Module 4: Discussion ForumRead and evaluate the following scenario:Deen, A., & Balkaran, R. (2013). An analysis of hotels and its similarities to the management of hospitals: A case study of a Provinc
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Journal of Economics and Behavioral Studies
Vol. 5, No. 9, pp. 5 73 -579 , Sep 2013 (ISSN: 2220 -6140)
An analysis of Hotels and its S imilarities to the Management of Hospitals: A case study of
a Provincial Hospital in South Africa
A. Deen , *R. Balkaran
Durban Univ ersity of Technology, South Africa *[email protected]
Abstract: The South African concept of Provincial Hospitals in South Africa is characterised by the fact
that it is managed by the state and its structure, operations and location were predomi nantly influenced
by its historical record and to a large extent the challenges experienced with its management is directly
linked to the problems of the past. This specifically has to do with the dire lack of essential resources from
financial aligned res ources to health care expertise. The stand - off here is against the desperate need for
basic health care services from the many millions that have been previously disadvantaged. The ability to
close this gap lies in the heart of efficient, effective and e conomical management of the provincial
hospitals. The management of hotels and its link to the management of hospitals becomes significant
within this context as essential elements such as hospitality and hospitality practice may be embraced
within the man agement of health care services within South Africa. The paper explores the strong
theoretical base of hospitality within hotels and its relevance to hospitals which is premised on service
delivery the roots of which are fixed on the efficiencies of manage ment practice. A theoretical model will
be explored in respect of its application to the management of provincial hospitals in South Africa. This is
further enhanced by a parallel study of a provincial hospital in South Africa which would incorporate
among st other an analysis of its socio -economic and legislative environments.
Keywords: Hotels, Hospitals, Health Care, South Africa
1. Introduc tion
The public sector is under -resourced and over -used, whiles the growing private sector, run largely on
commercial lines, caters to middle - and high -income earners who tend to be members of medical
schemes, which are a small amount of the population, and to foreigners looking for top -quality surgical
procedures at relatively affordable prices. The private sector also attracts most of the c ountry's health
professionals (South Africa Info , 2008). The government is under pressure servicing a large portion of the
population who are not medical schemes within the public sector affecting the way service is delivered to
the patients. Ntuli (n.d) agrees that the perilous growth of private healthcare providers in connection
with the scarcity of resources, including finances and health personnel, inevitably affects access to health
care for the majority of the population, and this is a phenomenon worthy of further examination from a
human rights perspective. This implies that difficulties begin from top level management and travels
through the system ultimately imp acting the consumer, which are the patients.
Hospitality service and service delivery : Severt, Aiello, Elswick & Cyr (2008) cited Lashley and
Morrison (2000) that hospitality provides a commitment to meeting guests’ needs as the primary focus in
commerci al operations through a host and guest relationship. The host and guest relationship is further
characterized by hospitableness typically extended by the host to the guests then reciprocated by the
guest to the host. Service is an intangible experience of performance that the guest or the customer
receives along with the tangible side of the product purchased. Because of service, people are a part of the
product and a good service team is essential. Ive (2000 ) identifies that to develop the highest standards of
service, a deep understanding of guests’ needs to be established, and further explains that it is the
understanding the person or guest who is requiring the service – the customer – and how and why they
need it – our product – in the first pla ce.
Figure 1 identifies the applied approach to the guest cycle within the hospitality industry. The guest cycle
represents the flow of business through a hotel identifying physical contacts, financial exchanges between
guest and hotel. According Bardi (2 011 ) guest hospitality begins at the arrival and registration process, as
the front desk clerk begins the check -in process with a display of hospitality toward the guest, including
eye contact an d a warm smile. Bardi (2011 ) continues by emphasizing the imp ortance of a warm 574
welcome to a guest is essential, as it is expected with a high quality product and a well developed delivery
system. Referring to Figure 1, Dix & Baird (1998 ) agree the reason we care for our customers, is because
we want them to come bac k, and once they have experience a product or service they have enjoyed, they
will want to repeat it. Ford & Heaton (2000 ) specify that the service encounter is the person to person
interaction between the customer and the person delivering the service. Fu rther acknowledges that the
service encounter and interactions have critical moments within them which is of crucial importance to
the guest’s evaluation of service quality, and may make or break the entire guest experience. The service
encounter may be de monstrated and actioned in Figure 1. Hence, Jones & Lockwood (1989 ) support that
any service encounter is of prime importance in determining the customer’s overall satisfaction with
experience and further explains this importance in his model of management influence on service.
Figure 1 : Applied approach to the gue st cycle Abbott &Lewry (1999 )
Figure 2 : A model of management influence on ser vice Jones & Lockwood (1989 )
Figure 2 illustrates the influence that the manager has on service interaction and provides the framework
for analyzing and discussing the effective management of service whe reby Jones & Lockwood (1989 )
believe that a manager needs to take a proactive approach to this encounter or experience. The model
reveals that there is an interperso nal interaction between the employee and the customer, which creates
the service encounter. The model also depicts that management control includes the selection and
training process of the employee, which enhances the interpersonal action to the customer in terms of the
quality of service, and marketing to the customer, which stimulates and creates the customer expectation.
Olsen, Teare & Gummesson (1996 ) support by stating the quality of the service rendered to external
customers (guests) exhibited in Fig ure 1 (The applied guest cycle ) depends on the quality of the service
rendered to internal customers (staff). Essentially this requires that staff be seen as customers and their
expectations understood, which can be identified in Figure 2, specifically ref erred to management control,
their persuasion of staff, and therefore influencing the service encounter. With specific reference Figure s1
(The applied guest cycle ) & 2(The model of management influence) Bardi (2011 ) further supports that a
hospitality manager needs to visualize the organization as dealing with the customer in terms of cycle of
service, represented in Figure 1 (The applied guest cycle) , a repeatable sequence of events in which
various people try to meet the customer’s needs and expectations at each point.
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Hospitality Management : Management is an integral part of the hospitality indus try. According to David
(2005 ) management is such an important element of the hotel industry that can make or spoil the
industry and fur ther defines it as a technique of getting things done through the efforts of others. Mullins
(1999 ) states that management relates to all activities and at all levels of the organization and the overall
responsibility of management can be seen as the attainment of the given objectives of the organization.
Guests who frequent hotels expect procedures to be designed to enable a smooth flow of service, which is
tailored to meet their in dividual needs. Keiser (1979 ) finds that industries where the product is service
and tends to be handcrafted, management concerns itself with people. The hospitality industr y is a people
industry and Keiser (1979 ) points out that in a factory, the management deal with only with its
employees as people; in retail establishment, the customers are the primary people concerned; whereas
the hospitality industry is different, both employees and customers are dealt with at the same time. In the
hospitality industry, employee commitment plays a major role in delivering a good customer experience,
in turn leading to customer satisfaction; hence, employees must understand the importance of service
and its relationship with the customer. Mullins (2001 ) outlines that the task of management is to make
the use of staff, and the responsibility of management is to manage, however the efficiency of staff and
their commitment to the aims and phi losophy of the establishment are fostered by good human
relationships and by the nature of managerial behaviour.
Williams & Uysal (2003 ) concur that in any service industry the service role is basic and essential, and
dependant on staff performanc e, and f urther explains that every employee who is in contact with external
customers affects customer satisfaction. Berger & Brownwell (2009 ) indicate that the hospitality industry
is a high – contact setting that places physical, mental and emotional demands on employees. And Ford &
Heaton (2000: 110) support that managers of effective hospitality organizations understand the value of
a strong culture and do whatever they can to reaffirm and support what the organization values, and if
the culture supports excell ent service, then the members learn that providing excellent service is what
they supposed to do. Price & Jaffe (2008 ) believe that service matters because customers who encounter
bad service tell their friends and find other companies with which they would want to do business. In
addition, in Figure 2 (The model of management influence) , Jones & Lockwood (1989 ) outline that a
manager has direct control over influence through selection and training whereby influencing employee
performance. Ford & Heaton (2000 ) consolidates that service effectiveness depends on everyone
throughout the organization taking service responsibi lity seriously and organizations need not hire
anyone who is unwilling or unable to provide and deliver outstanding ser vice. Jones & Lockwood (1989 )
are in support of Ford & Heaton’s service effectiveness and Berger &Brownwell’s quality service concepts
in his illustration and outlines that the manager does have influence over the role employee’s play, the
scripts they use, the design of the service delivery system, and the organization culture, which indirectly
affect control over each interaction the empl oyee is engaged in. Mullins (2001 ) justifies that the function
that distinguishes the manager above all others is the function no one but the manager can perform,
which is the ability to give others vision and the ability to perform , which is exhibited in Jones &
Lockwood’s model in Figure 1 . Furthe rmore, Walker & Miller (2010 ) declare that if you want your people
to treat guests courteously and serve them well, treat your associates courteously and well.
A Provincial Hospital in South Africa : According to Kandampully ( 2007 ), the national economy of every
country depends on its service infrastructure including transport, communication, education, health care
and various government entities. Hospitals are primarily for those who need in -patient care, altho ugh all
have outpatients departments, casualty and emergency care. The Provincial Hospital is a District and
Regional Hospital in line with the policy of the Provincial and National Departments of Health (Patient
information booklet). It has 543 beds and l ocated in Chatsworth, a suburb in the eT hekwini health district
(Chetty, 2009). During the apartheid era, there were huge inequities in the quality of care between
hospitals in formerly black areas, and hospitals in urban areas to serve white patients. These inequalities
still exist today. According to Melamed ( 2005), apartheid might have ended in 1994 but the struggle has
not ended, it has merely changed its shape as new forms of community solidarity and resistance have
emerged to fight for rights to housing, water and electricity, and workers’ rights. Material inequality has
deepened . In addition to the poverty and effects of post -apartheid, recession has also affected the
community their culture as well as The Provincial Hospital itself.
KwaZulu Natal is seen as one of most densely populated out of South Africa’s nine provinces and with the
over population are serious challenges of poverty, illiteracy and poor infrastructure. These variables
directly affect the Provincial H ospital , which are the contributing factors within the external environment.
According to Chetty ( 2010), a patie nt should seek treatment at the preferred clinic in the area, and only 576
once the patient receives a letter of referral then the next step should be a visit to the Provincial Hospital.
The patient must be prepared to wait up to 8hours in the queue for treat ment at the Provincial Hospital.
The Provincial Hospital is designated a District and Regional hospital which therefore has to provide
support to health workers in clinics the surrounding areas, provide community services, both in terms of
clinical care an d public health expertise. The Provincial Hospital has to also provide first level hospital
care for the district and be the place of referral from clinics, community health centers in the southern
region and be responsible for referring patients to higher levels of care when necessary (Chetty, 2009).
This indicates that the Provincial may have limited facilities, however cannot turn patients away
regardless of their limited capacity to treat all patients.
Delivery of Service at the Provincial Hospital
Figure 3 : A flowchart depicting the patient process at the Provincial Hospital in South Africa
(Unstructured interview Chetty, 2010)
Figure 3 represents an applied flowchart depicting the process that patient experiences when treatment
is sought at the Provincial Hospital similar to the applied guest cycle represented in Figure 1. Figure 3
illustrates that there are 8 steps that a patient has t o follow when seeking treatment. Figure 3 also
includes the environment influenced by the economic climate of the Chatsworth area, the transport
system and effects of post apartheid. Chetty (2010 ) outlines that a patient enters the Provincial Hospital
at t he security entrance and is directed by the security guards in to the waiting area of the Outpatients
department. Thereafter the Security directs a certain number of patients at a time into the waiting room
whereby patients queue in the waiting room for ap proximately an hour before proceeding on to their
next step. The patients’ start their day to seek treatment when they are sick. To have a regular check up
with appointment or just to collect medication begins with long hours of waiting. This is tiresome f or the
patient or any human. Furthermore, when a patient is sick and waiting with others who are also ailing
may promote further ailment . Patients then collect their respective blue cards. The blue card system
assists the Provincial Hospital in tracking pa tients’ activities. Unfortunately, an outdated system does not
contribute to efficiency and effectiveness of the delivery of health care to the public. Once the blue cards
are collected, they proceed to another queue to pay. Once the patient has paid for t heir blue card, the
patient thereafter waits for treatment.
A patient may wait for approximately 2 -3 hours depending on treatment and tests required. The final
point of the patient process as illustrated in Figure 3whereby the patient collects their treatment from the
pharmacy and then exits the hospital via Security. Figures 1 ( The applied guest cycle) & 3 (The patient
process) show similarities in terms of the steps involved for physical contacts and financial exchanges at
their respective organizat ions. According Srinivasan (2008 ) the needs of a patient can be identified within
the following requirements:
Attention: The patient requires immediate attention or at least the assurance that he would be
attended to within a particular time frame.
Informa tion: The customers of hospital services require information about treatment, facilities
and regular updates on patient’s health and progress. 577
Listening: The patient, though unwell, has the deep desire to be listened to.
Delivery of promised services: Expectations are built on promises. The customer must be given
all that is promised and more.
All of the requirements are the common values that pilot service delivery within the hospitality industr y
and illustrated in Jones & Lockwood’s model of management in Figure 2.These values should be executed
with the patient taking into consideration the interpersonal interactions of patient and hospital employee
and ultimately the service encounter pointed out i n the Jones & Lockwood’ s model.
Figure 4 : An applied model of management influence on patient service of the provincial hosp ital
Jones & Lockwood (1989 )
Figure 4 displays an applied model of Jones’s approach to management influence on patient service
within the Provincial Hospital. Similar to the model of Figure 1 , Jones & Lockwood (1989 ) illustrate the
influence that the manager has influence on service within th e interpersonal interaction. The applied
model (Figure 4 ) was adapted for the Provincial Hospital involving hospital management and front -line
employees for service quality improvement opportunities. This therefore provides the framework for
analyzing and understanding the effective management of service whereby Jones depicts the service
encounter between the employee and the customer. The applied model advances the service encounter as
“patient encounter” between the hospital employee and the patient. This model may be applied to all
customer -exposed departments within the Provincial Hospital together with its interdependent
departments. Ultimately, Jones & Lockwood advance that management control has influence in the
manner in which employees perform. Henc e, their psychological and social skills create an organizational
culture, which promotes or demotes the manner an employee delivers service.
The Provincial Hospital may not be selling a leisure stay as do the hospitality industry, however the
principles in the way that service is delivered behind both of these organizations are related and of vital
importance to both customer and patient. Hence Jones & Lockwood’s applied model explains simply the
necessary steps and the importance of management influence on staff and their attitude in their work,
which is essential to both hospitality and health care. Soumya (2001) suggests that the most popular role
of hospitality within the hospital sector are the supporting back of house areas and Singh (2006)
proposes whether it's through the avenues of food and beverage or facility management, hospitals are
outsourcing these vital components of their new business models to the players with core competencies
in this field - the hospitality industry. However it is clear that this role extends further than the tangible
similarities of these establishments. The result was in respect of the parallel fundamental systems within
the hospitality and health care environment and they are encapsulated in the way these establishment s
both deliver their respective services offered.
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Hospitality and hospitals : Many medical facilities in hospitals are mimicking hotel environments. Singh
(2006) certifies that hospitals are now taking the phrase 'being hospitable' to a new level, and beli eves
who better to turn to than the hospitality industry itself for assistance. According to Singh ( 2006), the
trend towards enhanced quality of services started when Dr Naresh Trehan, an executive director and
chief cardiac surgeon, who worked in the US, came and returned to India in 1988, was keen on
maintaining the standards he had witnessed and experienced in the US. All this meant a rigid clean and
hygiene policy and exceptional F&B guidelines. Fottler, Ford, Roberts, Ford & Spears (2000) agree that
over the last ten years the health care industry has recognized that the physical environment is a valuable
resource that can affect all of its customers. Fottler et al. (2000) further highlight a significant statement
that although most service organizatio ns give some thought to setting, its importance to the service
experience has been most thoroughly understood by those who view and treat their customers as guests,
that is the guest service industry.
Hospitality is referred to as an industry that takes c are of people who are away from their home and
Mullins (1995: 9) confirms that efficient service and effective service delivery is paramount to a
successful hospitality operation and customer satisfaction. Pienaar & Willemse (2008) cite Hochschild
(1983) w ith front -line service industry employees are confronted with extremely stressful and
demanding situations, like putting on a smile while dealing with a demanding and insulting customer —
what is typically referred to as emotional labour. Pienaar & Willemse further cite Pizam (2004) in his
definition of emotional labour is associated with higher levels of perceived stress, distress and turnover,
and lower levels of satisfaction in the service industries. In addition, in health care Du Toit et al . (2002 )
upho lds the following: -
Government institutions’ obligation to deliver services efficiently, effectively and economically
The public’s legitimate right to receive efficient, effective and economic services
The public’s legitimate right to demand quality servi ces if standards drop
Du Toit et al . (2002) states that it is the governments’ responsibility to provide service to the public,
which is effective, efficient, and value for money. In addition, the public are entitled to receive and
demand quality services.
3. Conclusion
Efficiency becomes important if we take into consideration that the resources available to deliver services
are far less than what the public demands in terms of service delivery. Because of the continuous shortage
of resources, the effici ency and economy of government institutions and public officials is crucial. Apart
from this, the public also expects efficiency, effectiveness and economy from government institutions and
public servants V an der Walt & Du Toit (1999 ). Hospitality is more than the extended service product that
is provided by hotels and restaurants. It is evident that hospitality and hospitality management has its
place within the health care environment, and it constitutes a significant role as it outlines the importance
of efficient and effective service delivery and customer satisfaction represented in Jones’s model of
management influence in Figure 2.
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UNSTRUCTURED INTERVIEWS
Chetty, K . (2010 ). Interviewed by A. Deen. RK Khan Hospital, Durban, 30 March