Service Uniqueness and Management Outcomes (SUMO) in Healthcare Services
P Subburethina Bharathi1, S Arun Kumar2
1Deputy General Manager – L&D, Kauvery Hospital, Trichy, Tamil Nadu
2Manager – L&D, Kauvery Hospital, Trichy, Tamil Nadu
Abstract
Healthcare delivery presents a unique challenge: the intrinsic intangibility, inseparability, heterogeneity, perishability, and personalised nature of clinical services demand managerial responses that produce tangible outcomes. The SUMO model (Service Uniqueness and Management Outcomes) offers an integrative framework linking these service characteristics (independent variables) with structured management levers accreditation (NABH/JCI), digital health platforms (ABHA/ABDM), leadership governance, and patient feedback systems (mediators) to yield measurable outcomes across clinical quality, patient experience, operational efficiency, staff well-being, and financial resilience. A recent case in Delhi, where the Health Information Management System (HIMS) integrated with ABHA IDs cut outpatient queues by approximately half following its July 2025 launch, exemplifies successful operationalisation of digital mediators. The model aligns with global standards such as ISO 9001 and WHO IPCHS and is particularly suited to Indian contexts undergoing digital transformation. This study deploys a mediational research design using SEM and moderation analysis to evaluate hypothesis based pathways across healthcare facilities in India and beyond.
Keywords: Service uniqueness; Intangibility; Inseparability; Heterogeneity; Perishability; Personalisation; SUMO model; Patient‐centred management; Digital health platforms; ABHA/ABDM integration; Operational efficiency; Clinical quality; Patient experience; Healthcare governance
1. Introduction
1.1 Global Health Imperative
Healthcare organizations worldwide are grappling with escalating complexity, demanding delivery of patient centred, safe, effective, efficient, and affordable care aligned to Universal Health Coverage. The Uberland Framework proposed by WHO in 2016 (Integrated People Centred Health Services, or IPCHS) calls for system reorientation built around people not diseases or facilities by executing five strategic shifts, from governance to care coordination.
1.2 The SUMO Lens: Why It Matters
In such a context, Service Uniqueness and Management Outcomes (SUMO) offers a structured model that connects intrinsic service attributes (intangibility, inseparability, heterogeneity, perishability, personalization) to tangible outcomes (clinical safety, experience, operational efficiency, staff & finances), mediated by discrete management levers. SUMO is specifically designed to be compatible with ISO 9001:2015 Quality Management Systems (QMS) and Joint Commission International (JCI) accreditation frameworks, allowing nations like India to align local innovation (ABHA/ABDM, NABH accreditation, feedback kiosks) with global standards.
2. Service Uniqueness in Healthcare (Independent Variables)
Healthcare exhibits five underlying credence service traits:
- 2.1 Intangibility: Patients cannot assess service beforehand; trust and reputation elements emphasized in both ISO and JCI quality systems, shape choice.
- 2.2 Inseparability: Delivery and consumption occur simultaneously during provider patient interaction.
- 2.3 Heterogeneity: Variability arises due to clinical complexity and individual differences.
- 2.4 Perishability: Non storable resources like appointment slots or OR time are lost if unused managed effectively via digital tools such as ABDM’s “Scan and Share” tokens .
- 2.5 Personalization: Involves shared decision making and preference accommodation, aligned with IPCHS’s call to “engage and empower people”.
3. Management Levers & International Quality Alignment
SUMO’s core asserts that management interventions, structured interventions, mediate or moderate how service uniqueness affects outcomes, in line with Donabedian’s Structure Process Outcome logic.
3.1 Accreditation and Institutional Quality (Structure)
3.1.1 NABH Accreditation (India)
NABH, under the Quality Council of India, enforces over 600 standards ranging from patient rights to human resources, hospital infrastructure, and patient safety governance; its 6th edition (2025) is aligned internationally.
3.1.2 ISO 9001 and IS EN 15224 (Global QMS Standards)
ISO 9001:2015 provides a universal QMS foundation, emphasizing context, leadership, process control, performance monitoring, and continual improvement, while ISO EN 15224:2017 adapts it to medical contexts, embedding clinical risk management and safety frameworks integral to SUMO’s mediator layer.
3.1.3 JCI Accreditation and Patient Safety Goals
The Joint Commission International (JCI) certifies facilities to a set of patient safety and quality standards (including the six International Patient Safety Goals), which align with SUMO’s outcomes structure, reducing healthcare associated infections, preventing wrong site, wrong patient surgery, and improving medication safety and communication.
3.2 Digital Ecosystems & Patient Engagement (Process)
3.2.1 Ayushman Bharat Digital Mission (ABDM)
India’s ABDM ecosystem enables nationwide ABHA health IDs, interoperability, and real time OPD booking via QR code based “Scan and Share”, leading to greater access, reduced wait times, and enriched data for care coordination.
3.2.2 Real Time Feedback Kiosks & Health ATMs
Feedback kiosks in Jhansi CHCs allow triaging of negative patient input to administrators within minutes (aligning with IPCHS goal of accountability); Health ATMs in Haryana integrate diagnostics and video consultations, reducing the impact of perishability and enabling personalization.
3.3 Leadership & Process Re-engineering (Process)
Accreditation readiness training, lean project teams, and operational redesign (e.g. queue systems, multidisciplinary committees) help mitigate heterogeneity and instability, improving patient safety culture and throughput performance in alignment with ISO and JCI continuous improvement mechanisms.
4. The SUMO Research Model (Conceptual Pathway)
4.1 Model Architecture
Figure (4.1): outlines a three tiered model with (A) Service Uniqueness as exogenous input; (B) Management Levers (structure & process alignments with NABH, ISO, JCI, ABDM, feedback loops, leadership); and (C) SUMO Outcomes (clinical safety, experience, throughput, retention, financial sustainability).
4.2 Hypotheses (from SUMO)
| H | Pathway | Expected Effect |
|---|---|---|
| H1 | Personalization × feedback tools → ↑ patient experience | Positive |
| H2 | Perishability moderated by digital booking → ↓ wait/time loss | Negative |
| H3 | NABH + ISO process robustness → ↓ adverse events | Negative |
| H4 | Multidisciplinary process redesign → ↓ LOS variance & ↑ throughput | Positive |
| H5 | Leadership training → ↓ staff turnover/burnout | Negative |
| H6 | Accreditation × efficiency gains → ↑ financial sustainability | Positive |
4.3 Measurement Strategy
- Data sources: NABH audit scores, ISO/JCI compliance checklists, ABHA/Scan and Share logs, wait time dashboards, patient satisfaction surveys (SERVQUAL adapted), HR turnover, cost per case financial data.
- Analysis methods: Structural Equation Modeling (SEM) for mediation paths, PROCESS macro for moderation analysis, multi group modeling (e.g. NABH vs non NABH), latent variable modelling.
5. Empirical Operationalization in Indian Settings (SUMO in Action)
5.1 Delhi HIMS as SUMO Leverage
From July 2025, Delhi’s 35 government hospitals—integrated with ABDM and using real time OPD data, achieved a 50% reduction in patient queues, demonstrating H2 pathways in practice.
5.2 Jhansi Feedback Kiosks
Negative patient ratings are flagged to administrators within minutes, prompting service corrections, validating H1 (feedback mediated personalization improves experience).
5.3 NABH Accreditation Case Studies
- KLE Hospital, Belagavi(North Karnataka) achieved full NABH accreditation in Jul 2025, targeted several domains including infection control and patient safety, reinforcing the H3 (structure) effect.
- GIMSR, Visakhapatnam, upgraded infrastructure and aligned with 6th edition NABH standards, affirming future path to clinical improvement embedded in H3 .
5.3.1. Case Evidence: Kauvery Hospitals
Kauvery Hospitals, a leading multispecialty healthcare chain in South India, provides a persuasive case of SUMO model application. Its operational philosophy emphasizes patient-centricity, clinical excellence, and technology integration, reflecting the service uniqueness inherent in healthcare delivery. By embedding evidence-based practices and aligning with NABH standards, Kauvery strengthens clinical safety while minimizing service heterogeneity.
From a management outcomes perspective, Kauvery has demonstrated operational efficiency by deploying digital appointment systems, AI-driven diagnostics, and patient feedback kiosks, thereby reducing waiting times and optimizing capacity utilization (perishability management). Human Resources plays a pivotal role through leadership development initiatives like KLIFT, KLIFFE etc., structured on boarding, staff welfare and continuous professional development programs, which contribute to high staff engagement and retention.
Moreover, Kauvery’s integration of Ayushman Bharat Digital Mission (ABDM) linkages and personalized care pathways highlights its ability to synchronize global quality standards with Indian healthcare priorities. This positions Kauvery Hospitals as a benchmark for effectively translating the SUMO framework into sustainable healthcare delivery practices.
6. International Standards & SUMO Integration
6.1 WHO IPCHS Framework Alignment
SUMO’s five service uniqueness constructs correspond to WHO’s five IPCHS strategies particularly governance, care coordination, and community engagement—while its outcome domains (safety, experience, efficiency, staff, finances) echo IPCHS performance goals.
6.2 ISO 9001 & ISO EN 15224 Fit
By treating management levers such as accreditation, process control, internal audit, and continuous improvement as mediators (structure/process), SUMO embeds ISO QMS architecture within its causal logic—connecting uniqueness to outcomes.
6.3 JCI Accreditation Standards Conformance
JCI’s patient safety and performance standards align with SUMO’s outcome domain definitions. Compliance with JCI also reinforces pathways for bridging the gap from service traits to outcomes through standardised data and safety culture.
6.4 ISQua & Global Credentialing
NABH’s ISQua recognition ensures that India’s national standards echo global best practices, positioning SUMO as a translatable construct that meets international expectations.
7. Global Relevance & Policy Implications
7.1 SUMO Adaptability across Systems
Though crafted with India in mind, the SUMO model supports cross country research: service uniqueness dimensions are universal, and international levers (ISO, JCI, IPCHS) apply equally. SUMO can serve as a global research template with local operational benchmarks.
7.2 Policymaker & Institutional Guidance
SUMO provides policymakers and hospital leadership with:
- A roadmapto link diagnostics (feedback, ABHA usage, throughput) with accreditation impact;
- A testing platformfor pilot programmes (e.g., ABDM, digital kiosks, accreditation scale up).
- A monitoring frameworkfor evaluating impact, benchmarking states or clusters via measurable outcomes.
8. Conclusion
By explicitly modelling the service uniqueness features of healthcare (intangibility through personalization), connecting them with structured management levers (accreditation, digital engagement, process redesign), and grounding outcomes in globally accepted quality benchmarks (clinical safety, satisfaction, efficiency, retention, finance), the SUMO framework enables both academic research and policy implementation at scale. Located at the intersection of India’s innovation ecosystem (ABDM, NABH) and international standards ecosystems (ISO, JCI, WHO IPCHS), SUMO provides a replicable template for improving healthcare quality worldwide.
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