Idea about sleep clinic and current market environment.

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

2. DECLARATION
I hereby declare that the dissertation entitled “Comparison of different
marketing strategy for sleep center” submitted for the M. B. A (Health Care
Management), degree is my original work and the dissertation has not formed the basis
for the award of any degree, associate ship, fellowship or any other similar titles.
Place:
Date: Signature of the Student
2|Page

3. CERTIFICATE
This is to certify that the Dissertation entitled “Comparison of different
marketing strategy for sleep center” submitted by (Chirag Hathi, Enrolment Number
:101114545), is a bonafide record of research work done by her/she under my guidance
at PRIST UNIVERSITY, Thanjavur, in partial fulfillment of the requirement for the award
of the degree MASTER OF BUSINESS ADMINISTRATION in Health Care
Management and the dissertation has not formed on the basis for the award of any
degree, associate ship, fellowship or any other similar titles.
Place:
Date: Signature of the Guide
3|Page

4. ACKNOWLEDGEMENT
I would like to express my sincere thanks and gratitude to SPARSH
HOSPITAL, AHMEDABAD for allowing me to complete my dissertation
project in the facility.
The structure and the content of this project have been deeply influenced by
many people for whom I wish to express my gratitude.
I sincerely thank Dr.Tushar Patel, Dr.Gopal Raval, Dr.Mukesh Patel,
Dr.Harjit Dumra & Dr.Varun Patel for giving me the opportunity to do my
project at “SPARSH HOSPITAL, AHMEDABAD”.
My sincere thanks go to Mrs. Manju Sharma ICRI-Ahmedabad and Dr.
Babita Agrawal (Principal ICRI Ahmedabad) for helping me in designing
my study.
Foremost, I would like to thank Dr.Gopal Raval(M.B,D.N.B(respiratory
medicine)DTCD FCCS) and Dr.Varun Patel(MB,DNB,Respiratory
medicine)who were kind enough to spare their valuable time and provided
several important guidance and suggestions at every stage of my study.
4|Page

5. CONTENTS
CHAPTER PARTICULARS PAGE NO.
/SERIAL. NO.
1 Hospital profile 6
1.1 Services
1.2 About doctors
2 Introduction of topic 9
2.1 Aim
2.2 objectives
3 Review of literature 10
3.1 Sleep Disorders
3.2 Sleep Clinic
3.3 Market environment
4 Research methodology 16
4.1 scope
4.2 Topic
4.3 Time duration
4.4 source of data
4.5 Method of data collection
4.6 Method of data collection
4.7 limitation
5 Planning & 17
Marketing strategy
6 Data collection 20
7 Observation 21
8 Conclusion 23
9 Recommendations and suggestions 24
10 Links and references 25
11 Annexure 26
11.1 forms
5|Page

6. 1 Hospital profile
Ashrai Associates is a group of young, highly
skilled, experienced and dynamic Pulmonary and
Critical care specialists, who have been
providing comprehensive Respiratory and Critical
care to patients residing in the Western region
of India for the last 5 years.
ASHRAI has played a pioneering role in the
development of several subspecialties in field of
Pulmonary & Critical Care Medicine not only in
Ahmedabad and the state of Gujarat but also in
the entire Western India Region.
 Maximum number of Medical Pleuroscopies & Therapeutic
Bronchoscopic Procedures in India
 The only group to have intensivists who have comprehensive training
in Transplants - Liver & Lung. We have now assisted in the maximum
number of Liver transplants in the state of Gujarat.
 Maximum number of patients of ARDS treated with Extracorporeal
Techniques (ECMO) in the state of Gujarat.
 The only facility in Gujarat to have state of the art Allergy Testing unit
 The First group to start Pulmonary Hypertension and ILD clinics in
Western India
 The First group to initiate comprehensive Domiciliary care for End
stage lung Disease patients with the help of trained medical &
paramedical staff
 The First facility in Gujarat to be approved for Phase II, III & IV trials
 The First Group to Establish a Comprehensive Sleep Diagnostic Center
and have a dedicated individual specializing in Sleep Disorders.
 The First & Only Group to Organize workshops for hands on Training in
Ventilatory Management, Spirometry, Bronchoscopy and Pleuroscopy.
6|Page

7. 1.1 Services
 Bronchoscopy
 Pleuroscopy
 PFT
 6MWT
 Allergy clinic
 Sleep clinic
 Smoking cessation
 Critical care
1.2 ASHRAI Doctors:-
Dr.Harjit Dumra:-
He is the chief intensivist at the Sterling Hospital. One of the member of the
infection control committee at Medisurge hospital. He is a respected national
and international faculty and has delivered talks on various topics across the
country.
7|Page

8. Dr.Tushar Patel:-
He is a main member of the ASHRAI group. He has special interest in
occupational lung disease. His area of expertise includes TB, Obstructive
airway disorders, Sleep disorders and PFT.
Dr.Mukesh Patel:-
He is highly skilled and experienced pulmonary and critical care specialist
practicing in Ahmedabad for last 12 years. He is the first pulmonologist in
country to start medical Pleuroscopy.
Dr.Gopal Raval:-
He is a dynamic pulmonologist and critical care specialist and he was
research fellow in international study of asthma and allergic condition in
children (ISAAC). He has taken training in sleep medicine from Indian
institute of sleep science, Mumbai.
Dr. Amrish Patel:-
He is one of the new generation of pulmonary and critical care specialist. He
is back bone of critical care service at ASHRAI. He is acore member of liver
transplant team.
Dr. Raj Bhagat:-
He is a well known allergy specialist practicing in Ahmedabad. His areas of
interest are respiratory medicine, allergy and applied immunology. He has
published various articles in “the Indian Practitioner” and “Gujarat Medical
Journal”.
Dr.Varun Patel:-
He is youngest member of the group. He has done his DNB (Gold Medalist)
from Amrita institute of Medical sciences, Kochi. He has presented number of
papers in the various states, national international conferences.
8|Page

9. 2 Introduction of topic
2.1 Aim: - To compare 3 different marketing strategy for the sleep clinic
2.2 Objectives:-
 To understand the sleep clinic service.
 To study the market environment and competition
 To study which marketing strategy is suitable for sleep clinic
9|Page

10. 3 Review of literature
3.1 Introduction about sleep disorders
Due to rapidly increasing knowledge about sleep in the 20th century,
including the discovery of REM sleep and sleep apnea, the medical
importance of sleep was recognized. The medical community began paying
more attention than previously to primary sleep disorders, such as sleep
apnea, as well as the role and quality of sleep in other conditions
Sleep apnea:-
While there are may be many symptoms for sleep apnea the more
significant symptoms are:
 Loud, irregular, snoring, snorts,
gasps and other unusual
breathing sounds during sleep
 Long pause in breathing during
sleep
 Excessive daytime sleepiness
 Fatigue
 Obesity
 Changes in alertness , memory
 Change in mood personality and behavior
 Impotence
 Morning headaches
 Frequent trips to bathroom at night
NOTE: 40% of OSA patients have diabetes.
Sleep apnea is among top 4 causes of heart disease.
Although obstructive sleep apnea and cardiovascular disease have common
risk factors, epidemiologic studies show that sleep apnea increases risks for
cardiovascular disease independently of individuals' demographic
characteristics (i.e., age, sex, and race) or risk markers (i.e., smoking,
alcohol, obesity, diabetes, dyslipidemia, Arial fibrillation, and hypertension).
10 | P a g e

11. Individuals with severe sleep apnea are at increased risk for coronary artery
disease, congestive heart failure, and stroke.
Sleep apnea has several health risks. Untreated sleep apnea may
lead to:
 High blood pressure
 Stroke
 Heart attack
 Congestive heart failure
 Cardiac arrhythmia
 Depression
 Glaucoma
 Obesity
 Diabetes
 Chronic fatigue
11 | P a g e

12. 3.2 Sleep clinic
Sleep Medicine is now a recognized subspecialty within internal medicine,
family medicine, pediatrics, otolaryngology, psychiatry and neurology in the
United States. In India it is still a new field.
Certification in Sleep Medicine shows that the specialist has demonstrated
expertise in the diagnosis and management of clinical conditions that occur
during sleep, that disturb sleep, or that are affected by disturbances in the
wake-sleep cycle.
This specialist is skilled in the analysis and interpretation of comprehensive
polysomnography and well-versed in emerging research and management of
a sleep laboratory.
Types of Studies
 Nocturnal Polysomnogram, NPSG – The standard overnight
diagnostic sleep study used to assess sleep disorders, including sleep
apnea, periodic limb movement disorders, insomnia, 24 hour sleep-
wake cycle disruptions etc. The study includes various physiological
measurements such as respiratory effort and airflow, EEG (brain
waves), EKG (Heart), EMG (muscle movement), oxygen saturations,
and snoring. These parameters are standard on every overnight sleep
study both diagnostic and therapeutic.
 Continuous Positive Airway Pressure, CPAP Titration – A
therapeutic study used to treat obstructive sleep apnea syndrome
(OSAS). The purpose of this study is to explore a variety of CPAP
pressures to determine which is the most effective in eliminating
apneic events and scoring.
 Split Study – A sleep study which combines a 2 – 4 hour diagnostic
test and a therapeutic test in the same night. This study is possible for
every adult so that patients with severe OSAS may be treated
immediately. If a patient is not “split” to CPAP then the study is run as
a NPSG. The patient may return for a full night of CPAP if the
diagnostic test finds evidence of sleep apnea and treatment is advised.
 Bi-Level Titration – An alternate therapeutic study used to treat
patients that have very high severe obstructive sleep apnea syndrome
or those that are intolerant of CPAP. Pressures are explored on the
12 | P a g e

13. inhalation and an alternate pressure on exhalation. This pressure
spread is used to ease the work of breathing.
 REM Behavior Disorder, RBD – a modified NPSG with electrodes
added to the arms (in addition to the legs) to determine the presence
of movement during REM, a stage of sleep during which the muscles
are immobile. This study is performed if a patient is suspected of
acting out his/her dreams at night.
 NPSG with End Tidal CO2 – a modified NPSG with the use of end
tidal CO2 monitoring. A useful adjunct to the airway recording to assist
in the detection of obesity hypoventilation and Hypercapnia, or CO2
retention. ETCO2 recording is considered the gold standard for
pediatric polysomnography.
 Expanded EEG Sleep Recording – An NPSG performed with a full
EEG montage during recording. This study is used to detect the
presence of nocturnal seizures in addition to other sleep disorders.
 Multiple Sleep Latency Test, MSLT – A study performed during the
day after a full diagnostic NPSG, this study is used to objectively
determine a patient’s level of sleepiness after a night’s sleep. The
MSLT is a series of five timed test, two hours apart, during which we
look to see whether a patient falls asleep, how quickly, and to what
stage of sleep the patient reaches. The MSLT is most commonly used
to diagnose narcolepsy or some degree of excessive daytime
sleepiness.
 Maintenance of Wakefulness Test, MWT – A study performed to
determine whether a patient is able to remain awake in a sleep
induced environment. The MWT is used to assess the efficacy of the
treatment of a sleep disorder
13 | P a g e

14. 14 | P a g e

15. 3.3 Market environment in India
The prevalence of obesity, sleep apnea, and the metabolic syndrome is
rapidly increasing in India and other south Asian countries, leading to
increased morbidity and mortality due to type 2 diabetes mellitus (T2DM)
and cardiovascular disease (CVD).
Obstructive sleep apnea (OSA) has been reported to be present in 7.5% of
Asian Indians in western India. Growing evidence indicates OSA to be
independently associated with obesity, hypertension, and excess
cardiovascular risk and mortality.
Patients with OSA have a high prevalence of insulin resistance and the
metabolic syndrome. Obese Asian Indians with OSA had higher abdominal
obesity and fasting blood glucose and a higher prevalence of the metabolic
syndrome as compared with obese subjects without OSA.
These data also indicate that the presence of OSA may increase the risk of
atherosclerosis and CHD independent of obesity in Asian Indians.
15 | P a g e

16. 4 Research Methodology
4.1 Scope of Study
4.2 Topic: - study output of three different marketing strategy
4.3 Time Duration of Project: - 45 days
4.4 Source of data collection:-
 Patient records
4.5 Method of data collection:-
 By filling up questioner form and feedback form for the patients.
 By interaction with doctors
 Observation
4.6 Methods of data presentation:-
 Graphical representation
4.7 Limitation: - time period was limited to measure accurate result.
16 | P a g e

17. 5 Planning:
5.1 Market research
Market research is any organized effort to gather information about markets
or customers. It is a very important component of business strategy.
Market research is for discovering what people want, need, or believe. It can
also involve discovering how they act. Once that research is completed, it
can be used to determine how to market your product
To know the awareness level of the sleep disorder in people and prevalence
of the disorder in this area a questioner (annexure) is formed and it had
been filed by 300 people.
Result of marketing research
Level of awareness about sleep Prevalence of disease in this area
apnea in this area
5.7% 48.56%
In India awareness level is very low and people do not take sleep disorders
seriously. Patients do not complain about symptoms until the condition is
worst.
OSA is prevalent in upper class of the India. It is also prevalent in top class.
17 | P a g e

18. 5.2 Marketing Strategy
To increase the awareness 3 marketing strategies has been adopted.
 Doctors: -
o Message: We want to assist you in providing the very best healthcare for
your patients.
o Local doctors were given informative brochures and basic idea
about sleep clinic.
o Call on physicians’ offices to educate the physicians and/or their office
managers on sleep disorders. Provide physicians and office managers
with screening information and educational brochures for their staff and
patients
o Thank you notes to physicians who have referred patients within 48 hours
of referral
 Events :- for general public as well as Doctors
o Event was organized on the Sunday so that we can target more
people.
o Advertisement for event was done by flyers which had been
distributed via news papers.
o A presentation was given by the doctor and self assessment
questioners were given to the audiences so that they themselves
can evaluate that they had sleep disorder or not?
 Advertisement and news:-
o Informative advertisement in local language was given in news
papers.
18 | P a g e

19. 19 | P a g e

20. 6 Data collection
Data collection was done by feedback form:-
Feedback form was given to each patient and filled form was collected from
them.(annexure 11.1)
From the patient data sheet we came to know about clinical data of the
patient. (annexure 11.1)
20 | P a g e

21. 7 Observation
Marketing Events Referred by Advertisement
strategy Doctor and news
No. of the 22 118 10
patients
Percentage 14.66 78.67 6.66
marketing strategy
advertisement
11%
referred
by doctor
25%
events
64%
21 | P a g e

22. Doctors %
Cardiologist 60
General physician 9.5
Pulmonologist 25
Others 5.5
Doctors
others
6%
pulmonologist
25%
cardilogist
60%
general
physicians
9%
From the patient clinical data sheet following data was obtained:-
 67% of the patients were having high BMI.
 25% of the patients were victim of sleep disorder just because of the
stress and life style.
22 | P a g e

23. 8 Conclusion and Discussion
Sleep diagnosis and sleep disorders are still new for the Indian market.
And people are not taking the disorder seriously until and unless their
family physician or any Doctor influences them. However, the mindset of
urban Indian patients is changing from treating illness to managing
wellness. In case of health care India is a Doctor Driven market.
Events and advertisement do have an effect but not satisfactory. Events
may influence the patient to think about the sleep disorder.
Advertisements helps in creating brand image or may be it creates
psychological effect in patient’s mind about the service that it is famous
and reliable. But it will not good result in short time. It will take time to
create a good image in the patient’s mind. Especially in the healthcare
market.
23 | P a g e

24. 9 Recommendations and suggestions
 Cardiologist and pulmonologist doctors should be targeted to
achieve goal.
 Obesity being the main reason of the sleep apnea that particular
type of the patient should be targeted. These patients may require
large-sized wheelchairs and beds and quick access to pre-surgical
appointments
 Sleep lab accreditation may help to create a good brand image.
 Risk of OSA is more in diabetic patient. Awareness in such patients
may help to create good patient base.
 Weight loss programs: About 67 percent of people with OSA are
obese. Partnering with local weight loss programs could increase
referral base. A loss of just 10 percent of body weight may cure
OSA or diminish it significantly.
 Transportation industry: It's widely recognized that drowsy driving
is very dangerous and that untreated OSA and narcolepsy may
increase risks. Both the aviation and the trucking industry now may
require sleep disorders screenings and/or maintenance of
wakefulness testing for vehicle operators. However cost of sleep
clinic is high so need to develop a good pricing strategy is
important.
24 | P a g e

25. 10 Links and references
 http://www.aasmnet.org/
 http://www.sleepdt.com/articles/5-2/
 National Library of Medicine, Bethesda
 http://sleepapnea.org/about-asaa.html
 National Heart, Lung and Blood Institute/National Center on Sleep Disorders
Research Expert Panel on Driver Fatigue and Sleepiness. Drowsy driving and
automobile crashes: report and recommendations. Available from: URL:
www.nhlbi.nih.gov/health/prof/sleep/drsy_drv.pdf.
 Essentials o healthcare marketing by Eric N. Berkowitz, page no.27-28
25 | P a g e

26. 11 Annexure
11.1 Forms:-
Format of the questioner:-
Name:- _________________________________________________
Age:-__________
Gender: -  Male  Female
1. Do you have problem of snoring?  Yes  No
2. Do you have problem with your alertness?  Yes  No
3. Do you feel morning headache?  Yes  No
4. Do you frequently feel sleepy in the day time?  Yes  No
5. Do you know what sleep apnea is?  Yes  No
Patient name:-
Age:-
Gender: -  Male  Female
1. Do you have problem of snoring?  Yes  No
2. Do you have problem with your alertness?  Yes  No
3. Do you feel morning headache?  Yes  No
4. Do you frequently feel sleepy in the day time?  Yes  No
More than one yes means you MAY have sleep disorder.
26 | P a g e

27. Feedback form:-
Feedback form
Patient name:- ________________________________________________________
Ph. No:- ______________
You came to know about our sleep center by:-
 Doctor 
Name of the doctor and contact no:-_______________________________
_______________________________
 Advertisement in the news papers 
 Event 
27 | P a g e

28. 28 | P a g e