Performance measurement of marketing of private dental practices

This dissertation aims to measure the performance of marketing in private dental practices in London using a balanced scorecard. It explores the limitations in marketing of private dental practices and develops a balanced scorecard to measure their performance. The investigation also discusses the importance and scope of the study, as well as the rationale behind conducting it. The dissertation follows a structured chapter format, including an introduction, literature review, research methodology, data presentation and analysis, results and discussions, and conclusion and recommendations.

Performance measurement of marketing of
private dental practices
.
MBA Dissertation
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Title: Performance measurement of marketing of private dental
Practices
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ABSTRACT
The marketing of private dental practices is the crucial task. The health care services of
UK are well known in term of technological updates and quality of services. This is the reason
behind high customer base in UK for the health care services. However, the dental care services
of UK private sector are not good enough in comparison to UK private dental practices. In this
regard both qualitative and quantitative study has been conduced through collection of primary
as well as secondary data. In this regard in-depth interview has been conducted with health care
professional who are working in the private dental clinics.
Furthermore, services users are also considered for the data collection process. The
findings of study reveals that balanced score card can be used to assess the performance of
marketing of private dental practices. It has also been found that this will provide scope for the
improvement and enables care homes to bring modifications in the present work environment.
Apart from this, study also reveals that marketing of services should be done with inclusion of
appropriate media in accordance with preferences of services users.
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APPENDIX 7 - DISSERTATION (PGBM73) DECLARATION
Statement of Originality and Authenticity
I confirm that the dissertation I am submitting is an original and authentic piece of work written
by myself that satisfies the University rules and regulations with respect to Plagiarism and
Collusion. I further confirm that I have fully referenced and acknowledged all material
incorporated as secondary resources in accordance with the Harvard system.
I also certify that I have taken a copy of the dissertation, which I will retain until after the Board
of Examiners has published the results, and which I will make available on request in pursuance
of any appropriate aspect of the marking and moderation of the work within the University
Regulations.
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Acknowledgements
First and foremost, I am grateful to my supervisor Thorben Haenel for his patience, dedicated
supervision and care. He is an expert in marketing which is highly related to the subject of this
thesis.
I would also like to show my appreciation to Professor Yahaya Alhassan who has been a
wonderful lecturer and inspiration.
I am grateful to my parents for their endless love and patience and support throughout all my
endeavours.
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TABLE OF CONTENTS
APPENDIX 7 - DISSERTATION (PGBM73) DECLARATION.............................................4
Acknowledgements........................................................................................................................5
Table of Contents.............................................................................................................................6
Table of Contents.............................................................................................................................8
CHAPTER 1: INTRODUCTION.................................................................................................7
1.1 Background and Context.......................................................................................................7
1.2 Aims and Objectives..............................................................................................................8
1.3 Scope and Importance............................................................................................................8
1.4 Rationale..............................................................................................................................10
1.5 Overview of Dissertation.....................................................................................................10
CHAPTER 2: LITERATURE REVIEW...................................................................................12
2.1 Introduction..........................................................................................................................12
2.2 limitations in marketing of a private dental practice...........................................................17
2.3 development of balanced scorecard to measure the performance of a dental practice.......18
CHAPTER 3: RESEARCH METHODOLOGY......................................................................28
CHAPTER 4: DATA PRESENTATION AND ANALYSIS......................................................35
Results of interview...................................................................................................................35
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Result of questionnaire..............................................................................................................35
CHAPTER 5: RESULTS AND DISCUSSIONS.........................................................................43
Balance score card to measure the performance of a dental practice........................................43
CHAPTER 6: CONCLUSION AND RECOMMENDATIONS..................................................46
6.1 Summary..............................................................................................................................46
6.2 Evaluation of Results...........................................................................................................47
6.3 Recommendations based on Evaluation..............................................................................47
6.4 Future Work.........................................................................................................................48
PERSONAL DEVELOPMENT....................................................................................................49
Appendix 1.....................................................................................................................................53
Appendix 2.....................................................................................................................................54
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CHAPTER 1: INTRODUCTION
1.1 Background and Context
The cost of health and social care has been witnessed increasing day by day that leads to health
care organizational for improving the quality of care, simultaneously, reduction of cost.
However, dentistry has a got a remarkable position within health care industry. The involvement
of government parties is seen less in dental care services, thus, most of the part remains mainly
private (Kominis and Dudau, 2012). The health professions working in the area of dental care
services are known generally to be private holders who run business at own skills and risk.
Furthermore, dental care is witnessed to be the area of health care that has been separated on the
basis of financing and delivery of care, from rest of medical care. The dental diseases are very
few in number and it is more likely to happen such dental diseases (Gawell, 2014). The
individuals have sometime experience the same kind of dental procedure so they become able to
judge the quality of service on the basis of learning from experience. The dental clinics are
responsible for improving their own performance so as to remain competitive in the marketplace.
The marketing of dental services is the most crucial era as dental care services are seen private.
Within UK, NHS dental service is the public unit which provides the care services to the people
of England however, it is witnessed with basic standard of care. In United Kingdom, there have
been evident number of dental insurance policies hence, people are looking for private dental
care as it provides better treatments and care. Furthermore, the limitations of London's private
dental market is lack of skill, lack of experience in staffing and employment and well and high
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cost (Kemp et al, 2012). However, the private dental market requires right marketing activities
for selling the services. With an aim of performance measurement of marketing of private dental
practices, this investigation is going to be conducted.
1.2 Aims and Objectives
Aim
The aim of present investigation is to carry out the performance measurement of marketing of
private dental practices in London
Objectives
- To critically evaluate the limitations in marketing of a private dental practice
- To develop a balanced scorecard to measure the performance of a dental practice.
- To investigate the current literature
- To identify gaps in the functioning of strategy and its delivery and make
recommendations for the same
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1.3 Scope and Importance
The major scope of present investigation is to investigate the performance of private dental
practices in UK in respect with marketing of services. From a long time, it has been witnessed
that the the performance of public dental care unit such as NHS dental service have been
declined so the public of England and UK are moving towards private dental care units. Hence,
it is more required to investigate how private care unit are performing in terms of finance,
operations, etc. The increase of demand for private dental care is a good sign for private clinics
to gain good profits and attain a competitive position in the market (White, 2010). The all thing
that is going to influence the growth of private dental market in UK is the marketing practices
conducted by private dental care. The scope of present investigation is to identify the gap
between existing marketing practices as well as in future courses of actions. The performance of
private dental practices are going to be measured on the basis of customer perspective, The
Business Process Perspective, financial perspective as well as learning & growth perspective.
The importance of present investigation is seen throughout the dental industry and to fill the
research gap, however the topic is very crucial to entire healthcare industry, but there have not
been any specific research is conducted. Hence, the specific scope of this investigation is to fill
the gap by carrying out the performance measurement of marketing of private dental practices
(Kemp, 2012).
The important of present investigation is seen for academician, students, research
scholars as well as entire healthcare industry. As a specific focus is given to the marketing of
private dental practices, hence, the investigation will helps private clinic owners to design the
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effective marketing practices of dental care services. Along with this, it will be helpful for the
organizations operating in dentistry to gain a competitive image while arranging practices in
proper manner. This research is going to investigate to be significant for healthcare students who
are practising for dental services to enhance the skills to manage a dental practice or apply this
approach in a healthcare setting or industry.
1.4 Rationale
The present investigation significantly aims at carrying out the performance measurement of
marketing of private dental practices within UK. However, the rationale behind choosing the
mentioned topic is the interest of researcher into healthcare field. Furthermore, it was required to
get research and understanding of how to market a dental practice. Prior to investigate it, the
requirements of measuring performance of a practice its limitations is to be investigation. The
present investigation is apt for making strong research into marketing a dental practice as well as
helps in improving and enhancing the skills of dentist to manage a dental practice or apply this
approach in a healthcare setting or industry (Kemp, 2012). From an initial investigation, it has
been witnessed that the people of London are increasingly desired for private dental care due to
its improving care for dental diseases. The major rationale behind conducting this present
investigation is to deals with the limitation that are going to be faced by private dental care units
of London.
In dentistry sector of UK, quality of care or services is major problem that can be
overcome by developing good relation with patients and improving the quality of dental practice.
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The rationale of present investigation is to develop a balanced scorecard for measuring the
performance of a dental practice and identifying the gaps in the functioning of strategy so that
effective improvements can be made to private dental practices (Chittoo, 2008).
1.5 Overview of Dissertation
This dissertation is going to be conducted within a predefined structural manner in which the
investigation will be shown in different chapters. The chapter structure of this dissertation is as
follows:
Chapter 1: Introduction: The very first chapter represents the aim and objectives of the
dissertation as well as it describes rationale behind conducing the present investigation. The
present investigation aims at carrying out the performance measurement of marketing of private
dental practices in London while using a balance score card.
Chapter 2: Literature review: Review of literature is the second major aspect of an research
study that investigates the secondary investigation that is available in association with the
research topic. The information in LR section includes the limitation of marketing in dental
practices as well as the various aspects of balance score card.
Chapter 3: Research Methodology: This chapter represents the tools and techniques that are
going to be used for the investigation. The mentioned chapter presents the type of research and
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philosophy that is used for this research. In addition the data collection and analysis tools have
also been used for the investigation.
Chapter 4: Data Presentation and Analysis: This chapter discusses about the analysis that has
been made through the information which is collected from range of services. This is the chapter
that represents the information using table and graphs.
Chapter 5: Results and Discussions: The discussion upon the information given by the
respondents as well as the results of data analysis are shown in this chapter.
Chapter 6: Conclusion and Recommendations: This is the final chapter of the investigation
that represents the crux of entire study and shows the objectives and aim of the dissertation is
attained.
CHAPTER2: LITERATURE REVIEW
2.0 Introduction
Review of literature plays an important role in success of any study because it provides solid
foundation of theories and different authors review related to particular topic. By conducting LR,
researcher can better understand the concepts of balance score card and its benefits in terms of
measurement of marketing of private dental practices using this method. In this regard, research
papers conducted by different scholars related to similar topic has been considered to properly
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understand implementation and benefits of balance score card method in health and social care
sector. This section covers various topics which can be described as follow. In the context of
measuring the role of balance score card method in health and social care from customer,
financial, learning and growth key performance indicators, investigator conduct review of
literature section. It covers information about needs of BSC in HSC in reducing challenges faced
by health care enterprises and Strategies required for implementing the BSC in health and social
care in a significant manner.
Balance score card and its requirement in HSC
2.1 Balanced score card: A strategic tool
David Norton and Robert Kaplan introduced the Balanced Scorecard in the year 1992 and was
published in the Harvard Business Review article (Kaplan & Norton, 1992).
Their objective of their research back then was to study performance measurement of multiple
companies whose intangible assets played a central role in value creation. They held intangible
assets of a company as the important focus and believed if companies were to improve the
management of these assets, they had to integrate the measurement of intangible assets into their
management systems.
After the successful publishing of their article it was adapted by many companies which further
added value to this tool. Today after over the years it has been adopted by thousands of non-
profit, private as well as public sectors around the world as a reliable management tool for
describing, communicating and implementing of a strategy of an organisation (Kaplan, 2010)
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The balanced scorecard retains traditional financial measures as well as investigates long-term
capabilities and customer relationships were are critical for success. The financial measures are
inadequate, however to summarize the journey a total overview and analysis of the investment in
customers, suppliers, employees, processes, technology and innovation is important for
measuring the outcome of an organisation (Kaplan and Norton, 1996).
Without clearer and detailed data, it's no wonder that numerous organizations have struggled in
executing their methodologies. Balanced score card plays the role of an excellent strategic tool
for imparting both procedure and frameworks which is clear and detailed that will help an
organisation actualize that technique and implement the right strategy and view their strategies in
a cohesive, systematic and integrated way (Kaplan and Norton, 2007).
Mobil North American Marketing and Refining, executed the balanced score card strategy map
to remake itself from controlled manufacturer of commodity items to a decentralized, client
driven association. The outcome of which was Mobil expanding its working income by more
than $1 billion every year and turned into the business pioneer (Kaplan and Norton, 2000).
Strategy maps like the Balanced score card demonstrate the links of the cause and effect by
which particular changes in the strategy result in desired outcomes. Intangible assets can account
for 80% of an organization’s value (Kaplan and Norton, 2006). Strategy maps demonstrate how
an association will change over its initiatives and assets which include the intangible resources,
for example, corporate society and employee knowledge into tangible results. Despite the fact
that intangible assets are recognised as the upper hand of any competitive organisation, no
reliable measurement tools exist to measure them and their quality which could summarise their
total impact on the organisation. The fundamental trouble is that the estimation of
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intangibleresources relies on upon their authoritative setting and an organization's strategy. The
quality does not live in any individual intangible asset. It emerges from the effect of all
combined assets and most important is the strategy chosen to interlink these assets. The balanced
score card builds a balanced strategy network of three dominant assets of any organisation which
constitute the employees, customers and the shareholders to be able to measure their complete
effect on the outcome of the organisation (Kaplan and Norton, 2000).
2.2 The four perspectives of the Balanced Scorecard
The balanced scorecard outlines four core perspectives and recommends that we analyse the
organisations from these four perspectives which help in mapping a unified and generalised
strategy which can be measured.
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Fig: 1 Adapted from Robert S. Kaplan and David P. Norton, “Using the Balanced Scorecard as a
Strategic Management System,” Harvard Business Review (January-February 1996): 76.
Financial Perspective
Concentrates on financial execution of an association. It typically covers the profit target of
business organizations and also the monetary allowance and cost-saving focuses of non-
profit driven associations. The financial strength of an association is a basic point of view
for directors to track. It is essential to note that measurement of this perspective is
generally the after effect of good execution in the other three scorecard perspectives.
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The Customer Perspective
The customer perspective is based on execution which focuses to identify with clients in the
business sector. It for the most part covers client development and administration focuses
and aims at maintaining:
 Customer satisfaction
 Customer retention
 New Customer Acquisition
 Customer Profitability
By meeting their emerging needs as well as on time delivery of product as a customer is the
most important aspect of any business.
The Internal-Business-Process Perspective
This point of view deals inner business forms which impact externally on customer satisfaction
and financial growth. Measurements in this perspective permit the organisation to know how
well their business is running, and whether what it provides and its administrations comply with
client prerequisites. These measurements must be deliberately outlined by the individuals who
know these procedures most personally, with our interesting missions these are not something
that can be produced by outside experts. This perspective has the ability to deal with both short-
term as well as long-term delivery objectives whose chain lies between customer needs identified
to the customer need satisfied.
18 Customer need identified Customer need satisfied

Organisational development (OD) such as team building and job enrichment is an
important part of this perspective. OD aids in the teams to be skilled and also to establish
strong interpersonal relationships within the team which helps keep the strategies
innovative, adaptable and effective which ultimately leads to successful implementation of
the mapped action as a whole team (Cummings and Worley, 2013). Organisational
Development comprises of leadership, teamwork and setting of standards to establish coherent
teamwork and clarify roles and responsibilities which makes data available, and aids in
understanding indicators of performance (Koeck, 2013)
The Learning & Growth Perspective
The final perspective is essential in dealing with long term and continuous improvement of the
organisation. In the competitive world new innovative ideas and strategies help deliver quality
and a new experience to shareholders and customers. This perspective arises from three major
components the people, systems and the procedures. With new age technology in all spheres
there is a constant gap that needs to be filled by new innovations, upgraded systems as well as
skilled labour. The learning and growth perspective helps analyse these gaps and thus create new
strategies to upgrade them (Kaplan and Norton, 1996)
2.3 Balanced score card adaptable in a Dental practice
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The Balanced Scorecard provides an adaptable structure that permits an organisation to make its
strategy express and to impart its qualities and operational execution in a totally straightforward
and effortlessly available group. The exploration exhibits that it gives an effective procedure
centring apparatus and when firmly connected to staff reward plans it can be a to a great degree
effective model for helping any organisation deliver the key goals and for conveying change.
Gaining popularity the Balanced Scorecard is being implemented and turning into a common
tool in the cutting edge administrator's toolbox. 30% of the main 100 UK Corporates (by
business sector capitalisation) have implemented the Balanced Scorecard as a measurement tool,
additionally during the overview done by Mackay it was seen that 31% of the 51 associations
researched were utilizing or planning to utilize the Balanced Scorecard (Mackay, 2004).
Experts such as Jensen, fight that the balanced scorecard is an imperfect tool with severe
limitations since it doesn't really give administrators a score stating 'that is a solitary esteemed
measure of how they have performed'. He proposes a procedure he calls ‘enlightened value
maximisation’ and recommends that associations ought to characterize a genuine (single
dimensional) score for measuring execution for the association or division (Jensen, 2002)
However according to Birchard the Balanced Scorecard is accepted to be effective in view of its
capacity to characterize the important success variables and measures that focus on development
and long term achievement. He additionally recommended that the Balanced Scorecard might
prove as inadequate for associations with transient financial issues or experiencing restructuring
(Birchard, 1996).
Lucas’s study highlights the closeness between the Balanced Scorecard's emphasis on critical
success factors which recommend that ‘instead of having accurate item costing as the centre of
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focus’, associations can make substantial increases by recognizing and concentrating on 'maybe a
couple of critical input drivers'. These drivers are fundamentally the same to the Balanced
Scorecard's basic achievement elements, around which the framework can arrange itself at
another level of suitability (Lucas, 1995).
The balanced scorecard (BSC) has been used flexibly, companies can use the BSC template to
develop their own strategy maps, which are based on the balanced scorecard which enables the
implementation of performance systems on top of pre-existing, already running, information and
workflow systems that support the daily business of the enterprise. (Vardangalos and Pantelis,
2000). Although there is little quantitative evidence from UK organisations directly linking
performance improvements and Balanced Scorecard initiatives nevertheless there are a
significant number of qualitative reports from satisfied users in both private and public sector
organisations which have especially shown great effectiveness of performance measures of the
financial perspective receiving high ratings (Mackay, 2004).
Thus with the balanced scorecard being successfully used in many organisations and the
adaptable nature of this tool which helps achieve a long term balanced view for an organisation
and which is easy to implement on the existing systems of organisation it would be an excellent
marketing measurement tool for a dental practice with its four distinct objectives give a full
picture as to whether the practice is meeting its objectives.
The organisations when implementing the balanced score card strategy are yet to see the
outcome of this strategy, but the pathway to it comprises of connected hypothesis. This strategy
map of the balanced score card determines these cause and effect associations, which makes
them testable. The key, then, to actualizing procedure is to have everybody in the association
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unmistakably comprehend the fundamental theories, to adjust every authoritative unit and assets
with those speculations, balanced score card manages to test the speculations consistently, and to
utilize those outcomes to adjust as required making it an excellent strategic tool for a dental
practice. (Kaplan and Norton, 2000)
Amatraunga and their colleagues (2002) conducted study to describe application of the balance
score card method to measure management performance with NHS facilities. They explored that
for measuring strategic performance of management in health and social care, BSC tool can play
an important role. In order to improve processes and attain organization goals within stipulated
time, it is necessary for the organization to understand proper implementation of balance score
method. Further, they described that balance is essential for any organization in context of
maximizing potential and effective movement (Amatraunga et al, 2002). From the study, it is
clear that over the recent past, enterprises have concentrated in using various methods for
creating healthy working culture at workplace. However, without strategic planning and
establishing link between programme activities, firms will be unable to measure performance
goals of enterprises in several terms such as budget, decision making and performance of
employees etc.
Further, Amatraunga and their associates described four perspectives of balance score
card in the context of HSC. In this regard, they were taken different performance indicators such
as customer, financial, internal business growth and learning & growth perspectives etc.
Customer perspective can be understood in terms of providing quality of goods and services to
patients within the stipulated time. Ability of employees, quality of information and effective use
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of quality systems are the major constraints associated with the balance score card method
(Amatraunga et al, 2002). However, capabilities, technologies and organizational design in HSC
related problems are associated with the implementation of balance score method at workplace.
Financial consideration for public organizations can be measured in forms of meeting needs of
their constituencies.
Figure 1: Four perspective of BSC
(Source: Amatraunga et al., 2002)
They explored that for retaining self-managing workers and attaining high quality, it is required
for companies to exhibit self-control. Manager of enterprise can use this approach to track past
results and learn about future. By discussing past findings with their colleagues, enterprise would
be able to examine internal capabilities and frame new strategies in an appropriate manner. They
suggest that in order to release the true potential of the balance score card, it is necessary for the
management of firms to consider several critical accomplishments which include alignment of
strategy, strategic feedback and more effective measurement and management of business
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performance against plan. Nonetheless, Broccardo (2015) argued that it is essential for health
care organizations to manage costs and maintain balance between quality and cost (Broccardo,
2015).
Further, Amatraunga and their colleagues in 2002 determined needs of balance score card
development in the context of NHS trust facilities. They found that this method helped them in
developing FM business objectives and translating these objectives into appropriate performance
measurement parameters. They argued that through applying balance score card method,
enterprises can be able to maintain data reliability, link performance measurement and link
performance measurement results to individual job descriptions in a significant manner. On the
basis of study done by researchers, it is identified that balance score method can be beneficial for
the organizations in several terms such as customer/stakeholders needs, identify critical success
factors, relation of enterprise with its customers, regular sampling of customers and service level
agreement between different parties (Amatraunga et.al., 2002). In addition, on the basis of result
of study, it has been observed that a balance score card implementation approach used within
NHS facilities had created a dramatic impact on performance of health care organizations such as
improving communication system, team-building and strategic priority settings etc.
Strategies required for implementing the BSC in health and social care
Lovaglio (2010) stated that over last two decades, most of the health and social care
organizations showed their interest in implementing Balanced Scorecard approach at global
level. However, conducting the research they faced issue related to availability of literature on
causal-effect relationships between different types of dimensions and implementation of a
quality evaluation system using balance score card method. In order to overcome this research
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gap, investigator used Structural Equation Models with latent variables. But due to presence of
lack of a global optimization criterion, researcher faced problem to examine result using this
approach. Further, Lovaglio tried to emphasize on using methodological conceptualization of the
Balanced Scorecard in the context of health and social care. In order to estimate causal
relationships among specified latent dimensions scholar used a suitable statistical approach
(Lovaglio, 2010). A two-step model building strategy was used to build structural model which
was based on partial correlations in terms of predictive power measured by the mean of the R2.
Researcher described that several types of systems are available to facilitate health structures in
improving quality like Continuous Quality Improvement and balance score card.
Furthermore, to identify causal relationships among latent dimensions specified in the
BSC framework, researcher proposed a suitable statistical approach. By considering this
approach, hospitals and health care professionals would be able to measure impact of policies
and management of health structures. Further, study produced a list of 25 Hospital indicators
(Key Performance index, KPI) in four major key areas that can be enlisted as follow.
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Figure 2: BSC key performance areas and key performance indicators
(Source: Lovaglio, 2010)
Experts of the Regional Healthcare directorate were filled different KPA areas in the
Balanced Scorecard model. In addition, official Regional Surveys on Patient Satisfaction was
conducted. For the purpose of Human capital and Economic area indicators data was collected
from administrative archives of the Healthcare Directorate of Lombardy Region. By applying
structured equation model, researcher was found that economy and clinical process dimensions
are still endogenous (Lovaglio, 2010). Figure shows that medical human capital remains an
exogenous and further, the link between patient satisfaction with clinical process and medical
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human capital disappeared. Moreover, the linked between Medical Human Capital and Clinical
Process remains significant in the given model.
Figure 3: BSC original model
(Source: Lovaglio, 2010)
From the findings, it is clear that R2 value of Clinical process and Economy are 0.582 and 0.677.
These values indicate that through applying balance score card method, hospitals and healthcare
professionals would be able to take advantage of clinical process and economy perspectives in an
appropriate manner. Hence, it can be said that balance score card method can be helpful for
organizations in terms of establishing link between various performance indicators and
performance management activities/processes effectively. The result shows that formal training,
the quantity of doctors and the performance of surgical staff are the major factors which can help
professionals to conceptualize the use of BSC in the Health sector. However, along with several
advantages of BSC in health and social care Lovaglio was failed to provide full picture of the
Regional Health system. On the other side, Jakobowicz and Derquenne (2007) argued that
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without considering system integration, innovation and the quality of Human resources, health
care practitioners and hospitals would be unable to improve accessibility, clinical efficiency of
Health structures and productivity in an appropriate manner (Jakobowicz and Derquenne, 2007).
From the findings of Lovaglio research, it can be said that future study can be conducted by
considering GSCA or PLS-PM oriented global model building strategies effectively.
2.4 Role of BSC in the context of reducing challenges faced by health care enterprises
Gao and Gurd (2014) found that Chinese hospitals has been criticized for poor bonus system and
doctors’ professional ethics. Aggravating patient expense was the other major factor which
creates issues for the organizations in China. In order to overcome such kinds of issues at
workplace, they suggest that balanced scorecard method will be helpful for hospitals and health
care professionals. They argued that BSC method can play crucial role to improve hospital
performance and solve issue facing by Chines hospitals. In the context of examining the
diffusion and implementation of the BSC in China, investigators used mainly three sources such
as a questionnaire survey, a print-media indicators and content analysis of the published papers.
In this regard, semi-structured interviews with managers of Chinese hospitals were conducted.
Investigator was sent questionnaire to the CEOs of 297 hospitals and all members of the
Shandong Hospitals Association. Out of the total population, 50 respondents from teaching
hospitals and113 respondents (38%) at CEO or senior administrator level participated in the
survey and shared their perception about use of balance score card approach in their day to day
health care operations (Gao and Gurd, 2014).The research evidence indicates that bonus systems
28

and poor pay of hospital professionals were creating issues for the organizations in order to solve
issues which was faced by enterprise in an appropriate manner.
Researchers identified that tightened budgets of Chinese government, financial pressure,
relatively low salary of medical staff, pressure from staff members and competitive pressure
were the major challenges which created problems for health care professionals and enterprises
in order to implement balance score method in a significant manner. From the survey result of
Gao and Gurd, it is found that majority (93%) of the hospitals heard about BSC but only eight
(7.1%) had implemented this system at their workplace. On the other side, 6 (5.3%) had used
other performance management tools to measure performance of an individual member at the
workplace. They found that BSC provides a more balanced framework for hospitals which helps
organizations to deal with quality, technique, efficiency, workload and development related
issues in an appropriate manner. Result of survey shows an encouraging trend among hospitals to
use BSC and this approach plays an important role in improving hospital operations and staff
motivation. In such kind of critical situation, it is essential for hospitals to find a good
performance system for the purpose of motivating staff and enhancing their contribution towards
organization growth. From customer perspective, BSC can be beneficial for HSC enterprises to
effectively utilize resources and delivering quality of health care services to their patients at the
stipulated time (Gao and Gurd, 2014). Along with this, balance scorecard method can also
helpful for Chinese hospitals to build performance salary systems and reduce challenges faced by
health care organizations and care home practitioners in a significant manner. However,
Jakobowicz and Derquenne (2007) criticized the fact which was provided by Gao and Gurd
(2014) regarding the role of BSC in financial pressure and hospital improvement. They suggest
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that without government support and keeping balance between patient needs, hospital
development and staff motivation, Chinese hospitals would be unable to get real advantages from
implementing balance score card approach at the workplace (Jakobowicz and Derquenne, 2007).
Along with BSC, performance measurement system may be helpful for organizations in
increasing public satisfaction during this period of reform. Besides that, sound benchmarking
data and effective use of performance management platform will be required to overcome
challenges which was faced by health care organizations (Gao and Gurd, 2014).On the basis of
study done by Gao and Gurd, it can be said that further study can be conducted by increasing
sample size and long term analysis in order to ensure management innovation in Chinese
hospitals.
2.5 Contribution of BSC in terms of bringing innovation in strategic performance
measurement systems
Gurd and Gao (2006) argued that BSCs are still in an evolutionary stage in health care
sector. In order to prove their statement, investigators analysed the published cases of BSC in
health care. In the context of providing answer of research question related to implementation of
BSC, in-depth analysis of multiple BSC cases by collecting primary data in several countries was
done. In this regard, two databases including Ebsco Host and Science Direct were used to
explore issues which come in balance score card approach use. Furthermore, contribution of this
method was measured using case studies related to financial (19), Customer (17), internal
business process (20), learning and growth or innovation and learning (11) and other
perspectives (14). In this regard, Guard and his colleague considered patient retention,
acquisition and satisfaction factors regarding customer perspectives. On the other hand, patient
30

satisfaction, safety and health, productivity and innovation key indicators were employed to
understand internal business perspectives of individuals in HSC organizations. Moreover, for
learning and growth perspective, human capital, Information capital, continuous innovation and
organization capital related indicators were considered by researchers (Gurd and Gao, 2006).
While, revenue growth and productivity indicators were carried out in order to explore financial
perspective of health care enterprises. From the study, it is found that learning and growth
perspective was similar to all industries. It can be said that all efforts to achieve balanced
accountability is based on cost, quality and care. However, Gurd and Gao (2006) criticized that
BSCs are still in an evolutionary stage in health care sector.
Diverse forms of BSC were found by researchers regarding to patient satisfaction in
internal process perspectives such as call centre response time, waiting time and solve weekly
patient complaints. From the result of study, it is identified that all BSCs in the healthcare field
appear to be at stage 1 or 2. Patient or customer perspective was at the top of the balance score
card. Findings of Gurd and Gao (2006) provided important insights into the current state of the
use of BSC in healthcare enterprises throughout the world. However, Kaplan and Norton (2001)
have argued that implementation of balance score card in different perspectives highly
influenced from the use of different strategic orientations within health care organizations
(Kaplan and Norton, 2001). Further, they suggest that in order to implement BSC in HSC, it is
essential for hospitals and care home practitioners to emphasize on long-term and short-term,
financial and nonfinancial objectives, efficiency and fairness related factors in the healthcare
industry. Gurd and Gao had argued that it is not an easy task for any organizations to implement
31

BSC at the workplace because most countries are struggling to contain health costs and patient
needs are also changed.
Performance measurement using strategic scorecard map
Hajdíkova and Zelena explored that correct measuring of the performance and
consideration of key performance indicators are required for HSC organizations in the context of
evaluating efficiency of organization and its use in strategic planning. In order to measure
performance of hospitality industry, researchers had used performance management from
financial perspectives such as depreciation, net profit, personnel costs revenues and subsidies.
Rationale behind conducting this research was to specific focus on health care services and
equipment’s used in hospitals to attain better medical care. However, Gurd and Gao (2006)
criticized that BSCs are still in an evolutionary stage in health care sector.
Due to change comes in lifestyle of people, demand of health and social cares are
increasing continuously. For the purpose of determining performance measures, investigators
were used strategy map to achieve effective performance management (Hajdíkova and Zelena,
n.d.). Different perspectives and objectives from the financial and non-financial point of view
were considered to develop strategy map that can be described as follow.
32

Figure 4: Strategy map of objectives for hospital industry
(Source: Hajdíkova and Zelena, n.d)
From the figure, it is identified that non-financial indicators have created high impact on
economic measures and these further reflects criteria’s and sub criteria’s and lead effective
performance of hospitals. In order to establish link between different indicators and links
between the objectives, Hajdíkova and Zelena were developed casual diagram which is explored
as follow.
33

Figure 5: KPIs for hospital industry
(Source: Hajdíkova and Zelena, n.d)
Grigoroudis, Orfanoudaki and Zopounidis (2012) were conducted research regarding to
strategic performance measurement in a healthcare organization. Their main aim behind
conducting research was to develop a performance measurement system for public health care
organizations in dynamic changing era. In this regard, they considered distinguished
characteristics of the HSC sector, important financial performance indicators, non-financial
performance indicators, satisfaction of internal and external customers and quality of services
offered by hospitals to their patients in the context of BSC methodology.
In the context of aggregating the marginal performance of KPIs, UTASTAR method was
used regarding the achievement of the defined strategic objectives in a significant manner
(Grigoroudis, Orfanoudaki and Zopounidis, 2012). Performance of enterprise was measured in
34

terms of financial, customer, internal business process, and innovation-learning key performance
indicators. In order to analyse the behaviour and the cognitive style of the DM, the UTASTAR
method which is a regression based approach adopted by researcher. This method provided result
on different parameters such as financial, customer, internal business process, and innovation-
learning which shows in below figure.
Figure 6: Financial and customer perspectives
(Source: Grigoroudis, Orfanoudaki and Zopounidis, 2012)
35

Figure 7: Internal growth and learning & growth indicators
(Source: Grigoroudis, Orfanoudaki and Zopounidis, 2012)
On the basis of calculated values, Grigoroudis and their colleagues (2012) stated that
redesign the process of diagnosis and taking important actions within stipulated time, these KPI’s
play an important role. However, lack of competition, emphasis on the long-term results,
strategic objectives assessed by the management of the hospital and the social character of the
organizations are the major factors that can influence performance of health and social care
enterprise effectively. Based on the present result researcher’s achieved, it can be said that
significant improvement and active participation of health care professionals will be required for
organizations in order to implement BSC approach in hospitality industry. However, several
other limitations such as assumptions regarding the performance of the assessed criteria and
compensation assumed only on the basis of the BSC system are associated with the present
research (Grigoroudis, Orfanoudaki and Zopounidis, 2012).Nonetheless, future research can be
conducted on the basis of the development of a hierarchically structured balance scorecard
36

system and dividing it into sub-objectives. From the study done by investigators related to
hospitality sector, it is identified that several critical issues such as align strategic initiatives, link
measures with rewards, communicate and link strategic objectives and clarify and translate
vision etc. can affects implementation process of BSC in HSC.
In addition, Chang, Lin and Northcott (2002) developed NHS performance assessment
framework. On the basis of six dimensions including health improvement, fair access, patient
experience and health outcome of NHS care were considered to measure performance and these
criteria’s reflects both outcome and performance measurement of organization in HSC. They
found that there is a casual relationship between process and outcome measures and this
relationship enables managers and healthcare professionals to effective use of performance
measurement system. However, along with several advantages of BSC in health and social care,
lack of evidence in developing framework and pertinent issue related to effective use of BSC
performance system were created challenges for hospitals and NHS to implement this approach
at workplace (Chang, Lin and Northcott, 2002). Future study regarding to overcome such kinds
of issues can be conducted.
2.6 Implementation of balance score method in health care system
Broccardo (2015) argued that it is essential for health care organizations to manage costs
and maintain balance between quality and cost. In modern era, changing lifestyle of people and a
variety of stakeholder groups are putting pressure to HSC companies to measure performance of
health and social care services and deliver them in lower cost in an effective manner. In this
regard, investigator was conducted an empirical analysis based on an Italian hospital case study.
From the past studies done by different researchers, it is clear that enterprises need a
37

performance measurement system to quick view of the business. Moreover, by considering four
perspectives which include financial, customer, internal business process and learning and
growth, a quality of performance measurement system can be developed. Further, Broccardo
(2015) explored that for several purposes such as inform patients about disease, deliver quality of
services, permit organizations and practitioners to market their services and leading the
organization in the desired direction etc. health care enterprises can adopt Balance Scorecard
approach.
Besides that, investigators explored the ways of guidelines to apply BSC in health and
social care enterprises in a significant manner. In this regard, empirical analysis of an Italian
hospital has been considered. The main strategic goals behind BSC implementation in hospitals
are extension of hours of clinical service, improvement of care continuity pathways, management
of waiting lists, new activities and development of existing activities and monitor and rationalize
pharmaceutical expenditures (Broccardo, 2015). In order to evaluate strategic map, strategy map
was developed by scholars and indicators were identified which reflects the given strategy map.
38

Figure 8: The Strategy Map in the Analyzed Hospital
(Source: Broccardo, 2015)
From the figure, it is clear that to monitor and measure the critical success factor, it is
essential that firm considers cost constraints, process efficiency, and staff presence factors during
implementation of BSC approach at workplace. However, several limitations are associated with
the present results such as the analysis is conducted only on the Italian hospital cases, one
empirical case analysed, some possible missed articles and few articles found which deals with
such kinds of performance indicators can also affect performance of balance scorecard
implementation in health and social care. The success of BSC approach highly depends on the
effective monitoring and evaluation of this technique. Through considering benchmarking
approach, enterprise can be able to bring long-lasting quality improvements to patient care in
Lebanon (El-Jardali, Saleh and Jamal, 2011). Due to time and resource constraints, only 14
39

hospitals were selected and limited sample size was taken to represent the whole spectrum of
hospitals in Lebanon. These were the major limitations of study conducted by El-Jardali and
their colleagues.
El-Jardali, Saleh and Jamal (2011) were conducted study to design, implement and
scaling up of the balance score card in hospitals in Lebanon. They implement principles to
measure the quality of patient care in public and private hospitals and improve the quality of
their health services. Step-wise development of the BSC for national hospital can be enlisted as
follow.
Figure 9: Step-wise development of the BSC for national hospital performance measurement
(Source: El-Jardali, Saleh and Jamal, 2011)
On the basis of study done by Broccardo, it can be said that future study can be conducted by
considering different factors such as critical comparison of the BSC implementation with other
40

countries and balance score card implementation issues in order to overcome gap present in this
research.
2.7 Conclusion
Amatraunga and their colleagues explored that for measuring strategic performance of
management in health and social care, BSC tool can play an important role. Lovagli (2010)
found that by applying structured equation model, researcher was found that economy and
clinical process dimensions are still endogenous. However, Gurd and Gao (2006) criticized that
BSCs are still in an evolutionary stage in health care sector. Grigoroudis, Orfanoudaki and
Zopounidis (2012) were conducted study to develop a performance measurement system for
public health care organizations in dynamic changing era. Nonetheless, Broccardo (2015) argued
that it is essential for health care organizations to manage costs and maintain balance between
quality and cost.
After conducting vast literature review on balance scorecard, its advantages and
implementation in health care organizations, it is found that different studies were conducted on
BSC and its deployment in HSC. However, there is not study was conducted regarding to
measurement of marketing of private dental practices using balanced scorecard approach. After
reviewing practical implementations of balance scorecard method in HSC, it can be said that this
approach will be beneficial for researcher in order to investigate real impact of this technique on
health care companies and their performance from finance, customer, learning and growth
perspectives in a significant manner.
41

CHAPTER 3: RESEARCH METHODOLOGY
3.0 Introduction
Research methodology is an important section of this study and it helps researcher to
discover answers of research questions by effective use of scientific approach. This section
covers information about research design, approach, data collection and analysis techniques.
These research terminologies helps investigator to investigate facts which is hidden and
which has been not discovered as yet. According to nature of the study to attain better
research objectives in a proper way, descriptive research design approach has been used.
This approach can be used for the purpose of understanding balance score card method and
strategies required for implementing the BSC in health and social care (Browning,
Thompson and Dawson, 2014). However, this chapter discusses the research design with the
idea to explain the research hypothesis and the purpose of this research.
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3.1 Research Model
Figure : Balanced Score Card Model
Source: (Kaplan and Norton, 1999)
The figure above illustrates the Balanced Score card which is the model for this thesis to
assess the effectiveness of marketing of dental practices. This model is used to assess the
four components of the balanced scorecard and the specific questions the practices should
answer to implement its strategy. It moves beyond the traditional financial performance
measurements, to additionally investigate other key areas such as the internal business
perspective, the learning and growth perspective and the customer perspective.
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3.2 Research Methodology
The research onion describes the concept of the research methodology used in the thesis.
Saunders et al 2009 proposed the research onion, and suggested six major layers that need to
be explored, which comprise of research philosophy, research approach, research strategy,
research methods, research reliability and validity, data collection and analysis.
Figure: The research onion model
(Saunders et al., 2009)
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3.3 Research Philosophy
According to Johnson and Clark (2006) the vital issue is less whether our research
philosophy is the right choice or the wrong choice, but it considered valid in the way we
defend and reflect upon our chosen philosophical strategies with the support of evidence
also Saunders et al 2005, contended no research philosophy is superior to the other. Every
rational strategy is better in its own particular manner and is dependent on your approach
and areas to be explored. The research philosophy along with the right adaptation of
methodology and strategies brings us closer to the objectives of research.
The research philosophies are - Pragmatism, Ontology, subjectivism, objectivism,
Epistemology, Positivism, Realism, Axiology, Interpretivism. Positivism, Interpretivism and
objectivism are most widely adapted to in research.
The orientation used in this research will be adapted using Hybrid philosophies. Objectivism
associated with a positivist approach which analyses patterns and relationships as well as
measurement of different social facts and phenomena’s. The Objective perspective
emphasises the structural viewpoints about administration in dental practice. Assumes that
administration in one dental association may be comparable to other dental associations.
Viewpoints of the structure over which management works might vary yet the substance of
the work is a whole lot same altogether in similar dental associations (Saunders et al., 2009).
The positivism philosophy is based on a scientific paradigm and is adapted when the
research involves working with social reality and the results can be generalised (Saunders et
al., 2009). The positivist approach gives the freedom in this research in analysing the data
45

quantitatively and measuring performance of the dental practice and generalising it to other
dental practices.
However to perceive the thought process and attitude of the dentists there would be a need
to adapt a Interpretitivist approach which considers research is value bound and what is
being researched is a function of a particular set of circumstances and individual
conditioning.
These research philosophies use mixed approach since ultimately the aim is to understand
and measure the performance no matter what approach is adapted.
3.4 Research approach
There are many ways to approach a research study however we look at the most frequently
used inductive and deductive research approach. Analysis be it Inductive or deductive
comprise of three main components: preparation, organizing and reporting. The similarity
in both approaches is the first component which is phase of preparation. In an inductive
approach the concepts are reached after the collection and analysis of the data, in contrast
the deductive approach comes to conclusions of the data findings based on the previous
knowledge or research. Thus Inductive approach could be a valid approach for new studies
which have not yet been researched and deductive approach is an excellent tool to compare
studies or findings based on previous theories (Elo and Kyngäs, 2008).
This research study uses deductive approach to answer the research questions and achieve
the objectives. The deductive approach explains causal association between variables also
the characteristic of deduction is that it can be generalised statistically to patterns in human
46

social behaviour. This approach is useful in quantitative data collection as well as based on
previous researches and structured methods controls to ensure validity of data (Saunders et
al, 2009).
However deduction is criticised by those in favour of inductive approach as deduction tends
to follow a rigid methodology which cannot be changed in the research choice of theory or
the way the hypothesis has been defined. Also, Blaxter et al, 2010 supported inductive
approach with the argument that it provides alternate explanations to the research problem
(Blaxter et al., 2010). Saunders et al., 2009 argued that in the inductive approach no data
patterns or theories emerge (Saunders et al, 2009).
3.5 Research strategy
The Methodical choice used in this research would be a mixed method qualitative and
quantitative design of data collection and analysis measuring performance in a mixed
approach. Mixed approach helps researcher to ensure that collecting data either sequentially
or simultaneously best in term of presenting research problem in a proper manner.
The rationale behind adopting both techniques is to analyse the actions and overcome the
chance of wrong interpretation of data (Martinus and Hedgcock, 2015). Qualitative data is
non-numeric nature and it is used to understand underlying reasons and opinions of other
scholars related to similar area. In this approach, small numbers of cases and respondents are
considered. This approach helps researcher in the context of understanding balance score
card method and its requirements from the financial, customers, internal business and
learning & growth perspectives in health and social care. In order to meet research aim and
47

objectives of present research and better understand the implementation of balance score
card, this approach can be helpful for investigator.
Quantitative data can be expressed in form of numeric or quantitative form and this data can
present in terms of ordinal, interval or ratio scales. As per the given case situation, survey in
the form of interviews can be employed in order to interact with health care practitioners to
know their perceptions about deployment of balance score method in health and social care
in a significant manner (Creswell, 2013). On the other side, to interact with participants and
understand their views regarding to use of balance score method, quantitative data analysis
technique can be employed. Numeric nature data can be collected from respondents with
help of different data collection techniques which include survey, questionnaire, interview
and so on.
3.6 Sampling
The target population intended to sample would be a population in the UK within England
and in the city of London. This includes owners of private dental practices that provide care
to patients. The target population included dentists, general or specialist dentists from south
east London. The south east of London was chosen on the basis of connection and
judgement as well as work relationships with the private dental practitioner in this area only
with an intention to ensure their participation and completion of the research. With the value
of private dentistry market growing at £2.3bn per year according to a NHS survey in 2014,
as well there has not been enough evidence based studies on implementation of the balanced
scorecard in the field of private dentistry this sample has been chosen.
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The number of observation to be selected for conducting the research can be defined as
sample size. The sample size for this research would be 6-8 private practitioner dentists; also
a group of 10-15 dental patients will be interviewed. These interviews will be used to collect
our primary data. The nature of interviewing is qualitative and quantitative; useful
information can come from a few or even a single interview (Roller and Lavrakas, 2015).
Well-judged selection of a small sample of variables can channel answers alternately in
other rarely-used ways through the questionnaire. Also we have no budget and a small time
frame for which it is not realistic to use a large sample (Kaplan and Norton, 1996). This
research requires to be built up by productive associations with respondents and through
hypothetical thought to address the exploration issue inside and out. In this manner even a
small sample size of cases will encourage close relationship with the respondents, and
upgrade the validity of in-depth survey interviews in dental settings (Vogt,Gardner and
Haeffele, 2012).
By using probabilistic (random) and non-probabilistic (non-random) sampling techniques,
appropriate sample size from given population can be collected. In non-probabilistic
technique, it is considered that universe is unequal and data can be collected on researcher
own perspectives. Convenience, quota and purposive sampling techniques are the major
kinds of non-probabilistic sampling (Yin, 2013). On the other side, in probabilistic
sampling, each element has an equal chance of selection. Cluster, stratified, simple random
and multi-stage are the main types of probabilistic sampling. On the base of the judgement
of investigator, judgemental or purposive sampling can be employed (Martinus and
Hedgcock, 2015).
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As per the given case scenario, purposive sampling technique can be used because it
provides opportunity to interviewer to collect information from respondents on the basis of
their interest and availability. In addition, this sampling technique allows researcher to
obtain basic data and trends regarding use of balance score method in measurement of
marketing of private dental practices in a significant manner (Creswell, 2013). Due to
availability of limited sample size and focused on specific characteristics of performance
measurement approach, this sampling technique and sample size chosen will be appropriate
for cited case. In this regard, investigator can be used interview approach to better
understand impact of BSC in dental activities in a proper manner. Small and target specific
population is enough to represent the whole population and able to represent the perceptions
of dentists related to use of balance score method in different aspects within organization.
3.7 Data collection and analysis
Collection techniques and analysis procedures are varied utilizing qualitative data and
quantitative data, data will be collected through in depth interviews, analysed as narratives. For
the purpose of collecting data related to use of balance score card, researcher can use both
primary and secondary sources. Primary data is fresh and collected by researcher first time (Yin,
2013). On the other side, secondary data is qualitative nature and it gathers from various
authentic sources such as books, journals, books, PHD thesis and online published articles. As
per the present case scenario, both primary and secondary data collection technique can be used.
Primary data can be collected from private practitioners and a group of 15 dental patients related
to subject matter so that appropriate decisions can be taken in stipulated time. For the purpose of
50

gathering information from participants in this method, 6-8 private health care practitioner
interviews will be conducted because they are familiar with use of balance score approach in
health and social care.
By applying this approach, investigator would be able to examine internal capabilities and
frame new strategies employed in HSC in an appropriate manner. As per the given case
scenario, interviews approach can be used. The main reasons behind considering this
method are easy correction of speech, development of relationship, less costly and time
saving. By selecting this method, investigator would be able to understand views of private
practitioners and a group of 15 dental patients to collect data (Vogt, Gardner and Haeffele,
M. L., 2012.). Semi-structured survey strategy has been used because it provides opportunity
to researcher to collect information in a systematic manner. Qualitative data analysis
technique covers information about needs of BSC in HSC in reducing challenges faced by
health care enterprises and strategies required for implementing the BSC in health and social
care in a significant manner.
However, along with several advantages some constraints which include biases of
interviewer, inefficiency of interviewer, lack of attention and incomplete processes are
associated with the use of interview method. However, by collecting data from authentic
sources and direct interact with participants; researcher tries his best to overcome chance of
miss-interpretation and redundancy of data related issues (Creswell, 2012). The qualitative
data will be collected and analysed through framed open ended questions, open ended
questionnaire was adapted in this research due to the small number of participants (Saunders
et al., 2009) . Whereas the quantitative part of this questionnaire will be analysed on the
51

basis of Likert scale questions, the 5 point Likert scale has been adapted since it helps the
one answering the question with a better understanding of what option should be chosen for
an answer. Seven-point Likert scales are known to be sufficiently sensitive enough to record
precise assessment of a strategy while remaining relatively compact and are more sensitive
to record test participant’s true evaluation than a 5 point scale (Finstad, 2010). However
some studies have shown them to be no different than each other.
Both quantitative and qualitative analysis can be done on the basis of gathering information
from primary and secondary sources. For analysing the qualitative data, different types of
themes will be prepared and analysed to overcome gap present in past studies. For analysis
the data collected from 6-8 private practitioner dentists and a group of 15 dental patients,
interview method can be used. In addition, for analysis information gathering from
interview, transcripts will be written. For market research analysis and concentrating on
multiple focus groups or a series of in-depth interview, this is a great tool.
3.8 Validity and reliability of data
Reliability and validity concept are followed in the entire research work to analyse data in a
systematic way. Besides that, for avoiding the biasness and misinterpretation of data related
problems, secondary data will be collected from authentic sources and prior permission will
be taken before accessing data of other related to topic. In addition, to check the validity
and reliability of data, standard methods have been used (Comstock, 2013). Primary or fresh
data will be collected from a group of 10-15 dental patients when they will be in comfort
zone so that accurate and valid response or answers of research questions as well as
52

importance of balance score method in health and social care can be identified in an
appropriate manner. Along with this, utmost care has been considered by investigator while
gathering information from primary and secondary sources (Sherry, 2013).
Validity of the study will help determine if the research truly measures the performance of
the private dental practices. The research instrument which is the balanced score card here
should help to analyse the research question. The validity will be determined by asking a
series of questions, and will often look for the answers in the research of others and
literature review (Browning et al, 2014). The methodology of this research uses a survey
which is descriptive and predictive nature and help investigator in recording observations
and the adaptation of a new developed score card in this research based on the balance score
card, when all these factors combined makes the research high in External validity. The
Construct validity in this research is high since variables which are the dentists included has
the same interest (Roller and Lavrakas, 2015). The Balanced score card increases the
Content validity since it would be adapted to measure the concept of the study.
Also the balanced scorecard being previously used as a successful measurement tool in
healthcare setting increases the Criterion validity of the study. However the Internal validity
will be low in the study as we do not have any controlled settings and have a high external
validity. The main reason behind low internal validity is that investigator has no controlled
over data collected from health care practitioners and a group of people (Comstock, 2013).
For example, if researcher will ask research question from dentists and other care
professionals regarding to know the importance and role of balance score card method then
whatever answers provided by them might be accepted by investigator without any argue.
53

The study has the potential to have a good reliability as it has been reproduced under a
similar methodology in NHS research and other health care settings to measure performance
and thus the balanced score card, the instrument is considered to be reliable. On the basis of
literature review section and identify research gap, it is clear that there is not study was
conducted regarding to measurement of marketing of private dental practices using balanced
scorecard approach. After reviewing practical implementations of balance scorecard method
in HSC with help of considering research terminologies, it is clear that that this approach
will be beneficial for health care enterprises in the context of measuring performance from
finance, customer, learning and growth perspectives in a significant manner (Research
Methodology, 2008). In addition, on the basis of research gap and reviewing other research,
it can be said that further study can be conducted by considering critical comparison of the
BSC implementation with other countries and adequate implementation of balance score
card in a proper manner.
Also consistency of results is extremely important in reliability, internal consistency in this
study will increase when different questions would be used in the survey to measure the
same construct to analyse the consistency of the results. Despite of that, to avoid biasness,
researcher gathered information from reliable and authenticate published sources in a
significant manner (Preliminary Research Steps, 2015). Ethical consideration has been
maintained by ensuring confidentiality and transparency in data collected from respondents
to increase their confidence and motivates to participate in further research activity.
3.9 Research limitation
54

Several limitations are associated with the present results such as analysis is conducted only
on the small sample size and only 6 patients and a small group of patients have been
considered. However, some possible missed articles and few articles found which deals with
measurement of marketing of private dental practices using balanced scorecard related
constraints are also associated with the present research (Research Conversation. 2015). The
success of research has been highly depended on the effective monitoring and evaluation of
research techniques. In addition, quality, cost and time are the other major limitations
associated with the use of deployment of present research. In given case concern, due to
time and resource constraints, only 15 respondents from patient groups have been selected.
However, in future by increasing sample size and using questionnaire method to collect
responses from respondents, reliability of outcome can be improved. Along with BSC,
investigator can conduct study on performance measurement system in order to increase
patient satisfaction during this period of reform.
Cross sectional study
55

On the basis of nature of research question and study on different groups of people who
differ in the variable of interest, this approach can be used. In medical research, this kind of
approach is used because it allows researcher to measure prevalence for all factors under
investigation in a significant manner. Takes place at a single point in time and looks at
numerous things at once (age, income, gender) are the major characteristics of cross
sectional study (Comstock, 2013). Time Horizon for this study will be cross-sectional based
on strategies such as a survey. As per the given case scenario, to measure the impact of use
of balance score method in health and social care this approach will be used.
Data can be obtained using self-supported survey which is interview nature. By the true
potential of the balance score card and know the employees perspective towards applying
this approach, investigator would be able to explore strategies or techniques were used by
health care practitioners in HSC (Lo, 2010). Different group of people who differ in variable
of interest can be considered for the present study. In this regard, a group of 10-15 dental
patients will be interviewed to know their perspective about implementation of BSC
approach at workplace. For the cited case, cross-sectional base strategy can be used because
it helps investigator to determine the influence of balance score method in marketing and
promotional activities of health and social care services.
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CHAPTER 4: DATA PRESENTATION AND ANALYSIS
4.0 Results of interview
In order to collect the primary data from private practitioner dentists, an interview has been
conducted. The data gathered through private practitioner dentists of London, qualitative
methods have been used. The section presents the analysis of primary information on the basis of
qualitative analysis:
Theme 1: Private practitioner dentists are agreed that balanced scorecard is the effective
tool to measure the performance of dental practices
The interview conducted with 6 Private practitioner dentists working in different organization
have shown that there is a specific need of having effective measurement of dental practices and
balance scorecard is an effective measure. However, the respondents have been made to
understand with the importance of balance scorecard. The healthcare professionals want to
regularly collect and evaluate relevant clinical and non-clinical indicators that helps in measuring
performance. According to them scorecard addresses quality of care at the different levels of
measurement including financial, customer, outcomes, internal processes, and learning and
growth. The primary investigation suggested that Balanced Scorecards in healthcare can be more
diverse as compared to other sectors. There were 3 Private practitioner dentists who have
positively supported the use of balance score card as it represents how organizations attains the
objectives of quality performance.
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Theme 2: Perceived limitations of marketing of a private dental practice
As per the private practitioner dentists there are some limitations of marketing that are faced by
private entity. The majority of respondents have said that the major limitations are personal
barriers like such as lack of skills in business knowledge or experience to run a practice. There is
also lack of experience in staffing that is considered as a major influencing factor of limitation.
Four private practitioner dentists have responded that the competition national level is another
limitation. In literature section, it has been viewed that 12 per cent of the dentists agreed with the
similar limitation (BDA, 2012).
Theme 3: Factors affecting financial performance of dental clinics in London?
The factors such as doctor patient relationship, cost of clinical services and quality of dental
clinical services have been found as the major influencing factors to the corporate entity that has
influenced financial performance. As per most of the Private practitioner dentists, it had been
evident that the satisfaction level of customers is another factor that affects the financial
performance of dental clinics in London. The majority of respondents said the patients who had
attended a private dental clinic found a high level of satisfaction that is good sigh for improving
revenues.
Theme 4: Improvements can be brought to the private dental practices
According the collection of primary data, it has been found that private dental practices can be
improved with the introduction of updated technologies. It facilitates to market the services in
the market in an effectual so as to increase the customer base. Further, customers views can be
58

incorporated in the decision making process while bringing improvement at workplace.
Similarly, majority of respondents said that private dental clinics can contact to government to
get financial assistance. This proves to be effective in bringing improvement in the corporation.
Apart from this, four respondents stated that cost effective sources of finance can be accessed so
as to remove potential limitations stated in the literature review.
Theme 5: What are different ways through which dental clinical practices can be
improved?
As per the collected data, it can be revealed that work environment of clinics can be improved to
increase customer base. Further, 5 participants stated that balanced score card is the most
effective method to measure the current performance of clinical practices against the set standard
like high rate of return and high customer satisfaction as well as low cost of production. Apart
from this, some of the respondents said that practitioners need to focus on training of staff
members so they can easily meet the expectations of service users. In addition to this, team
building approach need to be used so that practitioners, nurses and other care workers work
together so as to meet expectations of services effectively. This aspect is also helpful in reducing
cost as team building will serve as the indirect mode to provide training.
Theme 6: What are different measure can be used by health care professionals to market
private dental practice?
The collected data reveals that health care professionals can make use of internet for promotion
of products and services. This aspect of promotion facilitates to increase awareness among
customer regarding the availability of high quality dental clinic. Also, other number of media
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such as internet, local newspaper and pamphlets can be used for promoting products and
services. The selection of newspaper and pamphlet is based on budget of clinics. In addition to
this, it has also been found that respondents stated that balance score card can also be used to
measure the performance of clinics in term of marketing of services. This prove to be effective to
reduce the gap between actual and expected outcome of private dental practices.
4.1 Result of questionnaire
To access the information for this investigation, a questionnaire is designed and is made filled
by the respondents which were the patients of dental clinic.
Theme 1: Number of patients prefer dental care services
Criteria Responses
Yes 12
No 3
According the collection of primary data, it has been found that 12 respondents said that
they use private dental care services. On the other hand, 3 participants do not use dental care
services which are provided by privately owned organizations. It depicts that number of services
users are accessing private dental practices of London. Thus, it shows that corporation are
outperforming in the marketplace.
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Theme 2: Dentist at the practices are skilled and experienced
Criteria Responses
Yes 11
No 4
According the collection of primary data, it has been found that 11 participants stated that
dentists are skilled and experienced. It shows that, private dental clinics have command over its
staff members thereby need of service users can be satisfied in an effectual manner. Apart form
this, 4 participants stated that private owned dental clinics are not experienced and skilled
workforce. However, majority of respondents stated that private dental clinics ensure inclusion
of highly qualified professionals and practitioners.
Theme 3: Excellent experience in private dental clinic
Criteria Responses
Excellent 7
Satisfactory 4
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Moderate 3
Dissatisfaction 1
Worst 0
According the collection of primary data, it has been found that 7 respondents stated that
they had good experience of private dental clinics because it addressed their need effectively and
provide them good quality of services. Further, 4 participants stated that their experience was
satisfactory because they found good environment and their issues was resolved on right time.
Apart from this, 3 participator's experience was moderate whereas 1 had dis satisfactory
experience while accessing services from private dental clinic.
Theme 4: Are you satisfied with the service quality
Criteria Responses
Highly satisfied 8
Satisfied 2
Neutral 1
Dissatisfied 2
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Highly dissatisfied 2
While asking the subsequent question, out of 15, 8 patients said that they are highly
satisfied with the service quality, 2 said they are satisfied enough, 1 patient was neutral to the
same, 2 patients were dissatisfied because they did not find any quality provision in the services
and remaining 2 said that they are highly dissatisfied with the same aspect because a few times,
practitioners have not given proper support and care to them. Thus, on the basis of entire
discussion, it can be said that major number of patients are satisfied with the service quality of
dental care.
Theme 5: Most important factor while accessing services of private dental clinic
Criteria Responses
Quality of services 9
Experienced staff 2
Cost of services 2
Waiting time 1
Other 1
Quality of service matters a lot to all the patients because this is the only reason for which
they acquire services from dental care entity and this can be justified with the help of present
responses. At the time of asking about the factor which client access while acquiring services
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from private dental care, 9 patients said that they consider quality of services, 2 said that they
consider experienced staff, 2 said that they consider cost aspects, 1 patient said that they consider
waiting aspect and remaining 1 was in favor of other aspects.
Theme 6: Private dental clinic market is effective for dental practices
Criteria Responses
Agree 8
Neutral 2
Disagree 3
Strongly Disagree 2
Private dental clinic market is effective for dental practices and this has been evaluated
on the basis of patient's responses where in out of 15, 8 agreed to the same, 2 patients were
neutral, 3 disagreed and remaining 2 said that they strongly disagree to this. Hence, on the basis
of responses, it can be said that private dental clinic market is effective because it helps the
clients to acquire different types of services from the private market place. It is also clear that
people are satisfied with the services delivered at the private dental care.
Theme 7: Most important source of getting information about dental practices
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Criteria Responses
Internet 10
Family and friends 3
Local newspaper 1
Other 1
As per the contemporary scenario, internet is highly useful for people and it is also the
most important source of getting information about dental practices. Thus, while asking the
question, 10 patients said that they acquire information from internet sources, 3 patients said that
they get information from family and friends, 1 agree to local newspaper and remaining 1 said
other sources. Hence, it is clear that for patients, internet is the most useful source that aids in
grabbing information about private dental care entities.
Theme 8: Private dental clinic ensures inclusion of highly updated technology and proper
facilities
Criteria Responses
Strongly agree 7
Agree 4
Neutral 2
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Disagree 1
Strongly Disagree 1
Private dental care entity uses different tools and techniques for delivering proper
services to the clients and this has been evaluated on the basis of responses collected from the
patients. While asking this question, 7 patients strongly agree that private dental clinic uses
updated technological aspects, 4 patients agreed to the same, 2 were neutral, 1 marked it to
disagree and remaining 1 marked to strongly disagree. Thus, from the responses, it is clear that
patients prefer to acquire services from private entities because of the use of latest devices and
tools.
Theme 9: In what terms private dental clinic are better than public dental services
Criteria Responses
Highly qualified staff 9
Technological updation 3
Quick response 1
Good environment 2
Private dental clinics are far better than public dental clinics and this has been evaluated
on the basis of responses collected from patients. 9 patients said that private clinics are better due
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to highly qualified staff, 3 said that due to technological updating, 1 said because of quick
response and remaining 2 said because of good environment at the private clinic. Hence, from
the overall responses, it is clear that private dental care clinics are finer as compared to the public
ones.
Analysis on basis of dentist’s perspective
(Questionnaire enclosed in Appendix 1)
Overview
The health professions working in the area of dental care services are known generally to
be private holders who run business at own skills and risk. Furthermore, dental care is witnessed
to be the area of health care that has been separated on the basis of financing and delivery of
care, from rest of medical care. The dental diseases are very few in number and it is more likely
to happen such dental diseases. Herein, in researcher has focused on evaluating different aspects
of about the study that consist of customer perspective, internal business process perspective and
learning and growth perspective. However, in order to make in-depth analysis SPSS statistical
tool has been used in which different test has been selected for providing different hypothesis. As
data for the study has been collected from 7 dentist who work in private dental care homes and
makes valiant efforts to provide superior quality of treatments. Looking at the present condition
in UK, the graph of NHS dental services is declining day by day which has enforced large
number of audience to switch their medical prescription to private dental cares. Thus, the main
purpose of this analysis is to evaluate the effectiveness of services offered by the Private Dental
clinics to the people of London, UK.
Quantitative Analysis
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Quantitative data can be expressed in form of numeric or quantitative form and this data
can present in terms of ordinal, interval or ratio scales. As per the given case situation, survey in
the form of questionnaire has been employed in order to generate valuable and wide range of
information from health care practitioners regarding their perceptions about effectiveness of
services in satisfying the needs and wants of customers. Furthermore, to analyze the numeric
nature of gathered data quantitative data analysis technique (SPSS) has been employed in which
different tests has been used to make in-depth analysis on the selected topic. In addition to it, on
the basis of questionnaire, varied hypothesis has been framed which are proved by different
techniques such as Chi Square, ANOVA, Regression coefficient.
Customer perspective
Herein, researcher has focused on evaluating the perception private dentist towards their
customers. However, through the means of different questions researcher has asked dentist about
the effectiveness of services are that are being offered to the customers by the privately owned
dental cares in London. On the basis of this, hypothesis has been framed to evaluate the
relationship between offered services and satisfaction level of patients. However, with the help
of this hypothesis researcher is planning to evaluate whether offered dental services by dentists
are effective in satisfying the needs and wants of patients.
Multiple Regression
The main purpose of multiple regression is to predict a single variable from one or more
independent variables. However, it is considered as the extension of simple linear regression.
Through the means of multiple regression test, researcher can easily predict the value of a
variable based on the value of two or more variables.
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Hypothesis:
H0: There is a significant relationship between presently offered services and patient’s
satisfaction level.
H1: There is no significant relationship between presently offered services and patient’s
satisfaction level
Model Summary:
Table 1: Model Summary
Model Summary
Model R R Square Adjusted R Square Std. Error of the
Estimate
1 .888a .788 .576 .246
a. Predictors: (Constant), You listen to and learn from your patient’s, Increasing patient
satisfaction will increase uptake of dental treatments, We are providing adequate service to our
patients
ANOVA:
Table 2: ANOVA
ANOVAa
Model Sum of Squares df Mean Square F Sig.
1
Regression .675 3 .225 3.714 .155b
Residual .182 3 .061
Total .857 6
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a. Dependent Variable: The services provided by the dental practice meet or surpass patient’s
expectation/satisfaction
b. Predictors: (Constant), You listen to and learn from your patient’s, Increasing patient
satisfaction will increase uptake of dental treatments, We are providing adequate service to our
patients
Coefficients:
Table 3:Coefficients
Coefficientsa
Model Unstandardized
Coefficients
Standardized
Coefficients
t Sig.
B Std. Error Beta
1
(Constant) 5.273 .988 5.339 .013
We are providing
adequate service to our
patients
-1.000 .302 -1.291 -3.317 .045
Increasing patient
satisfaction will increase
uptake of dental
treatments
.364 .216 .555 1.680 .191
You listen to and learn
from your patient’s
.273 .189 .498 1.441 .245
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a. Dependent Variable: The services provided by the dental practice meet or surpass patient’s
expectation/satisfaction
Findings:
Herein, with the help of this test researcher evaluates whether there is relationship
between currently offered services and patients satisfaction level. However, in this satisfaction
level of patients is dependent upon the services offered by dentists.On the basis of above
computation of multiple regression statistical test, relationship between two variables has been
evaluated. However, the significance value of multiple regression is 0.05 in which if the value of
test is above defined significance value than there is not relationship between the variables, while
on the other hand, significance value of less than 0.05 indicates that there is relationship between
the variables. In the present given case, from the coefficient table, p = 0.045 which is less than
significance value of 0.05 indicates that there is relationship between providing adequate
services and satisfying the expectations of the customers. While on the other hand, with p value
of 0.191 which is greater than significance value of 0.05 it has been found that there is no
relationship satisfying the needs of customers will assist in uptake the dental treatments. Lastly,
higher significance value of 0.245 clearly indicates listening and learning from people will not
help in enhancing the customer satisfaction.
Interpretation:
From the above findings it has been analyzed that current practices followed in order to
provide the dental services to people in London are getting proper services to resolve their dental
issues. However, it is the duty of dentist to ensure that they make valiant efforts in understanding
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the needs and wants of patients so that their dental related problems can be solved in more
effective and efficient manner. But contrary to this, it is not essential that satisfying the needs
and wants will uptake the dental treatments because in order to do so dentist has to maintain long
term relation with the patient and constantly focus on provide people of London superior quality
of dental services so that they can be retained. Moreover, at present private dental care charge
high fees for resolving the dental problems for the patients. Therefore, in order to enhance the
level of patient’s satisfaction it is important for the dentists to charge affordable fees from its
patients so that they can be attracted to revisit the clinic.
Internal Business Process Perspective
Chi Square Test:
Ha0 = Null Hypothesis
Ha1= Alternative Hypothesis
Ha0: There is no direct association between internal business process and meeting with customer
expectation level.
Ha1: There is a direct association between internal business process and meeting with customer
expectation level.
In order to prove the above hypothesis different variables has been selected in which
three variables are dependent upon the one variable has been analyzed. Following are the
findings:
Your Practice is currently using the Organizational Development Approach & Patients needs are
being met:
Crosstab:
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Table 4: Crosstab
Crosstab
Count
Patient needs are being met Total
Neutral Agree Strongly disagree
Your practice is currently
using the Organizational
Development approach
Disagree 0 1 1 2
Neutral 1 4 0 5
Total 1 5 1 7
Chi Square Test:
Table 5: Chi Square Test
Chi-Square Tests
Value df Asymp. Sig. (2-sided)
Pearson Chi-Square 3.080a 2 .214
Likelihood Ratio 3.372 2 .185
Linear-by-Linear Association 2.100 1 .147
N of Valid Cases 7
a. 6 cells (100.0%) have expected count less than 5. The minimum expected count is .29.
 Findings:
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In the above defined table association between two variable has been identified. In
general context, higher significance value of 0.214 clearly indicates that there is no association
between current business development approach and meeting the needs of patients.
Your practice is currently using the Organizational Development approach & you are utilizing
innovation to improve internal processes to keep the dental practice moving forward:
Crosstab:
Table 6: Crosstab
Crosstab
Count
You are utilizing innovation to improve internal
processes to keep the dental practice moving
forward
Total
Strongly
disagree
Disagree Neutral
Your practice is currently
using the Organizational
Development approach
Disagree 1 1 0 2
Neutral 0 4 1 5
Total 1 5 1 7
Chi Square Test:
Table 7: Chi Square Test
Chi-Square Tests
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Value df Asymp. Sig. (2-sided)
Pearson Chi-Square 3.080a 2 .214
Likelihood Ratio 3.372 2 .185
Linear-by-Linear Association 2.100 1 .147
N of Valid Cases 7
a. 6 cells (100.0%) have expected count less than 5. The minimum expected count is .29.
Findings:
On the basis of above chi square table it has been analyzed that greater p value of 0.214
than the significance value of 0.05 which clearly indicates that current organizational
development approach is not allowing any innovation within the internal business process which
affects the overall dental services provided by dentist.
Your practice is currently using the Organizational Development approach & Patient exclusive
needs are being identified by the practice:
Crosstab:
Table 8: Crosstab
Crosstab
Count
Patient exclusive needs are being
identified by the practice
Total
Neutral Agree
Disagree 1 1 2
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Your practice is currently using
the Organizational
Development approach
Neutral 1 4 5
Total 2 5 7
Chi Square test:
Table 9: Chi Square Test
Chi-Square Tests
Value df Asymp. Sig. (2-
sided)
Exact Sig. (2-
sided)
Exact Sig. (1-
sided)
Pearson Chi-Square .630a 1 .427
Continuity Correctionb .000 1 1.000
Likelihood Ratio .599 1 .439
Fisher's Exact Test 1.000 .524
Linear-by-Linear
Association
.540 1 .462
N of Valid Cases 7
a. 4 cells (100.0%) have expected count less than 5. The minimum expected count is .57.
b. Computed only for a 2x2 table
Findings:
From the above computed chi square test, generated significance value of 0.427 is greater
than 0.05 which means there is no significance association between the variables. Thus, it can be
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said that, current organizational Development approach does not support in identifying the
Patient exclusive needs.
Interpretation:
Therefore, on the basis of above evaluation it has been identified that, higher significance
value in all three cases depicts that null hypothesis has been accepted and alternative is rejected
which means there is no direct association between internal business process and meeting with
customer expectation level. However, although it is essential but there are several other prospects
which are more important in terms of meeting the expectation level of patients such as dentist
should focus on overall patients health as well as improve the overall approach used in providing
the medical services to the patients. Further, improving internal business process will not help in
enhancing the satisfaction level of customers for the dentist. However, it is important for the
dentist working in private dental care to ensure that they offer quality of service at affordable
prices will help in improving the overall satisfaction level of the patients in London. In the
secondary analysis it has been identified that the above defined factors such as patient
satisfaction in internal process perspectives such as call center response time, waiting time and
solve weekly patient complaintsare important but on the generated findings medical services
offered are more prior in terms of satisfying the expectations of the patients.
Learning and Growth Perspective
ANOVA:
Ha0: Employee quality is nothighly dependent upon CPD and awareness of dental surgery
policies.
Ha1: Employee quality is highly dependent upon CPD and awareness of dental surgery policies.
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Table 10: ANOVA
ANOVA
Sum of
Squares
df Mean Square F Sig.
Practice staff is up to
date and well informed
about its Dental Audits
and Dental surgery
policies
Between
Groups
.000 1 .000 .000 1.000
Within Groups 2.000 5 .400
Total 2.000 6
CPD (Continuing
professional
development) for
dental professionals is
up to date
Between
Groups
.700 1 .700 2.692 .162
Within Groups 1.300 5 .260
Total 2.000 6
Findings:
As per above computed table, the significance value for testing the hypothesis is 0.05.
However, if the value of outcome is less than significance value than alternative hypothesis will
be accepted and if it is higher than null hypothesis will be accepted.Herein, p value in case of
Practice staff is up to date and well informed about its Dental Audits and Dental surgery policies
is 1.000 which is greater than the significance value which is 0.05 indicates that null hypothesis
has accepted. Similarly in case of CPD (Continuing professional development) for dental
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professionals is up to date p value of 0.162 is greater than the significance value of 0.05 depicts
that alternative hypothesis has been rejected.
Interpretation:
From the above evaluation of ANOVA table it has been interpreted that, null hypothesis
has been accepted which means that employees quality is not dependent upon CPD and
awareness of dental surgery policies. There are several other factors which play crucial role in
affecting the quality of employees in terms of offering services to the patients. However,
constantly providing training and development sessions to the dentists will assist in improving
his/her knowledge about the current trends and technology with the help of which they treat the
dental problems of people in London in effective and efficient way. Therefore, just focusing on
continuous professional development or maintaining up to date information about dental audits
and dental surgery policies will not help in enhancing the quality of dentist. It is the need and
wants of individual patient and accordingly molding the treatment will assist in enhancing the
quality which leads to better quality of services offered.
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CHAPTER 5: RESULTS AND DISCUSSIONS
The previous chapter analyses the information that is assessed from primary and secondary
sources, however, the analysis part presents the specific results for the private dental practices
and related marketing. The secondary investigation done in the previous section assess that there
are various barriers to the marketing of private dental services. As per the secondary information
the major barrier is the lack of skill to market the services as well as the limited section of
marketing challenges. However, the interview results is too wide as compared to the available
reasons. The private dentists have revealed that personal barriers such as lack of skills in
business knowledge or experience to run a practice as well as the competition at national level
are another limitation for the marketing of private dentist. As per the study of British Association
stated that the online website of private dental clinics is the major marketing tool to provide large
valid information to the service users. However, most of the patients make use of internet for
their treatment purpose and getting relevant information regarding their issues. Here, it has been
found that 67.4% patients make use of internet who are attending the hospital dental clinics. The
primary investigation revealed that the patients are highly satisfied with the service quality of
private dental clinics.
Balance score card to measure the performance of a dental practice
The use of balance scorecard is witnessed among the health and social care industry that aims at
assessing the performance of heath and social care settings. In addition to that it helps in aligning
the business practices with the vision and strategy. The model have four perspectives for
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measuring the performance such as learning and growth perspective, business perspective,
customer perspective and financial perspective. In respect with the dental practice, the model can
be used for monitoring the performance of a dental practice as compared to the corporate goals.
The rational behind using balance score card to measure the performance of a dental practice is
its successful implementation of by public health sectors such as NHS and other boards of health
(Woodward et al, 2004). The balanced scorecard (BSC) was developed by the Ministry of
Public Health (MOPH) so as to regularly monitor the progress of strategy to deliver a basic
package of health services. However, a specific focus is to be given to the financial perspective.
The following balance score cared is designed for measuring the performance of private dental
clinics that represents the objectives of private dental practices.
Learning and growth perspective
Measuring the dental hygienist
Assessment of Dental nurse training
Business Perspective
Assessment of dental treatments
Assessing quality of products
Evaluating services provide by care provides
Checking out patients standards and
requirements
Latest technology initiatives products and
treatments.
Customer Perspective
Assessing patient’s satisfaction
Evaluating dental experience
Financial Perspective
Increase in revenues
Reduction in cost
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Confidentiality of data Improving profit ratio
Improving return on investment
Financial perspective
Table 11: Financial perspective
Key success factors Key
performance
indicators
Target Performance
level
Summary Action Plan
(Explanation)
Improve profitability
Return of
capital
Achieve maximum of
capital employed ratio
in upcoming financial
years
For a private entity profit maximization is
the foremost objective so that major
financial aim of private clinic should be
achieving profitability that can be done
through reducing the cost of service
provided to dental patients. The
achievement of this objective can be
measured through evaluating the Return
on capital.
Reduction in cost
Operating
profits
Reduction in operating
expenses
The improved operating profit is the
major criteria of assessing the reduction in
cost of services. The effective use of
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clinical equipment’s and machinery is the
major aspect of reducing the operating
profits. It enables company to use its
assets for income generation.
Increasing return on
investments
Return on
shareholders
fund
Achieve more growth
from the current rate
in upcoming financial
years
The major aspect of financial perceptive
of the private dental practices is to capture
more market share through business
expansion. Therefore, they have to put
lots of investment and higher return
getting on investments is the major aspect
of sound financial performance. There can
be said a major aspect of attract
stakeholders for
Increasing revenues
Continual
increase in
revenue
Achieving increased
revenues by reducing
cost and effective
marketing of private
dental care services.
Use of effective local advertisements and
social media initiatives are the major
aspects of marketing of dental clinical
service is the major attract patients
towards products
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CHAPTER 6: CONCLUSION AND RECOMMENDATIONS
6.1 Summary
The above discussion and analysis chapter depict that balanced score card is the most effective
method to measure the performance of private dental clinics. This is because it has been
successfully used by public health sectors as well as NHS. This way corporations operating the
same sector can easily meet the expectations of service users and provide them good experience.
The reason behind selection of balanced score card is to ensure continuous improvement in the
working practices of private dental care associations. It facilitates to enhance the level of
satisfaction among service users. On the other hand, marketing of services need to be done by
using effective mode. This in turn management of dental health care corporations can easily
bring improvement in the services.
The research conducted with service users depict that private dental clinics give rich experience
to services users and enhances their level of satisfaction. It enables them for repeat purchase and
refer the same services to other. Ultimately these have positive impact on brand image of such
type of clinics. Furthermore, there are number of people who directly prefer to make use of
services which are being provided by private dental clinics. It facilitates to create their
competitive edge. However, limitations regarding the marketing of services is the crucial barriers
in the rapid growth of private dental clinics.
On the basis of evaluation of dentist perspective, it has been found that the customers’
satisfaction can be improved through offering superior quality dental services. Customers are
highly sensitive towards services provided since it is related to their health issues. Further, it is
seen that the internal process does not significantly impacts the level of satisfaction among
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consumers. However, it is with efficiency in process that the business unit is going to deliver
highly proficient services. The quantitative analysis also indicates that the CDP and surgery
policies and practices are not only reasons for improvising skills of employees.
6.2 Evaluation of Results
The results depict that balanced score card serve as the most important tool to improve the
overall performance of private dental care services. Here, score card is based on financial
perspective where main emphasis will be laid on profitability, cost of production and return on
investment as well as overall revenue of the firm. Furthermore, corporation which are providing
dental services, also need to take care of cost of production. In this regard, the main aim of the
firms to increase the profitability but by providing good quality of services to ultimate users.
Similarly, balanced score card has standard related to reduction in the operating cost wherein
management need to work accordingly. In case variations are found in the actual and expected
results then necessary actions can be taken to reduce the same to a great extent. However, it is
very important for organization to lay emphasis on effective utilization of available resources.
This in turn efficiency will be increased and thereby will be smooth flow of production.
Furthermore, professionals views related to marketing of services can also be considered.
In this regard effective media can be used for promotion of products and services. At the same
time, it is also very important to focus on cost structure otherwise overall performance will be
hampered.
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6.3 Recommendations based on Evaluation
The evaluation of the study depict that private dental clinic can put effort to plan for the
promotion of products and services. Here, organization can use balanced score card in all
perspective for example learning of staff members or to assess the performance of firm in
financial aspect. The time line for the measurement should be decided in advance wherein all
aspects will be considered like rate of return and return on investment. Accordingly performance
should be measured thereby deviations can be found. It shows that company need to review the
performance on the basis of set time and accordingly bring improvement in overall working
environment.
Furthermore, effective method can be used to promote the services. For example lucrative
advertisement can be prepared to address different issues of service users. Furthermore,
management can also use social media where target audience can ensure interactive session with
service providers. Similarly, focus can also be laid on training of staff members. However,
feedback should be taken from services users and accordingly training can be provided to staff
members. This leads to improve service quality of private dental clinics and enhance the level of
satisfaction.
6.4 Future Work
Further research can be done on comparing the performance of private dental practices in terms
of marketing activities followed by them. With the help of this research, strategies of the private
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dental companies can be identified that how they are influencing the customers of the market.
Another research can be done on growth and development of private dental organization in
London that how this sector of health care has been developed and how effectively they are
offering their services in market.
CHAPTER 7: Personal Development
I am a dentist by profession. I studied dental public health and was always interested in non-
clinical dentistry which further pushed me to study an MBA to cover the marketing and HR
skills, which are required to run a dental practice or any dental public health organisation.
It was indeed a very enriching experience to study this MBA and the thesis helped me look at
dentistry in a new light as it would help me achieve my dream of running a dental practice with
a full awareness of the business administration side of things as well as be involved in health
organisations and be able to contribute to both clinical as well as the business functions of the
system.
Prior to competition of present research I was not aware of some of the management skills time
management and completion of task before time. Also, I was not aware of the use of balanced
score card in dental clinics. Furthermore, before conducting the study I did not not about the
growth of private sector in UK. After conducting study, I learned about time management
strategies. This is because I have completed the project before the time through which my time
management skills has been developed to a great extent. Furthermore, I also learned the use of
balanced score care in health care setting so as to bring improvement in the overall
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performance. The current study also affect my current level of knowledge regarding the health
care industry of UK in term of private dental practices.
REFERENCES
Amatraunga, D. et al. (2002) Application of the balance score card concept to develop a
conceptual framework to measure facilities management performance within NHS facilities.
International Journal of Health Care Quality Assurance, pp.141.
Blaxter, L, Hughes, C and Tight, M. (2010) How to Research. 4th ed. Milton Keyes.
Birchard, B. (1996) Where Performance Measures Fail’, CFO: The Magazine for Chief
Financial Officers, 12(10), October, pp. 36.
Broccardo, L. (2015) The Balance Scorecard Implementation in the Italian Health Care
System: Some Evidences from Literature and a Case Study Analysis. Indian Institute of
Health Management Research SAGE Publications, 17(1), pp.25-41.
Browning, L., Thompson, K. and Dawson, D., (2014) Developing future research leaders:
Designing early career researcher programs to enhance track record. International journals
for researcher development, 5(2), pp.123-134.
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Chang, L., Lin, W.S. and Northcott, N.D. (2002) The NHS performance assessment
framework: A balance score card approach. Journals of management in medicine, pp.345.
Comstock, G. (2013) Research Ethics: A Philosophical Guide to the Responsible Conduct of
Research. Cambridge University Press.
Creswell W. J. (2003) Research Design Qualitative, Quantitative, and Mixed Methods
Approaches. 2nd ed. SAGE Publications.
Creswell, W. J. (2012) Qualitative Inquiry and Research Design: Choosing Among Five
Approaches. 3rd ed. SAGE Publications.
Creswell, W. J. (2013) Research Design: Qualitative, Quantitative, and Mixed Methods
Approaches. 4th ed. SAGE Publications.
Cummings, T and Worley, C. (2013) Organization development and change. Cengage
learning, (10), pp.4-8.
Elo, S. and Kyngäs, H. (2008) The qualitative content analysis process. Journal of
Advanced Nursing, 62, pp.107–115.
89

El-Jardali, F., Saleh, S. and Jamal, D. (2011) Design, implementation and scaling up of the
balanced scorecard for hospitals in Lebanon: Policy coherence and application lessons for
low and middle income countries. Elsevier Ireland Ltd, pp.305-314.
Finstad, K. (2010) Response Interpolation and Scale Sensitivity: Evidence Against 5-Point
Scales. Journal of usability studies, 10(5), pp.104-110
Gao T. and Gurd B. (2014) Meeting the challenge in performance management: the diffusion
and implementation of the balanced scorecard in Chinese hospitals. Oxford University Press,
pp.234-241.
Grigoroudis, E., Orfanoudaki, E. and Zopounidis,C., (2012) Strategic performance
measurement in a healthcare organization: A multiple criteria approach based on balanced
scorecard. Elsevier Ltd, pp.104-119.
Gurd, B. and Gao, T., (2006) Lives in the balance: an analysis of the balanced scorecard
(BSC) in healthcare organizations. International Journal of Productivity and Performance
Management, pp.6-21.
Hajdíková, T. and Zelená, V. (2014) Performance Management: The Proposal of a Strategic
Scorecard’s map for the Hospital Industry. Kidmore End: Academic Conferences
International Limited, pp.111-117.
90

Jensen, M. (2002) Value Maximization, stakeholder theory, and the corporate objective
function, Business Ethics Quarterly, (12) 2, pp. 235-256.
Jakobowicz, E. and Derquenne, C. (2007) A modified PLS path modeling algorithm handling
reflective categorical variables and a new model building strategy. Journal Computational
Statistics & Data Analysis, 51(8), pp. 3666–3678.
Kaplan, R. S. and Norton, D.P. (1992) The Balanced Scorecard: Measures that Drive
Performance, Harvard Business Review, pp. 71-79.
Kaplan, S.R. and Norton, P. (1996) Translating strategy into action the balance score
method. Massachusetts: Harvard Business School Press Boston.
Kaplan, R. S. and Norton, D.P. (1996) Using the Balanced Scorecard as a Strategic
Management System, Harvard Business Review, pp. 76.
Kaplan, R and Norton, D. (1996) The balanced scorecard: translating strategy into action.
Harvard Business Press.
Kaplan, R and Norton, D. (2000) Having trouble with your strategy? Then map it. Harvard
Business review.
91

Kaplan, R and Norton, D. (2007) Using the balanced score card as a strategic management
system. Harvard Business review.
Kaplan, R and Norton, D. (2006) How to implement a new strategy without disrupting
your organization. Harvard Business review.
Kaplan, R.S (2010) Conceptual Foundations of the Balanced Scorecard, Working Paper,
Harvard Business School, Harvard University.
Koeck, C. (1998) Time for organisational development in healthcare organisations. British
Medical Journal, pp.1267.
Lo, B. (2010) Ethical Issues in Clinical Research: A Practical Guide Lippincott. Williams &
Wilkins.
Lovaglio, G.P. (2010) Model building and estimation strategies for implementing the
Balanced Scorecard in Health sector. Springer Science Business Media, pp. 199–212.
Lucas, M. (1995) Efficient Consumer Response in the Grocery Industry, Working Paper,
Department of MSIS, University of Auckland, New Zealand.
92

Mackay, A. (2004) A Practitioners’ Report Based on: ‘Shareholder and Stakeholder
Approaches to Strategic Performance Measurement Using the Balanced Scorecard’. CIMA: A
Practitioner’s Guide to the Balanced Scorecard.
Martinus, K and Hedgcock, D. (2015) The methodological challenge of cross-national
qualitative research: Comparative case study interviews in Australia and Japan. Qualitative
Research Journals, 15(3), pp.373-386.
Roller, R. M. and Lavrakas, J. P. (2015) Applied Qualitative Research Design: A Total
Quality Framework Approach. Guilford Publications.
Sherry, E. (2013) The vulnerable researcher: facing the challenges of sensitive research.
Qualitative Research Journals. 13(3). pp. 278-288.
Vogt, W. P., Gardner, C. D. and Haeffele, M. L. (2012) When to Use What Research Design.
Guilford Press.
93

Vardangalos, G and Pantelis, A. (2000) An adaptable performance system based on the
balanced scorecard approach for measuring performance of individuals and groups in a
business environment. Electrotechnical Conference, (2), pp 729-732.
Yin, K. R. (2013) Case Study Research: Design and Methods: Design and Methods. SAGE
Publications.
Online
Research Methodology. 2008. [Online]. Available through: <https://explorable.com/research-
methodology>. [Accessed on 2nd November 2015].
Preliminary Research Steps. 2015. [Online]. Available through:
<http://www.uniteforsight.org/research-methodology/module1>. [Accessed on 2nd November
2015].
Research Conversation. 2015. [Online]. Available through:
https://researchdesignconnections.com/. [Accessed on 2nd November 2015].
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Appendix 1
DATE:
Dear Respondent,
I am currently conducting research into performance measurement of marketing of private dental
practices. It is a partial fulfilment for completing my MBA degree from University of
Sunderland
This questionnaire forms part of a research project to find out whether the marketing tool helps
to measure the marketing of a private dental practice. Your responses are important in enabling
me to obtain full understanding as possible of this topic. If you do decide to take part, the
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questionnaire should take you about ten minutes to complete. The information you provide will
be treated confidential.
Your answers from the questionnaire and others will be used as the main data set for my research
project for my degree in Masters in Business Administration at the University of Sunderland in
London. However, your decision to take part is voluntary but will be highly appreciated if you
kindly participate.
Yours faithfully,
Aloka Pagrut
Questionnaire for Performance measurement of marketing of private dental practices.
Please note the information will be treated confidential.
Customer Perspective
1. We are providing adequate service to our patients
Strongly disagree --- 1 --- 2 --- 3 --- 4 --- 5 --- Strongly Agree
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2. Increasing patient satisfaction will increase uptake of dental treatments
Strongly disagree --- 1 --- 2 --- 3 --- 4 --- 5 --- Strongly Agree
3. You listen to and learn from your patient’s.
Strongly disagree --- 1 --- 2 --- 3 --- 4 --- 5 --- Strongly Agree
4. The services provided by the dental practice meet or surpass patient’s
expectation/satisfaction/
Strongly disagree --- 1 --- 2 --- 3 --- 4 --- 5 --- Strongly Agree
5. In order to sell the more dental services what should we be doing from our patient’s
perspective? (Open ended)
6. What is our differentiating value proposition to our targeted patient’s? (Open ended)
Internal Business Process Perspective
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1. Patient exclusive needs are being identified by the practice.
Strongly disagree --- 1 --- 2 --- 3 --- 4 --- 5 --- Strongly Agree
2. You are utilising innovation to improve internal processes to keep the dental practice moving
forward.
Strongly disagree --- 1 --- 2 --- 3 --- 4 --- 5 --- Strongly Agree
3. Patient needs are being met
Strongly disagree --- 1 --- 2 --- 3 --- 4 --- 5 --- Strongly Agree
4. Organisational Development comprises of leadership, teamwork and setting of standards to
establish coherent teamwork and clarify roles and responsibilities which makes data
available, and aids in understanding indicators of performance.
Your practice is currently using the Organisational Development approach.
Strongly disagree --- 1 --- 2 --- 3 --- 4 --- 5 --- Strongly Agree
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5. Which process according to you is most critical for satisfying patients and shareholders in
a dental practice? (Open ended)
6. What do you need to excel at in order to deliver great service? (Open ended)
Learning and Growth Perspective
1. Systems and patient details are up to date (medical histories, dental histories, contacts
etc.)
Strongly disagree --- 1 --- 2 --- 3 --- 4 --- 5 --- Strongly Agree
2. Practice staff is up to date and well informed about its Dental Audits and Dental surgery
policies.
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Strongly disagree --- 1 --- 2 --- 3 --- 4 --- 5 --- Strongly Agree
3. CPD (Continuing professional development) for dental professionals is up to date
Strongly disagree --- 1 --- 2 --- 3 --- 4 --- 5 --- Strongly Agree
4. Do you feel increasing employee quality will provide high quality dental services as well
as decrease costs. (Open ended)
5. How will we know if we’re trained and ready? (Open ended)
Appendix 2 : Interview guiding questions for Professionals
1. Do you agree that balanced scorecard is the effective tool to measure the performance of
dental practices?
2. What are the limitations of marketing of a private dental practice?
3. What are different factors that affect financial performance of dental clinics in London?
4. What improvements can be brought to the private dental practices?
5. What are different ways through which dental clinical practices can be improved?
6. What are different measure can be used by health care professionals to market private
dental practice?
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Appendix 3
Questionnaire for patients / Service users
Do you prefer private dental care services?
 Yes
 No
Do you think that dentists at the practices are skilled and experienced?
 Yes
 No
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How was your last experience in private dental clinic?
 Excellent
 Satisfactory
 Moderate
 Dissatisfaction
 Worst
Are you satisfied with service quality of private dental clinic?
 Highly satisfied
 Satisfied
 Neutral
 Dissatisfied
 Highly dissatisfied
What is the most important factor while accessing services of private dental clinic?
 Quality of services
 Experienced staff
 Cost of services
 Waiting time
 Other
Do you agree that private dental clinic market for the dental practices effectively?
 Strongly agree
 Agree
 Neutral
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 Disagree
 Strongly disagree
Which is the most important source of getting information regarding dental practices?
 Internet
 Friends and family
 Local newspaper
 Other
Do you agree that private dental clinic ensure inclusion of highly updated technology and proper
facilities?
 Strongly agree
 Agree
 Neutral
 Disagree
 Strongly disagree
In what terms private dental clinic are better than public dental services?
 Highly qualified staff
 Technological updation
 Quick response
 Good environment
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Appendix 4
FEEDBACK SHEET – Aloka Pagrut (29/07/2015)
Feedback on Project Proposal:
Quality of the Strategic Project overview and objectives
This dissertation proposal is well presented with minor lapses in grammar and spelling, and some severe issues in
referencing which is not in-line with acceptable academic code of practice (!), all in all it is nonetheless in a good,
readable style with overall acceptable format. There is a reasonable rationale why this research on employee
retention should be undertaken. While the researcher introduces possible obstacles to some extent as well, the
reader gets quite a few times the feeling that personal (potentially biased, positive) opinion impacts on features
discussed and language expression, the student needs to carefully revise this for the dissertation. Also the way of
writing should be neutral (do not use “we …” or “I love …”).
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The aim and objectives are quite simple (and seem to be a bit broad first) giving the researcher plenty of scope
with the subject area but are quite focused in their intention of what is important – this should be further
supported by research questions. However, the number of objectives should be limited to a maximum of four.
Literature review synopsis and methodological synopsis
The literature review is well presented at the beginning but tends to become more vague, the range of books and
journals used to underpin the theoretical foundation for the research is not strong enough. There is some
understanding of the theory indicated. However, several times only the positive attributes of a theory or factor are
discussed and it seems as if the researcher brings in her own opinion already in this early stage, there is only little
indication what kind of pitfalls a theory or procedure brings along. Also on the one hand the overall literature
review could have been a more consistent text body or the paragraphs better linked. On the other there is a
generic logical structure visible.
Same case with the methodology, all in all well presented but limited at times e.g. research philosophy. This
research design seems not fully justified, for example the choice of the interview sample from experts and clients
should have been systematically justified or at least more critically discussed. The time schedule and milestones
are not outlined sufficient enough to be assessed, the student needs to review and develop this further.
The major recommendation while continuing to carry out this research project is not to bring in the researcher’s
own opinion and retain a neutral view on the industry. Overall, this is still a reasonable piece for a dissertation
proposal which with a little more care could have been much better.
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PGBM73 MBA DISSERTATION MODULE – Assessment 1
PROJECT PROPOSAL- 20% of Final Dissertation Module Mark
Candidate Name: Aloka Ashok Pagrut
Study Centre: University of Sunderland (London Campus)
Enrolment Date: Jan 2015 Registration number: 149139304
Project Title: Performance measurement of marketing of private dental practices.
Hand in Date of Proposal: 23/07/2015
Project Background:
Rationale for selection – importance and potential impact of the strategic project for an
organisation or business sector. Word Guide 500-750
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NHS dental service in England provides a very basic standard of care.
With the rise in the number of dental insurance policies and the broad options available patients
are seeking private dental care which is known to provide better treatments and materials.
With the increased demand of private dental care there are challenges with one-third dentists
believing that the dental market in their area is overcrowded. (BDA, 2013). In a report by British
Dental Association published in 2012, the BDA investigated how well the dentistry market was
working in the UK, it revealed that dentists were known to face personal barriers like lack of
skills in business knowledge or the experience to run a practice. Lack of experience in staffing
and employment-related difficulties were also some of the problems faced. About 12 per cent of
the dentists also referred to difficulties linked to the local dental market such as competition from
other corporate dentists (BDA, 2012). It is also seen that the success of the dental market
depends on its customers which are the patients as well as the doctor patient relationship, a study
showed that the majority of patients who had attended a private dental clinic found a high level
of satisfaction with the way the dentist communicates and the way costs were explained (Kemp
et al, 2012).
This paper investigates the entrepreneurial part of dental specialists in essential consideration
dentistry. It surveys the changes in dentistry. It recommends that this new setting will strengthen
the need to consider the business side of dental practice, specifically, the significance of value,
innovativeness and development, close by the significance of addressing the needs of patients.
An entrepreneurial methodology will be needed to manage dental practice in an inexorably
competitive environment.
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An entrepreneurial part is progressively critical in essential private dentistry, given the approach
shift towards semi markets, rivalry, new contracts, and patient decision. It is significant paying
little respect to whether it is in a private or NHS dental practice. The entrepreneurial part
includes 'the procedure of starting a business endeavour, sorting out the vital assets and
expecting the related dangers and rewards'. In dentistry the procedure may include, for instance,
the further advancement of the practice, a merging of practices, or the start-up of another
practice. Entrepreneurship in dental practice may be conceptualized as a common movement, as
opposed to the area of the individual dental specialist. This may be especially suited to bigger
practices where the entrepreneurial or administration part can't be attempted viably by one
person.
This paper has investigated the part of the business person in the connection of dental practice in
the UK. It has been recommended that “ In the undeniably turbulent and focused environment
business firms confront today, a kind of entrepreneurial pioneer unmistakable from other
behavioral types of initiative is needed” (Willcocks, 2012)
Nichols and Hassall in 2011 in their study examined the quality and substance of dental practice
websites by developing a review structure in view of regulations, direction and expert
knowledge, and applying this system to a random sample of UK dental practice websites. Given
the increasing popularity of technology, it could be assumed that a large proportion of dental
patients use the internet regularly. It was seen that 67.4% of a sample of patients attending
hospital dental clinics were using the internet on a daily basis (Ni Riordain and McCreary, 2009).
Dental practice sites that do exist don't follow current regulations. The way that a quarter of the
sites in the study wrongfully promoted Botox to patients which is a stressing measurement, these
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dental practitioners are pointlessly abandoning themselves open to indictment. Legality of some
advertised treatments is also questionable British Dental Association considers that a practice
website is a ‘vital marketing tool’.
From the current situation and research we can see that the dental market lacks the right
marketing activities. There is a need to understand the dental, patient and legal perspective. For
those involved in setting up of dental practice websites should be mindful of an extensive
regulations and guidelines, and should seek legal and expert advice on substance of advertising
so as to maximise the marketing of the practice. There is a need for more research and
understanding of how to market a dental practice for which first an assessment tool would be
required to measure the performance of a practice and to recognise its limitations. This topic
interests me as I am a dentist and in the future these would be useful skills to manage a dental
practice or apply this approach in a healthcare setting or industry.
Literature Review:
Identification of the key aspects of the business literature (e.g service quality) to be underpin the study. This
review should briefly cover the main ideas and business practice that will be considered. It should locate a
sample of the some of the main sources and identify key critical issues that might arise. – Word Guide 750 –
1000.
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To assess the success or failure of a practice we would need to develop a measurement tool
which could be adapted to measure the performance of a private dental practice. Our strategic
objectives of measuring performance of the company has to be translated into tangible goals and
actions with a set vision and strategy.
Kaplan and Norton’s innovation the Balanced score card has been used extensively in business,
industries and non-government organisations. It helps align business activities to the vision and
strategy. It could prove to be useful in monitoring performance of a dental practice against its
strategic goals. It gives a balanced view of important performance measures. It not only helps in
the measurement of a system but also the management of a system. It is an important aid in
translating the strategy into action.
It measures four perspectives the first one is the learning and growth perspective, the second is
the business perspective, the third is the customer perspective and fourth the financial
perspective.
In relation to a dental practice performance measurement these four perspectives are of utmost
importance.
The Learning and growth perspective in a dental practice could be important in measuring the
dental hygienist and dental nurse training. Knowledge, experience and growth in learning of
staff.
The Business Perspective could look at the internal business processes like do the dental
treatments, products and care provides are up to the patients standards and requirements. Is the
dental practice up to date with the latest technology, products and treatments.
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The Customer Perspective here would focus on patient’s satisfaction and the overall dental
experience with the practice which is the management, the hygienists and the dentists.
The Financial Perspective deals with the clinics financial data, this data could be treated
confidentially.
Balanced score cards have frequently and successfully been adapted by public health sectors as
well as NHS and other boards of health (Woodward et al, 2004). The balanced scorecard (BSC)
was developed by the Ministry of Public Health (MOPH) to regularly monitor the progress of its
strategy to deliver a basic package of health services. It proved to be enabling managers to
monitor performance and successfully identify strengths and weaknesses in the system. (Peters et
al, 2007).
Studies show that balanced score card could be used in various sectors. It is seen to be extremely
relevant to health care. These positive conclusions from the studies could be very useful in
creating a balanced score card for a dental practice with perspectives like quality of care,
outcomes and access (Zelman et al, 2003).
Objectives:
Identify 3-4 objective outcomes from the project in terms of what the project seeks to achieve for the organisation
or business sector. These objectives should reflect outputs not tasks to be completed and should emphasise the
areas for improvement to business performance the project will concentrate on.
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Objectives:
- To critically evaluate the limitations in marketing of a private dental practice.
- To develop a balanced scorecard to measure the performance of a dental practice.
- To investigate the current literature.
- To identify gaps in the functioning of strategy and its delivery and make
recommendations for the same.
Methodology:
Candidates should include a brief statement as to what they consider the main methods of primary and secondary
research are likely to be the most useful to achieving the project outcomes - Word Guide 300.
The Epistemology orientation used in this research will be adapted using Hybrid philosophies.
Objectivism associated with a positivist approach which analyses patterns and relationships as
well as measurement of different social facts and phenomenas. The positivist approach would be
useful in analysing the data quantitatively and measuring performance of the dental practice.
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However to perceive the thought process and attitude of the dentists there would be a need to
adapt a Interpretitivist approach which considers research is value bound and what is being
researched is a function of a particular set of circumstances and individual conditioning.
These research philosophies could also be termed as Pragmatic since ultimately the aim is to
understand and measure the performance no matter what approach is adapted.
The Methodical choice used in this research would be a Mixed method qualitative and
quantitative design of data collection and analysis measuring performance in a mixed approach.
The strategy used is a survey in the form of interviews.
Time Horizon for this study will be cross-sectional based on strategies such as a survey
(Saunders and Tosey, 2013).
Techniques and procedures Data collection and analysis. Collection techniques and analysis
procedures are varied utilising qualitative data and quantitative data, data will be collected
through in depth interviews, analysed as narratives.
The sample size for this research would be 6-8 private practitioner dentists, also a group of 10-15
dental patients will be interviewed. These interviews will be used to collect our primary data.
The nature of interviewing is qualitative and quantitative; useful information can come from a
few or even a single interview. Well-judged selection of a small sample of variables can channel
answers alternately in other rarely-used ways through the questionnaire. Also we have no budget
and a small time frame for which it is not realistic to use a large sample.
This research requires to be built up by productive associations with respondents and through
hypothetical thought to address the exploration issue inside and out. In this manner even a small
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sample size of cases will encourage close relationship with the respondents, and upgrade the
validity of in-depth survey interviews in dental settings (Crouch, 2006).
Validity of the study will help determine if the research truly measures the performance of the
private dental practices. The research instrument which is the balanced score card here should
help to analyse the research question. The validity will be determined by asking a series of
questions, and will often look for the answers in the research of others and literature review.
The methodology of this research uses a Survey, surveys are descriptive, predictive, help in
recording observations and the adaptation of a new developed score card in this research based
on the balance score card, when all these factors combined makes the research high in External
validity.
The Construct validity in this research is high since variables which is the dentists included have
the same interest. The Balanced score card increases the Content validity since it would be
adapted to measure the concept of the study.
Also the balanced scorecard being previously used as a successful measurement tool in
healthcare setting increases the Criterion validity of the study.
However the Internal validity will be low in the study as we do not have any controlled settings
and have a high external validity.
The study has the potential to have a good Reliability as it has been reproduced under a similar methodology in
NHS research and other health care settings to measure performance and thus the balanced score card, the
instrument is considered to be reliable.
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Also consistency of results is extremely important in reliability, Internal consistency in this study will increase
when different questions would be used in the survey to measure the same construct to analyse the consistency of
the results.
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