Management by processes for the satisfaction of service consumers

Summary

Process management and, in particular, its improvement is a fundamental element to guarantee business success today, with different methodological criteria to guide an organization to its achievement. The present work was developed with the aim of sharing elements that contribute to raising user satisfaction from the introduction of process management. The research carries out a detailed bibliographic study of the subject of customer satisfaction and process management.

Introduction

In the last decade there has been a general increase in interest in quality, both in industrial organizations and in service organizations. This interest is reflected in the increasing involvement of the scientific community in the investigation of quality issues, in the widespread implementation of quality techniques such as total quality management systems and the creation of teams. of quality and customer service programs among others. In general, it can be stated that the main objective pursued with this interest in quality is customer satisfaction and efficiency in achieving that satisfaction (adequate use of organizational resources) in order to maintain or increase business competitiveness.

The organizational benefits derived from the supply of quality products (consumer goods and services) are the assumption on which the investment of great economic and human efforts in achieving it is defended. There is a broad consensus regarding the benefits of a quality-focused business policy. Its effects on maintaining or increasing market share and customer loyalty to a brand or product are usually highlighted (Johns, 1996, p.9).

Quality management is related in a complementary way to cost control, level of benefits and direct advertising between clients (Buttle, 1996).

Service companies have a high relevance in local and regional economies, becoming this defining tertiary sector in the economic structure of any country, and especially in those impoverished or developing as those of the South American region where they generate high volumes. Formal employment and for its diversity, massification and impacts on societies, its correct orientation to the needs and requirements of consumers is a necessity.

Due to the aforementioned elements, the general objective of this work is defined as sharing elements that contribute to raising user satisfaction from the introduction of process management.

Development

There is frequent talk of the need to target companies to customers, not products. In the case of sanitary facilities, this orientation is towards service, promoting activities and new services with the aim of keeping the facility alive and maintaining a good level of supply. This is important, but the process should take into account the figure of the client and with it their needs, because if a client is interested in a company, with the information we offer, we are making above all a "promise of value »That we should fulfill (Perea, 2014).

In this sense, we should keep in mind that there are many marketing strategies that are perfectly applicable to the company under study, as long as the criterion that with the service provided, customers seek to improve their health status is prioritized.

Strategic marketing seeks to know what are the current and future needs of consumers, analyzes the market evaluating the possibility of venturing into new niches, identifies segments, guides the business in the possible opportunities offered by the environment and adds value to the product or service to achieve price compensation. The company must carry out a continuous analysis of the variables that intervene in the market, to formulate the necessary strategies considering its resources and its capacity to offer a competitive advantage.

1.1 The nature of service marketing.

For a better understanding of the nature of service marketing, it is necessary to analyze the services together with their definition and characteristics. The service according to Hernández-Bravo (2014) is defined as all those identifiable and intangible activities that are the main object of an operation that is conceived to provide satisfaction of consumer needs.

On the other hand, according to the definition of García-Muñoz (2003), this can be defined as any act or function that one party can offer to another, which is essentially intangible and does not result in any property. Its production may or may not be linked to a physical product.

However, a universally acceptable definition of services has so far not been achieved. However, the author of the present investigation considers these definitions as valid, focusing her analysis fundamentally on their qualities or characteristics beyond their definition. The following stand out as fundamental characteristics:

• Intangibility: Services are essentially intangible. It is often not possible to like, feel, see, hear or smell services before purchasing them. The customer can be given something tangible to represent the service, but in the long run the purchase of a service is the acquisition of something intangible, from the above it follows that intangibility is the definitive characteristic that distinguishes service products. Frequently services cannot be separated from the person offering them. A consequence of this is that the creation or realization of the service can occur at the same time as its consumption, be it partial or total. Goods are produced then sold and consumed while services are sold and then produced and generally consumed simultaneously,this element also shows its inseparability.Heterogeneity: It is often difficult to achieve standardization of production in services, because each «unit» of service provision may be different from other «units». Furthermore, it is not easy to ensure the same level of production from the point of view of quality. Likewise, from the point of view of customers, it is also difficult to judge the quality prior to the purchase in a homogeneous way. Capacity not used today cannot be sold tomorrow, contrary to what happens with tangible goods that can be stored. Property: Lack of property is a basic difference between a service industry and a product industry,because a client can only have access to use a certain service. Payment is made for the use, access or lease of certain elements. (García-Muñoz, 2003)

Another of the characteristics of the service lies in its nature, which allows determining the elements that have the greatest weight in the service and thus guide improvement actions. If the service is focused on people or people's possessions and what kind of actions are exercised on the above. Those actions can be tangible or intangible and can be oriented as described below (Mediavilla Saldaña, 2008):

• Targeted to physical customers: it requires greatly the action of one or more assets on people. The physical presence of the client is necessary to receive the service. Oriented to the minds of the clients: unlike the previous one, the physical presence is not necessary and the actions are prominently intangible. They focus more on the minds of the client and therefore allow the presence of the client to be dispensed with. A training can be received in a physical facility or be received remotely through the Internet. Oriented to the physical possessions of the clients: it does not need the client to be present, but the physical possession of the client. For example: the laundry service. It requires the garments, but not the presence of the client to be able to lend it.Oriented to clients' intangible possessions: direct client participation is not necessary in all cases. An example of this can be legal service where the client makes her request and presents information. The process can continue without the presence or participation of the client. (Melara, 2013)

On the other hand, following the criteria proposed by Lovelock (1984), there may be other categories of analysis that characterize the actions to be taken to improve services with a marketing approach:

• The nature of the service. It is distinguished in who or what receives the service and in whether or not it has visible consequences. The type of relationship. The service relationship can be formal or informal, and it can be a continuous or discretionary relationship. The singularity of the provision. The service can be carried out individually or collectively and with different levels of adaptation to the client. The nature of the supply and demand. There are different types of services depending on whether the temporary fluctuation of demand is high or low and depending on whether the offer adapts immediately or not to variations in demand. The way of supplying the service. The service can be performed in one or more places and distinguish between whether it requires the displacement of the consumer or the service provider.

If the service is seen from a marketing point of view, both goods and services offer benefits or satisfactions; both goods and services are products.

1.1.1 Strategies for better management in the marketing of services.

Service marketing management offers multiple opportunities to enhance customer interest in organizations. In various literatures it is possible to identify strategies to be taken into account by any service company that intends to develop improvements to its processes to increase consumer satisfaction. These strategies have been developed based on the characteristics of the services mentioned above. Some of these strategies will be discussed below:

• Making the service tangible: The problem of the intangibility of services must be solved by developing objects or goods that represent them, that is, bringing them as close as possible to being tangible. In this way, it facilitates the association of the service for the consumer and contributes to its greater success. Identify the service: It is important for the company to ensure that the service it offers is perfectly identifiable by the consumer and that there are differences with the competition. For this there is the name or brand of the service, which the company must ensure that for the client is an easy name to distinguish, remember and value. The name and brand of a company often coincide, but we must distinguish these two concepts. The trademark includes the name, but also adds symbols, colors and slogans,so that these elements convey the message that is intended to be given to users. Another way to bring the service closer to the consumer and get them to identify it through associating a known character with the service. Fixing the price based on the value received: According to Santesmases-Maestre (2012), three strategies can be established when setting the price of services taking into account the value that the service represents for customers. These strategies are based on satisfaction, relationships and efficiency. Satisfaction-based strategies aim to reduce consumer uncertainty, either by guaranteeing service or refunding the price if the customer is not satisfied. prices are based on the offer of the most advantageous prices for the client,in such a way that they manage to maintain long-term relationships with them. Efficiency strategies consist of sharing with the customer the cost reductions obtained with the aim of offering value to the customer. Carry out cross-selling: The concept of cross-selling is offer two or more products together, so that the global price of the two together is less than their price if they were offered separately. In order for an organization to obtain the highest profitability from a cross-sale, it must meet several requirements: guide the organization's activity to satisfy customer needs; have qualified and properly trained personnel to successfully cross-sell; encourage this activity;be able to obtain adequate information from customers and maintain good communication between employees and customers.Use personal promotion means: For this strategy it is essential to rely on personal sales and personal communication media, since personal communication with customers is the most effective way to promote the service. Differentiate by quality of service: An organization will ensure that the service it offers is more valued by the consumer when it manages to differentiate its quality. This is difficult to achieve since it is a very subjective and complicated measure. As service quality is a multidimensional and highly complex phenomenon, we can mention several attributes among which we highlight: reliability, agility, responsibility, competence,accessibility, courtesy, communication, credibility, security, etc. Therefore, it is concluded that quality is a very important objective that companies must achieve, since the fact of not achieving it can mean for the company loss of customers, increase in costs and reduction of benefits caused by errors.Create a solid corporate image: It is based on guiding the marketing of the company towards the consumer, on deepening the knowledge of the opportunities and threats of the environment and on focusing on the opportunities and weaknesses of the company. In this way, the company seeks to differentiate itself from the competition by adapting its services to market demand. "Industrialization" of the service: The industrialization of services can be achieved in three ways:by substituting people for tools that carry out the provision of the service; by replacing personalized service systems with planned and standardized systems; by combining equipment with systems. Service Singularization: It means for the company to adapt the services they offer to the needs and preferences of consumers in an individual and personalized way, so that the client perceives the service as exclusive to him. (Di Pierri D, 2014)It means for the company to adapt the services they offer to the needs and preferences of consumers in an individual and personalized way, so that the client perceives the service as exclusive to him. (Di Pierri D, 2014)It means for the company to adapt the services they offer to the needs and preferences of consumers in an individual and personalized way, so that the client perceives the service as exclusive to him. (Di Pierri D, 2014)

Traditional management has evolved towards full customer satisfaction and loyalty, so each person concentrates his effort on the task assigned to him, trying to do it according to the instructions and specifications received, which makes them work to raise the quality of its benefits.

1.2 Process and quality improvement.

The processes of a company are known to be organized around one or more macro objectives, which must be achieved through one or more strategies. From these arise processes that are broken down into sub-processes, which in turn are made up of activities and these by tasks. Therefore, a process can be defined as a set of activities, which must meet the following characteristics:

• Have a clear purpose. They can be broken down into tasks. They have inputs and outputs, customers, suppliers and the final product can be identified. Times, resources, managers can be identified (Vinajera-Zamora and Marrero-Delgado 2011)

Several articles published by different authors including Rey Reteiro (2007) state that process management is the way to manage the entire organization based on processes.

Process management focuses attention on the result of the processes, not on the tasks or activities, since there is information on the final result and each member of the organization knows how individual work contributes to the overall process; which translates into a responsibility with the total process and not with your personal task.

The main objective of Process Management is to increase the company's results through achieving higher levels of customer satisfaction, in addition to increasing productivity through:

• Reduce unnecessary internal costs (activities without added value). Shorten delivery times (reduce cycle times). Improve the quality and value perceived by customers so that it is pleasant for the supplier to work with. Incorporate additional activities service, low cost, whose value is easy to perceive by the customer.

Companies, once they manage their processes, can do it based on two fundamental approaches: by functions and by processes. The choice makes differences taking into account the characteristics of both types of management, which are set out below, since it is important to understand them before undertaking the analysis and improvement of any particular process.

Table 1. Differences between the organization by processes and the traditional functional one.

Aspect to compare	Management by functions	Process management
Organization	By specialized departments	By natural processes
Measurement criteria	Productivity and performance compliance	Competitiveness and commitment to results
Objective of the work	How to improve the task?	What tasks to do and for what?
Projection abroad	Bureaucracy - formalism	Flexibility - change - innovation
Chiefs' area of ​​responsibility	Functional bosses	Process managers
Decision-making criteria	Centralized	Part of everyone's job

Source: Adapted by the author based on the criteria for Vinajera - Zamora and Marrero - Delgado.

In addition to these differences, other qualities of the processes that are particularly relevant for the provision of health services must be taken into account: variability and repeatability. Both have been treated by various authors and in particular will be analyzed from the perspective of Pepper-Bergholz (2011).

• Variability: Every time the process is repeated there are slight variations in the different activities carried out, which in turn generate variations in the results of the process: "No two results are identical." Repeatability: Processes are created to produce a result. and try to repeat that result over and over again. This feature allows working on the process and improving it: "The more repetitions, the more experience and the better results"

These characteristics mean that, on the one hand, health activities must be protocolized or approved seeking the best practices, with the aim of achieving the best results, reducing their variability and, on the other hand, requires that the people who carry them out repeat it. over and over again to achieve the skill that guarantees quality in its execution.

The value added to the process must be seen as incremental in time, where the participation of each and every one of those involved affects or increases the quality of the result or final product. In organizations that mainly provide services, such as health, the most important asset that adds value to the final product is human resources, their commitment, training and experience, among many other tributes inherent to it, promote quality service, whose real meaning has different interpretations.

1.2.1 The meaning of quality.

According to Reeves and Bednar (1994), "regardless of the time period or the context in which quality is examined, the concept has had multiple definitions, more or less confusing, and has been used to describe a wide variety of phenomena." These authors reviewed the different ways of understanding quality, concluding that there is no universal and global definition of it, but basically four types of definition. The construct has been considered primarily as excellence, as value, as adjustment to specifications, and as satisfaction / improvement or response to customer expectations. Each of these definitions is briefly described below, along with some of the advantages and disadvantages of quality service in any organization.

1.2.1.1 Quality as excellence

Quality as excellence is defined as "the best" in an absolute sense. From this perspective, the achievement of quality implies that the organization must make the investment of the maximum possible effort to produce the best of results. Quality would be 'the best' in an absolute and universal way, so that only that product that is the best can be said to be 'of quality'. Among the advantages of adopting this definition for the organization that offers 'excellent' consumer goods or services would be the commitment of its employees - because they know that they produce or offer the best - and the pride of the clients for being able to buy the best goods or hire the best services.

However, this definition of quality as excellence is too abstract and subjective, as it does not clearly guide managers on the guidelines to follow to achieve that level of 'excellent' quality. Managers are required to somehow specify the definition of excellence, but it cannot be corroborated by customers until the good or service is available on the market. Finally, it should be noted that the price of an excellent good or service may be out of reach of the number of consumers necessary for the company to be viable in the future.

1.2.1.2. Quality as value

This definition of quality arises in the mid-18th century when some merchants start to produce / offer cheaper and lower quality (not excellent) products to reach a broader market. Quality as value no longer means 'the best' in the absolute sense, but 'the best for each type of consumer', that is, according to the consumer's use of the product and its price (Feigenbaum, 1951, in Reeves and Bednar, 1994). This author affirms that the quality of a product cannot be considered without including its cost and that, in addition, its quality is judged according to its price. The best thing, then, is the balance between the price and the value of what is purchased.

This definition of quality as 'value' allows very different products and experiences to be compared. For example, comparing a high standard hospital facility with a lower one. In this way, the quality of what is consumed / acquired is judged according to the price paid ('the product is good for what one has paid'). Consumers differentiate between quality and price levels, or value, when choosing a product / service. However, the concept of quality as value includes multiple product characteristics (convenience, use, duration, etc.), so the main problem with this concept lies in knowing which components are important to each person and what relative weights correspond to each of those components. An added problem is that the relative importance of each component can vary over time.

Lastly, the controversy between different authors regarding the relationship between quality and value stands out. They have been considered as synonyms, as different constructs and as subcomponents (value as a subcomponent of quality and vice versa). In short, they are closely related constructs whose limits have not been clearly established.

1.2.1.3. Quality as 'fit to spec'

Following the evolution of 'mass industrial production' in the United States, the concept of quality appears as 'adjustment to specifications'. This type of industry required standardized, higher-precision production that minimized manual labor. With this objective, standards began to be specified according to which the components and parts of certain products (weapons, watches, cars, etc.) should be produced. Quality meant ensuring the interchangeability of parts and the viability of the production system by adjusting to specifications.

Mass production required a statistical control of the quality of the components and, therefore, the development of a quantifiable and objective definition of quality. Thus, the task of the production engineer to obtain quality would consist of

• (a) define the consumer's wishes by expressing them in the form of physical characteristics of the product or 'specifications' and (b) find a way to obtain the product in a standardized way and with the established quality characteristics (ensure that the product conforms to the specs).

Starting with quality as an adjustment to specifications, the organization can use objective measures on its progress in achieving quality and assess the impact of the quality level on the overall management of the company. Therefore, the organization can achieve an efficient and effective provision of the product if the needs of the clients are correctly identified. For this identification, the components of the consumption or service good must be analyzed in depth.

On the other hand, this definition has certain disadvantages. First, consumers judge the products they consume or use subjectively and do not evaluate them in terms of compliance with specifications. For example, a car may offer total quality in terms of fit but a potential customer may not like it for its line or color. For some authors, this conception of quality may be inappropriate for services, especially in those cases in which human contact between clients and service personnel is frequent. Norman (1984, in Reeves and Bednar, 1994) questions the effects of service standardization as perhaps conforming to specifications in interaction may paradoxically result in lower quality.

A representative example of the application of this concept of quality in service companies are fast food restaurants (Mc Donalds, Pizza Hut…) that are characterized by a high degree of specification in their production and service methods. The specification offers great results in aspects such as speed and uniformity in cooking and flavoring food, but it may also imply a certain lack of flexibility and adaptation to customers. Some customers may perceive the adjustment to specifications in the human treatment (standard phrases of greeting or to complete the order) as unkind, unpleasant or dehumanized.

Finally, the definition of adjustment to specifications requires standardization that can hinder the adaptability or flexibility of an organization that wants to respond to changes in the market and the evolution of customer needs. The viability of a company focused on defining specifications also depends on the ability of its managers to identify customer needs.

1.2.1.4. Quality in response to customer expectations.

This definition of quality is the most widely used today. It emerged with the growth of the service sector and the development of research in the area of ​​'service marketing'. From this it was pointed out that the adjustment to the specifications did not take into account the unique characteristics of the services and that a definition of quality based on customers was necessary.

Beginning in 1950, methods of measuring consumer preferences and desires began to be developed, and from 1960, a major debate began on the applicability of the definition and techniques of quality from the industrial to the service sector. The differential characteristics between consumer goods and services (mainly the intangibility of services) led to a redefinition of quality for the service sector. Since then, only a definition of quality seems to have been widely considered appropriate by service researchers, a definition based on the perception of customers and the satisfaction of their expectations. So,'quality is what customers say it is and the quality of a particular product (consumer good or service) is what customers perceive of it' (Buzzell and Gale, 1987, in Reeves and Bednar, 1994).

Juran (1974, in Reeves and Bednar, 1994) includes this perspective in his definition of quality as the 'suitability of use' or the extent to which a product serves the user's purposes. It also indicates that this definition would be applicable to consumer goods and services. In 1988, he added that the concept of quality should necessarily include two ideas: first, quality means satisfying the needs of the customer - external and internal to the organization - and, second, the absence of product defects.

Among the advantages of this perspective, it stands out that the importance of the wishes of consumers is recognized, as they are the ones that ultimately evaluate quality. It is an external definition to the organization because it depends on the consumers, but the organization that manages to discover and satisfy the expectations of its clients in a continuous way presents an almost insurmountable competitive advantage. Furthermore, the measurement of this type of quality would allow comparing different types of products and industries.

Even companies in the same sector with different strategies could have the same level of quality, satisfying the expectations of two different market segments. This definition of quality as perceived by customers implies a subjective judgment of quality that makes its quantification considerably difficult. The main problem lies in creating the appropriate statistical measurement instruments.

• to measure customer expectations, especially those related to consumer goods and / or services purchased infrequently, to aggregate the individual perceptions of each customer regarding the importance of different characteristics of a product-service and to assess the quality of the most intangible aspects of services. Furthermore, this definition provokes an important debate on the distinction between the concepts of quality and customer satisfaction.

This is important to be attended to, since as Hopson and Scally (1993: 15) indicates, "when the service is below expectations it is bad service, good service is when the service exceeds expectations".

In this regard, Arellano (1993) indicates that "perception is the experience of the interpretation of a sensation produced by a stimulus, that depending on the experience and culture of individuals, they will observe the world around them." This is evidenced by the different statements about perceptions about the quality of the service received, depending on the individual characteristics of the client.

1.2.1.5. Quality according to ISO 9000/2001 Standards.

The ISO / 2000 standards are a consistent family of documents that allow any company to guide its development to higher levels based on compliance with the principles defined in them and the establishment of a strong documentary scaffold that provides the organization and other interested parties with Strong evidence about the effectiveness of their processes.

Standards, as one of their most notable successes, have an important set of internationally accepted definitions that make it possible to standardize criteria on the subject of quality. Among them is the definition of quality itself, understood as a relationship or level with respect to customer requirements; customer satisfaction understood as perception and the continuous improvement process that beyond defining it, lists the stages that guarantee its success: evaluation, analysis, correction and implementation. Three essential definitions for the development of this research are shown below:

• Quality according to ISO 9000/2000: Degree to which a set of inherent characteristics (3.5.1) meets the requirements (3.1.2). Characteristic: differentiating feature. Requirement: established need or expectation, generally implicit or obligatory. customer according to ISO 9000: 2000 Customer perception of the extent to which their requirements have been met Continual improvement process according to ISO 9000: 2000 Continuous process through the use of audit findings (3.9.6), audit conclusions (3.9.7) data analysis, review (3.8.7) by management or other means, and generally leads to corrective (3.6.5) and preventive (3.6.4) action.

The standards provide a regulatory framework for business action and therefore do not show models for their implementation, which must be developed by interested companies. This is evidenced in the following list of "actions" that can be found in the body of the standard:

• analysis and evaluation of the existing situation to identify areas for improvement; the establishment of objectives for improvement; the search for possible solutions to achieve the objectives; the evaluation of said solutions and their selection; the implementation of the selected solution; the measurement, verification, analysis and evaluation of the results of the implementation to determine that the objectives have been achieved, the formalization of the changes. ”

1.2.1.6 The relationship between quality and satisfaction.

Both quality and user satisfaction are considered critical aspects for the competitiveness of service organizations through their relationship with post-purchase or post-use behaviors (Luque et al. 1995). Oberoi and Hales (1990) affirm that for some authors the quality of service depends on its intrinsic nature, while for others, the quality resides in the perception of who uses the service.

In the first case, quality of service criteria should be established independent of the perception and opinion that users have of the service (Rosander, 1992). On the other hand, the second conception of quality, which understands it as the subjective perception that clients / users have of the quality of the organization or 'perceived quality', is the one that presents less clear limits regarding the concept of satisfaction, since it is also in a way an evaluation of the organization. This confusion is especially intense when quality is defined as the satisfaction of customer / user expectations and is operationalized through the paradigm of the unconfirmation of such expectations.

The similarities, differences and the relationship between the two concepts have been subject to deep debate. Although there are different positions on these issues, the majority position considers the perceived quality as more stable and more cognitive in nature than satisfaction, which would be more specific to each transaction with the service and of a cognitive-affective nature (Oliver, 1981). Other widely debated issues regarding the relationship between perceived quality and satisfaction are the operationalization of both constructs and the causal direction between them.

However, as Martínez-Tur (1998) points out, the variables used to study both constructs are similar, although the research objectives are usually different. Thus, research on satisfaction has focused on the study of the process that leads to satisfaction, its antecedents and consequents, while research on quality has been mainly directed to the analysis of its content or dimensions.

1.2.2 Measurement of service quality.

In general, the evaluation of the quality of services is considered more difficult than the measurement and evaluation of the quality of consumer goods (Gwashure, 1993, p.51). This difficulty is explained by the special characteristics of the services, among which the intangible nature of many attributes of the product-service stands out (eg atmosphere, the attitude of the staff, etc.).

Different methods have been developed for evaluating quality of service / customer satisfaction in health facilities, each with advantages and disadvantages and with a more or less partial perspective of quality of service. Therefore, it would be advisable to combine some of the methods outlined below as the most appropriate way to assess, manage and monitor service quality and customer satisfaction.

1.2.2.1 Complaints and compliments.

Organizations use customer complaints and compliments to assess the quality offered. The information obtained through this method is extremely valuable for identifying the company's weaknesses and opportunities for improvement. However, this information is not representative because only a small part of dissatisfied customers complain. Some customers are dissatisfied with the service received and will not return to the company, but do not express their dissatisfaction through complaints, acknowledging that the absence of complaints does not necessarily indicate that customers are satisfied.

1.2.2.2. Technique of critical incidents.

This is an active and systematic technique to identify points in which to improve quality. It consists of collecting and analyzing 'important experiences' that impress clients positively or negatively and that affect the development of their general and stable attitude towards the company, that is, the critical incidents that take place during the provision of the service.

Clients are asked to describe the most pleasant and unpleasant incidents that have occurred with the service during their stay with the company. These incidents are then classified into different categories according to whether they produce satisfaction, dissatisfaction, both effects, or neither. The categories are called: Satisfactory, Unsatisfactory, Critical, and Neutral. The problems, once identified, are analyzed so that managers and employees offer a solution (Lockwood, 1994; Bitner, Booms and Tetreault, 1990).

1.2.2.3 Service mapping ('Service mapping' or 'Blueprinting')

This technique consists of the systematic analysis of the production and consumption processes. The provision of the service is observed and the sequence of events that occur from the client's perspective is described. In this way, all those actions involved in service provision, the complexity of the process, the points of human interaction can be identified and graphic representations of each of the steps can be made. Each point of the employee-customer interaction is then analyzed and redesigned if necessary. This technique is especially useful for training employees and for redesigning organizational processes.

1.2.2.4 Quality audits.

An audit can be defined as 'an independent evaluation of the quality of service' (Juran and Gryna, in Jones and Lockwood, 1989, p.158). They are external evaluations of the nature of the service experience in an establishment. A simplified and increasingly used way to make this independent judgment is the visit of a 'mystery customer' in which a quality expert impersonates a customer without employees knowing about it to assess the quality of the service offered.

1.2.2.5 The measurement of service quality through attributes.

This measurement method assumes that the product consists of a set of attributes and, therefore, the quality of service would be a multi-attribute construct (Meyer and Westerbarkey, 1996, p.186). According to Johnston (1995, p.70), the perception of quality of the clients must consist of a heterogeneous range of attributes and the satisfaction of the clients is directly connected with the level of quality that the company offers. However, it is almost impossible to obtain customer satisfaction data for each quality attribute. For this reason, it is necessary to identify, among all the attributes that characterize the product-service, those that are fundamental for customers in their quality evaluation.

The multiple attributes of the product interact with each other influencing customer opinions and their level of satisfaction (Sasser et al., 1978; Bitner, 1992, both in Meyer, 1996, p.187). Quality measurement should focus on identifying the attributes or dimensions that most significantly affect the client's overall perception of quality and / or satisfaction and subsequent behavior. These, in turn, would be the attributes that indicate the main expectations and preferences of the clients and, therefore, represent key areas for improving the service. According to Meyer et al. (1996, p.193), ensuring customer satisfaction 'requires a creative talent from the manager to find the most competitive and valid quality dimensions,so that the customer vision can be easily established and reliable. '

In general, this type of measure is presented in the form of a questionnaire and is one of the most widely used in service establishments. One of the main advantages of this method is the relatively low cost of data collection due to its high standardization.

A special modality of quality measurement through attributes is the so-called importance / performance method. Using this technique, a score is obtained for each attribute on how important it is to the client and another score for their perception of the quality offered. For example, a customer may rate food in an inpatient hospital facility as very important and perceive it as very poor. In this way, the score received on the food would indicate an aspect on which action should be taken. Once both scores have been obtained for each attribute, they can be represented in a graph along two dimensions: importance and execution. Each quadrant requires a different strategy and a different level of execution to satisfy customers by achieving or exceeding their expectations,or to avoid dissatisfaction. The following strategies emerge from this classification:

• Improve: in this quadrant are the attributes that are perceived as important and that do not reach the appropriate level. Action must be taken to improve the level offered. Maintain: this category includes attributes perceived as important and reaching the level required by customers; The offered level must be maintained. Low priority: In this sector, attributes appear that clients do not consider important and whose level or execution is rather poor. They do not require further attention.Excess quality: here are attributes that are not important to customers but whose quality stands out. An excessive level of effort is being invested in these attributes. Importance (Martin, 1995).

1.2.2.6 The problems of measurement of the quality of service based on attributes.

One of the main obstacles associated with this method is the subjectivity inherent in human perception. On the one hand, it is difficult to determine what constitutes quality given that 'different customers give different weight to the various attributes of a product and / or a service' (Reeves and Bednar, 1994, p.433). The problem of identifying relevant attributes that are common to the entire sector has been tried to be reduced by selecting attributes for specific products and for specific market sectors. In this sense, the objective of this study focuses on identifying the key quality attributes of the sector. Another type of problem is methodological. Among them, the choice of the measurement scale stands out,the specific or global composition of attribute evaluation and the search for a reliable factor structure (Meyer et al., 1996, p.192; based on Churchill and Surprenant, 1982; Hausknecht, 1990; Landy and Farr, 1980). The theoretical and empirical relationship between the quality of specific attributes and the perceived global quality is not strictly additive, but can be understood as a unique concept that is different from the sum of its parts. Furthermore, at the methodological level it seems necessary to measure both constructs separately to ensure some reasonable validity of the data.it can be understood as a unique concept that is different from the sum of its parts. Furthermore, at the methodological level it seems necessary to measure both constructs separately to ensure some reasonable validity of the data.it can be understood as a unique concept that is different from the sum of its parts. Furthermore, at the methodological level it seems necessary to measure both constructs separately to ensure some reasonable validity of the data.

Aggregating the ratings of different customers to generate aggregate measures of attributes separately or globally also presents theoretical problems. It may be the case that consumers who think that an attribute is important perceive it as deficient, while those who think that the same attribute is not important may perceive that it reaches an adequate level (Ennew et al., In Meyer, 1996).

1.3.1 The basic principles of process management.

The analysis and improvement of processes requires deepening in the fundamental aspects that characterize the processes, being of cardinal importance an approach from the different strata that are recognized in the literature for their classification. There is currently consensus that it is possible to identify at least three different types of processes in a company (Nogueira et. Al., 2004):

• Strategic processes. Operational or key processes. Support processes.

These characteristics analyzed in process management are of great help to improve the services in the areas where they are provided, regardless of the field of application, the health area not being exempt from this useful differentiation. However, it should be noted that the area of ​​operational processes has its peculiarities which make it pay much more attention than in other areas because human lives are at stake. Here is an approach to the essential characteristics of these strata:

Strategic and planning processes: Covers communication, marketing, strategic planning and management systems. They are the processes of definition, design, development, implementation and monitoring of the Management System, including short, medium and long-term planning. These are related to the needs of the market. Its analysis allows guiding the rest of the organization's processes.

Product realization / service provision / operational or key processes: Includes the activities of process design, product development, commercial, billing, customer service. They are the processes related to the development, provision, production and marketing of products and services, customer service and satisfaction, complaints and claims, after-sales, development of solutions for the customer, management of the order portfolio. These are directly related to the client.

Support or support processes or resource management: processes related to business information and knowledge, personnel management, work environment, accounting and administrative processes, systems development, teams, technology innovation in use, updates are included here. IT, knowledge management and financial management, among others. These processes are responsible for providing the organization with the necessary resources.

After having carried out a characterization of the types of processes, it is possible to begin to approach the methodologies for improvement based on the fact that the analysis and improvement of processes includes the knowledge and evaluation of the reality that is within the organization, the interiority of all its areas, its management system and its results in order to know them objectively, taking into account strategic planning. There are different methodologies for process management which have been discussed by various authors (Nogueira, 2004; Medina, 2010) which will be analyzed below.

At least six methodologies were identified: Vellón (2002), Process Analysis and Rationalization (ARP), Paneque (2002), Amozarrain (1999), Methodology for process management and improvement, and Nogueira (2002).

The authors themselves studied some other existing methodologies for the improvement of business processes which were less attractive and / or were included in the previous methodologies, which is discussed in their respective works and is accepted by the author. They are mentioned in them:

• Systematic or scientific method of process improvement. Ishikawa.1985 Process Design Manual. Miguel Hernández University of Elche. 1997 Improvement of Business Processes for organizations. STX Arena Company. 2000 Review and Adjustment of Service Processes, Procedures and Standards. Sol Meliá Hotel Group, Quality Division, Cuba Division. 2001 Methodology for the Institutionalization of the Approach and Management of processes in an Organization. González Méndez. 2002.Methodology for Diagnosis and Identification of Opportunities for Process Improvement. Ruiz Ugalde. 2002 Procedure for the improvement of hotel operational processes. Negrín Sosa. 2002.

Of the methodologies identified, the author considers that those of Vellón (2002), Paneque (2002), Amozarrain (1999) and the Methodology for the management and improvement of processes are basically oriented towards the tacit description of the processes as a principle of analysis. lacking the use of diverse and more complex tools and even a methodological space in its structuring; ARP methodology presents a more analytical environment but focuses its analysis on rationalization (Stage II) which may be counterproductive since expansion stages may be necessary in order to increase the qualities of the service provided, restrictive thinking can lead to the deterioration of the process.The author considers the proposal by Nogueira (2002) as the most complete methodology, taking into account that it delimits specific categories or stages that better guide the practical development of improvements, which is included in methodological moment II (Process design) but also has as lack the not conception of an analytical moment for the improvement of the process.

Apart from the criticisms exposed, an analysis of all the methodologies identified allowed the delimitation of issues of practical interest to be taken into account for the proposal to improve the process.

The creation of an interdisciplinary work team made up of no more than seven people (Amozarrain, 1999, mostly members of the board of directors. They must have knowledge of the system and management tools, have the presence of an expert and appoint a member of the board of directors as coordinator of the project Likewise, a planning must be established for the meetings and the development of the project taking into account the stages defined in the project.

By means of a brainstorming session, a list of all the processes and activities that take place in the organization is drawn up taking into account the following premises: the name assigned to each process must be simple and representative of the concepts and activities included in it. Also, the process must be easily understood by anyone in the organization. It is recommended that the number of processes oscillate between 10 and 25 depending on the type of company (Amozarrain, 1999), since the identification of few or too many processes increases the difficulty of their subsequent management.

Once the organization's processes are listed, it is important to define what are the necessary processes that will finally appear on the organization's process map? The following criteria can be used for its determination: (ISO 9000: 2000)

• The processes that affect the degree of customer satisfaction, because the ability to meet their needs and expectations largely depends on them. The processes that are related to the organization's ability to supply compliant products and services. The processes that involve a high percentage of the organization's resources, and as a consequence, its optimization and efficiency have a very significant weight in achieving competitive results.

In this step we proceed to the elaboration of the organization's process map (if any), as an effective method to visualize the processes at all levels; ordered by their hierarchies and relationships, which provides management above all:

Use of the expert method as a group work technique for the generation of ideas and the search for consensus in various investigative moments (Suárez, 2001)

• Brain Storming. Delphi method (Kendall's coefficient).

Establishment of an order of priority for the improvement of the most important processes, taking into account the contributions that the client may receive and the costs that its implementation may have for the organization. The work team must carry out a subjective assessment taking as reference the following aspects:

• Calculate the cost of the improvement: an assessment of the cost thereof will be made taking into account the criteria of the experts. Impact on the client: The decisions of a company affect, directly or indirectly, the clients. Experts must ask themselves to what extent the improvement proposals have an impact on the satisfaction of the process.

A linear correlation analysis can help to understand intrinsic relationships that are not easily appreciated that help to enhance the proposed improvements.

An order of priority can be selected for the introduction of the improvements from an analysis in a double entry matrix (General Motors) similar to that carried out in the strategic type analyzes.

The insufficiencies detected in the methodologies as well as their useful contributions must be analyzed in an appropriate way so that, after being synthesized, they induce the conformation of a model suitable to the research needs of this work.

1.3.1 How to improve processes.

After a methodological discussion, it is necessary to delve into practices that accompany and help to materialize the research objectives that any improvement intervention entails.

In the scientific literature (Galloway, 2012; Trischler (2010); López Carrizota (2008) it is possible to find recommendations for making practical improvements in business processes. The first of these is to make it happen exactly as we want it to happen. process must first be made to happen. That is to say:

• Define the way to execute the process. Define a set of guidelines or instructions on how the process should be executed. Execute the activities of the process. According to the instructions previously established. Verify that the process has developed as planned (according to the instructions). Ensure that the next repetition of the process will be carried out according to the instructions. What deviations from the instructions have occurred? How can they be avoided in future occasions?

This cycle of activities ensures that there is a “defined or stabilized way” of doing things and that the process effectively conforms to this “stabilized way”.

Improve it once we have made it happen.

When, despite correctly carrying out the activities defined for the process, there are still problems (complaints from the recipients, waste of resources, etc.) or the process does not adapt to what the client needs (need to restructure the process), it is necessary apply the improvement cycle. An improvement action is any action aimed at changing the “way we want a process to happen”. These improvements should logically be reflected in an improvement in the process indicators. Management according to the principles of Total Quality uses various techniques and tools to improve the organization's processes. Some are creative and based on imagination, others are based on statistical techniques or specific methodologies,but they all have in common the purpose of improving the processes on which they are applied.

Another recommended recommendation to improve a process is to apply the PDCA improvement cycle (Plan, Do, Check, Act):

• Plan the improvement objectives for the same and the way in which they will be achieved. Execute the planned activities for the improvement of the process. Check the effectiveness of the improvement activities. Update the "new way of making the process occur" with the improvements that have proven effective.

Likewise, in these texts there can be found types of improvements that can be made to the processes and that can conceptually guide any attempt to improve the qualities of a process.

Structural improvements. A process can be improved based on creative contributions, imagination and critical sense. This category of improvement includes, for example:

• The redefinition of recipients. The redefinition of expectations. The redefinition of the results generated by the process. The redefinition of the participants. The redefinition of the sequence of activities.

These kinds of improvements are fundamentally conceptual. The tools and techniques used for this type of improvement are creative or conceptual, such as the New Tools for Quality Management, Customer Surveys, Reengineering, Value Analysis, the QFD and others..

Performance improvements. You can improve the way a process works by trying to make it more effective. For this type of improvement, the Classic Problem Solving Tools, Suggestion Systems, Experiment Design and other data-based ones are useful. The tools described for efficiency improvement can also be used, complemented by simple tools aimed at eliminating waste, such as 5S or 5W1H. This type of improvement is also based on working with data.

Conclusions

Up to this point, the theoretical foundations of consumer satisfaction in service provision in general and in health services in particular have been analyzed. Various definitions and marketing characteristics were analyzed in the consulted literature; It can be concluded that it is vitally important since in many companies it is the department that leads, and at the same time determines what is going to be offered, to whom it will be offered and, finally, to whom it will be sold.

Several process management tools were obtained from the consulted literature. Taking into account the characteristics and principles of this management model, it can be affirmed that it would be of great help to improve services, regardless of the field of application.

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