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The purpose of this paper is to present a historical overview of the health service sector in India. The development in the healthcare sector from the late eighteenth century into current times is examined from the prism of the role played by British and US healthcare systems in influencing change in the Indian setup.

Online databases searched were PubMed and JSTOR, using the search terms, “Indian health service system in transition”, “British influence on the Indian healthcare setup” and “American neo-liberal influence on Indian healthcare sector”. The authors then examined titles and abstracts of selected articles for short-listing relevant articles. Reference lists of selected articles were examined for further locating related studies. While this constituted the secondary literature for the current paper, reports by governmental and non-governmental organisation reports on the Indian health service system too were utilised as primary data sources.

Influenced by the British and later by the American healthcare system, the Indian healthcare network has undergone numerous changes. In the present era, the Indian healthcare system is increasingly veering towards the American model of healthcare delivery. Health is increasingly being conceived of as a commodity to be traded in the market, with the state’s role curtailed towards provisioning for and facilitating access of the weakest sections of the society through a means-tested insurance system. This has happened without adequate checks and balances on the private sector to ensure that the needs of the people accessing the system are adequately met.

By tracing the development of the health service sector in India and the motives that guide such change, the paper depicts how the thrust of the system has altered from one providing universal healthcare services to the people, irrespective of their ability to pay, at the time of independence to commercialisation in present times. With the marketisation of healthcare, the focus has shifted from serving people to profiting from the provisioning of healthcare.

The paper throws light on the underlying inadequacies of the Indian healthcare setup and the need for more active participation by the government in this sector in the future if it aims to make healthcare more equitably accessible to its vast population.

The purpose of this paper is to explore how and why information and communication technologies (ICT) are enrolled in the Indian healthcare sector for reasons over and above perceived efficiency gains.

The paper explores qualitative field data collected in the Indian states of Karnataka and Andhra Pradesh, and the city of New Delhi from an epistemological perspective of interpretivism. New institutional theory is employed to illustrate the mythical and ceremonial roles that ICT for development play in legitimizing development initiatives.

The analysis challenges the simplistic view that implementing health management information systems will translate directly to efficiency gains.

This paper furthers the theoretical understanding of how ICT, as social and material phenomena, function empirically beyond instruments of technical rationality. One limitation of the research is the relatively short duration of the fieldwork. A wider scope in the metrics used to evaluate success in development initiatives that implement ICT is called for.

Practical implications of this paper focus on the need to move away from simple deterministic visions of ICT for development towards an approach based on acknowledging outcome indeterminacy with regard to the consequences of ICT implementation in the Indian healthcare sector, and thus the need for genuine feedback loops.

This paper will be valuable to institutional and information systems theorists, and development practitioners. A framework is provided to unpack the institutional context that drives some of the inefficiency in the Indian healthcare sector.

Medical tourism encourages the traveling of patients, expert healthcare professionals and promotes cross-border trade in healthcare services. The Indian medical tourism sector is facing new challenges as well as certain ethical and legal issues because of continuous market changes and patient’s requirements while at the same time advancements in current health services have also been observed. It is therefore very important to understand and address the issues of the medical tourists. The purpose of this paper is to evaluate the important factors which can make India an affordable medical tourism destination.

In this paper, the factors influencing Indian medical tourism sector have been explored by conducting literature review, they are ranked according to the results of a questionnaire-based survey and further analyzed by using the interpretive structural modeling (ISM) approach. The mutual relationships between these factors were identified to develop an ISM model so as to find out the important factors which can make India an affordable place for medical tourism.

The results of the survey and the model show that cost of medical procedures, facilitation, and care, the infrastructure of Indian hospitals, clinical excellence and the competence of doctors and staff are the top level factors.

It is very important to address the concerns of the patients coming to a developing country like India for availing medical services. This research has evaluated the important factors which can make India an affordable medical tourism destination.

This research assesses the effects of globalization on delivery of healthcare services in India by conducting critical analysis of the medical tourism industry by collecting original data from the international patients coming to India for different types of medical procedures so that a comprehensive model can be prepared which will help the hospitals and policymakers to improve the processes related to medical tourism.

Indian healthcare system, especially in rural regions, faces several problems that prevent it from achieving universal and sustainable healthcare coverage. The purpose of this paper is to capture such problems through expert opinions and provide solution concepts that are derived from other similar scenarios.

Delphi study has been conducted with 38 experts from diverse areas related to the Indian healthcare sector. Nineteen theses were formulated based on the discussion with experts and were reconfirmed through intensive desktop research. Finally, theses were subjected to expert panel member’s evaluation.

The pool of arguments provided by the participating experts included 415 written statements explaining the (dis-)agreement with the theses. The experts achieved consensus in six theses with interquartile ranges smaller or equal to 20. The written arguments provided by experts were summarized into five different categories, namely interrelations/dependencies in healthcare, inequalities in healthcare, lack of proactive measures, importance of healthcare personnel and role of government in healthcare. Finally, a framework is proposed mapping the issues identified at different stages of the healthcare value chain. Problem-based cost allocation and hub-and-spoke model are discussed as potential solutions for the issues identified.

Lack of empirical and statistical data on the effective cost arising from the present issues suggests future research to determine these expenses and therefore examine the feasibility of applying the problem-based cost allocation framework discussed in this study.

Results show that merely targeting the supply side of healthcare falls short of the mark, especially in a country, such as India, with large socio-economic differentials. Healthcare system, hence, should be viewed from a market perspective, taking both forces of supply and demand into consideration.

This study intends to allow for a comprehensive approach to identify the issues in Indian healthcare system by reviewing the existing key studies in literature and validating it through empirical inputs from experts in the domain. Based on the validation, a framework is proposed mapping the issues identified at different stages of the healthcare value chain.

The purpose of this paper is to explore the voice of the customer, key performance indicators, critical to quality characteristics, critical success factors, and commonly used tools and techniques for deploying the Lean Six Sigma (LSS) strategy in Indian private hospitals, with special attention to the medical records.

The study utilizes the action research methodology to obtain a greater understanding of the use of LSS in the Indian healthcare sector. Multiple case studies were designed and successfully deployed to understand and ascertain challenges in LSS implementation. Five case studies were carried out in the Medical Records Departments (MRD) of four private hospitals in India.

Patients perceive that waiting in queue harms their health, which can be rectified by addressing the cycle time of the system. The research also found that effective leadership, availability of data, involvement of cross-functional team and effective communication are critical to the success of LSS projects. In addition, control charts, cause and effect diagram, 5S, gemba, two-sample t-test, standardization, waste analysis and value stream mapping are some of the common tools used to improve healthcare systems.

The research was restricted to studying the impact of LSS on the workflow and resource consumption of the MRD in Indian allopathic hospitals only. The validity of the results can be improved by including more hospitals and more case studies from the healthcare sector in different countries.

The findings will enable researchers, academicians and practitioners to incorporate the results of the study in LSS implementation within the healthcare system to increase the likelihood of successful deployment. This will provide greater stimulus across other departments in the hospital sector for wider and broader application of LSS for creating and sustaining process improvements.

This study aims to present Lean Six Sigma (LSS) deployment and sustainment strategies for the healthcare sector from a multi-level perspective. The objective is to present LSS implementation insights to enable policymakers, practitioners and academicians to test and develop an LSS framework for healthcare sectors.

The strategies identified are the result of a multi-method research design involving literature review, action research (AR) and Delphi study. Further, the AR portion of the study involved more than 10 years of projects focused on the deployment of LSS in the healthcare sector.

The strategies include a holistic view from the multi-level perspective, considering the Top Management Level, Middle Management Level and Operational Level. The authors ascertained 27 strategies across the three levels of organizational structure for the effective deployment of LSS. Further, the authors present a customized LSS “pocket guide” from the healthcare perspective for quick reference.

The strategies delineated in this study are based on the Indian healthcare section only; thus, further research in additional geographic contexts is needed. Also, further research is necessary to provide additional empirical validation of the effects of the identified strategies on LSS program outcomes and to verify that the strategies operate at the proposed organizational levels. Future research should also focus on identifying the interrelationships between strategies within and across levels, developing a “road map” for LSS implementation in hospitals and designing the LSS curriculum for medical schools and other medical training programs.

Observations of this study can contribute to developing a holistic framework for successful LSS implementation in the healthcare sector for academicians, practitioners and policymakers. This, in turn, ensures an enhanced value proposition, improved quality of life and reduced healthcare operational costs. Thus, it ensures a win-win situation among all the stakeholders of the healthcare sector.

The strategies put forth will enable the LSS researchers, academicians and, more particularly, practitioners to delve deeper into specific enablers and safeguard the LSS deployment from backlash. The research has two significant benefits. Firstly, it enhances the understanding of LSS from the healthcare perspective. Secondly, it provides direction for future studies with specific components for hospitals’ LSS framework, which can be further tested, refined and improved.

The present study aims to explore the barriers to Lean Six Sigma (LSS) implementation in the healthcare sector and develop the ranking of finalized barriers using the Decision-Making Trial and Evaluation Laboratory (DEMATEL) approach under a fuzzy environment.

The LSS barriers are identified through the literature review and validated by the expert's opinion and statistical analysis. A total of 124 experts were identified through the purposive sampling method for conducting this study. A questionnaire survey method is used to collect the data related to identified LSS barriers in the healthcare sector. The screened barriers are ranked through the Fuzzy DEMATEL approach.

In this study, a total of 21 barriers were identified with the help of a systematic literature review and screened 13 significant barriers by the expert opinions of healthcare personnel. The result reveals that “Lack of top management commitment and support, lack of awareness about LSS”, “resistance to culture change and inadequate resources emerges as the most critical barriers”. The prioritization of barriers facilitates the managers to make effective policies and guidelines for LSS implementation in healthcare organizations.

To avoid LSS implementation failure, the practitioners and researchers need to focus on LSS barriers as per suggested ranking more conventionally and make plans and adoption policies accordingly.

This study is unique in terms of investigation and empirical analysis of LSS implementation barriers in the healthcare sector in the Indian context. The outcomes of the present study will help the managers of healthcare organizations to make the strategies and policies for LSS implementation as per the recommended LSS barriers.

Blockchain technology (BCT) has multiple benefits across industries in varied contexts, but limited organizations have adopted such disruptive innovative technologies in the healthcare industry in India. The research on advancing the understanding of blockchain adoption (BCA) determinants in India's healthcare industry is limited. Thus, the study aims to identify the BCA determinants in the healthcare sector in India. Further, the impact of BCA was examined on organizational performance (OP).

The study utilizes Technology, Organization, and Environment (TOE) framework to investigate the determinants of BCA in the healthcare sector in India. The data were gathered using a seven-point Likert seven-point ranging from “strongly agree” to “strongly disagree” from 272 respondents working in the healthcare industry in India. The relationship within the framework was investigated using structural equation modeling.

The results demonstrate the positive impact of top management support, organizational size, organizational readiness, competitive pressure and government support on BCA in the healthcare sector. On the other hand, compatibility, security and privacy issues do not affect BCA. The results emphasize and validate blockchain’s importance in improving OP in the healthcare sector. Further, the results indicate that non-technological factors are paramount to improving BCA within the healthcare sector. Organizations should invest in employee training and development to ensure their staff have the necessary knowledge and skills to effectively manage BCT.

The model was developed for BCA in the healthcare sector in the Indian context; however, the model applies to other countries with the same business environment. Hence, the model can be further examined in diverse countries to generalize the findings.

The study offers valuable insights into the factors that influence BCA and OP in the healthcare sector. The results of this research can be used to inform policy decisions and guide practitioners toward promoting and facilitating the use of BCT in healthcare organizations.

To the best of the author’s knowledge, the present study is the first of its kind to examine the TOE framework in BCA within the healthcare sector and its implications on OP.

The purpose of this study is to capture patients' and employees' perception of quality of care in the Indian private hospitals and to find the possible perceptual gaps between both the groups.

Authors have referred to the Victorian patient satisfaction monitoring (VPSM) scale and studied the responses of 327 patients and 327 employees collected from six private Indian tertiary care hospitals. SPSS v26 software was used to conduct the data reliability test, descriptive analysis and Mann–Whitney U test.

Authors have found significant differences in perceptions of quality of care between the patients and employees in the Indian hospitals. Employees have high positive perceptions towards the provided medical care whereas the patients have less favourable perceptions for many quality indicators.

This study findings help the healthcare managers, practitioners and healthcare workers of the Indian hospitals to understand the perceptions of both the employees and the patients towards healthcare quality elements and help to reduce the existing perceptual gap in the process of providing quality healthcare services.

To the best of authors knowledge, this is one of the pioneering studies conducted in Indian healthcare industry to capture and compare the perceptions of both the employees' and the patients' perceptions of various quality of care elements. This study highlighted the existing perceptual gap between the employees and the patients on various healthcare quality elements and indicated the critical areas for improvement to provide high quality healthcare services.

The purpose of this paper is to understand and compare the level of patient’s expectations of healthcare services and their perceived performance. The paper also provides insights into the specific service factors and quality of hospital services which are required to meet the needs of Indian patients.

A total of 210 exit interviews were conducted using a structured questionnaire addressing the probable factors of quality related to healthcare services in a five-point Likert scale. The survey was conducted among the patients recently discharged and about to be discharged from private hospitals of Delhi and NC. A set of questionnaires is administered to collect responses on expected and perceived service qualities.

The paper reviews and discusses the importance of service quality for Indian patients using the SERVQUAL gap model as the measure of service quality. The results gave an overview of the perspectives of Indian patients on the quality of service in private hospitals. Patients indicated best satisfaction in some dimensions of services, namely, the tangible dimension of “hospitals provide ample parking spaces,” empathy dimension of “Doctors are never too busy to respond to my request”, assurance dimension of “I can depend on Doctor/Nurse,” and in the responsiveness dimension of “employees always communicate truly” on hospital matters.

The first limitation is in the scope of sample, that is research findings are limited to Delhi. The second limitation is that the research should have been done in two parts, that is by contacting the patient before they take the services and after the service encounter. Third limitation – for a better understanding, the analysis should have been performed on the gap between the patient’s perception and the perception of the medical service provider about the customer’s perception.

This research would be beneficial to healthcare organizations to do their best to achieve greater patient satisfaction. The findings of the paper that, for all dimensions, the patient’s perception is always higher than the expectation suggests that in the Indian healthcare segment, there is a need of dissemination of information regarding the most modern medical facilities.

This current research is concluded with the suitability of a model that can be used to find the levels of patient satisfaction for healthcare services. The present study is based on primary data and offers a systematic procedure that could form the cornerstone for providing further insights into the conceptual and empirical comprehension of patients perceived service quality and its constituents. The current emergency medicine patient’s service dilemmas are a complex interaction of patients and physician factors specifically targeting efficiency and patient satisfaction. The awareness of these issues particular to the emergency patient can help to maximize efficiency, minimize subsequent medico-legal risk and improve patient care if a tailored management plan is formulated.