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1 | Page Comparison of Different Marketing strategy for Sleep Center --------------------------------------------------------------------------------------------------- ------------------------------------------------------------- Dissertation submitted to PRIST UNIVERSITY, Thanjavur in partial fulfillment of the requirement for the award of the degree MASTER OF BUSINESS ADMINISTRATION In Health Care Management Submitted by (Hathi Chirag K.) PRIST UNIVERSITY Thanjavur (June 2012)

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Comparison of Different Marketing strategy for Sleep Center

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Dissertation submitted to PRIST UNIVERSITY, Thanjavur in partial fulfillment of the

requirement for the award of the degree

MASTER OF BUSINESS ADMINISTRATION

In

Health Care Management

Submitted by

(Hathi Chirag K.)

PRIST UNIVERSITY

Thanjavur

(June 2012)

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DECLARATION

I hereby declare that the dissertation entitled “Comparison of different

marketing strategy for sleep center” submitted for the M. B. A (Health Care

Management), degree is my original work and the dissertation has not formed the basis

for the award of any degree, associate ship, fellowship or any other similar titles.

Place:

Date: Signature of the Student

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CERTIFICATE

This is to certify that the Dissertation entitled “Comparison of different

marketing strategy for sleep center” submitted by (Chirag Hathi, Enrolment Number

:101114545), is a bonafide record of research work done by her/she under my guidance

at PRIST UNIVERSITY, Thanjavur, in partial fulfillment of the requirement for the award

of the degree MASTER OF BUSINESS ADMINISTRATION in Health Care

Management and the dissertation has not formed on the basis for the award of any

degree, associate ship, fellowship or any other similar titles.

Place:

Date: Signature of the Guide

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ACKNOWLEDGEMENT

I would like to express my sincere thanks and gratitude to SPARSH

HOSPITAL, AHMEDABAD for allowing me to complete my dissertation

project in the facility.

The structure and the content of this project have been deeply influenced by

many people for whom I wish to express my gratitude.

I sincerely thank Dr.Tushar Patel, Dr.Gopal Raval, Dr.Mukesh Patel,

Dr.Harjit Dumra & Dr.Varun Patel for giving me the opportunity to do my

project at “SPARSH HOSPITAL, AHMEDABAD”.

My sincere thanks go to Mrs. Manju Sharma ICRI-Ahmedabad and Dr.

Babita Agrawal (Principal ICRI Ahmedabad) for helping me in designing

my study.

Foremost, I would like to thank Dr.Gopal Raval(M.B,D.N.B(respiratory

medicine)DTCD FCCS) and Dr.Varun Patel(MB,DNB,Respiratory

medicine)who were kind enough to spare their valuable time and provided

several important guidance and suggestions at every stage of my study.

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CONTENTS

CHAPTER /SERIAL. NO.

PARTICULARS PAGE NO.

1 Hospital profile

1.1 Services

1.2 About doctors

6

2 Introduction of topic

2.1 Aim

2.2 objectives

9

3 Review of literature

3.1 Sleep Disorders

3.2 Sleep Clinic

3.3 Market environment

10

4 Research methodology

4.1 scope

4.2 Topic

4.3 Time duration

4.4 source of data

4.5 Method of data collection

4.6 Method of data collection

4.7 limitation

16

5 Planning &

Marketing strategy

17

6 Data collection 20

7 Observation 21

8 Conclusion 23

9 Recommendations and suggestions 24

10 Links and references 25

11 Annexure

11.1 forms

26

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1 Hospital profile

Ashrai Associates is a group of young, highly

skilled, experienced and dynamic Pulmonary and

Critical care specialists, who have been

providing comprehensive Respiratory and Critical

care to patients residing in the Western region

of India for the last 5 years.

ASHRAI has played a pioneering role in the

development of several subspecialties in field of

Pulmonary & Critical Care Medicine not only in

Ahmedabad and the state of Gujarat but also in

the entire Western India Region.

Maximum number of Medical Pleuroscopies & Therapeutic

Bronchoscopic Procedures in India

The only group to have intensivists who have comprehensive training

in Transplants - Liver & Lung. We have now assisted in the maximum

number of Liver transplants in the state of Gujarat.

Maximum number of patients of ARDS treated with Extracorporeal

Techniques (ECMO) in the state of Gujarat.

The only facility in Gujarat to have state of the art Allergy Testing unit

The First group to start Pulmonary Hypertension and ILD clinics in

Western India

The First group to initiate comprehensive Domiciliary care for End

stage lung Disease patients with the help of trained medical &

paramedical staff

The First facility in Gujarat to be approved for Phase II, III & IV trials

The First Group to Establish a Comprehensive Sleep Diagnostic Center

and have a dedicated individual specializing in Sleep Disorders.

The First & Only Group to Organize workshops for hands on Training in

Ventilatory Management, Spirometry, Bronchoscopy and Pleuroscopy.

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1.1 Services

Bronchoscopy

Pleuroscopy

PFT

6MWT

Allergy clinic

Sleep clinic

Smoking cessation

Critical care

1.2 ASHRAI Doctors:-

Dr.Harjit Dumra:-

He is the chief intensivist at the Sterling Hospital. One of the member of the

infection control committee at Medisurge hospital. He is a respected national

and international faculty and has delivered talks on various topics across the

country.

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Dr.Tushar Patel:-

He is a main member of the ASHRAI group. He has special interest in

occupational lung disease. His area of expertise includes TB, Obstructive

airway disorders, Sleep disorders and PFT.

Dr.Mukesh Patel:-

He is highly skilled and experienced pulmonary and critical care specialist

practicing in Ahmedabad for last 12 years. He is the first pulmonologist in

country to start medical Pleuroscopy.

Dr.Gopal Raval:-

He is a dynamic pulmonologist and critical care specialist and he was

research fellow in international study of asthma and allergic condition in

children (ISAAC). He has taken training in sleep medicine from Indian

institute of sleep science, Mumbai.

Dr. Amrish Patel:-

He is one of the new generation of pulmonary and critical care specialist. He

is back bone of critical care service at ASHRAI. He is acore member of liver

transplant team.

Dr. Raj Bhagat:-

He is a well known allergy specialist practicing in Ahmedabad. His areas of

interest are respiratory medicine, allergy and applied immunology. He has

published various articles in “the Indian Practitioner” and “Gujarat Medical

Journal”.

Dr.Varun Patel:-

He is youngest member of the group. He has done his DNB (Gold Medalist)

from Amrita institute of Medical sciences, Kochi. He has presented number of

papers in the various states, national international conferences.

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2 Introduction of topic

2.1 Aim: - To compare 3 different marketing strategy for the sleep clinic

2.2 Objectives:-

To understand the sleep clinic service.

To study the market environment and competition

To study which marketing strategy is suitable for sleep clinic

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3 Review of literature

3.1 Introduction about sleep disorders

Due to rapidly increasing knowledge about sleep in the 20th century,

including the discovery of REM sleep and sleep apnea, the medical

importance of sleep was recognized. The medical community began paying

more attention than previously to primary sleep disorders, such as sleep

apnea, as well as the role and quality of sleep in other conditions

Sleep apnea:-

While there are may be many symptoms for sleep apnea the more

significant symptoms are:

Loud, irregular, snoring, snorts,

gasps and other unusual

breathing sounds during sleep

Long pause in breathing during

sleep

Excessive daytime sleepiness

Fatigue

Obesity

Changes in alertness , memory

Change in mood personality and behavior

Impotence

Morning headaches

Frequent trips to bathroom at night

NOTE: 40% of OSA patients have diabetes.

Sleep apnea is among top 4 causes of heart disease.

Although obstructive sleep apnea and cardiovascular disease have common

risk factors, epidemiologic studies show that sleep apnea increases risks for

cardiovascular disease independently of individuals' demographic

characteristics (i.e., age, sex, and race) or risk markers (i.e., smoking,

alcohol, obesity, diabetes, dyslipidemia, Arial fibrillation, and hypertension).

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Individuals with severe sleep apnea are at increased risk for coronary artery

disease, congestive heart failure, and stroke.

Sleep apnea has several health risks. Untreated sleep apnea may

lead to:

High blood pressure

Stroke

Heart attack

Congestive heart failure

Cardiac arrhythmia

Depression

Glaucoma

Obesity

Diabetes

Chronic fatigue

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3.2 Sleep clinic

Sleep Medicine is now a recognized subspecialty within internal medicine,

family medicine, pediatrics, otolaryngology, psychiatry and neurology in the

United States. In India it is still a new field.

Certification in Sleep Medicine shows that the specialist has demonstrated

expertise in the diagnosis and management of clinical conditions that occur

during sleep, that disturb sleep, or that are affected by disturbances in the

wake-sleep cycle.

This specialist is skilled in the analysis and interpretation of comprehensive

polysomnography and well-versed in emerging research and management of

a sleep laboratory.

Types of Studies

Nocturnal Polysomnogram, NPSG – The standard overnight

diagnostic sleep study used to assess sleep disorders, including sleep

apnea, periodic limb movement disorders, insomnia, 24 hour sleep-

wake cycle disruptions etc. The study includes various physiological

measurements such as respiratory effort and airflow, EEG (brain

waves), EKG (Heart), EMG (muscle movement), oxygen saturations,

and snoring. These parameters are standard on every overnight sleep

study both diagnostic and therapeutic.

Continuous Positive Airway Pressure, CPAP Titration – A

therapeutic study used to treat obstructive sleep apnea syndrome

(OSAS). The purpose of this study is to explore a variety of CPAP

pressures to determine which is the most effective in eliminating

apneic events and scoring.

Split Study – A sleep study which combines a 2 – 4 hour diagnostic

test and a therapeutic test in the same night. This study is possible for

every adult so that patients with severe OSAS may be treated

immediately. If a patient is not “split” to CPAP then the study is run as

a NPSG. The patient may return for a full night of CPAP if the

diagnostic test finds evidence of sleep apnea and treatment is advised.

Bi-Level Titration – An alternate therapeutic study used to treat

patients that have very high severe obstructive sleep apnea syndrome

or those that are intolerant of CPAP. Pressures are explored on the

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inhalation and an alternate pressure on exhalation. This pressure

spread is used to ease the work of breathing.

REM Behavior Disorder, RBD – a modified NPSG with electrodes

added to the arms (in addition to the legs) to determine the presence

of movement during REM, a stage of sleep during which the muscles

are immobile. This study is performed if a patient is suspected of

acting out his/her dreams at night.

NPSG with End Tidal CO2 – a modified NPSG with the use of end

tidal CO2 monitoring. A useful adjunct to the airway recording to assist

in the detection of obesity hypoventilation and Hypercapnia, or CO2

retention. ETCO2 recording is considered the gold standard for

pediatric polysomnography.

Expanded EEG Sleep Recording – An NPSG performed with a full

EEG montage during recording. This study is used to detect the

presence of nocturnal seizures in addition to other sleep disorders.

Multiple Sleep Latency Test, MSLT – A study performed during the

day after a full diagnostic NPSG, this study is used to objectively

determine a patient’s level of sleepiness after a night’s sleep. The

MSLT is a series of five timed test, two hours apart, during which we

look to see whether a patient falls asleep, how quickly, and to what

stage of sleep the patient reaches. The MSLT is most commonly used

to diagnose narcolepsy or some degree of excessive daytime

sleepiness.

Maintenance of Wakefulness Test, MWT – A study performed to

determine whether a patient is able to remain awake in a sleep

induced environment. The MWT is used to assess the efficacy of the

treatment of a sleep disorder

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3.3 Market environment in India

The prevalence of obesity, sleep apnea, and the metabolic syndrome is

rapidly increasing in India and other south Asian countries, leading to

increased morbidity and mortality due to type 2 diabetes mellitus (T2DM)

and cardiovascular disease (CVD).

Obstructive sleep apnea (OSA) has been reported to be present in 7.5% of

Asian Indians in western India. Growing evidence indicates OSA to be

independently associated with obesity, hypertension, and excess

cardiovascular risk and mortality.

Patients with OSA have a high prevalence of insulin resistance and the

metabolic syndrome. Obese Asian Indians with OSA had higher abdominal

obesity and fasting blood glucose and a higher prevalence of the metabolic

syndrome as compared with obese subjects without OSA.

These data also indicate that the presence of OSA may increase the risk of

atherosclerosis and CHD independent of obesity in Asian Indians.

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4 Research Methodology

4.1 Scope of Study

4.2 Topic: - study output of three different marketing strategy

4.3 Time Duration of Project: - 45 days

4.4 Source of data collection:-

Patient records

4.5 Method of data collection:-

By filling up questioner form and feedback form for the patients.

By interaction with doctors

Observation

4.6 Methods of data presentation:-

Graphical representation

4.7 Limitation: - time period was limited to measure accurate result.

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5 Planning:

5.1 Market research

Market research is any organized effort to gather information about markets

or customers. It is a very important component of business strategy.

Market research is for discovering what people want, need, or believe. It can

also involve discovering how they act. Once that research is completed, it

can be used to determine how to market your product

To know the awareness level of the sleep disorder in people and prevalence

of the disorder in this area a questioner (annexure) is formed and it had

been filed by 300 people.

Result of marketing research

Level of awareness about sleep

apnea in this area

Prevalence of disease in this area

5.7% 48.56%

In India awareness level is very low and people do not take sleep disorders

seriously. Patients do not complain about symptoms until the condition is

worst.

OSA is prevalent in upper class of the India. It is also prevalent in top class.

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5.2 Marketing Strategy

To increase the awareness 3 marketing strategies has been adopted.

Doctors: -

o Message: We want to assist you in providing the very best healthcare for your patients.

o Local doctors were given informative brochures and basic idea

about sleep clinic.

o Call on physicians’ offices to educate the physicians and/or their office managers on sleep disorders. Provide physicians and office managers with screening information and educational brochures for their staff and patients

o Thank you notes to physicians who have referred patients within 48 hours of referral

Events :- for general public as well as Doctors

o Event was organized on the Sunday so that we can target more

people.

o Advertisement for event was done by flyers which had been

distributed via news papers.

o A presentation was given by the doctor and self assessment

questioners were given to the audiences so that they themselves

can evaluate that they had sleep disorder or not?

Advertisement and news:-

o Informative advertisement in local language was given in news

papers.

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6 Data collection

Data collection was done by feedback form:-

Feedback form was given to each patient and filled form was collected from

them.(annexure 11.1)

From the patient data sheet we came to know about clinical data of the

patient. (annexure 11.1)

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7 Observation

Marketing

strategy

Events Referred by

Doctor

Advertisement

and news

No. of the

patients

22 118 10

Percentage 14.66 78.67 6.66

events

64%

referred

by doctor

25%

advertisement

11%

marketing strategy

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Doctors %

Cardiologist 60

General physician 9.5

Pulmonologist 25

Others 5.5

From the patient clinical data sheet following data was obtained:-

67% of the patients were having high BMI.

25% of the patients were victim of sleep disorder just because of the

stress and life style.

cardilogist

60%

general

physicians

9%

pulmonologist

25%

others

6%

Doctors

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8 Conclusion and Discussion

Sleep diagnosis and sleep disorders are still new for the Indian market.

And people are not taking the disorder seriously until and unless their

family physician or any Doctor influences them. However, the mindset of

urban Indian patients is changing from treating illness to managing

wellness. In case of health care India is a Doctor Driven market.

Events and advertisement do have an effect but not satisfactory. Events

may influence the patient to think about the sleep disorder.

Advertisements helps in creating brand image or may be it creates

psychological effect in patient’s mind about the service that it is famous

and reliable. But it will not good result in short time. It will take time to

create a good image in the patient’s mind. Especially in the healthcare

market.

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9 Recommendations and suggestions

Cardiologist and pulmonologist doctors should be targeted to

achieve goal.

Obesity being the main reason of the sleep apnea that particular

type of the patient should be targeted. These patients may require

large-sized wheelchairs and beds and quick access to pre-surgical

appointments

Sleep lab accreditation may help to create a good brand image.

Risk of OSA is more in diabetic patient. Awareness in such patients

may help to create good patient base.

Weight loss programs: About 67 percent of people with OSA are

obese. Partnering with local weight loss programs could increase

referral base. A loss of just 10 percent of body weight may cure

OSA or diminish it significantly.

Transportation industry: It's widely recognized that drowsy driving

is very dangerous and that untreated OSA and narcolepsy may

increase risks. Both the aviation and the trucking industry now may

require sleep disorders screenings and/or maintenance of

wakefulness testing for vehicle operators. However cost of sleep

clinic is high so need to develop a good pricing strategy is

important.

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10 Links and references

http://www.aasmnet.org/

http://www.sleepdt.com/articles/5-2/

National Library of Medicine, Bethesda

http://sleepapnea.org/about-asaa.html

National Heart, Lung and Blood Institute/National Center on Sleep Disorders

Research Expert Panel on Driver Fatigue and Sleepiness. Drowsy driving and

automobile crashes: report and recommendations. Available from: URL:

www.nhlbi.nih.gov/health/prof/sleep/drsy_drv.pdf.

Essentials o healthcare marketing by Eric N. Berkowitz, page no.27-28

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11 Annexure

11.1 Forms:-

Format of the questioner:-

Name:- _________________________________________________

Age:-__________

Gender: - Male Female

1. Do you have problem of snoring? Yes No

2. Do you have problem with your alertness? Yes No

3. Do you feel morning headache? Yes No

4. Do you frequently feel sleepy in the day time? Yes No

5. Do you know what sleep apnea is? Yes No

Patient name:-

Age:-

Gender: - Male Female

1. Do you have problem of snoring? Yes No

2. Do you have problem with your alertness? Yes No

3. Do you feel morning headache? Yes No

4. Do you frequently feel sleepy in the day time? Yes No

More than one yes means you MAY have sleep disorder.

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Feedback form:-

Feedback form

Patient name:- ________________________________________________________

Ph. No:- ______________

You came to know about our sleep center by:-

Doctor

Name of the doctor and contact no:-_______________________________

_______________________________

Advertisement in the news papers

Event

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