Customer relationship management in a tertiary level hospital

This cross-sectional study was conducted at OPD of Khulna Medical College Hospital (KMCH). This study aimed to assess the status of Customer Relationship Management (CRM) in a tertiary level hospital in Khulna city from 1 January to 31 December 2016. Total 200 samples were included purposively. Among them 150 respondents were health care receivers and 50 participants were health care providers and interviewed with a pre-tested semi-structured questionnaire and a checklist was used to collect information regarding administrative facility, physical facility and utility services. Data were analyzed by using Statistical Package for Social Science version (SPSS) 22 and appropriate statistical tests were performed. Most (62.3%) of the service receivers were satisfied about the doctors dealing in OPD. It was found that majority of service provider (82%) had not knowledge about CRM and its objectives. Majority (82%) of the service receiver came to hospital willingly and (47.3%) of service receivers were spent less than one hours for getting total treatment.). Most (40%) of service providers said that there were a lack of service provider, modern equipment and medication in the OPD and they recommended that enhanced manpower, modern equipment and adequate supply of medication. About half 49.3% of the service receivers suggested in manpower should be increased. Therefore, attempts could be taken to implement customer relationship management as a process for improving hospitals performance and improving communication between service providers and service receiver in hospitals.


Introduction
Customer Relationship Management (CRM) is a business approach that integrates people, processes and technology to maximize the relations of an organization with all types of customers. The true value of CRM is to transform strategic operational processes and business functions in order to retain customers and increase customer loyalty. According to Koh and Tan (2005), Customer Relationship Management is a core strategy in managing interactions between commercial organizations and their customers. It is no less important in a healthcare context. Because patients are the key customers of hospitals and other healthcare settings". The term Patient Relationship Management (PRM) is used for systems in the organizations. With PRM, healthcare organization focus is set on determining and meeting patient needs (Siau, 2003). Hospital is a highly complex socio-economic scientific organization which provides comprehensive health care to the society and acts as a referral centre. Hospital problems are multifarious. Sixty percent of hospital budget was spent on wage and salaries of the staffs (Salauddin, 1998). When people were helped and their working 2.4. Study period The study was conducted for the one year during the period of January, 2016 to December, 2016.

Study population
Health care receiver who attended the OPD services of Khulna Medical College Hospital and Health care providers who worked in that hospital.

Sampling technique
Purposive sampling was used for data collection.

Sample size
Sample size was calculated through following formula. n = Z²pq/d² From the above formula the estimated sample size was 384.

Inclusion criteria Inclusion criteria for service receiver-
 Taking treatment facility in Medical college hospital  Willing to participate in the study Inclusion criteria for service provider- Permanent employee of the institution irrespective of age, gender and religion  Having work experience in the study place for more than six months

Research tools
Semi-structured interviewer administered questionnaire was developed to collect the data. The questionnaire was prepared by using the selected variables according to objectives. Completed questionnaires were checked by the supervisors before collecting the data and questionnaire were planned designed according to the objectives to get information of the different variables. The questionnaire was prepared in English then translates in bangle. The questionnaire was pretested in the 500 bedded general hospital Mukda. It was conducted in Bangla language after the questions were pretested and necessary modifications were made. This result not included in final thesis For collection of data, both questionnaire and checklist were used. Separate questionnaire was used for health care providers and health care receivers.
Checklist was used to collect information regarding administrative facility, physical facility and utility services.

Statistical analysis
After completion of data collection, to maintain consistency, the data were checked and edited manually and verified before tabulation. Data were coded, entered and analyzed in a computer. The statistical analysis was conducted using SPSS version 22.

Results and Discussion
This cross-sectional study was conducted in a tertiary level hospital named Khulna Medical College Hospital, Khulna. The study was carried out among 150 health care receivers and 50 participants were health care providers of this hospital. The demographic characteristics of the respondents are shown in Table 1.  Table 1 showed that the highest value was 21-30 years which was 23.3% of the total value. The lowest value was below 10 years which 7.3% of the total value and Mean age ±SD=36.15 ±16.46. Most of the service receivers were male which value 53 % and rest of the service receivers was 47% female. The frequency of no formal education was 14 among the 150 receiver which was 9.3 % of the total value. The frequency of primary level was 35 (23.3%) of the total value. Junior school level was 36 (24%). Secondary level was 37 representing 24.7% of the total value. Only 28% of the receiver completed the above Secondary degree. A sizeable number of the receivers 14% were rickshaw puller, followed by 20.7% who were employed in various trades, majority 31.3% of whom was professional house wife. Most of the receiver 17.3% was student. Another 16.7% receiver said that they were others profession. Monthly family income of the service receivers, the highest value was 10001-20000 taka which was 61 (40.67%) receivers among 150 Receivers. Service provides by age, the highest value was 36-40 years which was 26% of the total value. The lowest value was more than 55 years which 6% of the total value and Mean age ± SD= 41.02±9.11. From the 50 respondents, 29 representing 58% were males and 21 respondents representing 42% were females with educational level from Junior School Certificate and SSC, 12% obtaining Higher Secondary Certificate, with 12% obtaining the graduation and 28% complete the post-graduation degree. Within the respondents 20% were Doctor, followed by 16% were Nurse. Majority 26% of whom were professional Office attendant. Another 6% were receptionist, 8 % were pharmacist, 20% were ward boy and 4 % were others profession.  Table 2 shows that there were 82% of the respondent came to the hospital OPD willingly for the treatment of their illness and only 18% of the service receiver came to there by the advice of others. Among them 104 receivers get the doctor according to their demand and 46 patients didn't get the doctor according to their demand. 91.3% of service receivers said that they easy to find the OPD, 8.7% of the receivers said that they did not find the OPD easily and 69.3% of the receivers quickly registered their name and there were 30.7% of the service receivers did not quickly registered their name from the tick counter of OPD. During data collection 71 (47.3%) service receivers reported that they spent time less than 1 hour at the hospital for getting total health service, the 47 (31.3%) receivers said they spent times between 1-2 hours at the hospital for getting total health services. The 9.3% service receivers who spent times between 2-3 hours for getting total health services, rest of 18 (12.6%) receivers said that they spent times more than 3 hours for getting total health services.  Table 3 shows that there were 84% of the service receiver said that the doctor listen their problem carefully and there were 16 % of the service receiver said that the doctor don't listen their problem carefully and different patient get different advice from the doctors. 108 patients take only prescription among 150, 19 patients give advice only among 150, 45 patients ask to collected drugs among 150, 17 patients take advice for operation among 150 and 60 patients take advice for investigation among 150.  Figure 1 shows that there were 41% service receiver said that the doctor explain their health problem and 59% of the service receiver said that the doctor don't explain their health problem during the service receive.

Waiting time for doctors
Up to 30 min 30-60 min More than 60 min The above Figure 2 shows that the waiting time of the service receivers, there were 74.7% service receivers said that they wait up to 30 minutes for doctor and there were 6% service receivers said that they wait 30-60 minutes for the doctors and 19.3% service receivers said that they wait more than 60 minutes for the doctors. The above Table 4 shows that the opinion regarding the problem faced during receiving services, there were 47.3% of service receivers gave opinion about the dissatisfaction of physical facility, 36.7% were decrease number of manpower, 35.3% were disturbance by broker, 31.3% were require long time, 29.3% were decrease medicine supply, 26.7% were poor security. 22.0% were unclean and unsatisfactory toilet facilities, 19.3% were interfere of medicine representative, 16.7% were dissatisfaction of investigation, 14.7% were no provision of safe drinking water and rest of 14% service receivers gave opinion about OPD shifting. Suggestion by the service receiver regarding services in tertiary level hospital for improving services. 49.3% of the service receivers suggested that manpower should be increase which rank was first (1). 40.7% of the service receivers suggested that seating arrangement should be modernized, 37.3% of service receivers suggested that improved the OPD security by involvement of RAB, 33.33% of service receivers suggested that improvement of the doctor patient relationship. Regarding the medicine supply 29.3% of the service receiver suggested that availability of medicine should be needed for better treatment. About the facility of hospital 26% service receivers suggested that establishes modern investigation facilities. Regarding cleanliness and hygiene practice 25.3% of the service receivers suggested that toilet should be clean for improve the satisfaction level. About the counter facility 24.7% of the service receivers suggested that counted should be separated for staff and patient. Drinking water facility 20% of the service receivers suggested that provide safe drinking water. Regarding the shifting 18.7% of the service receiver suggested that add the evening shifting which rank was last (10).  To the question "Dose your hospital OPD follow one of the objective of PRM?" as shown in Table 6, there were 50 service providers, 8 representing 16% of the provide have gave their opinion that Hospital OPD actually follow one of the objective (Improving patient service) of PRM and 1 representing 2% of the provider gave their opinion which hospital OPD does not follow any objective of CRM (PRM), and 41 (82%) didn't have knowledge regarding about CRM objective. Most (40%) of the service providers gave their opinion to enhance manpower, modern equipment and enough medicine availability, 5% of the providers gave their opinion for the enhance manpower, 4% of the respondents gave their opinion to develop cleaning facility and only 2% of the respondents said that to ensure enough emergency medicine supply.