Dissertation Proposal

(Healthcare Management)

By
Priyanka Singhal
Delhi
 Table of Content
Aim......................................................................................................................................3
Objectives............................................................................................................................4
Introduction..........................................................................................................................5
Introduction..........................................................................................................................5
Organizational Background.................................................................................................6
Literature review..................................................................................................................7
Literature review..................................................................................................................7
Rationale............................................................................................................................10
Hypothesis..........................................................................................................................11
Research methodology.......................................................................................................11
Research methodology.......................................................................................................11
Primary research and secondary research..........................................................................13
Quantitative and Qualitative Methods in Health Care Management.................................16
Research ethics...................................................................................................................18
Conclusion:........................................................................................................................20
Conclusion:........................................................................................................................20
Time Scale.........................................................................................................................21
Reference...........................................................................................................................23
Aim

The healthcare industry has now become the most vibrant industries across the world.
With growing size of this industry, demand for potential and skilled mangers and
healthcare professionals is also increasing. The demand and requirement for the managers
have mounted because there is urgent need for meeting the challenges of this potential
market. With the globalization of the healthcare industry, healthcare mangers and
professionals must possess practice-oriented, international and intellectual skills.

Healthcare management aims to furnish managers with the potentials that are needed for
the future global healthcare facilities. With the application of the healthcare management,
managers are able to collate the incompatible managerial skills to enhance the quality
while decreasing the cost at a same time.
Objectives

The need and demands for quality healthcare services has been increased so fast that it
has become an issue for the Apollo Hospital as well. With new trends, pressure is there to
deliver new and better delivery services. Earlier people were coming to the healthcare
centers but now healthcare centers have located themselves near to the patients’ house.
Other issues affecting healthcare management is the managed care contracting, which has
become a serious issue for every healthcare organizations. Increasing the growth of
healthcare contracting is foreseeable but some of the organization in healthcare field
lacks proper data for the managed care contracting.
Introduction

Healthcare management is a kind of process that seeks to manage and overlook properly
one or two elements of the healthcare system. Today, great chances are there to become a
manager within the healthcare field. If we find Apollo Hospital groups, it tends clear that
they have applied healthcare management properly in their vast business. (Mclaughin,
2008) The current surrounding and environment for the healthcare organizations consists
of many forces that demands extraordinary changes in the organizations. These forces
consist of increased customer look, changing demographics, strengthen governmental
pressure and rise in competition. Meeting such challenges requires efforts from the side
of healthcare organizations such that they can be thorough with the fundamental changes
and consistently inquire the new actions so as to produce new values. Healthcare is an
information-intensive process. Pressures for the professional and healthcare managers is
rising as healthcare organizations are looking for the ways that lessen the costs, enhance
quality and able to access the managed care. Also, healthcare has been developed as a
complex system. There should be proper coordination of the information technology with
the twofold effects of the complicacies in organizations still assuring consistent growth in
the field of medical technology. Healthcare organization is a field which is in relation to
the set of activities including administering, managing and leading of hospitals,
healthcare systems and network of healthcare clinics.

Healthcare management program was basically launched at the University in Chicago in

United States of America in the year 1934. The program is for two years; first year is for
providing formal graduation to the students and the second year is for the purpose of
internship. Healthcare management developed as an independent profession in the year
1978. After which it is considered to be the hidden profession in the field of healthcare
with the emergence of the involvement of low profile managers rather than directly
involving professions like medicine and nursing. In the recent years, there is great need
for the healthcare management in the organizations because the developed countries are
facing problems in balancing quality, access to healthcare providers and systems and
cost.
Organizational Background

Apollo Hospital

In today’s world, Apollo Hospital Group has not only gained name but has also become a
leader in the field of health care centers by delivering quality health care in Asia. Besides,
it is being considered to be the biggest incorporated firm in healthcare aspect as well as it
is complete in every aspect.
Apollo is a powerhouse which you can trust blindly as its business is vast expanded with
over 50 hospitals inclusive of 8500 beds, diagnostic clinics, a chain of hospital
management colleges and nursing schools across Asia. Aim of Apollo Hospital is to
make use of advanced technology with old traditions which are running down from
centuries.
Apollo Hospital Enterprise Limited was actually incorporated as a Public company
in1979. With the contributions of Dr. C Reddy, it became the first group that opened up
the notion of corporate delivery in healthcare in India. It was then, the first company to be
listed on the Bombay stock Exchange.
Literature review
Healthcare professionals or the manager’s plans, coordinates, directs and supervises the
healthcare delivery. Rapid changes in the healthcare management lead to refurbishing of
authorized standards and curricula. Healthcare management is multidisciplinary in nature
which not only covers the healthcare aspects but also borrows the prospects of the public
administration and business administration. A survey conducted informally by some trade
magazine, Modern Healthcare, suggests that 70% of the business executives and
educators believe in employing healthcare management in the healthcare organizations.
Whereas 50% of the people believe that other areas or fields like trade finance, IT, etc
should be given more importance. Several articles or journals for healthcare management
have been published. Many of the research journals have reported the research that has
been done on the healthcare and their conduits.

Books

New Frontiers in Healthcare Management by Deborah Shlian – this book states the
opportunities and threats that have been faced by the healthcare management. Leadership
challenges have been a greater threat in the healthcare organizations. It also states that
still there is a rise in managed control enrollment, many mergers and acquisitions are
going to take place, also the cost of prescription is on rise and an intense pressure is on
employers to provide its employees with healthcare benefits. (Shlian, 2001)
Healthcare Administration by Lawrence Wolper - this book says that healthcare
administration has become a major issue since the beginning of 21st century. It also states
the ethical issues related to healthcare services as poor are paying more for healthcare
services than rich.
Healthcare management by John R. Schermerhorn – with the tremendous change in the
healthcare workplace, everyone needs to react to these changes. Managers are
accountable for delivering high quality and creating diverse work environment. This book
also says that at every level, managers have different roles to play and has to perform
varied duties. (Schermerhorn, 2007)
Haimann’s Healthcare management by Rose T Dunn – this book is well written and able
to deliver the role, duty and functions of supervisors in healthcare system. (Dunn, 2007)
Advances in healthcare management by John Blair- this book contains research project or
research proposal which includes state of the art reviews and research on some specific
topics in the area of healthcare management.
The Next Generation of Healthcare delivery by Michael A Murer – this book states as
healthcare services keeps on changing, it is vital for all the healthcare organizations to
insistently check the patterns of development such that cost effective and high quality
healthcare services can be delivered.
Healthcare Management: Organization Behavior and Design by Stephen. M Shortell –
this book states the purpose of taking decisions by healthcare managers in their respective
field. The objective of the book is to state the motivational factors for the employees in
the improvement of the healthcare services. Some suggestions are being provided to
healthcare mangers for providing motivation to their employees and coworkers. .

Risk Management Handbook for Health Care Organizations, by Hardcover, Jossey-Bass

& Roberta Carroll – this is the 4th edition of the book which suggests the implementation
of the risk management in healthcare organizations. All the associated risks have been
carefully amended to show the prevailing and present changes in healthcare organizations
and administrations. This book provides the information regarding legal, regulatory
updates to the new professional and healthcare managers. This book makes use f user-
friendly technique and represents information regarding new up coming risks in
healthcare industry. It also consists of timely approaches or measures for patient safety,
risk financing, error reduction and bioterrorism response and preparedness. Show the
Management Principles for Health Care Professionals, by Joan Liebler, Paperback,
Fourth Edition, Jones and Bartlett Publishers – The book is perfect for those healthcare
professionals without any need for knowing their field for specialty. The realistic
commands and instances in the book show the multidisciplinary backgrounds.

Articles –

Jim Ayers & Larry Benson

Administrative Radiology Journal, August 1995

This article states that there are 10 ways in which managers can coordinate with the
difficulties of healthcare environment. These 10 ways are divided into three categories
which are operations control, operation effectiveness and operation control. This is
basically for healthcare professionals to be able to deal with managed care.

Administrative Radiology Journal, December 1994

Many healthcare professionals have to face unnatural management challenges. This

article suggests how these professional can deal with the current realities related to
healthcare market various kinds of tools and methods have been mentioned in this article
for rewarding and measuring the performance of doctors and professionals.

James B. Ayers & Robert C. Bonhag, DMD

Administrative Radiology Journal, Date: November 1998
The key to success of healthcare organizations are the people. As there is intense
competition among the healthcare organizations, new innovative ideas and rewards for
measuring future success is necessary. The article suggests that there is need for
evaluating current performance as well as there is need for the development of new
reward techniques so as to have satisfaction from the employee side and enhancement of
competitiveness

Jim Ayers, Lawrence Benson, & Robert Bonhag DMD

Journal of Healthcare Resource Management, October 1996

The healthcare providers are confused so as to which healthcare industry is in difficulty

with physicians, hospitals and group of physician to deal with managed care and patient
customer providers. It is vital for the providers to respond to the requirements of the
managed care organizations and HMO’s.

Jim Ayers & Mark Marcussen

Administrative Radiology Journal, March 1989

There is an urgent need for the cost-effective delivery of healthcare services. Most of the
service industries are reluctant to adapt the industrial tools in designing their performance
process and evaluating their performance. This article suggests such tools for the
healthcare setting.

The conventional, lucid administration model recommends that development will

advance organizational conclusions. Healthcare organizations face extensive ambiguity in
their surroundings. To reduce uncertainty, healthcare organization seeks to “be familiar
with” their surroundings through scrutinizing behaviors; to lessen prospect uncertainty,
they plan predictable environmental changes and intend desired outcomes. Strategic
planning augments the probability that the healthcare administration’s structure, strategy,
culture, and any other key preferences will fit mutually and fit within the up-and-coming
environment.
Rationale

The article shows the research findings that have been conducted to see the impact of
development of new HMO for the healthcare organizations. The study shows the
association between the initial rationales which leads to the creation of the mission
statement for the Apollo hospital and its performance. The findings present importance of
the mission statement in the hospital and its likely success if the missions have been
created for the organization.
Hypothesis

If the development of new HMO is in accordance to the cultural, ethical and religion
beliefs, then financers as well as the patients is attracted to it.

Research methodology

Aim of research – to see the development of new HMO would affect the management
activities of Apollo hospital

Objective of the Research – to provide people the facilities and service of a new HMO by
optimally using the resources and efforts of the healthcare professionals

To see how research purpose and research objectives are developed, let us consider the
case of Apollo hospital keening healthcare management in their organization. They
have decided to use their resources to work a health management organization
(HMO). The resources are wide, as would be predictable in a large teaching and
research healthcare centers with a well-built confined reputation.

Leading HMOs are testing with the demi-science called substitute medicine hoping to
heal harms when normal medicines are unsuccessful. This is an astonishing drift.
Many doctors still sight some substitute methods with great cynicism- the health
maintenance organizations have a status for spurning all except the most unswerving
treatments. whilst most of the HMOs by now offer chiropatic coverage, a number are
adding acupunturists and massage therapists, in conjunction with the practitioners
called naturopaths who use herbal therapies, relaxation remedies, yoga and many
more.

Managers of Apollo Hospital enterprise gathered for a meeting and represent their
thoughts and research to construct support for the notion within the hospital. The
meeting came to an end with some sort of worries and problems. The problem was
how to decide the market demand in the region to hold another HMO although each
member of the planning committee was persuaded of the potential benefits of the
proposal, bed consumption rate and teaching programs, the confirmation is required
to demonstrate the financers before they begin investing resources into the proposal.
(Yin, 2009)

After the second meeting with the hospital planning committee, quick agreement was
achieved that the chief principle of the study was to deal with the decision as to
whether the offer for an HMO should be followed to the viewpoint of marketing
major investments in its execution. Following is the purpose of the study consists of
research questions and a statement of the study scope.
Research

Question: what is the demand for the new HMO?

Scope: limited to staff, students and faculty of the university.

The study was restricted to the university students, staff and the faculty for several
reasons. First the university management was favorably liable toward the plan,
giving it the best possibility of achievement in those surroundings. If support from
that group was not in confirmation, then the prediction would not be bright in other
organizations .Second, the budget restraint made it improbable that any valuable
research should be carried out for more than one organization. No geographic limits
were there, as it was consider that distance from the home to HMO should have only
a weak pressure on individual choice in the proposed HMO. Finally, the following
set of purposes and objectives are set;

Purpose: what target market segments should the HMO emphasize?

Objective: recognize the market sections which are most paying attention in the proposed
HMO. Assess their feasible rate of consumption of medical services from their past
medical records.

Purpose: what services should be offered at what price level?

Objectives: recognize the features or characteristics of health plans that would have the
greatest control on an individual’s option among options.

Number of hypothesis were developed as to who was most probable to be paying

attention in the plan. Of course, they would have to express strong interest in the plan
as described to them. Besides, good prediction would be those who were disgruntled
with the treatment or quality of their current plan, did not have a long standing
connection with a family doctor, had positive attitudes toward the Apollo Hospital,
and were not registered in other healthcare plans through their spouses.

Research design – a research design is a blueprint used to guide research study towards
its objectives. The procedure of scheming research study involves many consistent
decisions. The most important decision is the alternative of research because it
decides how the information will be accessed. (Marczyk, 2009)

Types of approach

Exploratory approach – it is done when one is looking for imminent into the common
nature of a problem, pertinent variables that require to be measured and alternative
decisions. The research methods are highly elastic, qualitative and amorphous.
(Hartwig, 1979)
Descriptive research – descriptive research clinches a large populace of marketing
research.

Causal research – when it is vital to present that one variable causes or develops the value
for the other variables, a causal research approach must be used.

The first step is to use exploratory research approach to generate all possible reasons for
the problem. Thereafter, a combination of descriptive and a causal approaches is
used to narrow the possible causes.

Primary research and secondary research

Primary research – primary research is done to collate specific research purpose for the
further research. A variety of techniques, ranging from qualitative research to survey
methods may be employed To make choice for the best research approach for the
HMO, a victorious decision has to be made which having large number of strengths
and least weakness in relation to the options. Once this is obtained by uniting quite a
few methods to take gains of their best characteristic and curtail their limitations
(Axinn, 2006)

Our research for HMO would engage preliminary qualitative research followed by a
survey to depict the notion of the healthcare organization to a wide representative
sample and test of the hypothesis.

The principle survey options were mail questionnaires and personal or telephone
interviews. (Fowler, 2009 dissertation proposal.doc)

Personal interviews – the interviewer interviews the respondent in person. There is direct
contact between the interviewer and the respondent.

Personal interviews using trained interviewers are too costly and would be feasible only
with a sample that was too small to identify adequately the differences.

Telephone interviews – the respondent is interviewed by the interviewer on telephone.

There is no direct contact between the interviewer and the respondent.

Telephone interviews would have been difficult to conduct both because of the length of
the questionnaire and the evident need for multiple category questions, which are
awkward to communicate orally.

Mail questionnaires – the questionnaire is administered through fax. The interview may
or may not have contact with the respondent.

The response rate would be low unless substantial incentives and follow ups are not
provided.
The solution was a self administered questionnaire, with door to door delivery and pickup
by untrained survey assistants. .

Secondary research – secondary data are by now available, because they were
composed for some other functions other than solving the basic problem. Included
here are:

Syndicated data sources, such as consumer purchase panels.

Databanks and other sources like government sources such as Census Bureau
Existing company information system

Research Tactics and Implementation

Measurement –

The first step is to understand the research purpose into information requirements and
then into questions that can be answered by expected respondents. One of the
purposes of HMO study is to assess viable demand for the proposed HMO in relation
to their current health plan. This means the information will be required on the
respondent’s overall assessment of the projected HMO, their liking for the proposed
HMO relative to their current health plan and their possibility of accepting the new
plan if it becomes obtainable.

Once the individual questions have been decided, the measuring instrument has to be
developed. The researcher designing an effective questionnaire must be concerned
with how questions on sensitive topics such as income can be asked, what the order
of the question should be and how misinterpretations can be avoided.

Sampling Plan

Most of the marketing research studies are restricted to the sublet of the total population
or sample which is applicable to the research questions. One approach is to select a
sample for the proposed HMO is probability sampling, in which all population
members have a chance of being in the sample.

Anticipating the Analysis

Before actual data collection commences, the researcher must be attentive to the
likelihood that the data will be not enough for testing the theory or will be interesting
but unable of supporting act recommendations. With these anxieties in mind, the
researcher should map how each of the data items is to be examined. One useful
device is to generate imaginary dummy data from the questions in the measurement
 tool. The dummy data can be examined to make sure that the consequences deal with
the objectives.

Analysis of value versus cost and time involved

Cost-benefit analysis should be likely to conclude if the research should be taken as

designed or if it should not be conducted at all.

One of the mechanisms of cost is time. A research study for the proposed HMO can take
six months or more. It may be place such that a time phase will not delay a decision,
thus generating the jeopardy that set of attractive circumstances will be missed. The
examination can bring to a close that either the research design is cost efficient and
should be preceded further or that it is not and should be ended.

Errors in research design

The value of research project is based on the overall excellence of the research design
and on the data collected and examined based on the design. More than a few
possible sources of error can have an effect on the quality of a research procedure.
The errors can persuade the variety of stages of the research procedure and result in
imprecise or ineffective research conclusion.
Quantitative and Qualitative Methods in Health Care Management

Quantitative research approach

These are research methods that are based on the scientific approaches in providing
numeric value for the study. Researcher establishes various relationships among
these numeric values. Statistical analysis is also being implemented to find the scope
and strength of the causal relationship. (Creswell, 2009)

Advantages:
The findings of quantitative research are in the form of numeric values or statistics that
are easy to explain and bring effective working.
Comparing can be done easily as well as the hypothesis can be formulated and
development of objectives.
The researchers can be tested on the basis of its effectiveness in observations by using
effective quantitative methods.

Disadvantages:
Any false numeric value can mislead the research study and purpose.
With the simplification of research study, the quantitative research becomes less
meaningful.
Artificial environment can be set up if there is unnatural settling of numeric values.

Qualitative approach

Healthcare management includes the planning, monitoring and coordinating the financing
and delivery of medical services. Healthcare professionals and managed care doctors
or managers work in such an environment where there is constant increase in costs,
demand for innovations in medical and care technology and regulations by
government. Also, healthcare managers work with multiple people like third party
insurers and health care providers. Healthcare management is therefore a complex
and composite process. Luckily, various qualitative methods are there to assist
research in healthcare management.

Various qualitative methods

In our research, healthcare managers are concerned with the issues of developing new
HMO, in which qualitative methods can be used for the effective working.
Qualitative methods helps in reaching to a specific decision related to the research
purpose. Qualitative research tools and methods can be applied to Apollo hospital for
 healthcare management which includes Nominal group technique, focus groups,
brainstorming sessions and Delphi. (Merrium, 2009)

Nominal group techniques – these are kind of group discussion which are held to deal
with a particular issue. At the time of nominal group techniques, each member group
independent of others are asked to pen down a list of notions regarding the issue
under discussion. Then, group members are asked to present their ideas one at a time
which is then followed by a huge discussion. After all the individual group members
have accessed their thoughts and each group has discussed them, each member then
ranks the notions which are being presented. NGT is a kind of interactive process
that emerges after several ideas and their respective discussions.
Focus groups- it is the most popular technique in marketing and is a group interview. The
sizes for the group can vary accordingly from eight to twelve people. In healthcare
management, focus groups are best for providing discussion on important issues or in
evaluating patient satisfaction. Many healthcare organizations make use of focus
groups to know their strengths and weaknesses from the view points of the patients.
Focus groups of practitioners and patients helps in exploring important issues like
service delivery.
Brainstorming – in brainstorming sittings or sessions, healthcare managers call together
or assemble a group of applicable people like medical professionals and medical
providers so as to know the problems or emerging issues evaluate impacts or think
for other strategic alternatives. At the time of brainstorming sessions, each individual
from the group present their concepts and notions following with a short
explanations such that the problems could be addressed. During these sessions,
healthcare managers are needed to provide new ideas so as to meet new challenge.
These sessions are helpful for the hospitals as the changes in public policy and
medical technology poses new threats and challenges to the healthcare management.
Expert insight – According to W.J Duncan and Peter Ginter, brainstorming and nominal
group techniques are the effective decision making tools for the healthcare
management. With these techniques healthcare managers are able to know the
demand and applicability of the new proposed HMO.
Delphi – it is an effective and popular technique to evaluate qualitative data for the issues
which are in relation to the environment in which healthcare organizations works or
operates. Under the method of Delphi, healthcare mangers end to seek opinions of
professionals on a specific issue. After assessing and collecting the opinions of the
professionals, mangers evaluate them and the send further to the experts for their
expertise judgments and opinions. By this way, synthesis of opinions generates.
Research ethics

Ethics in research can be considered to be the vital matter. These can be evaluated by the
difference between its acceptability and unacceptability.

The key or the most significant ethical issue is the safeguard of data or information
obtained from the patient, which is both personal and private. Initially, medical
records of patients were available to everybody and anybody but now it is no more
obtainable. Nowadays, majority of the healthcare organizations keep the records of
patients confidential and safe.

An ethical worry of many healthcare professionals, nurses and doctors is to shield

themselves from the hazard of obtaining communicable sickness from the patients,
particularly if the patient past record is not available for some or any other reason. Even
though, healthcare experts have all the rights to secure themselves from the a range of
viruses which might be conveyed to them by the patients, yet, simultaneously they are
responsible for not showing these protective measure to the patients which might cause
them uncomfortably for the patients.

Besides, marketing of the healthcare organizations is important to create awareness about

its existence and services which it is offering. Precision should be followed such that
hospitals and healthcare organizations follow certain rules and ethics. To take care of
ethical issues by Apollo Hospital, the staff and authorities of the hospital should be
certain about the information which they are going to provide while advertising their
organization. The information and data so provided should not be false and have accuracy
in it. Whilst marketing their healthcare management in the organization, Apollo should
take care that they are not forcing people for adopting their services or they are not
making use of any harmful tools of marketing. The main purpose of the marketing should
be the health of the patient; this objective should be the main tool for marketing. Profit is
vital but should not be the basic principle for the organization.

The present issue in healthcare research is concerned with the fact that medical research
is now only related to developing countries and low income groups. Earlier it was carried
in the developed countries. The main purpose of this shift is the rapidness and ease with
which healthcare organizations have to spend less money that are needed for running
trials in such countries. Even the application of ethical regulations and rules are much
less in these countries.

It is easy to have participation from the members for trials in low income countries as
poor people are in favor of accepting such proposals by the rich medical and healthcare
organizations such as Apollo. The underlying problem in such case is providing
information to the participants regarding the research study, effects of the drugs and the
kind of medicines they are using which is important to know for carrying out the trials.
Another ethical issue is the low quality care is shown to low income countries.
Conclusion:

Modernism in medical services and application of the best obtainable medical knowledge
tends to solve the problems and concerns of individual patients. as well as provide huge
potential in assisting the patients and the overall healthcare system.The development of
policies and procedures in Apollo Hospital had been able to decrease the premature death
rate and enhanced the quality life of the patients. Also, healthcare management is cost
effective and seeks greater profit for the very hospital.

Healthcare management also consist the financial growth and feasibility of the Apollo
Hospital. The importance of healthcare organization can be realized only when the
hospital is fully staffed with professionals and healthcare managers and is financially
sound to invest in the advanced equipment. A basic concept behind the role of healthcare
management is to provide affordable healthcare services to an average person. If in a
community many people are unable to pay the fees for the laboratory or for prescribed
drugs, then there is inadequate access to the healthcare services. Therefore, if people are
unable to have adequate access for the medical services then there is not proper
application of healthcare management. (Kelley, 2007)

Apollo hospital has adequately practiced preventive medicine has realized in lessening of
premature death, accidental death, preventable death and infections that are being
acquired within the hospital. Healthcare management implements policies and procedures
which are specifically designed for the improvement in the quality health of patients
which it serves.

Apollo hospital is being very effective in financial aspect due to which it is able to adopt
quality healthcare management in their organization. No organization is able to spend or
adapt healthcare management in their system until it is not earning well enough. The
outcomes of better healthcare standards cannot be enhanced until it has not effectively
implement the healthcare management. Due to this, there are better outcomes from the
expected patients and favorable healthcare standards. (Gapenski, 2007)
Time Scale

Key activities Time scale (Plan of Resources required

(Milestones) action)

Project proposal 29th April 2010

submission

Project proposal

Approval
Introduction, aims and 30th June 2010 University Library,
objectives, reading, Online library sources.
reviewing books and
journals.

Reviewing the statistical 30th June 2010 University Library,

research methods for Online library sources,
questionnaire preparation Tutor’s help

Formulating the 15th July 2010 Approval from the tutor

qualitative and and university ethics
quantitative board. University
questionnaires and students list and email Id.
sending to students

Completion of Literature 15th August 2010 University Library,

review, analysis and Online library sources.
discussion

Data collection, review, 15th August 2010 Statistical tools

analysis and
interpretation
Conclusions, 15th September 2010
recommendations and
submission
Reference

Axinn, W& Pearce, L (2006), Mixed Method Data Collection Strategies, New York:
Cambridge University Press

Creswell, J (2009), Research Design, Qualitative, Quantitative and Mixed Approaches,

USA: Sage Publications Inc

Dunn, R (2007), Haimmen’s Healthcare Management, America: Library of Congress

Cataloging-in-Publications Data

Gapenski,L (2007), Understanding Healthcare Financial Management, America: Library

of Congress Cataloging-in-Publications Data

Fowler, F (2009), Survey Research Methods, USA; Sage Publications Inc

Hartwig, F (1979), Exploratory Data Analysis, Sage Publications Inc

Kelley, D (2007), Applying Quality Management in Healthcare, America; Library of

Congress Cataloging-in-Publications Data

Mclaughin, D & Hays, J (2008), Healthcare Operation Management, America: Library of

Congress Cataloging- in- publication Data

Marczyk, g & DeMatteo, D (2003), Essentials of Research Design and Methodology,

New Jersey: John Wiley & Sons, Inc

Merriam, S (2009), Qualitative Management, San Francisco: John Wiley & Sons Inc

Shlian, D (2001), New Frontiers in Healthcare Management, USA: Writers Club Press

Schermerhorn, J (2007), Healthcare Management, United States: John Wiley & Sons, Inc

Yin, K (2009), Case Study Research, United States of America: Sage Publications Inc