PhD RESEARCH PROPOSAL -1

RESEARCH TOPIC : A STUDY ON RELATIONSHIP BETWEEN e-

CRM IMPLEMENTATION AND e-LOYALTY FOR HEALTHCARE
INDUSTRY : A CONCEPTUAL FRAMEWORK AND HYPOTHESIS

BY

S.SENTHIL GAVASKAR

RESEARCH SCHOLAR

DEPARTMENT OF MANAGEMENT STUDIES

PONDICHERY CENTRAL UNIVERSITY

PONDICHERY
CONTENTS

1. Proposed Research Title

2. Synopsis

3. Overview of the study

4. Need of the study

5. Objective of the Study

6. Industry profile

7. Review of literature research and theory

8. Proposed Research methodology

9. Expected deliverables

10. Conclusion

11.Time Schedule for the proposed Research plan

1. PROPOSED RESEARCH TITLE

A STUDY ON RELATIONSHIP BETWEEN e-CRM

IMPLEMENTATION AND e-LOYALTY FOR HEALTHCARE
INDUSTRY: A CONCEPTUAL FRAMEWORK AND HYPOTHESIS

2. SYNOPSIS

The purpose of this research study is to find out the relationship between e-CRM
implementation and e-Loyalty in hospital Industry. With increased globalization,
competition , today every company witness higher customer turnover , growing customer
acquisition costs and rising customer expectations in products and services. In today’s
hyper competitive and fastest world , e-CRM has became very important for many
companies in different sectors and received a increased amount of interest among many
scholars and practitioner especially in recent years . Many hospitals and patients in US,
U.K and in other European countries companies have received immense benefits in using
e-CRM system. In this study the researcher has made an attempt to find out the
feasibility of implementing e-CRM system in hospitals in India . Further in this study the
researcher try to find that whether e-CRM helps both the doctors and patients ? In what
way e-CRM system is useful for doctors and how it is useful for patients ?

For doctors e-CRM can be useful to track the customers (patients), their history and can
prescribe the required medicines through e-CRM system itself. Where as for the patients
this system is useful to track the doctors , especially the specialists , cost of treatment , can
share the nature of the problem etc., through the system from the home or from the working
place without contacting the doctor.
The study also focuses on how this system helps to retain the customers (patients) by
knowing their needs and fulfilling their needs by providing the required service through
e-CRM system. This system offers more personalization of services, using one to one
marketing plans, improving customer services and support and using IT for giving more
services in hospitals will increase customer satisfaction, loyalty, and retention.

Customer satisfaction will cause loyalty and retention . Customer retention is

really important and good for both doctors and hospital management ; since customer stay
longer, use the service more and more frequently it cause increase wallet share also it is
cheaper to keep existing customers happy rather than to attract new ones . Dyche
stated that five-percent increase in customer retention results in a 25 to 95 percent increase
in profits.
In all, implementation of e-CRM application in hospital industry will bring more
satisfied and loyal customers. This in turn may help the sector to gain more benefits such
as increase in the rate of retention , increase revenue and profitability, reduce internal
costs, reduce marketing costs, improving customer services, create positive word of
mouth, market share growth , improve marketing methods ,streamlined business
process ,better understanding/addressing customer requirements , higher productivity
and protect marketing investment with maximize returns. All these benefits for a
hospital can be a source of long-term and sustainable competitive advantage.

3. OVERVIEW OF THE STUDY

The research topic namely “A Study on relationship between e-CRM

implementation and e-loyalty ” is a study conducted for healthcare Industry. The health
care industry is one of the world's largest and fastest-growing industries. Consuming over
10 percent of gross domestic product of most developed nations, health care can form an
enormous part of a country's economy. A health care provider or health professional is an
organization or person who delivers proper health care in a systematic way professionally
to any individual in need of health care services. e-CRM is all about managing customer
relationships through Online. This view of e-CRM completely changed the operations of
many organizations. Today corporate became more concerned about maintaining and
retaining the existing customers then striving completely making new ones. This new
dimension of marketing changed the entire approach, companies changed their marketing
strategies, and every customer is different than other so each one is being treated
differently. Different CRM strategies are used by the companies, which allow them to
identify their best customers, try to satisfy their needs and continuously increase their
level of satisfaction and take them up to the loyalty level.

As marketing has entered the 21st Century, a significant change is taking place in
the way companies interact with customers. The traditional view of marketing as a simple
exchange process—a concept that might be termed transaction-based marketing—is
being replaced by a different, longer-term approach.

The essence of the information technology revolution and, in particular, the

World Wide Web is the opportunity to build better relationships with customers than has
been previously possible in the offline world. By combining the abilities to respond
directly to customer requests and to provide the customer with a highly interactive,
customized experience, companies have a greater ability today to establish, nurture, and
sustain long-term customer relationships than ever before. The ultimate goal is to
transform these relationships into greater profitability by increasing repeat purchase rates
and reducing customer acquisition costs.

The need to better understand customer behavior and focus on those customers
who can deliver long-term profits has changed how marketers view the world.
Traditionally, marketers have been trained to acquire customers, either new ones who
have not bought the product category before or those who are currently competitors’
customers. This has required heavy doses of mass advertising and price-oriented
promotions to customers and channel members. Today, the tone of the conversation has
changed from customer acquisition to retention. This requires a different mindset and a
different and new set of tools. A good thought experiment for an executive audience is to
ask them how much they spend and/or focus on acquisition versus retention activities.
While it is difficult to perfectly distinguish the two activities from each other, the answer
is usually that acquisition dominates retention.

4. NEED FOR THE STUDY

Managing each customer relationship is the heart of CRM, while traditional

market metrics hardly allowed the companies to make operational decisions that affect
individual customers. e-CRM helped the organizations to improve its mass marketing and
campaign measures. The Indian healthcare industry is seen to be growing at a rapid pace
and is expected to become a US$280 billion industry by 2020. The Indian healthcare
market was estimated at US$35 billion in 2007 and is expected to reach over US$70
billion by 2012 and US$145 billion by 2017.

According to the Investment Commission of India the healthcare sector has

experienced phenomenal growth of 12 percent per annum in the last 4 years. Rising
income levels and a growing elderly population are all factors that are driving this
growth. In addition, changing demographics, disease profiles and the shift from chronic
to lifestyle diseases in the country has led to increased spending on healthcare delivery. It
is important to implement an e-CRM system in India for benefits of both doctors and
patient.

Contrast with traditional CRM being implemented under ERP (Enterprise

Resource Planning) interface communicating in firms and with their customers, e-CRM
optimizes the customized environment via web browser. This provides beneficial for
effective communication not only enterprises to external customers and internal
departments. Business personalized each of their customer profile unified in entire
organization. By “central repository”, customer may communicate with different
department staff in the corporate via Internet (or phone call). And firms are able to use
the marketing analysis for customer more mature services. As each department integrates
customers’ information, they can focus on individual operational duty more efficiently,
so that firm may reduce execution cost.

Traditional B2B customers are usually seeking ways in order to decrease the
firm’s expense. Customizing the specific service and reducing the repeated routine cost
of service can expense least. Due to information technology developing, websites
information has been becoming an important medium to reduce collecting cost and time,
and it becomes a long-term relationship eventually. At the same time, more complex
collaboration can be implemented on networking platform.

As the internet is becoming more and more important in business life, many
hospitals consider it as an opportunity to reduce customer-service costs, tighten customer
relationships and most important, further personalize marketing messages and enable
mass customization e-CRM is being adopted by many hospitals in European countries ,
because it increases customer loyalty and customer retention by improving customer
satisfaction, one of the objectives of e-CRM. E-loyalty results in long-term profits for the
hospitals using online facilities because they incur less costs of recruiting new customers,
plus they have an increase in customer retention. Together with the creation of Sales
Force Automation (SFA), where electronic methods were used to gather data and analyze
customer information, the trend of the upcoming Internet can be seen as the foundation of
what we know as e-CRM today.

As we implement e-CRM process, there are three steps life cycle.

1. Data Collection: About customers preference information for actively (answer

knowledge) and passively (surfing record) ways via website, email, questionnaire.
2. Data Aggregation: Filter and analysis for firm’s specific needs to fulfill their
customers.
3. Customer Interaction: According to customer’s need, company provide the proper
feedback them.
We can define eCRM as activities to manage customer relationships by using the
Internet, web browsers or other electronic touch points. The challenge hereby is to offer
communication and information on the right topic, in the right amount, and at the right
time that fits the customer’s specific needs.

By implementing a cost effective e-CRM system in India lot of benefits are there
for both patient and doctors. Doctors know in advance about the patient history and
health status. Patient Information is saved for future use and this system will save time
for patient.

5. OBJECTIVE OF THE STUDY

5.1 PRIMARY OBJECTIVE

The main objective of this study is to study the relationship between e-CRM
implementation and e-loyalty in hospital Industry.

5.2 SECONDARY OBJECTIVES

• To find out awareness of using e-CRM among the doctors and patients.
• To find out the uses of e-CRM for patients
• To determine the uses of e-CRM for doctors
• To analyze the pros and cons of using e-CRM system
• To analyze the effectiveness of e-CRM.

6. INDUSTRY PROFILE

HealthCare Industry:

India has made significant progress in improving healthcare, but there are huge
challenges in extending basic services to the rural population. Of all the challenges India
faces, improving access to basic healthcare is perhaps one of the most pressing—from a
straightforward human development perspective as well as to ensure a solid foundation
for future economic growth.

Despite India’s dazzling recent economic performance, persistent widespread

poverty means that malnourishment and communicable diseases remain serious
problems. Healthcare indicators vary widely across states, partly reflecting the differing
levels of resources available to state governments, but one trend that is totally consistent
is that indicators are much worse in rural areas than in urban ones.

The problem is, first and foremost, one of access. India has a rudimentary network
of public hospitals and clinics in any case—the government estimated there was a
shortage of 4,803 primary health centers and 2,653 community health centers in 2006—
but the issue is particularly acute in rural areas. Public hospitals are rare outside of large
cities—a significant problem in a country where some two-thirds of the population still
live in the countryside. According to a study conducted by the Confederation of Indian
Industry, the formal healthcare system reaches only about 50% of the total population.

India is also desperately short of doctors, with only 645,825, or 0.6 per 1,000
people, in 2004, according to the World Health Organization (WHO). Many locally
trained physicians are tempted abroad by better pay and prospects; moreover, healthcare
workers who do remain in India prefer the cities where job prospects and wages are
better, resources are greater and the quality of life is far higher.

The current Indian National Congress-led government has made the provision and
availability of primary healthcare to all one of seven policy priorities under its-so called
“common minimum programme” designed to cater to the “aam admi” (“common man”).
In other words, the main objective of government health policy is merely to achieve an
acceptable standard of health among the general population. Its spending in this area is
lavish. In the interim budget delivered on February 16th, for example, finance minister
Pranab Mukherjee announced the following budgetary allocations for the 2009/10 fiscal
year:
 One possible solution to improving rural healthcare in India might come through
innovative uses of technology. One idea currently on the drawing board proposes using
microchips to create portable ultrasound scanners. These could be delivered to villages,
and the scan administered even by someone with no medical training—the actual reading
could be done by trained medical staff in a hospital/clinic in a bigger city with the image
transmitted electronically. Given the scale of India’s resourcing issues, this might prove
to be a more effective means of improving rural healthcare provision than trying to equip
hundreds of thousands of remote villages with trained medical staff and expensive
medical equipment.

7 . REVIEW OF RELEVANT RESEARCH AND THEORY

HEALTHCARE INDUSTRY

The health care industry includes the delivery of health services by health care
providers. Usually such services are paid for by the patient or by the patient's insurance
company; although they may be government-financed (such as the National Health
Service in the United Kingdom) or delivered by charities or volunteers, particularly in
poorer countries. The structure of health care charges can also vary dramatically among
countries. For instance, unlike the United States, Chinese hospital charges tend toward
50% for drugs, another major percentage for equipment, and a small percentage for
health care professional fees.

HEALTHCARE IN INDIA

Healthcare in India features a universal health care system run by the constituent
states and territories of India. The Constitution charges every state with "raising of the
level of nutrition and the standard of living of its people and the improvement of public
health as among its primary duties". The National Health Policy was endorsed by the
Parliament of India in 1983 and updated in 2002. However, the government sector is
understaffed and underfinanced; poor services at state-run hospitals force many people to
visit private medical practitioners.
This chapter starts by stating the importance of customer retention for the profitability of
the companies. Then different strategies observed by companies to build long term
relations are discussed including CRM and e-CRM . Wang and Head (2006) describe two
stages namely customer acquisition and customer retention for building customer base in
an online business environment. First stage is related towards attracting customers to visit
a retailer website, and make purchases where as in second stage properly satisfied and
experienced customers return and establish a long-term relationship. Different researchers
have been stressing on stronger relationships of customers with the companies.
Reichheld and Sasser (1990) and Phelps (2001, p. 26) observed that profits of companies
can rise if their customers are in stronger relationship with them. Reichheld and Sasser
(1990) further states that properly served customers can generate more profits for the
companies and are good advertisers of the companies as well. Reichheld and Teal (1996,
p. 37) also believe that most businesses can observe an increase in profits if the customers
stay longer with them.

Ross (2005) has mentioned that cost of getting a new customer is five to eight times of
maintaining an existing customer. Phelps (2001, p. 26) states that the customers become
more dependent on the company as their lifetime value grows with the company, and in
this way there are less chances that customers will be attracted of the lower prices offers
of the other competitors. He also believes that loyal customers are advocators of the
business and encourage friends and acquaintances to buy.

From the above discussion we can infer that it is important for companies to retain their
customers by making certain kind of relationships with them, in order to be successful
and profitable. This is exactly what Ross (2005) is of the view that companies for many
years have been using Customer Relationship Management (CRM) methods in traditional
ways in past as well. He defines the CRM as the combination of marketing, sales and
service activities of an organization for the purpose of knowing its customers,
understanding their needs, knowing the best product and service mix for them and
providing services and values that will lead to profitability and will strengthen the
relationship with the customers. According to Gummesson (2002, p. 3) and Hughes
(2003, p. 21) Customer Relationship management (CRM) emerges in the marketing
world in early 1990's. Gummesson (2002, p. 3) defines CRM as “CRM is the values and
strategies of relationship marketing- with particular emphasis on customer relationships-
turned into practical application." Hughes 2003 (p. 21-22) explains that CRM was based
on the idea to gather much information about customers, prospects, promotions, and other
such things and to put them in a big database. According to them there were two
fundamental goals under consideration for designing CRM. First was to maintain
relationships with customers based on information about the customers and to use that
information to guide communications and contacts with the customers and second was to
make right offering to the right customers at right time with the help of available
information, so that sales can be increased and customers become happy.

According to Chaffey et al. (2003, p. 218-223) CRM is an approach towards building and
keeping long term relations with the customers. CRM implicates incorporation of several
marketing approaches such as relationship marketing (RM), one-to-one marketing, direct
marketing and database marketing. It is quite pertinent to throw light on all these
marketing approaches. According to Gordon (1998, p. 9) "Relationship Marketing is the
ongoing process of identifying and creating new value with individual customers and
then sharing the benefits from this over a lifetime of association. It involves the
understanding, focusing and management of ongoing collaboration and sharing through
interdependence and organizational alignment." He also states that although relationship
marketing employs traditional marketing principles yet it is very different. Gummesson
(2002, p. 3) defines RM as “Marketing based on interaction within networks of
relationships". Where as Solomon, (2006, p. 11) describes it as the phenomenon of
making relationships between brands and customers that will la st a lifetime where
marketers interact with customers on a regular basis; give them certain facilities which
cause the customers to keep in touch with the brand. In one-to-one marketing, according
to Chaffey etal., (2003, p. 218) a unique dialogue occurs between a company and
individual customers or group of customers where as direct marketing is the way of
targeting marketing communications and (often) delivering the value proposition itself to
individual customer. Solomon, (2006, p. 11) states that another way of relationship
building is database marketing which is a process of storing and tracking consumers’
buying habits through the use of computer and making policies and strategic decisions
according to customers needs. Therefore a comprehensive definition of CRM can be
described as “Customer Relationship management (Anderson and Kerr, 2001, p. 2) is a
comprehensive approach for creating, maintaining and expanding customer
relationships.”

According to Zineldin (2005) there is a strong competition among businesses today

therefore managers and marketers are agreed on developing long term relationships with
their customers for the development and survival of the companies. Zineldin (2006)
states that companies with stronger relationship with customers are in the best position to
retain their customers. According to him CRM is an effective method to maintain
customer database and by that company can best understand the customers' needs and
more precisely their relationship need better than the other competitors. He stressed that
stronger relationship with the customers is more important than low prices, big promotion
offers, and advanced technology.

Yaeckel et al. (2002, p. 245-246) believe that CRM is not a new concept; it is a process
not a software product or technology. This process manages interactions between a
company and its customers. Hardware, software, and service are one of the components
for supporting the strategy of CRM. CRM can be beneficial in two ways (Foss et al.,
2004, p. 90), firstly it improves customer retention and loyalty and secondly the higher
customer profitability because of less customer recruiting costs and reduced costs of
sales.

According to Romano et al. (2004) the latest technique which the companies are using
now a day for increasing and enhancing their marketing skills is electronic customer
relationship management (eCRM).
CRM:

Customer relationship management (CRM) is a widely-implemented strategy for

managing a company’s interactions with customers, clients and sales prospects. It
involves using technology to organize, automate, and synchronize business processes—
principally sales activities, but also those for marketing, customer service, and technical
support. The overall goals are to find, attract, and win new clients, nurture and retain
those the company already has, entice former clients back into the fold, and reduce the
costs of marketing and client service.[1] Customer relationship management describes a
company-wide business strategy including customer-interface departments as well as
other departments.

As we enter the new millennium, CRM is changing many industries and

influences many customers and businesses. CRM can be defined as managerial efforts to
manage business interactions with customers by combining business processes and
technologies that seek to understand a company’s customers. Companies are becoming
increasingly aware of the many potential benefits provided by CRM. Some potential
benefits of CRM are as

• Increased customer retention and loyalty.

• Higher customer profitability.
• Creation value for the customer.
• Customization of products and services.
• Lower process, higher quality products and services.

Despite the fact that CRM as a concept has emerged only recently in both the IT and
marketing fields, the literature offers multiple definitions of CRM. Four definitions were
chosen to demonstrate the correlation between Information Systems and Marketing, both
of which comprise the two major components of CRM:
 • CRM is at the core of any customer-focused business strategy and includes the
people, processes, and technology questions associated with marketing, sales, and
service.
• CRM is defined as a management approach that enables organizations to identify,
attract and increase retention of profitable customers by managing relationships
with them.
• Practicing elements of an approach to marketing that uses continuously refined
information about current and potential customers to anticipate and respond to
their needs.
• CRM is not a technology or even a group of technologies. It is a continually
evolving process that requires a shift in attitude away from the traditional business
model of focusing internally. CRM is an approach a company takes toward its
customers supported by thoughtful investment in people, technology and business
processes.

E-CRM:

Electronic customer relationship management (eCRM) is the latest technique companies

are using to increase and enhance their marketing skills and capabilities. Integrating both
technological and marketing elements, eCRM covers all aspects of the customer’s online
experience throughout the entire transaction cycle (Pre-purchase, At-purchase and Post-
purchase). Jutla et al (2001) describe eCRM as the customer relationship care component
of e-business. Greenberg (2000) suggests that eCRM is CRM online. According to
Romano and Fjermestad (2001), eCRM is concerned with attracting and keeping
economically valuable customers and eliminating less profitable ones. Rosen
(2001) suggests that eCRM is about people, processes, and technology, by omano and
Fjermestad (2003) there are five major non-mutually-exclusives eCRM research areas:
eCRM markets; eCRM business models; eCRM knowledge management; eCRM
technology and eCRM human factors, and each major area is composed of minor ones. In
the context of e-commerce, Sterne (1996) proposes a framework to characterize online
customer experience, consisting of three stages: pre-sale, sale, and after-sale interactions.
Lu (2003) uses this framework to study the effects of ecommerce functionality on
satisfaction, demonstrating that eCRM features contribute differently to the satisfaction
associated with each transaction stage. Following the same line, Feinberg et al. (2002)
map the eCRM features of retail websites into the pre-sale, sale, and post-sale stages in
investigating the relationship between eCRM and satisfaction. The usage of the
transaction cycle framework to classify satisfaction is also supported by Khalifa and Shen
(2005), who investigate the relative contribution of pre-sale, sale, and post-sale
satisfaction to the formation of overall satisfaction.

.e-CRM is a system with the purpose of aligning the firm’s planning, processes, and tools
with the strategic intent of maintaining and enhancing the relationship between the firm
and the customers it serves. e-CRM Electronic CRM concerns all forms of managing
relationships with customers making use of Information Technology (IT). e-CRM is
enterprises using IT to integrate internal organization resources and external marketing
strategies to understand and fulfill their customers’ needs. Comparing with traditional
CRM, the integrated information for e-CRM intraorganizational collaboration can be
more efficient to communicate with customers.

This definition includes the additive ebusiness construct of a “system,” and shifts
the focus for e-CRM to “maintaining and enhancing” the relationship with a firm’s
existing customers. While there is a great body of research on both CRM and eCRM, the
eCRM literature can generally be classified into two strands: 1) the need to develop and
nurture trust and loyalty in customer relationships, and 2) the best practices and methods
for maximizing eCRM activities.

Since new customers may be hard to come by, keeping your existing customers
satisfied and maximizing Customer Lifetime Value (CLV) becomes increasingly
important. CLV is the process of looking at a customer’s potential lifetime contribution to
your businesses revenue stream rather than looking at the individual contribution to
income from each transaction. A key factor in making a customer a lifetime customer is
the relationship that the person has with the organization. Since we have been examining
how high levels of cognitive dissonance can reduce customer satisfaction and therefore
repeat purchasing, even more attention to satisfying existing customers and fostering an
even greater amount loyalty is paramount.

Having and managing a relationship with your customers is one way to increase
brand loyalty. The goal of Customer Relationship Management (CRM) is to help create
and increase customer equity. Numerous studies have found that a CRM emphasis can
give mutual benefit to both the company and customer. Customer retention studies have
also shown that by increasing customer retention levels, profitability can be increased.

E-CRM features that many online retailers utilize include the ability to complain,
E-mail capability, information for first time users, mailing lists, frequently asked
questions (FAQ) section, member benefits, site customization, chat rooms, bulletin
boards and site tours just to name a few. Feinberg and Kadam demonstrated that the
amount of e-CRM factors present on a company web page was related to customer
satisfaction levels. They then were able to demonstrate that as e-CRM increases on a site,
the higher the level of customer satisfaction will be.

The environment we will be examining is the online environment, therefore it is

Important to look at what common elements effective web pages contain. Rayport and
Jaworski (2001) identified what they classify as the 7 C’s of effective website design.
These C’s include: Context, Content, Community, Customization, Communication,
Connection, and Commerce. The context is the actual layout and design of the web page.
The context refers to the text, video, sound, and picture elements contained on the site.
The Community aspect of effective design pertains to the ability of user-to-user
communication and interaction. Customization is the web sites ability to allow the user to
customize or personalize the site to their liking, giving the content and features that they
want. Communication refers to the availability of user-to-site, site to-user, or two-way
communication. Connection relates to the amount of links to other sites that are included
in the design of the sponsoring web site. Commerce refers to the ability of the website to
allow for commercial transactions between the company and the visitor/customer. Many
of these “C’s” translate very well to e-CRM and relationship building theories. Therefore
this study focused on creating scenario’s in which websites were created utilizing the 7
C’s, within the context of e-CRM, in the hopes of reducing dissonance levels of
consumers.

Since the cognitive dissonance literature suggests that high levels of dissonance
can reduce customer satisfaction, and the e-CRM literature suggests that use of e-CRM
elements on a website can increase satisfaction, this study offers hypotheses that the use
of e-CRM should decrease the post-purchase levels of cognitive dissonance experienced
by a consumer.

Today many companies use e-CRM as a tool to sell the products and services and
to maintain long term relationship with the customers. Today many corporate have
realized that Customer relationship Management is an important factor for retaining the
customers over a long period. IT industry plays a vital role establishing the powerful and
cost effective CRM system. By the use of CRM system many corporate increases the
customer relationship and the satisfaction of the customer. In this project the scope of
CRM system is restricted to HealthCare Industry. In India there is a necessary for
Healthcare Industry like Hospitals to maintain their patient and to provide all the possible
benefits in online. This enables the use of e-CRM by various hospitals. Though the
implementation of CRM system is costly the result that the hospital is going to achieve is
enormous. In this busy world patient need an end to end solution for healthcare related
problem through online. e-CRM system enables both patient and providers to
communicate effectively and reduce their time gap. All the information about the patient
is maintained and the providers can able to get it whenever they required. The concept of
Health Information Exchange (i.e Exchange of health information about the patient
across hospitals) can also be achieved by the use of CRM. CRM enables to avoid
duplication of data, patient security, and to provide easy access over health information.

In India currently the CRM system is used in only few hospitals with limited
information. The scope of this project also involves how to use the CRM system with
maximum information and also in an effective way. Also the study involves collection of
health information, maintaining that information, exchange of information etc. The best
way of implementing CRM system with online data storage is also considered in this
study.

E-trust and e-satisfaction as antecedents of e-loyalty

E-loyalty is widely defined as customer’s favorable attitude and commitment towards the
online service that results in repeat use of hospital services by the customer (Srinivasan
et al., 2002). As a result, e-loyal customers bring increased profitability to the hospitals
that use online hospital services through long-time customer commitment and reduced
costs of acquiring new customers (Reichheld et al., 2000). E-loyal customers are not the
ones seeking the lowest prices, but the ones willing to get good service at premium
prices. They also tend to refer new customers to the hospitals that use online services by,
providing rich potential sources of profit (Reichheld et al., 2000). Further, E-loyal
customers utilize the hospital service by more than newly acquired customers and can be
served with reduced operating costs (van Riel et al., 2001). Therefore, even though the
cost of establishing online loyalty is larger than that of traditional method , profit growth
accelerates at an even faster rate once the relationship has been built (Reichheld and
Schefter, 2000). These previous findings point to the need for understanding how e-
loyalty is developed. In explaining the establishment of e-loyalty, both e-satisfaction and
e-trust are found to play a central role. For example, studies discovered that e-satisfaction
and e-trust influence e-loyalty either individually, such as e-satisfaction _ e-loyalty
(Anderson and Srinivasan, 2003), and e-trust _ eloyalty (Sirdeshmukh et al., 2002), or in
a sequential order, such as E-trust_ e-satisfaction _eloyalty (Gummerus et al.,2004). Trust
has been conceptualized as ‘‘customer confidence in the quality and reliability of the
service offered’’ (Gabarino and Johnson, 1999) and has been presented as a central
attribute in relationship initiation, formation and maintenance in a variety of exchange
contexts (Sirdeshmukh et al., 2002). Previous studies suggest that trust has significant
impact on the establishment of loyalty in both offline (Chaudhuri and Holbrook, 2001;
Singh and Sirdeshmukh, 2000) and online (Park and Kim, 2003; Pitta et al., 2006).
8. PROPOSED RESEARCH METHODOLOGY

8.1. Research Design

A Research design is purely and simply the framework and plan for the study that
guides in collection and analysis of data. It is a blue print for a complete study.
8.1.1 Type of Research design
In this study the researcher has proposed to use both exploratory type and
Analytical type of research design . Exploratory type of research design is used to
explore the possibility of implementing e-CRM in hospitals and analytical type of
research design is used to analyze the effectiveness of e-CRM in maintaining the
relationship with the customers (patients )
8.1.2 Area of Study
The research work will be carried out in leading hospitals in Chennai. The
respondents would be doctors and patients who use e-CRM system.

8.2 Questionnaire Design

8.2.1 Research instrument
The research instrument used for the study is structured questionnaire. A structured
questionnaire consists of set of questions arranged in a sequenced manner in order to
extract the viewpoint of respondents to the subject / problem under study. The questions
in the questionnaire are of both open ended and close ended type. The type of questions
is Dichotomous, Multiple-choice type, Likert scale type and Ranking type questions.
8.2.2 Pilot Study
The researcher before collecting the primary data conducts pilot study for the purpose
of evaluating the strength and weakness of questionnaire. The pilot study would be
conducted among CRM consultants to verify and validate the Questionnaire . After
conducting the pilot study the researcher may redesigned the questionnaire by eliminating
irrelevant questions and incorporating relevant questions to the study.
8.3 Data Collection Method
 The researcher will use questionnaire to collect primary data from the
respondents. A separate Questionnaire was designed for doctors and patients in order to
elicit response on use of e-CRM tool.

8.3.1 Types of Data

Data were collected from two sources namely
i) Primary data
Primary data are those, which will be collected afresh and for the first time and thus
happen to be pertaining to the current research process. Primary data would be collected
from doctors and patients through a separate Questionnaire designed exclusively for
them.
ii) Secondary data
Secondary data were already available data, which will collected through various sources
like CRM Journals , Websites , previous dissertation work, Research papers and articles
on e-CRM, Magazines, and from various CRM Books

8.4 Sampling Design

A sample design is a definite plan for obtaining a sample from a given population. It
refers to the technique of procedure, the researcher adopts in selecting the items for the
sample. Sampling may be defined as the selection of some part of an aggregate of
totaling on the basis of which a judgment or inference about the aggregate of totaling is
made. The sample has been restricted to doctors working in hospitals and patients .

8.4.1 Population for the study

The researcher used Chennai region for his study. The population for this study is around
437 doctors working in leading hospitals and 4871 patients.
8.4.2 Sampling Unit
Doctors working in hospitals and patients visiting the hospitals for treatment were taken
as the sampling units.
8.4.3 Sampling Technique
Doctors:
The researcher used disproportionate stratified sampling technique to arrive the sample
size of 44 (10% of 437 Doctors) for his research study
Slno. Specialist Population Percentage Sample
1. General Physician 143 10 14
2. Dermatologist 42 10 04
3 Gynecologist 33 10 03
4. Child specialist 58 10 06
5 Nephrologists 16 10 02
6 Neurologist 23 10 02
7 Oncologist 17 10 02
8 Pshycotrist 17 10 02
9 Pediatrist 22 10 02
3. Dentist 16 10 02
4. ENT 17 10 02
5. Others 33 10 03
Total 437 44

Patient:
The researcher use random sampling technique to arrive the sample size of 243 patients
(5% of 4871 Patients) for his research study

8.5 Statistical Tools and techniques

1. Percentage analysis is used to give a tabulated representation of the respondents

viewpoint

Percentage = Number of Responses / total number of respondents x 100

2. Weighted Average method

Weighted Average method is used to sum up the views of the various respondents to
obtain mean score for the particular statement.

Mean score= Total score / Number of respondent

Where Total score = Number of respondent x weighted average
3. One sample run test

This test is used to test the randomness of sample

µ r = [(2*n1*n2)/( n1*n2)]+1
σ r2 = [2*n1*n2(2*n1*n2-n1-n2)]/[(n1+n2) 2 (n1+n2-1)
Where
n1 = Number of occurrence of type 1
n2 = Number of occurrence of type 2
r = Number of runs
µ r = Mean of runs
σ r = standard deviation of the runs
UCL = µ r + [95% C.L.) (σ r)
LCL = µ r – (95% C.L.) (σ r)

4. Chi-square test : Chi Square test is used to test the null hypothesis to find the
relationship between two variables

χ 2 = (0-E) 2/E
Where
0 = observed value
E = Expected value
Degree of freedom = (r-1)(c-1)
Where
r = Number of rows
c = Number of columns
If calculated value < table value accept Null Hypothesis
If calculated value > table value reject Null Hypothesis accept Alternative Hypothesis

5. Kendal’s coefficient of concordance.

1. Null hypothesis (Ho): There is a difference in attributes.

2. Alternative hypothesis (H1): There is no difference in attributes.

FACTORS
K= N=
A B C
Judge 1 ∑Rj =
Judge 2
Judge 3
Judge 4
Judge 5
 Sum of
rank (Rj)
(Rj – Rj)² S=

Rj =
∑Rj
n
S = ∑ (Rj – Rj) ²

Where
S = Kendal coefficient of concordance, Rj = Rank assigned by judges for various
attributes
__
Rj = Mean of the rank, K = No. of respondents, N = No. of factors

8.6 LIMITATIONS

• The scope of this project is limited only to Healthcare industry.

• The study is restricted to leading hospitals in Chennai city
• The findings of the study may be solely based on the information
provided by the respondents.
• The findings of the study are subjected to bias and prejudice of the
respondents.
• The findings cannot be generalized and are subjected to change in future

.
9. EXPECTED DELIVERABLES

• The advantage of using e-CRM system for both doctors and patients.
• The way how e-CRM helps to maintain the history of patients and how it
is useful in maintaining long term relationship with the customers.
• Providing various operations for patient including registration, admission
and treatment and bill payment in online.
• Storage of patient information in centralized repository.
10. CONCLUSION

e-CRM emerges from the Internet and web technology to facilitate the implementation of
CRM; it focuses on Internet- or web-based interaction between companies and their
customers. (Rosenbaum & Huang 2002) argue that the main driver for eCRM adoption
seems to be a commonly shared belief that it improves customer loyalty and retention
through the enhancement of customer satisfaction, as customer satisfaction is one of the
more immediate objectives of eCRM. E-loyalty brings high rate of customer retention
and reduced Cost for recruiting new customers that leads to long-term profitability to the
online retailer (Reichheld et al., 2000). The purpose of conducting this research is to find
out the feasibility of implementing e-CRM in hospitals that facilitate better and quick
interaction between doctors and patients. this paper is to develop a comprehensive model,
which describes the relationship between eCRM factors and E-loyalty at different
adoption stages of transaction cycle (Pre-Service , At-Service and Post-Service). The
framework builds upon the view of eCRM and E-loyalty presented within the paper.
Based on the literature review, this paper identified eleven variables that relevant to the
objective of this study. The independent variables (IV) for this study include Pre-
service/eCRM, At-Service/eCRM, Post Service/eCRM, and E-Trust, while the use e-
satisfaction and e-loyalty are listed as the dependent variables (DV). This paper proposes
that Pre-Service/eCRM is constructed from three independent
variables: Web-Site Design, Search Capabilities, and Loyalty Programme. On the other
hand, Payment Methods, and Privacy/security are proposed as the independent variables
of At- Service/eCRM, while Post-Service/eCRM is constructed from three independent
variables: Order tracking, on time delivery and after sale service. These variables build
up a Conceptual framework that is inline with the objectives of this paper. In future
research, this model will be explored by conducting quantitative study.
11. TIME SCHEDULE FOR PROPOSED RESEACH ACTIVITIES

TOTAL AVAILABLE TIME FOR RESEARCH WORK-3 YEARS

RESEARCH TIME SCHEDULE IN MONTHS

ACTIVITIES 3 6 9 12 15 18 21 24 27 30 33 36
Preliminary
work
Literature
review
Questionnaire
design
Research
methodology
Determination
of sample size
Data collection
(Survey)
Data analysis
and
Interpretation
Findings
Suggestions
and
Conclusion
Preparation of
final report
 FEEDBACK ON YOUR RESEARCH PROPOSAL

TOPIC: Good area for research. Please read below for more detailed requirements
before conducting the study.

Your literature search is broad and general about eCRM. Please make a literature search
specifically on eCRM in the healthcare services sector and hospital services in particular
from papers published in international research journals listed in standard databases
accepted worldwide. If you come to the campus, you can use our univ library for doing
Journal database searches. This is necessary to first establish a research need. CRM and
its uses in general cannot be directly applied to hospital services as this service is more
people-based. To understand how CRM has been used in hospitals you have to look at
other papers in this area. You need to explain why you have chosen this service area –
establish the need for research. Using text books for literature search can be limited to
just general definitions and journal paper search may please be increased as books will
not give any details of the research design.

Healthcare sector is a broader term and can have even have govt as its customer in
providing data on immunization and health education programs etc. From your proposal
it looks like you are concentrating on Hospital services – specifically restricted to patients
experiences with eCRM from hospitals.

Let us come to the sampling, the independent variables and dependent variables after
studying the existing research base on this topic. I am not very convinced with the
sampling as well as the variables you have listed as of now and would like to see a more
indepth literature search. Basically CRM can be sen more effectively only when there is a
need for a long-term relationship between the customer (not only the patients but also the
primary caregivers at home or attendants or relatives) and a hospital. Or when distance
makes face-to-face meetings difficult as in Medical Tourism situations. Reading up the
published research will make the topic clearer and more focused in your mind so that you
can design your study.

I am giving some links to some papers based only on a Google search. This is not enough
as Google is a general search engine. Please also try out Google Scholar. You will also
have to come and access some of the eJournal databases from the library. For papers on
healthcare and hospital services sector, please go to PubMed Central website. Many
medical research papers have been made free for access.

http://www.indmedica.com/journals.php?
journalid=6&issueid=21&articleid=178&action=article

http://www.expresshealthcaremgmt.com/20040115/management01.shtml

http://www.123eng.com/forum/viewtopic.php?p=13793
http://www.scribd.com/doc/25838018/CRM-Practices-Interactions-in-Health-care-
Industry

http://www.ehealthonline.org/articles/article-details.asp?Title=Customer%20Relationship
%20Management&ArticalID=1641&Type=MEDICAL%20TOURISM

http://www.ineag.gr/ICICTH/papers/session10/Georgakas%20crm%20model.pdf