action can and should be taken, irrespective of external pressures.

While having a discussion with the administrators, doctors etc of these five hospitals during collection of completed survey, it is interested to note that some of them shared their thoughts which include proposal of multiple approaches to ensuring safety and improving quality. Some think money should be invested in more personnel; others think that doing more of the same would not improve quality. Which strategies are most appropriate and

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cost effective for a particular hospital in a specific situation? Which approach should a government promote?

This may not be a complete review of available research on multiple quality topics but an attempt in synthesizing many types of research into hospital quality strategies. The aim of this study is to come out of few constructive thoughts enabling the decision makers to better formulate, implement and evaluate strategies. Research puts competing claims made by proponents of each approach into perspective and can help avoid costly mistakes from choosing the wrong strategy or implementing it incorrectly. There is no strong scientific evidence of which strategies are effective. It is difficult to make valid comparisons among strategies. But there is useful research that gives partial assessments of results, describing different types of strategy, and suggesting means of implementation.

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APPENDIX II

QUESTIONNAIRES USED FOR THE STUDY

1. QUESTIONNAIRE FOR PATIENTS This survey is to successfully complete my doctoral research in management education related to hospitals in Hyderabad and their service quality. It is extremely critical having the below information and your help is greatly appreciated. We assure the confidentiality by keeping your identity unrevealed. This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer all we are interested in is a mark that best shows your expectations about firms offering health services.

1. The hospital has upto date equipment. 2. The hospital physical facilities are visually appealing. 3. The staff (doctors, nurses etc) is well dressed and appears neat. 4. The appearance of the physical facilities of the hospital is excellent, keeping in view of the type of services required. 5. When the hospital promises to do a treatment (operation/diagnosis etc) by a certain time, it did so. 6. When you have problems, the staff (doctors, nurses etc) was sympathetic and reassuring. 7. The hospital is dependable 8. They have provided their services at the time they promised to do so 9. They have maintained all the records accurately. 10. The hospital did not tell patients exactly when services will be performed 11. You did not receive prompt service from the hospital staff (doctors, nurses etc) 12. Staff (doctors, nurses etc) of the hospital not always willing to help patients 13. Staff (doctors, nurses etc) of the hospital are too busy to respond to patient request promptly xvii

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14. You can trust the staff (doctors, nurses etc) of the hospital. 15. You feel safe in their transactions with the hospital staff (doctors, nurses etc). 16. The staff (doctors, nurses etc) of the hospital is always polite. 17. The staff (doctors, nurses etc) get adequate support from the hospital to do their jobs well 18. The hospital did not give you individual attention 19. Staff (doctors, nurses etc) of the hospital did not give you personal attention 20. Staff (doctors, nurses etc) of the hospital do not know what your needs are 21. The hospital did not have your interests at heart 22. The hospital did not have operating hours convenient to all their patients

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Personal Information

Gender

: Male

Female 30-60 1 Lakhs Rural School Second time Surgical College More times Medical 3 Above 60 Above 3 Lakhs

Age (Years) : Below 30 Income per Below annum (Rs) : Lakh Residing in: Education: No. of visits: Category of treatment: Urban Illiterate First time ICU 1

I sincerely thank you for spending your valuable time and kindly return the filled-in form to the investigator who handed over this to you.

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2. QUESTIONNAIRE FOR ADMINISTRATORS This survey is to successfully complete my doctoral research in management education related to hospitals in Hyderabad and their service quality. It is extremely critical having the below information and your help is greatly appreciated. We assure the confidentiality by keeping your identity unrevealed.

This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. Do this by picking one of the seven numbers next to each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer all we are interested in is a number that best shows your expectations about firms offering health services. 1. The hospital has upto date equipment. 2. The hospital physical facilities are visually appealing. 3. The administrative staff is well dressed and appears neat. 4. The appearance of the physical facilities of the hospital is excellent, keeping in view of the type of services required. 5. When the hospital promises to do a treatment (operation/diagnosis etc) by a certain time, it did so. 6. When patients have problems, the administrative staff is sympathetic and reassuring. 7. The hospital is dependable 8. You have provided services at the time you promised to do so 9. You have maintained all the records accurately. 10. The hospital did not tell patients exactly when services will be performed 11. Patients did not receive prompt service from the administrative staff 12. Administrative staff of the hospital not always willing to help patients 13. Administrative staff of the hospital are too busy to respond to patient request promptly 14. Patients can trust the administrative staff of the hospital. 15. Patients feel safe in their transactions with the Administrative staff. xix 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 6 6 6 6 7 7 7 7

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16. The administrative staff of the hospital is always polite. 17. The administrative staff get adequate support from the hospital to do their jobs well 18. The hospital did not give individual attention to patients 19. Administrative staff of the hospital did not give personal attention to patients 20. Administrative staff of the hospital do not know what patients needs are 21. The hospital did not have patients interests at heart 22. The hospital did not have operating hours convenient to all their patients

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I sincerely thank you for spending your valuable time and kindly return the filled-in form to the investigator

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3. QUESTIONNAIRE FOR DOCTORS This survey is to successfully complete my doctoral research in management education related to hospitals in Hyderabad and their service quality. It is extremely critical having the below information and your help is greatly appreciated. We assure the confidentiality by keeping your identity unrevealed.

This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. Do this by picking one of the seven numbers next to each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer all we are interested in is a number that best shows your expectations about firms offering health services. 1. The hospital has upto date equipment. 2. The hospital physical facilities are visually appealing. 3. The doctors are well dressed and appear neat. 4. The appearance of the physical facilities of the hospital is excellent, keeping in view of the type of services required. 5. When the hospital promises to do a treatment (operation/diagnosis etc) by a certain time, it did so. 6. When patients have problems, the doctors were sympathetic and reassuring. 7. The hospital is dependable 8. You have provided services at the time you promised to do so 9. You have maintained all the records accurately. 10. The hospital did not tell patients exactly when services will be performed 11. Patients did not receive prompt service from the doctors 12. Doctors of the hospital not always willing to help patients 13. Doctors of the hospital are too busy to respond to patient request promptly 14. Patients can trust the doctors of the hospital. 15. Patients feel safe in their transactions with the doctors. 16. The doctors of the hospital are always polite. 17. The doctors get adequate support from the hospital to do their jobs well xxi 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 6 6 6 6 7 7 7 7

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18. The hospital did not give individual attention to patients 19. Doctors of the hospital did not give personal attention to patients 20. Doctors of the hospital do not know what patients needs are 21. The hospital did not have patients interests at heart 22. The hospital did not have operating hours convenient to all their patients

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4. QUESTIONNAIRE FOR NURSES This survey is to successfully complete my doctoral research in management education related to hospitals in Hyderabad and their service quality. It is extremely critical having the below information and your help is greatly appreciated. We assure the confidentiality by keeping your identity unrevealed.

This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. Do this by picking one of the seven numbers next to each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer all we are interested in is a number that best shows your expectations about firms offering health services. 1. The hospital has upto date equipment. 2. The hospital physical facilities are visually appealing. 3. The nurses are well dressed and appear neat. 4. The appearance of the physical facilities of the hospital is excellent, keeping in view of the type of services required. 5. When the hospital promises to do a treatment (operation/diagnosis etc) by a certain time, it did so. 6. When patients have problems, the nurses were sympathetic and reassuring. 7. The hospital is dependable 8. You have provided services at the time you promised to do so 9. You have maintained all the records accurately. 10. The hospital did not tell patients exactly when services will be performed 11. Your patients did not receive prompt service from the nurses 12. Nurses of the hospital not always willing to help patients 13. Nurses of the hospital are too busy to respond to patient request promptly 14. Patients can trust the nurses of the hospital. 15. Patients feel safe in their transactions with the nurses. 16. The nurses of the hospital are always polite. 17. The nurses get adequate support from the hospital to do their jobs well xxiii 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 6 6 6 6 7 7 7 7

1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6

7 7 7 7 7 7 7 7 7 7 7 7

18. The hospital did not give individual attention to patients 19. Nurses of the hospital did not give personal attention to patients 20. Nurses of the hospital do not know what patients needs are 21. The hospital did not have patients interests at heart 22. The hospital did not have operating hours convenient to all their patients

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

5 5 5 5 5

6 6 6 6 6

7 7 7 7 7

I sincerely thank you for spending your valuable time and kindly return the filled-in form to the investigator who handed over this to you.

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5. QUESTIONNAIRE FOR PARAMEDICAL STAFF This survey is to successfully complete my doctoral research in management education related to hospitals in Hyderabad and their service quality. It is extremely critical having the below information and your help is greatly appreciated. We assure the confidentiality by keeping your identity unrevealed. This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. Do this by picking one of the seven numbers next to each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer all we are interested in is a number that best shows your expectations about firms offering health services. 1. The hospital has upto date equipment. 2. The hospital physical facilities are visually appealing. 3. The Paramedical Staff are well dressed and appear neat. 4. The appearance of the physical facilities of the hospital is excellent, keeping in view of the type of services required. 5. When the hospital promises to do a treatment (operation/diagnosis etc) by a certain time, it did so. 6. When patients have problems, the Paramedical Staff were sympathetic and reassuring. 7. The hospital is dependable 8. You have provided services at the time you promised to do so 9. You have maintained all the records accurately. 10. The hospital did not tell patients exactly when services will be performed 11. Your patients did not receive prompt service from the Paramedical Staff 12. Paramedical Staff of the hospital not always willing to help patients 13. Paramedical Staff of the hospital are too busy to respond to patient request promptly 14. Patients can trust the nurses of the hospital. 15. Patients feel safe in their transactions with the Paramedical Staff. 16. The Paramedical Staff of the hospital are always polite. 17. The Paramedical Staff get adequate support from xxv 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 6 6 6 6 7 7 7 7

1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6

7 7 7 7 7 7 7 7 7 7 7 7

the hospital to do their jobs well 18. The hospital did not give individual attention to patients 19. Paramedical Staff of the hospital did not give personal attention to patients 20. Paramedical Staff of the hospital do not know what patients needs are 21. The hospital did not have patients interests at heart 22. The hospital did not have operating hours convenient to all their patients

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

5 5 5 5 5

6 6 6 6 6

7 7 7 7 7

I sincerely thank you for spending your valuable time and kindly return the filled-in form to the investigator who handed over this to you.

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6. QUESTIONNAIRE FOR SUPPORT SERVICE STAFF This survey is to successfully complete my doctoral research in management education related to hospitals in Hyderabad and their service quality. It is extremely critical having the below information and your help is greatly appreciated. We assure the confidentiality by keeping your identity unrevealed. This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. Do this by picking one of the seven numbers next to each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer all we are interested in is a number that best shows your expectations about firms offering health services. 1. The hospital has upto date equipment. 2. The hospital physical facilities are visually appealing. 3. The Support Staff are well dressed and appear neat. 4. The appearance of the physical facilities of the hospital is excellent, keeping in view of the type of services required. 5. When the hospital promises to do a treatment (operation/diagnosis etc) by a certain time, it did so. 6. When patients have problems, the Support Staff were sympathetic and reassuring. 7. The hospital is dependable 8. You have provided services at the time you promised to do so 9. You have maintained all the records accurately. 10. The hospital did not tell patients exactly when services will be performed 11. Your patients did not receive prompt service from the Support Staff 12. Support Staff of the hospital not always willing to help patients 13. Support Staff of the hospital are too busy to respond to patient request promptly 14. Patients can trust the nurses of the hospital. 15. Patients feel safe in their transactions with the Support Staff. 16. The Support Staff of the hospital are always polite. 17. The Support Staff get adequate support from the hospital to do their jobs well xxvii 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 6 6 6 6 7 7 7 7

1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6

7 7 7 7 7 7 7 7 7 7 7 7

18. The hospital did not give individual attention to patients 19. Support Staff of the hospital did not give personal attention to patients 20. Support Staff of the hospital do not know what patients needs are 21. The hospital did not have patients interests at heart 22. The hospital did not have operating hours convenient to all their patients

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

5 5 5 5 5

6 6 6 6 6

7 7 7 7 7

I sincerely thank you for spending your valuable time and kindly return the filled-in form to the investigator who handed over this to you.

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APPENDIX III LIST OF TABLES

Table no. Title CHAPTER 1 1.1 1.2 Key Indicators 6 Page no.

1.3 1.4 1.5 1.6 1.7 1.8 1.9

Establishment of Primary Health Centers, sub centers and 9 Community Health Centers in India As per different Five Year Plans Percentage of Private Hospitals with different bed sizes 10 Classification of Hospitals Types of Ailment Complexities Total Number of Hospitals in India, 2007 Health care Accreditation in various countries Goals specified in the National Health Policy 2002 Chronology of Service Quality Research 20 23 27 41 46 53

CHAPTER 2 2.1 2.2 2.3 2.4 2.5 List of some prominent hospitals in Hyderabad Sample selection of hospitals Sample Selection of Respondents Staff Sample Selection of Respondents Patients Variables / Parameters / Characteristics identified 83 85 86 86 88

CHAPTER 3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Definition of Original Ten SERVQUAL Dimensions Definition of Modified SERVQUAL Dimensions 122 124

Comparative Analysis of Quality Implementation Issues in 146 the Selected Hospitals Comparative Analysis of Product Information in the 152 Selected Hospitals Comparative Analysis of Pricing Information in the 155 Selected Hospitals Comparative Analysis of Promotion Information in the 158 Selected Hospitals Comparative Analysis of Placing Information in the 159 Selected Hospitals xxix

3.8 3.9 3.10

Comparative Analysis of People Information in the Selected Hospitals Comparative Analysis of Process Information in the Selected Hospitals Comparative Analysis of Physical Evidence Information in the Selected Hospitals CHAPTER 4

161 164 166

4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24

Perceptions of Administrative Staff on Tangibles Dimension Perception of Doctors on Tangibles Dimension Perception of Nurses on Tangibles Dimension Perception of Paramedical Staff on Tangibles Dimension Perception of Support Staff on Tangibles Dimension Perceptions of Administrative Staff on Reliability Dimension Perception of Doctors on Reliability Dimension Perception of Nurses on Reliability Dimension Perception of Paramedical Staff on Reliability Dimension Perception of Support Staff on Reliability Dimension Perceptions of Administrative Staff on Responsiveness Dimension Perception of Doctors on Responsiveness Dimension Perception of Nurses on Responsiveness Dimension Perception of Paramedical Staff on Responsiveness Dimension Perception of Support Staff on Responsiveness Dimension Perceptions of Administrative Staff on Assurance Dimension Perception of Doctors on Assurance Dimension Perception of Nurses on Assurance Dimension Perception of Paramedical Staff on Assurance Dimension Perception of Support Staff on Assurance Dimension Perceptions of Administrative Staff on Empathy Dimension Perception of Doctors on Empathy Dimension Perception of Nurses on Empathy Dimension Perception of Paramedical Staff on Empathy Dimension xxx

180 181 182 183 185 188 189 190 192 193 196 198 199 200 202 205 206 208 209 210 214 215 217 219

4.25 4.26

Perception of Support Staff on Empathy Dimension Two Way ANOVA test between Hospitals and Tangibles (Administrative Staff)

220 223 225

4.27 4.28 4.29 4.30 4.31 4.32 4.33 4.34 4.35 4.36 4.37 4.38 4.39 4.40 4.41 4.42 4.43 4.44 4.45 4.46 4.47 4.48 Two Way ANOVA test between Hospitals and Tangibles (Doctors) Two Way ANOVA test between Hospitals and Tangibles (Nurses) Two Way ANOVA test between Hospitals and Tangibles (Paramedical Staff) Two Way ANOVA test between Hospitals and Tangibles (Support Staff) Two Way ANOVA test between Hospitals and Reliability (Administrative Staff) Two Way ANOVA test between Hospitals and Reliability (Doctors) Two Way ANOVA test between Hospitals and Reliability (Nurses) Two Way ANOVA test between Hospitals and Reliability (Paramedical Staff) Two Way ANOVA test between Hospitals and Reliability (Support Staff) Two Way ANOVA test between Hospitals and Responsiveness (Administrative Staff) Two Way ANOVA test between Hospitals and Responsiveness (Doctors) Two Way ANOVA test between Hospitals and Responsiveness (Nurses) Two Way ANOVA test between Hospitals and Responsiveness (Paramedical Staff) Two Way ANOVA test between Hospitals and Responsiveness (Support Staff) Two Way ANOVA test between Hospitals and Assurance (Administrative Staff) Two Way ANOVA test between Hospitals and Assurance (Doctors) Two Way ANOVA test between Hospitals and Assurance (Nurses) Two Way ANOVA test between Hospitals and Assurance (Paramedical Staff) Two Way ANOVA test between Hospitals and Assurance (Support Staff) Two Way ANOVA test between Hospitals and Empathy (Administrative Staff) Two Way ANOVA test between Hospitals and Empathy (Doctors) Two Way ANOVA test between Hospitals and Empathy (Nurses) xxxi

226 227 228 229 230 231 233 234 235 236 237 238 239 240 242 243 244 245 246 247 249

4.49 4.50

Two Way ANOVA test between Hospitals and Empathy (Paramedical Staff) Two Way ANOVA test between Hospitals and Empathy (Support Staff) CHAPTER 5

250 251

5.1 5.2 5.3 5.4 5.5

Summary of hospital service quality dimensions Gender distribution of Patients Age distribution of Patients Income Distribution of Patients

261 265 266 267 268

Residence distribution of Patients 5.6 Education distribution of Patients 5.7 No. of visits distribution of Patients 5.8 Category of treatment distribution of Patients 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 Case Processing Summary of Hospital * Gender Cross Tabulation Case Processing Summary of Gender * Hospital Cross Tabulation Chi-Square values of Hospital * Gender Cross Tabulation Chi-Square values of Gender * Hospital Cross Tabulation Case Processing Summary of Hospital * Age Cross Tabulation Chi-Square values of Hospital * Age Cross Tabulation Case Processing Summary of Hospital * Income Cross Tabulation Chi-Square values of Hospital * Income Cross Tabulation Case Processing Summary of Hospital * Residence Cross Tabulation Case Processing Summary of Residence * Hospital Cross Tabulation Chi-Square values of Hospital * Residence Cross Tabulation Chi-Square values of Residence * Hospital Cross Tabulation Case Processing Summary of Hospital * Education Cross Tabulation Chi-Square values of Hospital * Education Cross Tabulation Case Processing Summary of Hospital * Number of Visits Cross Tabulation Chi-Square values of Hospital * Education Cross Tabulation xxxii 273 274 275 275 276 277 278 279 280 280 281 282 282 283 284 285 272 270 269

5.25 5.26 5.27 5.28 5.29 5.30 5.31 5.32 5.33 5.34 5.35 5.36 5.37 5.38 5.39 5.40 5.41 5.42 5.43 5.44 5.45 5.46 5.47 5.48 5.49 5.50 5.51 5.52 5.53 5.54 5.55 5.56 5.57 5.58 5.59 5.60 5.61 5.62 5.63 5.64 5.65 5.66

Case Processing Summary of Hospital * Category of Treatment Cross Tabulation Chi-Square values of Hospital * Category of Treatment Cross Tabulation Two Way ANOVA test between Hospitals and Tangibles Two Way ANOVA test between Hospitals and Reliability Two Way ANOVA test between Hospitals and Responsiveness Two Way ANOVA test between Hospitals and Assurance Two Way ANOVA test between Hospitals and Empathy Description of Service Quality Gaps Gap Scores of Apollo Hospital Tangibles Gap Scores of Care Hospital Tangibles Gap Scores of NIMS Tangibles Gap Scores of Gandhi Hospital Tangibles Gap Scores of OGH Tangibles Average Overall Scores Tangibles Gap Scores of Apollo Hospital Reliability Gap Scores of Care Hospital Reliability Gap Scores of NIMS Reliability Gap Scores of Gandhi Hospital Reliability Gap Scores of OGH Reliability Average Overall Scores Reliability Gap Scores of Apollo Hospital Responsiveness Gap Scores of Care Hospital Responsiveness Gap Scores of NIMS Responsiveness Gap Scores of Gandhi Hospital Responsiveness Gap Scores of OGH Responsiveness Average Overall Scores Responsiveness Gap Scores of Apollo Hospital Assurance Gap Scores of Care Hospital Assurance Gap Scores of NIMS Assurance Gap Scores of Gandhi Hospital Assurance Gap Scores of OGH Assurance Average Overall Scores Assurance Gap Scores of Apollo Hospital Empathy Gap Scores of Care Hospital Empathy Gap Scores of NIMS Empathy Gap Scores of Gandhi Hospital Empathy Gap Scores of OGH Empathy Average Overall Scores Empathy Average Scores on Expectations, Perceptions and Difference between Expectation and Perception: Gap-5 Aggregated dimensional scores and overall Service Quality Index (SQI): Gap 5 Average scores of average dimensions SERVQUAL Scores by Dimensions and by Hospitals

286 287 288 289 290 291 292 297 298 300 301 303 304 306 307 308 310 311 313 314 315 317 319 321 323 325 327 328 330 331 333 334 336 338 340 341 343 345 347 350 351 353

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LIST OF CHARTS

Chart No.

Title CHAPTER 1

Page No.

1.1 1.2 1.3

Number of hospitals and number of beds 9 Comparative expenditures between public and private 11 sectors in India Health Expenditure as per cent of GDP 2003 16 CHAPTER 4

4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21

Perceptions of Administrative Staff on Tangibles Dimension Perception of Doctors on Tangibles Dimension Perception of Nurses on Tangibles Dimension Perception of Paramedical Staff on Tangibles Dimension Perception of Support Staff on Tangibles Dimension Staff Perception on Tangibles Dimension Perceptions of Administrative Staff on Reliability Dimension Perception of Doctors on Reliability Dimension Perception of Nurses on Reliability Dimension Perception of Paramedical Staff on Reliability Dimension Perception of Support Staff on Reliability Dimension Staff Perception on Reliability Dimension Perceptions of Administrative Staff on Responsiveness Dimension Perception of Doctors on Responsiveness Dimension Perception of Nurses on Responsiveness Dimension Perception of Paramedical Staff on Responsiveness Dimension Perception of Support Staff on Responsiveness Dimension Staff Perception on Responsiveness Dimension Perceptions of Administrative Staff on Assurance Dimension Perception of Doctors on Assurance Dimension Perception of Nurses on Assurance Dimension

180 181 182 184 185 187 188 189 191 192 193 195 197 198 199 201 202 204 205 207 208

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4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30

Perception of Paramedical Staff on Assurance Dimension Perception of Support Staff on Assurance Dimension Staff Perception on Assurance Dimension Perceptions of Administrative Staff on Empathy Dimension Perception of Doctors on Empathy Dimension Perception of Nurses on Empathy Dimension Perception of Paramedical Staff on Empathy Dimension Perception of Support Staff on Empathy Dimension Staff Perception on Empathy Dimension

209 211 213 214 216 217 219 220 222

CHAPTER 5 5.1 Gender Distribution of Patients 5.2 Age distribution of Patients 5.3 Income Distribution of Patients 5.4 Residence Distribution of Patients 5.5 Education Distribution of Patients 5.6 Number of Visits Distribution of Patients 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 Category of Treatment Distribution of Patients Gap Scores of Apollo Hospital Tangibles Gap Scores of Care Hospital Tangibles Gap Scores of NIMS Tangibles Gap Scores of Gandhi Hospital Tangibles Gap Scores of OGH Tangibles Average Overall Scores Tangibles Gap Scores of Apollo Hospital Reliability Gap Scores of Care Hospital Reliability Gap Scores of NIMS Reliability Gap Scores of Gandhi Hospital Reliability Gap Scores of OGH Reliability Average Overall Scores Reliability Gap Scores of Apollo Hospital Responsiveness Gap Scores of Care Hospital Responsiveness Gap Scores of NIMS Responsiveness Gap Scores of Gandhi Hospital Responsiveness xxxv 272 299 301 302 304 305 306 308 309 311 312 314 315 317 319 321 323 271 269 268 267 266 265

5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 5.32 5.33 5.34 5.35 5.36 5.37 5.38 5.39 5.40

Gap Scores of OGH Responsiveness Average Overall Scores Responsiveness Gap Scores of Apollo Hospital Assurance Gap Scores of Care Hospital Assurance Gap Scores of NIMS Assurance Gap Scores of Gandhi Hospital Assurance Gap Scores of OGH Assurance Average Overall Scores Assurance Gap Scores of Apollo Hospital Empathy Gap Scores of Care Hospital Empathy Gap Scores of NIMS Empathy Gap Scores of Gandhi Hospital Empathy Gap Scores of OGH Empathy Average Overall Scores Empathy Overall Service Quality Index Average scores of average dimensions SERVQUAL Scores by Dimensions and by Hospitals

325 326 328 329 331 332 334 335 337 339 341 343 345 346 350 352 353

LIST OF FIGURES
Figure No. Title CHAPTER 1 1.1 Flow of relationship within Health Sector operators 32 Page No.

CHAPTER 3 3.1 3.2 3.3 3.4 3.5 3.6 Correlation between Modified SERVQUAL Dimensions 125 and Original Ten Service Quality Gap Model by Zeithaml et al. 130 Key Factors Contributing to Gap 1 Key Factors Contributing to Gap 2 Key Factors Contributing to Gap 3 Key Factors Contributing to Gap 4 132 132 133 134

CHAPTER 5 5.1 5.2 The Gap Model (Reproduced from Parasuraman, Zeithaml and Berry, 1985) Extension of the Gap Model 295 296

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