Dengue in Delhi

It is again that time of the year.

The deadly Dengue virus is busy stalking its prey in Delhi and adjoining areas. The hospitals are struggling to find beds to accomodate people who want to get admitted, many out of fear rather than a positive diagnosis. The blood banks are busy dispensing blood and platelets to an increasingly desperate patient population. The pharmacists are busy stocking and dispensing anti viral medications to all and sundry.

Dengue has almost become an annual phenomenon in Delhi. It is around this time, when the monsoons are at their fag end when Delhi gets its share of Dengue. The municipal authorities are busy defogging the city, releasing large advertisements in local newspapers advising citizens to ensure that they do no have stagnant water bodies at home and that they remain covered head to toe so that the dreaded aedes mosquite does not get an opportunity to bite. I am sure the chief minister will soon be broadcasting appeals on the local radio and TV stations asking people to watch out against the mighty 'aedes' mosquito, which strikes during the day. The opposition politicians will also soon get into the act by blaming the ruling politicos for not taking enough precautions and subjecting the hapless citizens of Delhi to this menace. In short the Dengue circus has been unleashed on Delhi

The disease itself has been known to mankind since the mid 1779. The first recorded epidemic happened almost simultaneously in 1780's in Asia, Africa and North America. Dengue fever has become more common in the closing decade of the last century and is now considered to be the second most common mosquito borne disease after malaria. More than 40 million dengue fever cases are being reported annually across the globe since the late 1990's. The recent outbreaks of Dengue epidemic have been recorded in Brazil, Parague, Cuba and Mexico in South America and Indonesia, India, Pakistan, Malaysia and the Phillipines in Asia.

The symptoms of the disease include a sudden onset of fever with severe headache and chills, muscle and joint pains and characterstic red rashes that start from the lower limbs. Gastritis, nausea, abdominal pain, vomiting and diarrhea are also often evident. Severe cases may result in bleeding from nose, mouth and the gums.

Prevention measures include preventing the breeding of the mosquito larvae as well as personal protection against mosquitos. The larvae grow in stagnant water bodies around the household such as water stored in buckets, tanks, flower pots, coolers, plastic mugs etc. The best way to avoid larvae breeding is to use fresh water for daily use and avoid storing water. Personal protection agaisnt mosquitos will imply using mosquite repellant creams, wearing protective clothing, which covers arms and legs and using mosquito nets.

The hospitals as I mentioned earlier are busy. The patients even with mild symptoms and without any confirmation of dengue want themselves admitted. Those who do have dengue are being provided support and care, which includes a course of anti-viral, hydration through oral and intravenous fluids and blood/platelet transfusions if required.

No one really knows how to control this increasingly common and sometimes deadly disease. Vaccines are still under development and as yet there aren't really any effective ones available. The mosquitos are a reality in hot and humid climates and inspite of all precautions mosquitos can hardly be completely avoided.

In the absence of anything else, education about the disease and the steps required for its prevention remains the most potent antidote.

Pic from http://www.flickr.com/ owned by Lord V

Hospital Advertising That Works

It is a myth to believe that hospitals do not need advertising.

Many a times I have come across the argument about hospitals wasting money on expensive advertising, which seldom works and puts off customers. In my earlier avtars as the Head of Marketing Communications in large hospitals I have been at loggerheads with my other colleagues, who have often voted against my advertising proposals. Here is why I believe they are wrong and advertising works in healthcare just as much as it does in any other service.

The caveat of course is that the hospital's communication must be subtle, the message must be designed to ring a bell and should be done in a manner, which is consistent with the customer's sensitivities. An over the top message, which is loud and persistant and tries to do too many things will certainly put off customers.

Advertising at the end of the day is a promise of service to a customer. This is true of all advertising and is just as much true for healthcare services advertising. There is no reason to believe that as a consumer of healthcare services I wouldn't want to know what the hospital next door really stands for?

The hospital advertising that would really work has to emanate from a deep understanding of the consumer behaviour, when he is required to choose a hospital. No one wants to go to a hospital to enjoy a few days away from work. One is forced to go to the hospital under the press of circumstances. The desire is usually to get out of the hospital as quickly as possible with a positive medical outcome, and with the least dent to ones pocket.

When a customer walks into the hospital he is anxious, fearful of surrendering control of his body to the hospital, uncertain of the outcome. The customer at one level is seeking medical care for whatever problem he has, at another level he is seeking a reassurance. A reassurance that he will be treated with understanding, compassion, honesty and dignity, that he will have access to the very best that medicine has to offer and above all a reassurance that in the end everything will turn out to be right.

A hospital in its communication must be able to connect with the customer at this level. The communication must be designed to inspire trust. The message must have an emotional connect, should make a consumer believe that this hospital is the best place to be in the worst of times. The emotional core must be clearly defined and set off against logical props such as great doctors, state of the art equipment, processes that help deliver a great experience and people trained to understand and quickly respond to patients needs. The real challenge for communications professionals is to put this in a neat campaigns (without making it look slick or put on), which communicates simply and eloquently with the customers.

Once the communication is designed the media choices have to be made. This is critical and somehow the least understood by marketers. The message should be powerful and yet flexible to be adapted to the needs of traditional print media, out of home media and increasingly the digital media. The media mix has to be carefully worked out. This is the tricky part because the mix will clearly depend upon the target audience, which varies from hospital to hospital.

The Common Pitfalls
Hospitals tend to try and cram too many things in a single piece of communication. This happens when the communication is shaped by too many people each with their own perspective. Typically the advertising layouts go around and opinions are sought from various quarters including the heads of various departments, senior doctors and anyone else who may have a point of view. This in itself is not such a bad exercise. The real fun begins when the Head of Marketing is asked that these views be squeezed into the communication so that it pleases one and all who matters in the hospital. This is disasterous as in all this one forgets that the advertising is meant to appeal to the customers and is not a tool to keep various stakeholders in the hospital happy.

The other reason why I suspect healthcare advertising sometimes does not work well is that the promise made in the communication does not entirely gets delivered as a seamless experience across the hospital touchpoints. Somehow the people, who are to deliver the promise remain clueless about the promise till they see the advertising out in the media !

This to say the least is like committing harakiri. Internal communication and training to align touchpoint experiences with the communication promises rarely happens.

Conclusions
Healthcare advertising is an investment that can pay rich dividends as long as it is handled in a sensitive manner keeping the needs of the customers in mind. It is essential that a hospital walks the talk, which can only happen when the service delivery is aligned to the communication promise.

Healthcare advertising is tricky and has many variables. However, that is hardly a reason to not to attempt it.

On the Back of a Star

The star syndrome is a common phenomenon, which dazzles many a newly minted hospital.

I have been part of several start-up hospitals and have attended numerous meetings where all those who matter spout the now so familiar arguements about staying away from the 'stars' in the medical firmament. The arguements run something like this.

The star doctor (a well established doctor with a roaring practice) will be too set in his practices, will bring too much baggage and will never follow our pristine processes, which are far superior to his current practices. He will be a bad influence on everybody else. Another arguement goes that we do not believe in the 'star' system. Why should a 'star' enjoy priviliges, which are not available to our other doctors. A third arguement goes that we believe in growing our own stars. The hospital brand should be the real star and not individual doctors.

One can not really pick a flaw in any of these arguements. Star doctors are known to be egoistic, believe that making patients wait only adds to their stature, often indulge in practices, which are against the laid down hospital policy, break rules with impunity and in general do what they please. The management treats them with undue deference often causing resentment amongst peers. All this because they know they pull in a large number of patients and contribute significantly to the hospital revenue.

Once a new hospital commences operations without stars and the overheads mount relentlessly, while the revenue stream is at best a trickle, the need of a 'star' is felt acutely. The desire to ramp up fast and keep the promoters and other stakeholders off ones back takes precedence over all those arguements cited earlier.

The Star becomes the saviour. The CEO and all other 'chiefs' go 'star' chasing. The star is difficult to catch and quite often one can only sight it in the middle of the night. Meetings happen at his convenience usually anytime between midnight and 3 in the morning. Once on board he is treated like royalty. The star joins with a retinue comprising of his personal staff (numerous secretries, personal assiatants etc.), other doctors ranging from senior consultants to residents and the like. The star is presented to potential patients as as a great trophy. The hospital starts shining in the star's reflected glory. The patients start coming in and life becomes wonderful.

The bliss lasts for a few years. The star is able to fill up many beds. The trouble begins when one realises that under the star's dazzle nothing else grows. He eclipses the hospital brand, does not allow others to take roots, keeps the hospital management genuflecting to his whims and fancies and often bullies patients leading to bad word of mouth. The aura of the star starts diminishing.

Soon the hospital realises that probably they were better off without the star. The old arguements are resurrected. The star starts becoming a mere mortal. The hospital realises that getting rid of the star might not be a bad idea. However, it is easier said than done. Rememeber within the hospital's system the star has many a planets revolving around him.

Eventually the star is either eclipsed or simple allowed to wither away. The management team now believes that they can pull in patients on the strength of the hospital's brand name and soon the star finds itself being wooed by another new hospital, which has come up in these years and is desperately looking for a star to shore up its fortunes.

I wish this was a fable. Folks at all the leading hospitals in Delhi, which include Max Healthcare, Fortis, Apollo Hospitals and Artemis will bear this out. Some are at the stage where their 'stars' are falling, others are desperately looking for the stars to light up their lives.

The great game goes on...

The image is from http://www.flickr.com/

The Marketing of a Doctor

Do doctors need Marketing ?

I have worked for more than 8 years in healthcare services Marketing and am yet to meet a doctor who says that he does not need Marketing support. The funny thing is that all of them believe that the Marketing team always does more for the next guy and all of them collectively believe that the Marketing team does very little work in the hospital!

Dr. Bharat Inder Singh a well known family physician in South Delhi and former colleague at Max Healthcare, once told me that the only marketing he knows is putting a board outside his clinic and start treating patients well. Things have moved on since. Things really have moved on since.

I have learnt that while the hospital needs to quickly establish itself as a centre of excellence, the individual doctors are the most important element in the Marketing of a hospital. In the early phase of a hospital it is mostly the doctors who will draw new patients largely from the pool of patients they have treated earlier. While this may last as a steady stream for a few months, this stream of patients will never be adequate to sustain a new hospital. Thus doctors need to get involved in the Marketing of themselves. The Marketing team's task is to create opportunities of engagement of these doctors with potential patients, referring doctors and increasingly HR managers in large corporates. In this post I will examine the role of the doctors and the medical teams in connecting with the referring physicians.

The success of this effort is largely based on how well this collaboration between a doctor and the Marketing team works.

A doctor, who has joined a new hospital needs to understand that it will take some time for the patients to start trickling in. I have known many a doctor who are extremely chary of going in the 'field' with the sales team. This is somehow considered to be infra-dig. They would much rather be in the hospital and wait for the patients to materialise. Some would rely on expensive advertising rather than 'soiling their hands' with the sales folks, asking for patient referrals.

Rarely has this approach succeeded in generating patient traffic.

Most successful doctors know that their is no shortcut to success. Customers today have choices and those who go out to engage with customers, the local populace and the referring doctors stand a much greater chance of building a thriving practice. They also know one simple truth...there is no shame in asking people to visit them if they need help or taking out a prominent local doctor for dinner to get to know him better and build a relationship, which will culminate in patient referrals.

Continuing Medcal Education (CME) programs generally a euphemism for an evening do, involving local physicians (or those of a particular speciality) are common. These provide a platform for a set of doctors usually from a hospital to engage with local outside doctors. In my experience these are necessary in the initial phases to introduce a set of hospital doctors to referring doctors. It is rare that on these occasions a relationship can be forged, which will culminate in patients for the hospital. The next stage of engagement is generally with a smaller group of doctors (10-12) over cocktails and dinner. Finally the sales team will get the hospital doctors to meet referring physicians one on one. It is of utmost importance that a relationship is established between the doctors themselves. Patient referrals follow automatically.

Once patient referrals start, the hospital doctors must keep the referring doctor in the loop. A thank you letter, a phone call informing of the patient's progress can go a long way in cementing the budding relationship. The sales team's role here is to ensure that nothing slips between the cracks and they usually facilitate the communication between the hospital doctors and the referring physicians.

Medical conferences, paper presentations, academic newsletters also help in establishing the hospital doctor's credibility. It is important that the referring doctors be fully aware of the capabilities of the doctors they are refrring their patients to. The conferences also serve as a networking platform for all the doctors.

While all these help get patients for the first time, a doctor will start referring patients on a continuous basis only once he develops confidence in the doctor he is referring patients to. This can only happen when the medical outcomes are good, the patient has a great experience in the hospital and the communication channels between the referring and the referred doctors are working well. I have known of a hospital, where an orthopaedic surgeon and a laparoscopic GI surgeon will happily get patients from the referring doctors, while the cardiologists and the cardiac surgeons will endlessly struggle. The reasons for this were not far to seek. The medical outcomes in cardiology and cardiac surgery were not as good as those in other areas, the doctors hardly ever communicated and the reasons for poor outcomes were always swept under the carpet. I am afraid the situation in this hospital is unlikely to improve unless the core problem is acknowledged and fixed.

At the end of the day the sales team is just as good as the weakest link in the medical delivery team.

6 Ways To Get the Best Out of Your Doctor

Doctors too are humans. Very often, when confronted with a medical crisis we tend to forget this simple fact. In my many years of experience of working closely with doctors in large corporate hospitals, I have learnt that by observing the following few simple rules one can extract the best out of ones doctors.

1. Honesty is the Best Policy

It is imperative that you be brutally honest with your doctor. Hiding things such as a bad drinking habit or a past history of parental abuse will only make things difficult for your doctor. Remember a doctor is trained to understand and he will not pass judgement on your lifestyle or your past. It may also help if you were to make a small checklist of things that you plan to share with your doctor.

2. Trust Your Doctor

It is of immense importance that you trust your doctor completely. Do not hesitate to ask questions but never give the impression to your doctor that you do not trust his judgement. Medicine is endlessly complicated. No two individuals react to a disease or a medicine in the same manner. Your doctor has the knowledge and the experience to the do the best he can do for you. And if you have genuine reasons for not trusting your doctor, do not continue under his care for a day longer. Have a honest chat with him, explain to him your reasons for discomfort and inform him that you will be unable to continue under his care. Many of us hesitate to engage our doctor in a discussion like this fearing that our doctor will take it otherwise and will be offended. Most doctors will understand and even help you find another specialist who will probably be able to help you better.

3. Knowledge is Power

Try and learn as much as you can about your ailment. Information is easily available over the internet or ask for Patient Information Literature from your care managers at the hospital. It is a myth to believe that doctors are uncomfortable with knowledgable patients. The truth is that most doctors encourage their patients to learn more about the disease and the treatment options. This helps your doctors to engage with you much better.

4. Be Vigilant...Always

Illnesses seldom happen all of a sudden. While on a hospital bed one often looks back at the small tell tale signs that one ignored before the onset of an illness. That momentary loss of sensation in a limb, that small black out that one ascribed to fatigue, that heaviness in the chest, which one tried to cure by popping an antacid all return to haunt us as serious illnesses. The surest way of getting the best out of your doctor is to visit him or at least call him when you feel anything, which may be out of the ordinary.

5. Follow Instructions

When you have decided to continue under the care of your doctor follow her instructions carefully. If you have any doubts, ask her as many times as you need to. Do not discontinue medication the day you start feeling better. Quite often we tend to ignore certain advise, which involves lifestyle changes such as regular exercise or a daily constitutional. Remember there is no advise, which is less or more important. If there are some instructions that you genuinely can not follow, inform your doctor. She in all likelihood will offer you an alternative that you will find more suitable.

6. Be a Patient Patient

During bouts of ill health, patience is difficult to muster. We all want to regain good health as soon as posssible. We must understand that our doctor is not a magician. Medicines which work instantaneously are yet to be discovered. The simple truth is that healing takes time. Lifestyle changes if required take even longer to take effect. The best way to recover from a bout of illness is to first accept your situation, understand what your doctor is trying to achieve and wait patiently for the time to come for you to resume normal life.

The Marketing of a Hospital

Before I get into the business of writing about the Marketing of a Hospital in India I must establish my credentials.
I have been working in the arena of Marketing of Heathcare Services for the last 8 years or so. I have been involved with Apollo Health and Lifestyle Ltd., which is the franchisor of Apollo Clinics part of the Apollo Hospitals Group, headed the Marketing and later the Corporate and International Sales for Max Healthcare a large healthcare services company based in Delhi and for the last two years have been heading the Sales and Marketing function at Artemis Health Institute, a tertiary care hospital based in Gurgaon and promoted by the Apollo Tyres group.
When I started working for Apollo Hospitals as the Marketing Manager for The Apollo Clinics and later at Max Healthcare I was often asked the question as to what really a Marketing person did in a hospital. Marketing of hospitals was understood to be a big no no. If you had a good hospital infrastructure and some well known doctors working for you the conventional wisdom dictated that the patients will follow.
Over the years this line of thinking has completely changed. Healthcare Services Marketing is gradually coming of age. We now even have advertising agencies dedicated to healthcare!
Some of the reasons for this sea change are not far to seek.
Patients to Customers
Patients are fast metamorphing into customers. They are just not satisfied with being a passive presence in their treatment. Increasingly they are demanding that they be included as active partners in their care. They are far more knowledgable and willing to question their care givers including the doctors. Hospitals are realising that for them to succeed in today’s environment they have to engage with patients/customers in a manner which they appreciate and understand. The communication, which engages with customers is generally the prerogative of the Marketing folks. This often translates into Patient Information booklets, detailed instructions before admission, during hospital stay and after the discharge. Extensive websites provide authentic information and hospitals like Artemis also provide interactive websites (http://www.artemisinteractive.in/), which allow patients to communicate freely with each other. Artemis also engages with customers by organising Public Forums, where eminent doctors interact with the public at large.
The Need to Standout
The healthcare revolution is truly underway in India now. The great urban middle class in large metros has multiple choices for their healthcare needs. Most of these hospitals have a lot going for them. However, most of them do not have much to differentiate them from each other. The failure rate of a bypass surgery in Apollo, Escorts, Max and Fortis Hospital is less than 2% and would compare favourably with any hospital across the world. Increasingly the medical expertise is becoming a given. The battle for differentiation is now gradually moving towards the overall customer experience that a hospital is able to deliver to its customers at all touchpoints. The Marketing teams in a hospital defines customer experience parameters and oversee the delivery of this experience at various touchpoints.
The Advertising Conundrum
Advertising in healthcare services have always been a contentious issue. Many people see hospitals splurging money on slick advertising as an effort to profit from some people’s misery. Afterall no one goes to a hospital to enjoy themselves. Hospitals are quite aware of this latent sentiment and try to be discreet about their marketing communication. However, with the patients gradually moving towards becoming customers the old taboos are disappearing fast. An increasing number of customers see private hospitals as commercial enterprise and understand that the stakeholders do need profits. (What they continue to object to and rightly so is to reckless profiteering) In the future healthcare advertising will gain more prominence and we will see more hospitals and probably doctors advertising their services in various media.
The Health Insurance
Presently Health Insurance has a miniscule penetration (4%) in India. With pureplay health insurance companies (Star Health, Apollo DKV and yet to start Max BUPA) commencing operations and with MNC’s offering health insurance coverage to their employees and their families, health insurance is poised for explosive growth. From the perspective of the customers cashless services at all corporate hospitals have taken the all important issue of price out of the customer equation. Thus in this unfolding scenario the differentiation will be through communication salience and top of the mind recall.
The Constant Customer Engagement Paradigm
In the days of yore a hospital interacted with patients only when they came to the hospital and stayed as inpatients. In today’s dynamic environment hospitals engage with customers throughout their lifestyle. Specialised programs are being devised, which enrol customers who are high risk for a disease (cardiac diseases-people with a family history, sedantary lifestyle, high stress levels, smokers and hypertensives). The hospital endeavours to be in constant touch with this group of people. The idea is to remain engaged so that God forbid if something happens the hospital is not too far off. The hospitals are now also devising Post Discharge Care Programs, which allows them to maintain a dialogue with patients even after they have been discharged from the hospital.
These in reality are another version of ‘loyalty programs’. (More on this in a separate post) adapted to the needs of the healthcare industry.
The Marketing function in hospitals is thus fast emerging as a critical function. The Marketing folks are tasked with engaging with customers (no more patients) both outside and inside the hospital. Happily for customers this can only mean a far better hospital experience and not just better care

The Role of Referral Fee in Healthcare Marketing

Referral Fee has always been one of the most controversial issue in the Marketing of Healthcare Services in India.
Large tertiary care hospitals derive much of their revenue from patients who are admitted in the hospital. The revenue comes from the room rent (that the hospital charges from the patients), the surgical fee, the anaesthetist’s fee, the Operating room charges, the investigations that the patients need during their stay in the hospital and the medicines and other sundry consumables that are used by the patients.
Patients who need admission rarely walk into the hospital requesting admission. They generally come through the Emergency Room (the ER) or are referred by their family physicians or other specialists who practice outside the hospital. Many a times patients are also referred by smaller secondary care hospitals or nursing homes.
Quite often the large tertiary care hospitals find themselves wooing these individual family physicians, specialists and smaller nursing homes. The wooing may take the form of a well defined relationship program, which may entail engaging the referring doctors by offering them ‘visiting rights’, free passes for CME’s (Continuing Medical Education Programs), junkets abroad mostly in the guise of International Conferences, subscription to prestigious medical journals (usually quite expensive) and lavish dinners and entertainment.
More often than not the hospitals today offer a cash payout to these doctors usually a percentage of the bill the referred patient runs up in the hospital. This payout is called the ‘referral fee’.
The referral fee is looked down upon by most hospitals. In my conversation with senior doctors and sundry hospital CEO’s I have always noticed the sneering tone in which the ‘other’ hospitals are always derided for its questionable practices. It is always like ‘everyone does it except us’. I have had the occasion to sit in meetings after meetings (usually of start up hospitals) where hospital policy is enunciated in high falutin language and the referral fee is trashed as an ‘unethical practice’, which our hospital will never resort to. Usually 6 months or less into operations the reality of referral fee raises its head and suddenly it becomes alright to pay, mostly because the other hospital across the city does it all the time.
The CEO who had almost sacked the Sales Head for suggesting Referral Fee as an option for driving sales is discreetly instructed to figur out a way to offer the fee to referring doctors. Issues regarding keeping a track of ‘referred patients’ and their bills , the network of doctors to be paid off and the exact mechanism of the payoff are discussed and finalised. The money begins to flow. All this is of course very hush hush and in public the stance always is that we have nothing to do with such reprehensible practices.
The question that really begs an answer is whether this practice is really as obnoxious as it is made out to be?
Let us examine this issue from the customer’s perspective. I as a customer would trust my family doctor to refer me to a hospital, which he thinks will provide me the best care. To send me to any other place for commercial or any other reason is clearly wrong. By doing so my family physician breaches my trust.
However, will I still object if my doctor refers me to a hospital, which he genuinely feels is the best for me and also gets paid for it? I would probably be not bothered about this kind of financial arrangement between my family physcian and the hospital.
Now if the hospital was to offer me a discount, which is equivalent to the doctor’s commission, will I still not object. Will I be okay if the hospital was to inflate its pricing by 10%, which is supposed to be paid to my doctor. The answer would be a most emphatic NO. Why should I end up paying a heftier hospital bill just because my family doctor sent me to the right hospital?
How can one be sure that a Family Physician will not end up sending a patient to a hospital, which pays him the most? It is mostly upto his conscience. The referral fee will be an inducement for at least some doctors to refer patients to a hospital, which may really not be best for him. This unfortunately my friends in the world of medicine vehemently deny. Unfortunately as long as the perinicious system of referral fee remains there is no way of ensuring that a patient will not deliberately be referred to a hospital, which may not be the best for him.
Thus I believe that the Referral Fee should not have any place in the practice of medicine. Hospitals succumbing to this practice because of pressure for early profits from their stakeholders must stand firm.The healthcare industry needs to self regulate. Maybe the government should set up a regulatory body with real powers to check and discourage these practices.
As far as patients are concerned they must encourage their family physicians to offer them choices, check out the referred doctor’s credentials and the infrastructure available at the referred hospital. Blind trust in the matter of ones health can turn out to be quite perilous.