Nimet Emel Luleci  ( Marmara University, Istanbul, Turkey. )
Hatice Nilay Gemlik  ( Marmara University, Istanbul, Turkey. )
Gulfer Bektas  ( Acibadem University, Istanbul, Turkey. )
Yagmur Manioglu  ( Health Care Manager, Istanbul, Turkey. )

Objective: To evaluate the perspective of private hospitals regarding experience innovation.
Methods: The qualification-type study was conducted in Istanbul, Turkey, in February 2015, and comprised 17 hospitals where patients and employees were interviewed using a semi-structured consultation guide. The employees were examined regarding the meaning of innovation, awareness of experience innovation and its measurement. The patients were asked about the reason for choosing a hospital, the actual reason for arrival at the hospital and the impressions while leaving the hospital. Based on the obtained answers, experience innovation was examined.
Results: Of the 87 subjects interviewed, 51(59%) were patients and 36(41%) were hospital employees. Overall, there were 61(70%) women and 26(30%) men in the age range of 21-75 years. It was observed that the tendencies of hospitals for innovation activities were high, but they confused it with novelty.
Conclusions: Investments made without taking experience innovation into account do not convert into targeted results.
Keywords: Innovation of experience, Private hospital, Creativity, Novelty. (JPMA 65: 1108; 2015).


Introduction

Hospitals are complex structures which are chaotic and require large investments. At the same time, in these structures, which should be competitive, quality standards are rather significant. Innovation is required in order to improve the capabilities for meeting the expectations of the patients, provide sustainability for the hospital to compete.
Innovation is presentation of a product, process or implementation, which are new for the business operations and the market. The particular innovation types frequently mentioned in the literature are product, process and service innovations. The innovation of experience is also included as the subtitle of the service process.
Innovation is not an invention and is defined in various ways. Innovation is derived from the Latin word "innovatus" and is defined as "initiation of new methods in a social, cultural and administrative environment".¹
According to the Organisation for Economic Cooperation and Development (OECD) definition, "Innovation is implementation of a product, good or service or process; of a marketing method, which is new and significantly changed; or implementation of a new organisational method in business implementations, business organisations or external affairs".
Innovation is defined as implementation of the ideas that create value,² development and rapid introduction to the market of the new products and services which create awareness.³
And, according to Christopher Freeman, "Failure to innovate means death."⁴
Within the increasing competitive conditions of today, the business operations have to innovate continuously in order to precede their existence.4 Authors claim that innovation is the key of competition for hospitals.^5,6
A proactive approach is important for meeting the requirements of patients.⁷ Many factors such as the speed of responding to such requirement, service quality, design, and development of new services, new administration and organisation models require innovation.¹
The reasons for innovation inside the hospital include recognition as a novelist and to be able to sustain such recognition, holding a wide product range enabling selection among options, having the hope and will for increasing the profit, holding the morale high in business operation and capability of creating organisational environments suitable for creativity and more novelty.⁸
It is stated that through innovation, economic growth and development of countries could be realised, the life quality can be improved and the competition power of the hospitals will increase.⁹
Eight types of innovation have been defined. There are new product innovation, disorderly strategic innovation, implementation innovation, process innovation, marketing innovation, business model innovation, structural innovation and experience innovation.¹⁰
The experience innovation is the impression left on the patients while using available products or presented services. This effect may be a neutral effect and also involves ordinary new experiences which fascinate the patients.
For instance, while it is expected that a mammography device which shoots in a shorter time should serve a more shorter time service, any rude attitude from the technician or lack of interest in the patient creates a negative effect on the profile of the service receiving party and as an innovation of experience for service receivers highlights the attitude towards them. For the hospital, the investment does not clearly reflect on the patient.
A hospital is an institution where health services are rendered and the patients are hospitalised when required. Hospital services rendered in the past by religious organisations and volunteers are today rendered by health professionals such as physicians, surgeons, nurses, midwives and pharmacists.
As required by the nature of the health services, the smallest mistakes may create dangerous results for human life.¹¹ At first glance, this situation creates the perception that the implementation of innovation in hospitals would be difficult. However, efforts for integration of continuous improvements in medical science into diagnosis, treatment and rehabilitation processes bring together the innovation. Besides, it is seen that hospitals, as the places where many more activities take place as a component of the diagnosis and treatment procedures, such as hospitality, food, technical services, education and patient registration, are big business operations in order to implement innovation.
When the transformation programme in health in the present century is examined, legal regulations and SSI (Social Security Institution) agreements create a severe competition area by turning the reasons such as prolongation of life time of society, increase in the number of chronic patients and high number of hospitals into large investments by the health providers. High competition level in the health sector, improvement of technology, implementation of high quality standards, increase of access to health services, easy access to information for health service receiver and improvement of the area of health management make the innovation of experience in health services.


Subjects and Methods

The qualification-type study was conducted in Istanbul, Turkey, and covered and covered 17 hospitals out of 28 categorised in group A by the relevant authorities.¹² Health professionals and patients were interviewed using a semi-structured consultation guide as providers and receivers of service. The employees were examined regarding the meaning of innovation, awareness of experience innovation and its measurement. The patients were asked about the reason for choosing a hospital, the actual reason for arrival at the hospital and the impressions while leaving the hospital. Based on the obtained answers, experience innovation was examined.
While preparing semi-structured questions, ideas were sought from three academicians who were not part of the study.
Health professionals included physicians, nurses and health managers.


Results

Of the 87 subjects interviewed, 51(59%) were patients and 36(41%) were health professionals. Overall, there were 61(70%) women and 26(30%) men in the age range of 21-75 years.
Major findings from private hospitals were as follows:
A hospital mentioning that it rendered service of international standard and quality defined itself as a green, nature-friendly hospital that was self-productive and emphasised that it provided the services of birth photographs, hotel agreements for accommodation of patients\' relatives, accepting patients merely for the daytime and home care services.
Another hospital provided robotic surgery with conscientious and ethical approach and tried to break the hospital\'s perception by designing the hospital as a shopping centre (Date of establishment: 1989).
One hospital stated that it had arranged a playground for children, phone messages were sent to the patients on special days, a whirlpool bath was installed in patients\' rooms, stewardesses accompanied patients in polyclinic service and distributed flowers on Women\'s Day (Establishment date: 1997).
Another private hospital enumerated innovation implementations like calling the discharged patients by phone, smiling faces in the free car parking area, care-giving consultants, sedative decorations, five star hotel service, unlimited internet and implementation of optional menu (Establishment date: 1985).
One private hospital talked of innovations in terms of long-term employment of physicians, baby photo album arrangements, pregnancy training, free mammography in cancer week, free scanning for Women\'s Day, post-natal hairdressing services and informative web pages (Establishment date: 2002).
Another hospital stated that it organised classical music concerts for patients receiving chemotherapy with a contracted high school. (Establishment date: 1992).
One hospital counted innovation implementations like calling the discharged patients within two weeks, calling patients to remind them of their appointments, not using the word "no" in the hospital, arranging a foreign language class for nurses, frequent use of brochures for information, discharging patients using wheelchairs to make themselves feel special, publication of the photo of the newborn babies on their web page and delivery of the babies in the room. (Establishment date: 1991).
One hospital, active under a charity, stated that every job is everyone\'s job and when the patient arrives at the emergency room his/her clothes are cleaned and returned at the time of discharge. (Establishment date: 1989).
Another hospital, executed the logic that "Every complaint is a gift". As such, complainants were appreciated as "they are our guests". (Establishment date: 1996).
Major findings obtained from 51 patients in the study were:
"Since the prices for examination, investigation etc. are affordable, I prefer this place. I am satisfied with the attention paid to patients. They have smiling faces. They text us on special days. They follow-up my treatment and remind me of my appointments."
"I trust my physician, and I will go to the hospital where my physician moves. My physician merely requires the examinations that are really necessary. Furthermore, this hospital also cares about sanitation and hygiene. It is generally clean."
"It has good accessibility. Despite the fact that its charges are high, I prefer to come here. In any emergency, I can easily get here. The attention paid to patients is also good. A personnel accompanies me throughout every process until I leave the hospital. They pay attention to me and help me in completing the formalities easily."
Evaluating the main points, it is seen that hospitals with no awareness of experience innovation are preferred because of hospital fee, affiliation to the physician and credibility, attention given to them, hygiene and easy accessibility.


Discussion

In the hospital sector, the significance of technology is constantly emphasised, but the effect of the implemented technology on the patient is not understood so clearly. The innovation of experience comes to fore at this point.
Despite serious investment plans, large budgets and financial resources, it is seen that this does not reflect on the profile of the service receiver correctly. This study shows that in sectors, such as hospitals, where the purpose of profit is essential but secondary, by determining the requirements correctly, a small added value does not require large investments.
Hospitals do not define these novelties as innovations and are not aware of innovation and they merely conduct studies for increasing the number of patients. If studies are conducted on experience innovation, the actual needs of the patients would be determined and due differences would be made where it matters. In our study, for example, reluctant attitude of the nurses while providing music for the patients during chemotherapy caused a meaningless environment for the patient.
Partial image quality is recognised by the patients, but not by hospitals. Helping the patient leave a hospital with a positive image is vital.


Conclusion

Investments made without taking experience innovation into account do not convert into targeted results, and the receivers of service do not necessarily get influenced by lavish expenditure if it does not add value to the quality of service.
Conflict of interest: There is no conflict of interest.



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