CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
CUSTOMER PREFERENCES TOWARD PEDIATRIC HEALTH CARE
A project submitted in partial satisfaction of the
requirements for the degree of Master of Science in
Health Science
Health Administration
by
Anne F. Shelley
May' 1982
The Project of Anne F. Shelley is approved:
California State University, Northridge
ii
ACKNO\vLEDG EMENTS
I am grateful to my committee members,
Mr. Allen G.
Herkimer, Dr. Jerome Seliger and Dr. Donald M. Hufhines,
for their guidance and assistance in enabling me to see
this project through.
A note
Krishnamurty,
of
for
sincere
his
appreciation
generous
to
offering of
Dr.
G.
time
B.
and
expertise in the analyses of the project data.
Special thanks to the cooperation of Fran Frey and
the staff at Childrens Hospital of Los Angeles' Department
of Planning and Public Affairs for their input to the
development of the survey instrument and for putting aside
precious time for consultation.
Finally,
a note of thanks to the respondents who
participated in the interviews,
attentiveness.
iii
for their cooperation and
CONTENTS
Page
.....
APPROVAL PAGE
ii
ACKNOWLEDGEMENTS •
iii
LIST OF TABLES • •
vi
LIST OF FIGURES
vii
CHAPTER
1.
2.
INTRODUCTION
1
Statement of Problems
4
Statement of the Problem
6
Signiticance of Problem • •
7
Description of Study Type .
8
Organization of Paper
10
BACKGROUND •
ll
Review of Literature
........
Setting of Project
The Sponsoring Organization.
3.
METHODOLOGY
ll
17
• • •
18
20
Statement of Problem
20
Objectives .
21
Detinitions
23
Sources of Data and
Their Measurement
24
Analysis
26
• • • •
Limitations
27
lV
4.
5.
RESULTS
28
Demographic Findings
28
Attitude Survey • • •
31
Knowledge Survey
47
CONCLUSIONS, RECOMMENDATIONS, AND
SUMMARY • • . • • • • •
50
Conclusion
50
Recommendations •
52
Summary
54
BIBLIOGRAPHY
57
APPENDICES
A.
B.
c.
D.
E.
.............
...
...
lJ.l!:FINI'l'lONS
....
POSITIVE COMMENTS ABOUT CHLA
. . . .
QUESTIONNAIRE
60
68
71
CONSUMER-PATIENT RECOMMENDATIONS TO
CHLA
............
73
AlJlJITIUNAL COMMENTS BY CONSUMERPATIENTS
75
..............
v
TABLES
Table
1.
Page
Respondent's Age, Marital Status, and
Number of Children: Number and
Percent .
29
2.
Respondent's Race:
29
3.
Respondent's Occupation and Education
30
4.
Respondent's Source of Medical Coverage
31
5.
Most Frequently Named Hospital in the
Los Angeles Area • • • • • • • • • . •
32
Respondents Who Had Brought Child to
Hospital
• • • • • • • • • .
. . .
33
Respondent's Preferred Hospital for
Pediatric Care
• • • • • •
34
Cross-Tabulation of Hospital by Geographic
Area
35
Other Hospitals Selected as the Preferred
Pediatric Hospital
• . •
• • .
36
6.
7.
8.
9.
Number and Percent
. ..
.........
10.
Ranking Profile
11.
Service Area UtJ.lized and Service Rating
of CHLA
12.
13.
14.
15.
16.
...........
Service (.;HLA Should Otter
.
Quiz 1 . . . . . . . . . . . . .
Quiz 2 . . . . . . . . . . . . .
Quiz 3 . . . .
. ......
Quiz 4 .
..........
Vi
...
...
. . .
...
...
...
...
...
...
42
45
46
47
48
...
...
48
49
FIGURES
Figure
1.
2.
3.
Page
Variability and Ranking of Factors When
Respondents Were Asked:
If you had
to Use a Hospital for your Child, which
Factors would be Important, in order of
Importance? •
38
Var1ab1lity and Ranking of Factors When
Respondents were Asked:
It your Child
Had to be Admitted to the Hospital, Based
on the Particular Hospital you Selected,
Rank the tollowing Factors in order of
Importance
• • • • • • • • • • • • .
41
Variab1lity and Ranking of Factors Based on
Respondents Ranking of the Factors Related
to the Most Desirable Qualities of Any
Hospital
• • • • • • • • . • • . • • • •
44
vii
CHAPTER 1
I.
The goal
of
a
INTRODUCTION
hospital
marketing program which
wishes to be both successful and accepted,
should be
to eliminate barriers to people in obtaining needed health
care services,
without creating artificial needs or inap-
proriate demands for those services.
Marketing program
objectives can include several options:
unified, positive public image for the
(1) creating a
hospital~
(2) de-
veloping a better understanding of the perceptions of, and
demands
on,
the
hospital
by
each
of
its
constituent
groups: and (3) appropriately designing and promoting the
hospital's services.
This project focused on item two above,
specifi-
cally, the patient-consumer attitudes toward acute care
hospitals,
with primary attention given to attitudes
toward pediatric
Angeles (CHLA).
care
and
Childrens
Hospital
of
Los
It was felt that a project of this kind
would be most helpful to an organization such as CHLA,
whose future seemed uncertain as a result of historical,
financial and organizational realities.
A survey instrument was developed to test the attitudes and the level of knowledge of consumers about acute
1
2
care hospitals, and pediatric health care in an acute care
setting.
The questionnaire was developed with significant
input from members of the CHLA's Department of Planning
and Public Affairs, and from a review of the literature.
Administration of the questionnaire was achieved through
the selection of non-probablility samples based on geographic
location.
The survey yielded information about demographic,
cultural and socioeconomic variables.
Findings indicated
most respondents to be white females aged 30-39,
with at least one child.
married,
Most respondents owned their own
home and had lived at their present address for 1-3 years.
Respondents were primarily homemakers with some college
education.
A combined income of $25,000-$50,000 was re-
ported for most respondents with almost half of all respondents covered by some form of commercial insurance.
Interviews were conducted with 93 respondents during
the months of July, August,
and September,
1981.
Cedars-
Sinai Medical Center was the hospital named most often by
respondents when asked to name a hospital in the Los
Angeles Area.
Doctor's recommendation was the most impor-
tant factor in choosing the use of any hospital for children,
whereas,
reputation of the hospital was the most
important factor when the choice of a particular hospital
was justified by the respondent.
Good doctors was chosen
as the most desirable quality of any hospital.
3
One-fourth of all respondents interviewed had been a
patient or had had a family member as a patient at CHLA.
Most were inpatients at the Hospital and gave an overall
service rating of excellent.
of this
The most unexpected finding
survey indicated that
32% of the respondents
favored walk-in treatment as the service they felt CHLA
should offer the community.
4
II.
Historically,
STATEMENT OF PROBLEMS
hospitals developed their services to
suit the physician and the hospital rather than the community and the patient.
health care system,
The impetus for changes in the
from a management orientation with a
product concept toward a management orientation with a
marketing concept,
movement.
can be traced back to the consumerism
The decade of the sixties was one of extreme
social criticism for all institutions including the hospital.
The central criticism was that the hospital was not
responsive to the community.
There was much truth to this
as the hospital had been too busy keeping in step with
medical and technological advances - the product concept.
The system had given greater priority to the search for
medical solutions than to the quest for community health
problems.
The consumer movement continued to remain in the
forefront during the early and middle 1970's.
But now
consumerism seems to have been set aside given the nation's political and financial
ever,
conservative trend.
How-
some authors believe that consumerism will continue
to have a significant impact,
especially,
in the field of
5
marketing.
Bloom and Greyserl believe consumerism has
moved through the stages of its life cycle in much the
same way consumer packaged goods or consumer durables do.
They believe consumerism has experienced a large degree of
market fragmentation and now offers a wide variety of
brands of consumerism to different segments of society.
Within these brands of consumerism,
porters exists.
competition for sup-
For these reasons, hospital management
must change its orientation, shifting its emphasis from
the services and the products produced to the people.
Most hospitals that have initiated a marketing program have focused on the physician.
The Physician Support
Program at Childrens Hospital of Los Angeles includes the
creation of a physician liaison function to provide immediate, effective response to physician needs, mechanisms
to improve the Hospital's ability to communicate effectively with the referring physician, efforts to reform the
Hospital's admitting procedures,
the distribution of ap-
propriate publications, and the expansion of courtesies
provided to Attending Staff.
The Physician Support Program at CHLA is an understandable response since physicians are the Hospital's
primary source of patients.
However, the consumer-patient
1 Paul N. Bloom and Stephen A. Greyser, "The Maturing
of Consumerism," Harvard Business Review,
NovemberDecember, 1981, p. 130.
------
6
must be targeted for marketing as well.
The hospital
industry must realize that it is in the health care business, not the medical care business.
It is important that
the hospitals target the physician for marketing, but to
forget about the consumer-patient, is to forget about a
vital segment of the market.
Statement of the Problem
The Marketing Concept is a management orientation
that holds that the key to achieving organizational goals
consists of the organization's determining the needs and
wants of target markets and adapting itself to delivering
the desired satisfactions more effectively and efficiently
than its competitors.2
The marketing concept begins with
existing or potential consumer needs and wants, plans a
coordinated set of programs and services to serve those
needs and wants, and in return satisfies its goals through
creating consumer satisfaction.
The specific problem of this project is to identify
shifts in customer preferences and attitudes,
and demon-
strate through the employment of a survey instrument, the
usefulness of receiving input from the consumer-patient in
the
design
of
goals
and
objectives
for
the
hospital
organization.
2 Philip Kotler, Principles of Marketing (Englewood
Cliffs, N.J.: Prentice-Hall, Inc.-,-1980), p. 22.
7
Significance of Problem
The prelude to all planning is investigation.
This
is certainly the case for the planning of marketing strategies.
Information is a requisite required.
Information
about potential target markets and their reactions
various marketing mixes,
to
and the collection and analysis
of this information is the function of marketing research.
This activity is concluded to some degree in health care
institutions in the form of questionnaires and surveys of
patients and physicians.
Marketing research may also be used by health care
executives prior to introducing a new service.
Analysis
of market data provide valuable insights as to whether a
potential market exists and its size.
It aids in esti-
mating the probable success and reduces the element of
risk.
Although a certain amount of marketing research is
conducted in health care organizations,
it has not at-
tained the needed comprehensiveness by studying the whowhat-where-when-why-how of actual and potential markets.3
This project is a marketing research effort aimed at
separating the problems from the symptoms.
For instance,
CHLA's lower census figures may be a symptom of a more
3 Roberta N. Clarke and Linda Shyavitz, "Marketing
Information and Market REsearch - Valuable Tools for
Managers," Health Car~ Management Review, Winter, 1981,
pp. 73-77.
8
basic problem:
lack of a marketing orientation.
This
project is directed at increasing CHLA's management knowledge of the Hospital's external environment,
specifically
its customer market.
Description of Study Type
A survey instrument was developed to assess consumer
attitudes toward acute care hospitals.
A review of the
literature in addition to input from the sponsoring organization were used in its construction.
The survey in-
strument, a questionniare, consisted of a three part document.
Items were designed to identify information in the
following three areas:
1.
Demographic:
Cultural and Socioeconomic
2.
Attitudinal:
Opinions and Preferences
3.
Knowledge:
Respondents understanding of the
health care industry.
The questionnaire was designed with the intention of conducting personal interviews, with the interviewer completing the survey form.
It was felt that this would
remove some of the barriers that might exist between the
respondent and the interviewer.
A review of the questionnaire contained in Appendix
A will reveal extensive inquiries regarding the respondent's demographic,
cultural and socioeconomic status.
A
total of eleven questions made up the demographic profile
for each respondent.
The second part of the survey con-
9
cerned the attitudes and preferences of respondents and
included 20 questions.
It focused primarily on factors
the respondent considered most important in choosing a
hospital for pediatric care.
section was concerned
The
last third of this
with attitudes toward CHLA, and was
completed only by those who had previous experience with
the Hospital.
The third part of the survey contained four
questions designed to give an indication of the respondent's understanding of the health care industry.
p •
10
III.
ORGANIZATION OF PAPER
The presentation of this project begins with a review of the literature.
As will be discussed, most mar-
keting research programs in the health care industry were
first initiated by Health Maintenance Organizations.
This
form of health care delivery relies heavily on a reliable
estimate of potential enrollees, since revenue is based on
number of members and not acuity of disease.
A chapter on
methodology will follow and include a review of the objectives of the project as well
as
a
discussion of
the
sources of data and their measurement, the analysis of the
data, and the limitations of the study.
Next, the find-
ings will be presented from the questionnaire and discussed relative to the objectives of the project.
A
concluding chapter will provide recommendations specific
to the future of CHLA and applicable to all acute care
facilities.
Finally, areas in health care marketing need-
ing further research and study will be discussed.
CHAPTER 2 - BACKGROUND
I.
REVIE~l
OF LITERATURE
The example of health care marketing research most
cited in the literature is the enrollment process for
Health Maintenance Organizations (HMO's).
Studies re-
lating the characteristics of individuals and plans to the
decision to
findings.
as:
join a HMO have produced some interesting
Acito4 summarizes the results of such studies
(1) Persons with greater risk of sickness and greater
frequency of hospital use were found to be members of
HMO's; (2) there was found to be no relationship between
utilization and expenditures and tendency to join
HMO's~
(3) larger family sizes with older heads of households,
greater income and higher educational attainment were
found to be among the joiners of HMO's; and (4) married
persons with children aged 6 to 18 and a greater proportion of blacks tended to choose HMO' s.
Studies reporting results of opinion, preference,
and attitude surveys were also examined by Acito.s
These
4 Franklin Acito,
"Consumer Decision Making and
Health Maintenance Organizations:
A Review," Hedical
Care, January, 1978, pp. 3-4.
5Ibid., pp. 6-7.
11
12
studies described respondents from the general population
who were not actually confronted with the decision to join
a HMO.
One study examined the interest in health in-
surance of the sample.
It was found the persons who felt
their income was well below average for their geographic
areas indicated the highest demand for health insurance.
However,
when the added cost of insurance was mentioned,
this group showed the greatest decline in reported demand.
In addition,
they found that older persons and married
persons with children tended to have high demand
insurance.
for
As far as overall consumer preference for
group practice,
some evidence has been found the younger,
better-educated individuals tended to prefer group practice as did blacks and persons in middle income groups.
In a study by Luft,6 factors affecting the use of
physician services were examined.
The results are compar-
able to those of other studies which find that health
status is the primary determinant of utilization.
is not at all a factor in utilization.
found to correlate with education,
primary determinant of
check-up.
the
Income
However, income is
and education is a
likelihood of obtaining a
In addition, it was found that the lower utili-
zation of people with no usual source of care was only
6 Harold s. Luft, John D. Hershey, and Joan Morrell,
"Factors Affecting the Use of Physician Services in a
Rural Community," Health Care Management Review, Winter,
1981, P• 70.
13
partly attributable to the different socioeconomic characteristics of the group who responded.
These studies
suggest the relative unimportance of price and the critical role of need in the choice of provider.
In
recent
years
increasing
importance has
placed on the evaluation of medical care.
been
Upon discharge,
patients are sometimes asked to fill out a hospital patient questionnaire in which the patient is given the
opportunity to express hisjher attitudes toward his/her
hospital stay.
One such study found several patient char-
acteristics to influence perception of medical care.7
It
was found that patients previously admitted to the particular hospital rated the hospital higher than first-time
patients.
This suggests that some learning takes place
during hospitalization.
tant variable.
Length of stay was also an impor-
Patients staying in the hospital less than
two weeks rated the hospital higher than patient hospitalized more than two weeks.
Race and social class vari-
ables also had a significant effect on perception of care.
However,
the authors were unable to offer any explanation
for this result.
7 Eleanor Nelson-Wernick, Hal s. Currey, Paul w.
Taylor, Mar ion \Joodbury and Alan Cantor, "Patient
Perception of Medical Care," Health Care Management
Review, Winter, 1981, p. 70.
14
A review article by Lebow8 focuses on studies using
consumers evaluation of quality of medical care.
cusses
the
studies
in
light of Donabedian' s
preaches to quality of care:
come, and impact.
four
ap-
structural, process, out-
However, he suggests a fifth approach
to the evaluation of medical care:
care.
He dis-
patient perception of
Lebow does not feel comfortable grouping patient
perception of care with process or outcome of care.
He
believes that the mood of the questioned individual and
the time of assessment are two factors which affect the
patient's perceptions but are not accounted for in process
or outcome quality assurance programs.
Lebow9 summarizes the results of one study using
patient opinions.
The most desirable qualities sought in
a medical center were, first, good doctors, followed by
well-trained staff, information from doctors, personal
interest in patient, pleasant staff, and privacy,
of importance.
Satisfaction was found to be related to
improvement in condition,
in the patient,
ditions.
in order
personal interest of the staff
and explanation received about their con-
Also, patients who rated the medical facility
negatively on one item tended to do so on other items as
well.
8 Jay L. Lebow, "Consumer Assessments of the Quality
of Medical Care," Medical Care, April, 1974, p. 328.
9 rbid., P. 330.
15
In another study examined by LebowlO, it was found
that the overall level of patient satisfaction with care
was related to the amount of information received by the
patient.
The researchers employed a patient satisfaction
questionnaire with patients
recently discharged after at
least a two-day stay at a large hospital.
cular study,
In this parti-
17% of the respondents felt they would be
reluctant to return to this hospital again if they had to.
Additional studies evaluated by Lebowll found that patients rated technical accuracy,
staff,
personal interest of
and accessibility as the most important characterIn another study, personal interest of
istics in care.
the physician, accessibility of the service, and convenience for the pat1ent were important factors in judging
care.
In a study conducted by Hulka,l2 the attitude of the
public toward physicians and medical services was examined.
sions:
The survey instrument consisted of three dimenprofessional competence,
Overall,
cost/convenience.
10 Ibid., p.
personal qualities,
attitudes
were
and
favorable
331.
llibid., p. 331.
1 2Barbara
s.
Hulka, Lawrence L. Kupper, Mary B.
Daly, John c. Cassel, and Frederic Schoen, "Correlates
with Satisfaction and Dissatisfaction with Medical Care:
A Community Perspective,"
Medical Care, August, 1975,
PP• 648-658.
16
toward the professional competency and the personal qualities of physicians.
Accessibility,
including costs and
convenience, were less highly regarded.
satisfied than
Whites.
women
and
Blacks
less
Men were less
satisfied
then
Particularly negative attitudes were expressed
toward the personal qualities of physicians by young
Blacks,
whereas among Blacks over 60 the negative effect
It was also found that
was toward costs and convenience.
having a regular physician and long attendance with that
physician were correlated with positive attitudes.
The
most negative feeling was expressed by women without a
regular source of care.
It seems as though the hospital must be sensitive to
what people perceive they are getting (caring, relief from
pain and anxiety,
knowledge about their condition,
re-
storation of function) in return for its costs to them
(out-of-pocket payment,
nity).
discomfort,
inconvenience,
indig-
The perceptions of current and prospective pa-
tients are what will affect their behavior,
perceptions are accurate or not.
whether such
The hospital by identi-
fying and analyzing factors influencing consumer choice
can change consumer behavior.
By utilizing specific mar-
keting techniques one can alter the nature of the exchange
relationship underlying that behavior.
17
II.
SETTING OF PROJECT
Childrens Hospital of Los Angeles (CHLA) served as
the sponsoring organization for this project.
CHLA is a
tertiary care center primarily serving the southwestern
United States.
The primary market area includes the area
from San Francisco in the north to the Mexican border in
the south to Las Vegas in the east.
However, the Hospital
sees patients from every state and all over the world.
The population served includes children from birth through
18 years of age.
In some cases, patients are seen up to
21 years of age.
Six geographic areas in the Los Angeles Area were
selected for this project, and these areas represented a
major source of patients for the Hospital.
Sites where
the survey was conducted consisted primarily of shopping
centers,
parks and recreation centers.
The following
indicates the geographic areas where the survey was conducted and the number of respondents interviewed from each
target area:
Geographic Area
Los Angeles
San Fernando Valley
Basin
San Gabriel Valley
"604" Corridor
Conejo Valley
Number of Respondents
6
25
17
19
9
17
18
Interviews were obtained from 100 respondents during
the months of July, August and September, 1981.
Of these
100 interviews, 93 questionnaires were completed; seven
surveys were incomplete and so were eliminated.
The Sponsoring Organization
Childrens Hospital of Los Angeles was founded as a
private,
charitable hospital April 1, 1901, by a small
group of women from the King's Daughters,
anthopic organization in Los Angeles.
the first phil-
In 1932, the Hospi-
tal became affiliated with the University of Southern
California School of Medicine as a pediatric teaching
hospital.
The Hospital contains a long history of firsts
·and continues to maintain its reputation as one of the
world's leading pediatric tertiary care centers.
Hospital
Yet,
the
lags far behind other major teaching facilities
in terms of its management capabilities.
The inadequate performance of the management team is
no match for the excellence demonstrated by the professional staff.
It is not so much the members of the man-
agement team, but rather, the resources available to management to make effective decisions.
agement team are well-qualified,
l1embers of the man-
having extensive exper-
ience and credentials to match the demands of their positions.
Unfortunately, the lack of resources, taken for
granted in other organizations,
retards management effec-
19
tiveness.
This lack of resources is most evident in the
area of marketing.
decisions
(MIS).l3
without a
The Hospital seems to make pertinent
formal
marketing information system
The investment of the Hospital into a MIS would
provide the management team with timely and accurate information to improve planning, execution, and control.
The lack of resources is further compounded by a
particular Board member who yields considerable power and
authority due to her generous donations to the Hospital.
Add to these problems the erosion of the Hospital's reputation and referral network and you have an anti-marketing
philosophy in the Hospital's planning and developmental
efforts.
The much publicized budget cuts of 1980, some long
standing systems problems, the geographic location, and
increasingly aggressive competitors have forced CHLA to
reevaluate their interpal and external environments.
The
Hospital has begun to take a marketing approach in order
to survive.
Hopefully, the Hospital will face the reality
of the situation and will take the time to make the drastic changes necessary to save the vital community interests it serves and maintain its high quality standards in
pediatrics.
l3Philip Kotler, Principles of Marketing (Englewood
Cliffs, N.J.:
Prentice-Hall, Inc.,-r980), p. 136.
CHAPTER 3 - METHODOLOGY
I.
STATEMENT OF PROBLEM
Marketing involves
the pr'actical application of an
understanding of human motivation in terms of exchanges of
values.
Through exchanges, various social units attain
the inputs they need.
By giving up something,
acquire something else in return.
they
This something else is
normally valued more than that which is given up, which
explains the motivation for
the
exchange.l4
Health care
has a cost to the consumer in time spent, travel, risk,
perceived loss of dignity,
dependency,
etc.
The hospital
employees may receive the gratitude and improved functioning of the patients as a benefit in addition to their
salaries and titles.
When services are considered in
reciprocal benefit terms,
the need for the provider to
understand the consumer becomes as important as the need
for the consumer to understand what the provider has to
offer. 15
14 Philip Kotler,
Marketing for Non.:...profit
Organizations, (Englewood c1T£fi-;-"New Jersey:--J?rent.:lc::e=
Hall, 1975), P• 5.
15 william A. Flexner, Curtis p. McLaughlin, and James
E. Littlefield, "Discovering What the Health Consumer
Really Wants," Health Care Management Review, Fall, 1977,
P• 44.
20
21
The purpose of this project was to assess the needs,
wants, and values of a specific service area in order to
evaluate existing acute care hospitals from the consumerpatient perspective.
The specific purpose is to undertake
a marketing research of a particular service area.
The
problem is to demonstrate through the employment of a
survey instrument the need to elicit information from the
consumer-patient regarding his/her opinions, attitudes,
and preferences toward acute care hospitals, generally
pediatric acute care and CHLA.
The tasks pertinent to the problem:
(1) development
of a survey instrument to test the level of knowledge of
consumer-patients about the hospital industry,
and to
measure their attitudes and preferences, and to provide
demographic,
cultural and socioeconomic data on the con-
sumer-patient; (2) administration of the survey instrument
to the target markets based on geographic location; and
(3) assessment of the needs,
wants,
and values of the
respondents.
Objectives
Marketing is the distinguishing,
any hospital.
unique function of
A hospital is set apart from all other
providers of health care by the fact that it markets a
program or service.
Since it is the
job of hospital
marketing to produce what the market needs,
marketing
22
should be the foundation area in objective setting for the
Furthermore,
hospital.
marketing demands prior decisions
of high risk which requires
a need
for objectives
in
respect to all resources.
The goal of this project was to establish the need
for input from the consumer-patient,
and to recognize the
importance of monitoring shifts in consumer preferences
regarding the creation and elimination of programs and
services.
At the same time, it was hoped that this pro-
ject would incrase the knowledge and understanding of
CHLA 1 s
management
staff about consumer-patient attitudes
and preferences toward pediatric acute care.
The follow-
ing objectives provided the direction toward attainment of
the goal:
1.
To obtain a demographic
respondent interviewed.
profile
of
each
2.
To determine the most frequently named hospital(s) in the Los Angeles Area.
3.
To determine the accessibility respondents had to
a regular source of health care.
4.
To determine the respondent•s favored choice of
hospital when utilizing a hospital for pediatric
care.
s.
To ascertain the importance of various factors in
choosing a hospital for pediatric care.
6.
To ascertain the most desirable qualities of any
hospital.
7.
To ascertain the respondent•s satisfaction with
the services provided at CHLA.
23
a.
To determine the service respondent's believe
CHLA should provide to the community.
9.
To obtain the consumer's understanding of the
health care industry.
A review of the survey instrument utilized for this
project will reveal a variety of responses required by
each respondent.
questions,
There are ranking questions,
multiple choice,
yes-no
and open-ended questions (see
Appendix A).
Definitions
In this project, marketing is defined as human activities directed at satisfying needs and wants through
exchange processes.l6
of life.
Its goal is to maximize the quality
This project is a marketing research effort,
which is only one function involved in the set of marketing activities.
For the purposes of this project,
the
reader may wish to acquaint himself/herself with some of
the marketing terminology (see Appendix B).
l6Philip Kotler, Principles of Marketing (Englewood
Cliffs, New Jersey: Prentice-Hall, Inc., 1980). pp. GlG9.
24
II.
SOURCES OF DATA AND THEIR MEASUREMENT
In this project,
the primary market of Childrens
Hospital of Los Angeles (CHLA} was divided into different
geographic regions, based on the notion that consumerpatient needs or responses vary geographically.
Geo-
graphic segmentation allows the hospital to distinguish
their geographic markets according to market potential.
In this way, the Hospital can allocate different resources
and use different marketing strategies in each of the
~eographical
regions.
As already discussed,
six geographic areas in Los
Angeles were selected for this project.
Sites where the
survey was conducted consisted primarily of shopping centers, parks and recreation centers.
The data were col-
lected over a three month period beginning in July and
ending in September, 1981.
The questionnaire was com-
pleted via personal interview,
with the interviewer nor-
mally writing the responses to each question.
The method
of conducting the survey proved effective in obtaining
respondents' cooperation in finishing the interview as it
usually generated conversation.
Each respondent was approached ·and asked,
"Would you
25
mind taking a survey on your attitudes towards children's
health care?
It's for a project of mine in school."
Each
respondent willing to take the survey was assured that the
responses would be kept confidential and that
responses could not be traced to them.
obtained from 100 respondents,
individual
Interviews were
but seven surveys were
incomplete and so were eliminated.
The collected data were coded and keypunched for
processing with the Statistical Package for the Social
Sciences.
Market characteristics were examined through
the use of frequency distributions and crosstabulations.
26
III.
ANALYSIS
The data collected during the project were analyzed
by use of descriptive statistics.
For the most part,
descriptive statistics include frequencies,
and
ranges.
lations.
Selected
statistics
means,
include
cross
modes,
tabu-
A complete review of the data may be found in
the chapter on results.
In addition, the data are ana-
lyzed by the use of the open-ended responses given in the
questionnaire {see Appendix C,
D & E).
While this is
qualitative and limited in representation {consumer-patient response was low),
it is reflective of the project's
worthwhileness and appeal.
27
IV.
LIMITATIONS
The project was intended to provide a descriptive profile
of factors, identified by the consumer, associated with
acute care hospitals,
Los Angeles.
and generally Childrens Hospital of
One could hardly say that the 93 respondents
are representatives of the Greater Los Angeles Area.
project used non-probability sampling;
determined who would be interviewed.
are no confidence intervals,
determined,
The
the interviewer
As a result,
there
the reliability cannot be
and the validity is open to question.
strengthen the research,
To
if true quota samples were drawn,
a much larger sample size would be required to meet the
demands of representativeness.
Chapter 4 - Results
A survey instrument was developed to assess consumer
attitudes and preferences toward pediatric health care in
acute care hospitals.
graphics,
Information was obtained on demo-
attitudes and preferences,
and understan,ding of
the health care industry from respondents within the designated geographic areas.
The findings are reported
below with reference to each of the objectives of this
project.
Demographic Findings
Objective 1: To obtain a demographic profile of each respondent.
Of the 73% of the sample who were married, 87%
reported at least one child.
The single group consisted
of 14% of the sample and corresponds with those 13% having
no children.
Of the respondents, 41% had two children.
Of the respondents,
74% were female and 26% were male (see
Table 1).
28
29
Table 1
Respondent's Age, Marital Status, and Number
of Children: Number and Percent
Age
>19
20-29
30-39
40-49
50-59
~60
#
0
27
34
16
11
5
Only
%
Marital Stat.
0
29.0
36.6
17-2
11.8
5.4
Single
Married
Widowed
Divorced
Separated
one
cultural
%
#
13
68
2
6
4
# of
Children
14.0
73.1
2-2
6.5
4.3
variable
was
0
l
2
3
4
#
12.9
23.7
40.9
9.7
12.9
12
22
38
9
12
obtained
%
- race.
White and Black constituted over 86% of the total sample;
80% of the sample were Caucasian.
A religious variable
was not part of the survey (see Table 2).
Table 2
Respondent's Race:
Race
White
Black
Hispanic
Asian
Indian
Other
Number and Percent
#
74
6
6
4
0
3
%
79.6
6.5
6.5
4.3
0
3-2
Socioeconomic variables included occupation,
cation and income.
edu-
Of the 93 respondents interviewed, 34%
described their occupation as homemakers with 14%, 15%,
and 16% of the respondents describing themselves as office
workers,
managerial,
and professionals,
respectively.
Of
30
the sample,
39% reported some college education, while 28%
reported college graduation.
$25,000 -
A middle income range of
$50,000 was reported by 37% of the respondents
(see Table 3).
Table 3
Respondent's Occupation and Education
Occupation
Homemakers
Management
Professional
Office Worker
Technical
Trade·
Retired
Student
#
%
32
15
14
13
8
5
3
3
34.4
16. 1
15.1
14.0
8.6
5.4
3.2
3.2
Other variables
reported
Education
#
Professional
College Graduate
Some College
High School
Tech/Voc School
Less Than 12
6
6.5
28.0
38.7
21.5
2.2
3.2
in the demographic profile
included data on horne ownership,
and type of medical coverage.
26
36
20
2
3
%
time at present address
Of the sample, 67% of the
respondents reported owning their horne with 32% reported
renting their living quarters.
Of the 93 respondents
interviewed, 30% had lived at their present address for 13 years.
Those individuals reporting living at their
present address less than one year or more than 25 years
made up 12% of the sample.
Of the sample,
insurance.
44% had some form of group or private
Another 25% claimed Blue Cross as their major
form of medical coverage.
Health Maintenance Organization
~
31
enrollees accounted for 16% of the respondents (see Table
4) •
Table 4
Respondent•s Source of Medical Coverage
Paying Agent
Self
Private/Group
MediCare
MediCal
Blue Cross
HMO
#
9
41
2
3
23
15
%
9.7
44.1
2.2
3.2
24.7
16.1
Attitude Survey
Objective
2:
To determine the most frequently named
hospital(s) in the Los Angeles Area.
The first question
required respondents to name a hospital in the Los Angeles
Area.
fined:
Some respondents wanted the Los Angeles Area deDid Los Angeles mean the city or the county?
Respondents were informed that this meant the total Los
Angeles County Area.
Cedars-Sinai Medical Center was
named most often by 15 respondents of the total 34 different hospitals named,
with Kaiser named second most
often by 8 respondents (see Table 5).
32
Table 5
Most Frequently Named Hospital(s) In
The Los Angeles Area
Hospital
Number of
Respondents Named lst
No. of Respondents
Named 2nd & 3rd
15
15
Cedars-Sinai
Kaiser
USC County
Northridge
Holly Presby
UCLA
Huntington
Los Robles
CHLA
7
8
7
5
5
4
15
6
6
15
4
4
0
2
7
0
Respondents were then asked to name two or more hospitals
in the Los Angeles area.
were named.
About 60 different hospitals
This time Cedars-Sinai, UCLA and USC County
Hospitals were named 15 times each with Kaiser and Childrens named second most often by 7 respondents (see Table
5) •
Next,
respondents were asked if they ever had to
bring their child to a hospital.
If the respondent had no
children, they were asked if they ever had to bring any
child to the hospital.
70% of the sample reported bring-
ing their child to the hospital.
were
named
as
the hospital
31 different hospitals
their child was
brought.
Kaiser was named most often by 7 of the respondents with
Northridge Hospital Foundation and Cedars-Sinai Medical
Center named second most often by 5 respondents each (see
Table 6).
33
Table 6
Number of Respondents Who Brought Child
to a Particular Hospital
Number of Respondents Who Brought
Child to a Particular Hospital
Hospital
Kaiser
Northridge
Cedars-Sinai
Westlake Comm.
Los Robles
Childrens
Objective 3:
7
5
5
4
4
3
To determine the accessibility respondents
had to a regular source of health care.
asked if they
Respondents were
had a regular family phisician.
only one aspect of accessibility.
This is
Of the sample,
73%
indicated that they had a regular family physician and 27%
indicated that they did not have a regular family physician.
Objective 4:
To determine the respondent's favored choice
of hospital when utilizing a hospital for pediatric care.
This question required the respondent to choose a hospital
in the event they had to admit their child to the hospital.
Eight hospitals were listed and respondents were
informed that they should specify another hospital if the
one they were to choose was not listed.
All hospitals
given are considered key competitors of CHLA and are major
acute care facilities located in one of the six geographic
areas of the county of Los Angeles.
It is important to
34
note that respondents were not aware of CHLA as the sponsoring organization.
The results shown in Table 7 indicate that of the
given hospitals CHLA was chosen by 19 respondents.
ever,
How-
the majority of respondents indicated other hospi-
tals as their choice in the event their child had to be
admitted to the hospital.
Kaiser was named most often by
5 respondents with Los Robles Hospital named second most
often by 3 respondents.
A total of 23 hospitals were
named by 32 respondents.
Table 7
Respondent's Preferred Hospital
for Pediatric Care
Hospital
Other
CHLA
UCLA
Cedars-Sinai
Northridge
Huntington
Tarzana
Glendale Adventist
Long Beach Memorial
Number of
Respondents
Percent of
Respondents
32
19
12
10
34.4
20.4
12.9
10.8
7.5
7.5
3.2
2·2
7
7
3
2
1
1.1
Crosstabulation of geographic area by hospital indicates that in most cases the geographic area determined
the choice of hospital.
As can be seen from Table 8, of
25 San Fernando Valley residents interviewed, six selected
35
Table 8
Cross Tabulation of Hospital by Geographic Area
"604"
HOSPITAL
L.A.
Northridge
Hospital
Foundation
SFV
6
Basin
Corridor
1
Tarzana
Medical
Center
2
Conejo
Valley
1
Glendale
Adventist
Hosptial
1
1
Long Beach
Memorial
Hospital
Childrens
Hospital
of Los Angeles
SGV
1
3
4
4
Huntington
Memorial
Hospital
3
5
7
Cedars-Sinai
Medical Center
1
6
2
1
2
UCLA
Hospital
2
2
4
2
Other
Hospitals
1
10
5
2
6
8
36
Northridge Hospital,
Center.
In short,
and two selected Tarzana Medical
it seems as though the geographic
residence of the respondent is a factor effecting choice
of hospital.
It is interesting to note the number of
respondents who indicated some other hospital.
Of the 23
other hospital specified, 15 would be considered small
community hospitals (see Table 9).
Table 9
Other Hospitals Selected as the
Preferred Pediatric Hospital
Objective 5:
Other Hospitals
#
Kaiser
Los Robles Hospital
St. Joseph Med Cntr
Holy Cross Hospital
Downey Cornm. Hospital
5
3
2
2
2
To ascertain the importance of various fac-
tors in choosing a hospital for pediatric care.
The survey instrument contains three questions that
require the respondent to rank factors from most important
to least important regarding (1} the use of any hospital
for children,
children,
(2) the choice of a particular hospital for
and
(3}
the
most desirable quality of any
hospital.
The first ranking concerns itself with the general:
If you had to use a hospital for your child, which factor
37
would be most important?
Nine factors are given and the
respondent may specify other factors that are not listed.
Figure
1 shows the
factors
ranking for each factor.
the factor doctor's
and the varabili ty of the
For example,
recommenda~ion
factor distance from home.
the variability of
is less than for the
This indicates that respon-
dent's choice of the factor doctor's recommendation is
generally agreed upon, whereas the factor distance from
home is more spread out and less decisive.
RANKED FACTORS
4th
5th
6th
7th
8th
9th
20
6
3
3
1
0
0
2
8
24
15
12
12
14
6
18
29
23
14
4
1
2
1
1
Distance from home
7
12
14
12
11
12
11
11
3
Cost of Medical Services
1
5
3
9
18
21
17
13
6
Type of Payment Required
0
1
1
6
11
13
26
27
~mployees
1
1
3
11
24
22
13
14
4
29
19
21
11
6
4
1
2
0
0
1
0
0
1
5
10
11
65
FACTORS
1st
Doctor's Recommendation
37
Peer's Recommendation
Reputation of the Hospital
are Friendly
& Understanding
Quality of Care
Ease of Parking
Figure 1.
2nd
3rd
23
0
1
2
3
4
5
6
7
8
8
9
Variability and ranking of factors are shown based on respondents
ranking of the factors when asked:
If you had to use a hospital for
your child, which factors would be important, in order of importance?
PROFILE RANKING
1.
2.
3.
4.
5.
Doctor's Recommendation
Quality of Care
Reputation of the Hospital
Distance from home
Peer's Recommendation
6.
7.
8.
9.
Employees are Friendly &
Understanding
Cost of Medical Services
Type of Payment Required
Ease of Parking
w
00
39
With a total of 9 factors to rank, there are 9J0 or
387,420,489 possible ranked combinations.
92 different
rankings were obtained from a sample of 93.
A ranking
profile using the mode was compiled based on cumulative
choice.
Doctor's recommendation was chosen by 37 respondents
as the most important factor in use of a hospital for
children.
Quality of care and reputation of the hospital
were ranked second and third,
respectively.
However,
one
could argue a tie between these two factors for second
most important factor
in use of a hospital.
ranked
that
in the middle,
is,
factors
through eighth were more variable.
ranked
fourth
Perhaps if a much
larger sample size were obtained these factors
ordered differently.
Factors
would be
Parking was clearly considered the
least important factor with 65 respondents placing this
factor last in their individual rankings.
In short,
rank-
ings seem to indicate very strong preferences for most and
least important factors as reflected in the varability of
the factors doctor's recommendations and ease of parking.
The second ranking question gives additional insight
into the respondent's choice of hospital in the event
their child had to be admitted to the hospital.
It asks:
Which factors determined your choice of hospital in the
event your child had to be admitted to the hospital?
This
40
question complements the first ranking which was concerned
with general factors related to the choice of any hospital.
The respondent is asked to rank the factors in order
of importance based on what factors determined their
choice of a particular hospital.
spondent is asked:
Specifically, the re-
Which of the following factors deter-
mined your choice of hospital the most?
Figure 2 shows the factors and the variability of the
ranking for each factor.
Eight factors are given with the
respondent free to specify other factors not listed that
he/she feels are important.
Peer's recommendation and
type of payment required are two factors dropped from the
first ranking and the factor, have been there before, is
added to the second ranking.
Some of the factors are
reworded but mean the same, i.e., personal physician selected hospital means the same as doctor's recommendation.
RANKED FACTORS
FACTORS
1st
Distance from home
14
Reputation of the Hospital
28
1
2nd
3rd
4th
5th
5
6th
7th
8th
15
14
6
1
9
10
8
17
27
19
8
5
3
2
31
26
22 6
12
3
7
11
Cost of Medical Services
1
1
7
8
8
Employees are Friendly
& Understanding
0
2
3
17
34
Parking Convenience
0
0
1
1
1
13
26
49
Personal Physician Selected
Hospital
16
23
14
19
9
3
4
5
Have Been There Before
20
12
16
10
6
4
7
18
Quality of Care
14
19
22
13
2
2
0
Figure 2.
2
3
4
21
8
Variability and ranking of factors are shown based on
respondents ranking of the factors when asked: If your
child had to be admitted to the hospital, based on the
particular choice of hospital you selected, rank the
following factors in order of importance.
PROFILE RANKING
1.
2.
3.
4.
Reputation of the hospital
Personal Physician Selected Hospital
Quality of Care
Have Been There Before
5.
6.
7.
8.
Distance from home
Employees are Friendly
& Understanding
Cost of Medical Services
Parking Convenience
"'I-'"
42
With a total of eight factors to rank, there are sB
or 16,777,216 possible ranked combinations.
89 different
rankings were obtained from a sample of 93.
A ranking
profile using the mode was compiled based on cumulative
choice.
Reputation of the hospital was ranked first fol-
lowed by personal physician selected hospital and quality
of care.
Parking was again,
clearly considered the least
important factor in determining the respondent's choice of
hospital
(See Table 10).
Table 10
Ranking Profile
Any Hospital Profile
Particular Hospital Profile
Doctor's recommendation
Quality of Care
Reputation of the Hospital
Personal Physician Selected
Hospital
Quality of Care
Have Been There Before
Distance from Home
Employees are Friendly &
Understanding
Cost of Medical Services
Parking Convenience
Reputation of the Hospital
Distance from Home
Peer's Recommendation
Employees are Friendly &
Understanding
Cost of Medical Services
Ease of Parking
43
Objective 6:
To ascertain the most desirable quali ti tes
of any hospital.
The third and final ranking concerns the most desirable quality of any hospital.
Respondents are given six
factors and can specify other factors if not indicated.
There are 46,656 possible ranked combinations.
Fifty-
seven different ranked combinations were obtained from the
sample of 93 respondents.
A ranked profile using the mode
was compiled based on cumulative choice.
Good doctors was
ranked the most desirable quality of any hospital.
The
personal interest shown in the patient's medical condition
was ranked second followed closely by explanations given
about
medical/ surgical condition/treatment.
Privacy was
ranked sixth. (See Figure 3).
Results from the rankings seem to elicit a strong
indication of likes and dislikes.
Generally speaking,
the
factors that respondents were not sure of or had a neutral
feeling about were placed in the middle.
Objective
7:
To ascertain the respondent's satisfaction
with the services provided at CHLA.
This next question
was the first indication the respondents received that the
survey was a
joint venture with CHLA.
question was asked of all respondents:
in your
family ever been a
The
following
Have you or anyone
patient at CHLA?
23
re-
spondents replied positively and went on to answer the
RANKED FACTORS
FACTORS
1st
2nd
The personal interest shown in
the patient's medical condition
18
32
Friendly and helpful staff
1
Privacy
1
1
3rd
4th
27
10
2
15
33
0
6
21
13
2
Good doctors
52
Explanations given about
medical/surgical condition/treatment
12
32
22
7
6
10
Accessibility and convenience of
services
Figure 3.
3
5th
6th
3
3
35
7
10
25
49
5
2
0
12
9
6
23
19 5
28
4
6
variability and ranking of factors are shown:based
ci>.n respondents ranking of the factors related to
the most desirable qualities of any hospital.
PROFILE RANKING
1.
2.
3.
4.
5.
6.
Good Doc tors
The personal interest in
the patient's medical condition
Explanations given about medical/surgical
condition/treatment
Friendly and helpful staff
Accessibility and convenience of services
Privacy
.r:::.
.p.
45
next three questions.
The 70 respondents who had had no
experience with CHLA skipped these three questions.
The
first question in the 3-question series con-
cerning CHLA asked respondents to rate the service area
utilized.
the second question asked respondents to rate
the service received at CHLA overall.
The third question
was an open-ended question which asked respondents to
indicate their reasons for their rating of the service at
CHLA (see Table ll).
Table 11
Service Area Utilized
Inpatient
Outpatient Clinic
Emergency Room
A Special Unit
(#)
9
5
5
4
Service Rating of CHLA
ill
Excellent
Satisfactory
Poor
No Opinion
14
7
1
l
Following the 3-question series about CHLA, two questions were asked of all respondents.
The first question
asked the respondent to indicate something positive about
the Hospital,
while the second question asked the re-
spondent for changes or recommendations that would help
improve the services at the Hospital.
Those who had had
experience with CHLA found these questions to be redundant~
some felt they could not answer or make any recom-
mendations.
Appendix C and Appendix D list the responses
to these two questions.
46
Objective 8:
To determine the service respondent's be-
lieve CHLA should provide to the community.
One of the more fascinating results of the survey was
this next question:
Which one of the following outpatient
services do you feel CHLA should provide to children in
the community?
It required respondents to indicate
outpatient service.
~e
Some respondents wanted to know which
services listed CHLA presently provided.
These respon-
dents were informed that it really did not matter which
services were currently offered as the Hospital wanted to
know which one service they preferred as consumers.
The results of this question are shown in Table 12.
Walk-in treatment was chosen by 32% of the sample.
eight respondents who specified other,
Hospital
The
indicated that the
should offer nutritional services or they indi-
cated their preference for all of the series listed,
after they were
informed a
even
second time that only one
service was requested.
Table 12
Service CHLA Should Offer
Outpatient Service
Walk-in Treatment
Trauma Center
Poison Center
Community Health Education
Other (Nutrition)
Mobile Clinic
Well Baby Clinic
Transportation to the
Hospital
(#)
(%)
30
18
12
10
8
6
5
32.3
19.4
12.9
10.8
8.6
6.5
5.4
4
4.3
47
Knowledge Survey
Objective 9:
To obtain the consumer's understariding of
the health care
industry.
The third part of the survey
instrument attempted to obtain a measure of the level of
knowledge of the respondents.
The interviewer believed
that the four questions asked were something that would be
common knowledge of one who read the newspaper or watched
the news on television.
The first question required the respondent to indicate an example of a Health Maintenance Organization (HMO)
from five items.
Kaiser was the correct response and was
chosen by 58% of the sample.
UCLA Hospital was chosen
second by 23% of the sample (see Table 13).
Table 13
Quiz 1
An example of a Health Maintenance
Organization (HMO} is
Kaiser
UCLA
National Medical
Enterprise
A nursing home
A hospital that
Has a ER
#
54
21
sa-:-1
22 6
10
4
10.8
4.3
4
4.3
%
0
The second question asked respondents to indicate the
most
recent trend
in the hospital
industry from
four
48
i terns.
68% of the respondents chose the correct response,
an increase in outpatient services, with 28% of the respondents choosing an encouragement of physicians to specialize (see Table 14).
Table 14
Quiz 2
The most recent trend in the
hospital industry is
An increase in outpatient services
An encouragement of physicians to
specialize
63
#
%
67.7
26
28.0
3
1
3.2
1.1
An increase in length of patient
stay
An enforcement of visiting hours
The third question asked respondents to indicate what
group they felt physicians wre historically associated.
This was close.
33% of the respondents chose the correct
response of barbers,
however,
39% of the respondents felt
butchers was the correct response (see Table 15).
Table 15
Quiz 3
Historically, physicians are
associated with which group?
Butchers
Barbers
Merchants
Court Jesters
Blacksmiths
#
36
31
16
9
1
%
38.7
33.3
17.2
9.7
1.1
49
The fourth question asked respondents to indicate the
health care profession in which a nationwide labor
shortage exists.
87% of the respondents selected the
correct profession of nurses (see Table 16).
Table 16
Quiz 4
A critical labor shortage exists
nationwide for which health care
profession?
#
Nurses
81
Physicians
8
Administrators 2
Pharmacists
1
%
87.1
8.6
2.2
1.1
CHAPTER 5
Conclusions, Recommendations, and Summary
I.
CONCLUSION
The San Gabriel Valley and "604" Corridor Regions
appear
to be CHLA's
patients.
Hospital,
As such,
major
market areas
for pediatric
they represent strongholds of the
and efforts should be made to maintain its share
of those markets.
Expansion into the Conejo Valley and
Antelope Valley seems to offer the least risk and the
.highest payoff, as these areas are growth markets.
Ef-
forts to expand into the saturated Basin Areas appear
bleak because of the dominance of competitors of CHLA,
such as Cedars-Sinai Medical Center and UCLA Hospital and
Clinics.
The San Fernando Valley may offer some oppor-
tunities,
with persistence.
CHLA must focus its first real marketing efforts on
territory with which it is familiar in the hopes that
early success will reinforce the confidence necessary to
overcome the intense competition which exists in all
Areas.
At the
same time,
these early successes will
hopefully secure the support of physicians and employees,
who are both determining factors to any future CHLA may
wish to enjoy.
50
51
This project was very fruitful in its generation of
findings.
However,
these findings are based on a non-
probability sample of 93 respondents and represent investigatory outcomes which occurred in a field environment.
The important con t rib uti on of this pro j e c t is the
demonstration of the importance of eliciting information
from the consumer-patient about his/her needs and wants.
The information contained in this document should be considered part of the vital interests of the Hospital.
52
II.
RECOMMENDATIONS
This decade of rapid social and technological development and impending emergency impels managers of most
health care organizations to examine the concept of marketing.
The inability of administrators to properly use
the existing body of information both for improving the
effectiveness of their hospital organizations and for
facilitating their adaptation to changing environments
appears to be a salient feature of today's health care
organizations.
CHLA's
Hopefully, an outsider's perspective of
situation of this project generated the following
recommendations for CHLA:
1.
To develop new services that are distinctive to
the pediatric health care market and CHLA, i.e.
nutritional services, walk-in treatment, child
obesity clinic, embryonic surgery.
2.
To bolster current "star" services to safeguard
the Hospital against market penetration by competitors, i.e. Neonatal, Oncology Programs.
3.
To utilize a horizontal integrative strategy and
purchase firms serving children's interests, i.e.
day-care centers, amusement parks.
4.
To correct systems errors, i.e. waiting time,
admitting procedures, discharge and communication
gaps between referring and attending physicians.
s.
To sponsor a mobile clinic through contracts with
schools for immunizations, examinations.
53
6.
To set up and/or sponsor community education
programs through P.T.A. 's and community governments, and community organizations.
7.
To build loyalty and trust among consumers toward
the Hospital through quality advertising and
image enhancement campaigns.
8.
To institute a Marketing Information System in
which data is available on current interval
events and external environments, with a goal
toward achieving more rigorous findings from
information by applying advanced statistical
procedures and models utilizing a computer.
54
III.
SUMMARY
This project undertook a study of the primary service area
of Childrens Hospital of Los Angeles (CHLA) to ascertain
the attitudes and preferences of the consumer-patient
toward pediatric care and the Hospital.
A survey instru-
ment was developed with input from members of CHLA's
Department of Planning and Public Affairs and a review of
the literature.
The Los Angeles Area was divided into six
major areas and 93 respondents were interviewed.
collected on the demographic,
status of
respondents~
respondents~
Data was
cultural and socioeconomic
the attitudes and preferences of
and the level of understanding of the health
care industry of respondents.
Analysis of the data was
conducted using the Statistical Package for the Social
Sciences.
Open-ended questions were compiled by hand.
Findings were reported relative to the objectives of the
project.
The overall goal of establishing the need for
input from the consumer of care to the design of programs
and services in health care was achieved.
Future studies of this kind should be conducted on a
regular basis.
Though the consumer-patient is the primary
user of the hospital's services,
be examined for their input.
other parties should also
Third-party payors, manu-
55
facturing agents of pharmaceutical and laboratory supplies,
government agencies,
and the employees of the
organization are some of the groups which need to be
considered for input if the hospital is to design its
services to match the demands of its various constituents.
Additionally, studies relating physician demands versus
patient demands of the hospital organization need to be
examined, and contradictory demands lessened.
Marketing research is aimed at providing more specific information about one problem area.
It should pro-
vide information to management that will effectively eliminate the range of choices available
in
solution to a problem and making a decision.
the
selecting a
In this way,
information obtained as a result of a
research effort becomes knowledge,
and
marketing
hopefully in-
creases the effectiveness of the organization.
Marketing is a relatively new field in health care
administration, and many misconceptions surface about the
role of marketing in health care.
It is equated with
selling and promotion, and perceived as a threat to the
medical profession.
As a result, marketing programs when
first launched, must market themselves to all potentially
affected parties,
especially the physicians.
Given the recency of most health care marketing programs,
it is imperative that a firm marketing data base be
established.
Most of this information is already owned by
56
the
hospital,
but dispersed
By establishing a
throughout the
organization.
Marketing Research Division within the
Marketing Department,
this data can begin to be collected
and provided to top management as knowledge to make effective decisions.
57
BIBLIOGRAPHY
1.
Aci to, Franklin.
"Consumer Decision Making and
Health Maintenance Organizations:
A Review,"
Medical Care, January, 1978, pp. 1-13.
2.
Bloom, Paul N., and Greyser, Stephen A.
"The
Maturing of Consumerism."
Harvard Business
Review, November/December, 198~pp. 130-139.
3.
Brooks, Charles H.
"Associations Among Distance,
Patient Satisfaction, and Utilization of Two
Types of Innl~r-City Clinics," Medical Care,
September/October, 1973, pp. 373-383.
4.
Clarke, Roberta N., and Shyavi tz, Linda.
"Marketing
Information and Market Research - Valuable Tools
for Managers."
Health Care Management Review,
Winter, 1981, pp. 73-77.----
s.
Cooper,
Phillip
Germantown,
1979.
6.
Cooper, Phillip D., and Maxwell, Richard B., III.
"Marketing:
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Hospital and Health Services Administration,
Summer, 1979, pp. 34-53.
7.
Cunningham, Robert M., Jr.
"Consumerism:
The Tables
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8•
Fa 1 be r g , \'l a r r en C • and Bonne m , S hi r 1 e y.
"Good
Marketing Helps a Hospital Grow."
Hospitals,
June 1, 1977, pp. 70-72.
9.
Fink, Daniel J., M.D.
"Developing Marketing
Strategies for University Teaching Hospitals."
Journal of Medical Education, July, 1980, pp.
574-579.
D., ed.
Health Care Marketing.
MD:
Aspen Systems Corporation,
58
10.
Flexner, William A., McLaughlin, Curtis p., and
Littlefield, James E.
"Discovering What the
Health Consumer Really Wants."
Health Care
Management Review, Fall, 1977, pp. 43-49.
11.
Goldsmith, Jeff c.
"The Health Care Market:
Can
Hospitals Survive?" Harvard Business Review,
September/October, 1980, pp. 100-112.
12.
Houston, Charles s., M.D., and Pasanen, Wayne E.
"Patients' Perceptions of Hospital Care."
Hospitals April 16, 1972, pp. 70-74.
13.
Hulka, Barbara s., Kupper, Lawrence L., Daly, Mary
B., Cassel, John c., and Schoen, Frederic.
"Correlates of Satisfaction and Dissatisfaction
with Medical Care:
A Community Perspective."
Medical Care, August, 1975, pp. 648-658.
14.
Ireland, Richard c. "Using Marketing Strategies to
Put Hospitals on Target."
In Marketing in
Nonprofit Organizations, pp. 123-13~--Ed1ted by
Patrick J. Montana.
New York:
American
Management Association, 1978.
15.
Kotler, Philip, ed.
Marketing for Nonprofit
organizations.
Englewood-Cliffs-;-New_J_e_iSey!
Prentice-Hall, Inc., 1975.
16.
Kotler, Philip.
Principles of Marketing.
Englewood
Cliffs, New Jersey:
Prentice-Hall, Inc., 1980.
17.
Lebow, Jay L. "Consumer Assessments of the Quality
of Care." Medical Care, April, 1974, pp. 328337.
18.
Lovelock, Christopher H.
"Concepts and Strategies
for Health Marketers."
Hospital and Health
Services Administration, Fall, 1977, pp. 50-62.
19.
Luft, Harold s., Hershey, John C., and Morrell, Joan.
"Factors Affecting the Use of Physician Services
in a Rural Community."
American Journal of
Public Health, September, 1976, pp. 865-871.
20.
MacStravic, Robin E.
Marketing by Objectives for
Hospitals.
Germantown, MD: Aspen Systems
Corporation, 1980.
MacStravic,
Robin E.
"Marketing:
Changing
Prospective Patients' Behavior."
!:!~~.E~t~_!_
Progress, June, 1979, pp. 47-49.
21.
59
22.
Metzner, Charles A. and Bashsur, Rashid L. "Factors
Associated with Choice of Health Care Plans."
Journal of Health and Social Behavior, December,
1967, pp-.-291-299.
23.
Miller, John A.
"Marketing Basics for Hospital
Managers." Hospital Forum, July-August, 1980,
1980, pp. 7-12.
24.
Nelson-Wernick, Eleanor, Currey, Hal s., Taylor, Paul
w., Woodbury, Marion, and Cantor, Alan.
"Patient Perception of Medical Care." Health
Care Management Review, Winter, 1981, pp. 65-72.
25.
Pollard, Michael R.
"Fostering Competition in Health
Care." In Regulating Health Care, pp. 158-167.
Edited by Arthur Levin, M.D.
New York:
The
Academy of Political Science, 1980.
26.
Ross, David E., and Tripoli, F.J.
"Fiscal Risks,
Methods, Rewards Shape Community Outreach
Success." Hospitals, July 16, 1977, pp. 86-88.
27.
Scitovsky, Anne A., McCall, Nelda, and Benham, Lee.
"Factors Affecting the Choice Between Two
Prepaid Plans." Medical Care, August, 1978, pp.
660-681.
28.
Stratmann, William C. "A Study of Consumer Attitudes
About Health Care: The Delivery of Ambulatory
Services." Medical Care, July, 1975, pp. 537548.
29.
Stuehler, George, Jr.
Planning Relate."
96-99.
30.
Ware, John E., Jr., and Snyder, Mary K. "Dimensions
of Patient Attitudes Regarding Doctors and
Medical Care Services." Medical Care, August,
1975, pp. 669-682.
31.
Zimmerman, James P. "Service Areas and Their Needs
Must Be Reassessed." Hospitals, September 1,
1975, pp. 46-48.
32.
Zuckerman, Alan M.
"Patient Origin Study Profiles
Service Area, Evolving Patterns." Hospitals,
July 16, 1977, pp. 83-85.
"How Hospital Marketing and
Hospitals, May 1, 1980, pp.
60
APPENDIX A
Thank you for agreeing to take the time to complete this
survey!
I am a graduate student in Health Care Administration at
Cal State University, Northridge.
I hope this survey will
answer some questions I have about the consumer's
attitudes and understanding of the health care field.
Your responses will be used to create and eliminate health
programs to better meet your needs as health care
consumers.
The responses you provide will remain
confidential.
Please answer all questions by circling the appropriate or
correct response.
All questions must be answered;
otherwise your survey wT11 be invalidated.
·Thank you 1
61
DEMOGRAPHIC PROFILE
Under 19
20 - 29
30 - 39
40 - 49
50 - 59
60+
1.
AGE
2.
MARITAL STATUS
3.
SEX
4.
NUMBER OF CHILDREN
Single
Married
Widowed
Divorced
Separated
Female
Male
0
1
2
3
4 or over
5.
HOME mVNERSHI P
Own
Rent
Other
6.
TU1E AT PRESENT ADDRESS
7.
OCCUPATION
Less than 1 year
1 - 3 Years
3 - 5 Years
5 - 10 Years
10 - 25 Years
More than 25 Years
Managerial
Skilled Trade
Laborer
Office Worker
Technical
Professional
Homemaker
Student
Retired
62
8.
EDUCATION
9.
INCOME
10.
Less than 12 Years
High School Graduate
Technical/Vocational School
Some College
College Graduate
Professional Degree
Under $10,000
$10,000 - $14,999
$15,000 - $19,999
$20,000 - $24,999
$25,000 - $49,999
$50,000 & over
HOW MEDICAL EXPENSES ARE PAID
Self-Pay
Private Insurance
MediCare
MediCal
Blue Cross/Blue Shield
HMO Member (i.e. Kaiser)
11.
RACE
Caucasian
Black
Hispanic
Asian
Indian
Other
63
ATTITUDE SURVEY
1.
Name a hospital in the Los Angeles area.
2.
Can you name two more hospitals?
3.
Have you ever had to bring your child to a hospital?
YES
NO
4.
If yes, which hospital?
s.
If you had to use a hospital for your child,
factor would be more important?
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
doctor's recommendation
peer's recommendation (i.e. word of mouth)
reputation of the hospital
distance from home
cost of medical services
type of payment required
employees are friendly and understanding
quality of care
ease of parking
other (specify)
which
64
6.
Please rank the criteria in #5 in order of importance
Least
_Important
Host
Important
7.
Do you have a regular family physician?
YES
8.
If mychild had to be admitted to the hospital,
would choose
a.
b.
c.
d.
e.
f.
g.
h.
i.
9.
I
Northridge Hospital Foundation
Glendale Advertist Medical Center
Tarzana Medical Center
Long Beach Memorial Hospital
Childrens Hospital of Los Angeles
Huntington Memorial Hospital
Cedars Sinai Medical Center
UCLA Hospital
other (specify)
Which of the following factors determined your
choice in #8 the most?
a.
b.
c.
d.
e.
f.
g.
h.
i.
10.
NO
distance from home
reputation of the hospital
cost of medical services
employees are friendly and understanding
parking convenience
personal physician selected hospital
have been there before
quality of care
other (specify)
Please rank
importance.
Most
Important_
the
criteria
in
#9
in
order
of
Least
_Important
65
11.
The most desirable quality of any hospital is
a.
b.
c.
d.
e.
f.
g.
12.
the personal interest shown in the patient's
medical condition
friendly and helpful staff
privacy
good doctors
explanations given about medical/surgical
condition/treatment
accessibility and convenience of services
other( specify)
Please rank
importance.
the
criteria
of
NO
Outpatient Clinic
Emergency Room
A Special Unit
Inpatient
Other (specify)
How would you rate the service you received
Childrens Hospital of Los Angeles overall?
a.
b.
c.
d.
16.
order
If you answered YES to # 13, please indicate the
service area utilized otherwise, go to #17.
a.
b.
c.
d.
e.
15.
in
Have you or anyone in your family ever been a patient
at Childrens Hospital of Los Angeles?
YES
14.
#11
Least
Important
Most
Important
13.
in
Excellent
Satisfactory
Poor
No Opinion
Please indicate the reason for your choice in #15.
at
66
17.
If you had to say something positive about Childrens
Hospital of Los Angeles, what would you say?
18.
What changes or recommendations would help improve
the services at Childrens Hospital of Los Angeles?
19.
Which one of the following outpatient services do you
feel Childrens Hospital of Los Angeles should provide
to children in the community?
a.
b.
c.
d.
e.
f.
g.
h.
20.
Walk-In Treatment
Trauma Center
Transportation to the Hospital
Well Baby Clinic
Poison Center
Mobile Clinic
Community Health Education
Other {specify)
I encourage you to write any comments you may have in
the space remaining.
67
HEALTH CARE INDUSTRY QUIZ
1.
An example of a Health Maintenance Organization (HMO)
is
a.
b.
c.
d.
e.
2.
The most recent trend in the hospital industry is
a.
b.
c.
d.
3.
an
an
an
an
increase in length of patient stay
encouragement of physicians to specialize
enforcement of visiting hours
increase in outpatient services
Historically, physicians are associated with which
group?
a.
b.
c.
d.
e.
4.
UCLA Hospital
a nursing home
a hospital that has an emergency room
National Medical Enterprises
Kaiser
court jesters
barbers
butchers
blacksmiths
merchants
A critical labor shortage exists nationwide for which
health care profession?
a.
b.
c.
d.
physicians
nurses
pharmacists
administrators
68
APPENDIX B
DEFINITIONS!
To acquaint the reader with some of the marketing
terminology used in this page,
the following definitions
of marketing terms is provided:
1. Hospital Marketing Opportunity - An attractive arena
of relevant marketing action in which a particular
hospital is likely to enjoy superior competitive
advantages.
2.
Consumerism - An organized social movement seeking to
strengthen the rights and power of consumers vis-a-vis
sellers (the hospital and/or physicians).
3.
Culture - Anything that is learned.
4.
Demand - Wants which one is able and willing to
satisfy through purchased behavior.
s.
Environmental threat - A challenge posed by an
unfavorable-trend-or-specific disturbance in the
environment which would lead, in the absence of
purposeful marketing action, to the stagnation or
demise of a hospital, service, or speciality.
6.
Expectations-performance theory - A consumer's
sat.1sfa-Ctlon-rs-afunctfon-of-the-consumer IS service
expectations and the service's perceived performance.
7.
Image persistence - The result of people's continuing
to-5ee what they expect to see, rather than what is.
1 These definitions are from Philip Kotler, Principles
of Marketing (Englewood Cliffs, N.J.:
Prentice-Hall,
Inc., 1980), PP• Gl-G9.
69
a.
Market - The set of all actual and potential buyers
of a service.
9.
Marketing - Human activity directed at satisfying
needs and wants through exchange processes.
10.
Market demand - The total volume that would be bought
by a defined customer or patient group in a defined
geographical area in a defined time period in a
defined marketing environment under a defined marketing program.
11.
Marketing concept - A management orientation that
holds the key to achieving organizational goals
consists of the organization's determing the needs
and wants of target markets and adapting itself to
delivering the desired satisfactions more effectively
and efficiently than its competitors.
12.
Marketing information system - A continuing and
interacting structure of people, equipment, and
procedures designed to gather, sort, analyze,
evaluate,
and distribute pertinent,
timely and
accurate information for use by marketing decision
makers to improve their marketing planning,
execution, and control.
13.
Marketing mix -The particular blend of controllable
marketing -variables - Product, Price, Promotion,
Place - that the hospitals uses to achieve its
objectives in the target market.
14.
Marketing research - The systematic design,
COl"lection, -analysl.s 1 and reporting of data and
findings relevant to a specific marketing situation
facing the hospital.
15.
Marketing strategy -The fundamental marketing logic
by which the hospital intends to achieve its
marketing objectives. Marketing strategy consists of
a coordinated set of decisions on target markets,
marketing mix, and marketing effort.
16.
M~E~e:!::_
E~~~tE~:!::_~o~ The ho spit a 1' s seeking
increasing revenues for its current services in its
current markets through more aggressive marketing
efforts.
70
17.
Market Potential - The limit approached by market
demand as industry marketing expenditure goes to
infinity, for a given set of competitive prices and a
given environment.
18.
Market ~mentation - The act of dividing a market
into distinct and meaningful groups of buyers
(consumers-patients) who might merit separate
services and/or marketing mixes.
19.
Needs -A feeling of a sense of self-deprivation.
20.
Product concept - A management orientation that
assumes that consumers will favor those products that
offer the most quality fdr the price, and therefore
the hospital should devote its energy to improving
service quality.
21.
Production concept- A management orientation that
assumes that consumers will favor those products
and/or services that are available and affordable,
and therefore the major task of management is to
pursue improved production and distribution
22.
Selling concept - A management orientation that
assumes that consumers will either not buy or not buy
enough of the hospital's services unless the hospital
makes a substantial effort to stimulate their
interest in its services.
23.
Service - Any activity or benefit that one party can
offer to another, is essentially intangible, and does
not result in the ownership of anything.
24.
Strategic planning - The managerial process of developing and maintaining a strategic fit between the
organization and its changing market opportunities.
25.
Target market -A well-defined set of customers/consumers-patients whose needs the hospital plans to
satisfy.
26.
Wants - Needs shaped and modified by culture.
71
APPENDIX C
Respondent's comments to the question:
If you had to say
something positive about Childrens Hospital of Los
Angeles, what would you say?
1.
You will get help if you wait long enough
2.
Tremendous capabilities; a variety of specialities
3.
Heard care is excellent
4.
Extensive research in childhood diseases
outstanding reputation for treating extremely ill
children
5.
What the name Childrens stands for is good - health
care for children
6.
Gave explanations and knew what they were doing
7.
very thorough and up-to-date knowledge
8.
Concerned and helpful staff
9.
Competent medical care
10.
Great that CHLA is a hospital just for kids
11.
Heard that CHLA has a good reputation
12.
My sister has nothing wrong with her eyes to this day
13.
Seems like CHLA has good care in critical situations
14.
Excellent care in emergency situation,
treating childhood injuries and diseases
15.
My friends have spoken highly of CHLA
16.
CHLA offers specialized care for children
good
in
72
17.
CHLA is known for good doctors, good equipment, and
state of the art technology
18.
CHLA is in a good location,
Angeles
19.
CHLA is a full-service hospital, well located, at
little or no cost to patients
20.
Close by, accessible by bus, has a good staff
21.
CHLA has good quality of care and expertise in
children's health care; facilities are good
22.
CHLA has good advanced equipment and good doctors;
heard this from other people
23.
Cedars-Sinai has better quality of care:
My husband
is a pediatrician on staff at both hospitals, I
should know.
24.
I heard that CHLA flys children in from other areas
25.
CHLA must be the best place for children since they
specialize in pediatric health care and therefore
know the needs of children
26.
CHLA had a good staff in the early 1970's
27.
It's good that CHLA has a special interest in
children and does not spread its attention among
other groups
28.
CHLA has research
29.
I have read articles about the NICU
30.
Excellent care, good doctors, expertise
central to all of Los
I
73
APPENDIX D
Respondent's comments to the question:
What changes or
recommendations would help improve the services at Childrens Hospital of Los Angeles?
1.
More adequate staff to cut down on waiting time
2.
Expedite the ER process and give the patient more
explanation about medical condition
3.
Increase Public Relations so CHLA will become more
familiar to the consumer
4.
Offer full services so there is no need for transfers
or waiting
5.
Parking needs improvement
6.
Find a cure for asthma
7.
Increase training for doctors and nurses
8.
Wider publicity and exposure of
Hospital
9.
CHLA is like a clinic - not a warm atmosphere and too
much red tape
services
of
the
10.
Staff should adopt more friendly attitudes
11.
Terrible location
12.
ER waiting time is ridiculous, resident on call
should be in the hospital regardless of speciality
13.
Long waiting time
14.
Take in ER cases faster
15.
Faster admitting, more nurses
16.
Lodging facilities for parents coming from a long
distance
17.
Should have counselors
74
18.
Staff should pay attention to the patient, the person
paying the bill
75
APPENDIX E
Respondent's comments when encouraged for any additional
information that they felt was important to include in the
survey
1.
ER should not be used as a walk-in or outpatient
clinic
2.
CHLA should build
inform public of
should let people
the USC School of
3.
Pasadena has excellent pediatricians and have some
that specialize in cardiac care
4.
There should be a nutritional approach to children's
health care including more natural therapies~ i.e.
vitamins and diet, and less medication via drugs.
s.
I wish I knew more about CHLA
6.
CHLA has no right to make the cancer child a victim
of their "best interests." The parents should always
be kept informed and given the right to choose the
medical care that they feel is appropriate for their
children - the father seemed very caring and
concerned for this child's security and welfare~ CHLA
doctors felt they knew best and did not.
7.
When my child needs medical care, insurance coverage
is considered first, but in a serious case, the best
doctor is most important. Distance, parking and even
the cost are secondary factors.
In any case, doctors
and the hospital will provide free services when they
know you cannot pay.
a.
My choice of hospital for my child would depend on
the medical problem.
Besides, my children are
covered by Kaiser so they would most likely go to a
Kaiser Hospital
9.
CHLA should provide all pediatric services.
satellite clinics and reach out to
existence and capabilities~ CHLA
know that they are affiliated with
Medicine
76
10.
My husband owns a substantial amount of stock in
National Medical Enterprises - is CHLA a National
Medical Enterprises Hospital?
11.
I prefer university-teaching hospitals, however, UCLA
Hospital care is terrible as there is no provision
for the parent to remain in the room with the child;
UCLA Hospital lacks sensitivity to emotional needs of
children.
12.
Billing system needs improvement; housekeeping needs
improvement.
13.
CHLA is a specialized hospital and should not offer
general pediatric care such as a well-baby clinic or
walk-in treatment, as a general hospital can handle
this.