The HIS Devil in Healthcare Experiences

Information technology is meant to enhance the quality of service and experiences delivered in a hospital. Once a patient is registered in the hospital, the subsequent visits can than be recorded and the visit log used for either customising the services or improving the experiences. It also helps the hospital maintain patient records, which can be pulled out at the push of a button. These can help the medical teams see a fairly complete patient history and allow correct diagnosis.

More intelligent systems are now deployed at state of the art hospitals, which even provide aid to physicians in diagnosing and treating a patient's condition. They also ask a question and alert the doctor if they spot an anomoly. For example if a drug prescribed to be administered is contra indicated or if it has been given by another doctor on duty two hours ago, the system can raise an alert and inform the doctor. These systems are great to have.  

The only hitch with all this is that HIS systems being used by most hospitals in India deliver far less than what they promise. I have been part of various tech committees set up to evaluate these products and oversee their implementation and I must say that there exists a big gap between what is promised, what is delivered and ironically what ends up being used. 

Here is what goes wrong.

The HI systems are just unable to cope with the OPD volumes of a busy hospital. In India patients do not show up a few minutes before their appointed hour. They usually come late and expect instant service. Quite often the doctors also come in late and invariably the HI system is under constant pressure to push the patients through. The queuing system is mostly non existant. In some hospitals nurses double up as patient care executives with little knowledge of how to tackle the HIS. Patients start venting their ire on the hapless nurses and everything breaks into utter chaos. 

The doctors are still quite at sea with the computers and myriad HIS screens. Can one really blame them? In medical colleges I am not sure if they have an elementary course in managing a computer. They also train mostly in government run busy hospitals, where they have to see 100 or more patients in an hour. Now to connect with a computer is difficult for them and in the opinion of many, an unnecessary ordeal. The patients always bring their files and the doctor if necessary can scan their history from those files. 

The billing systems are unable to cope with the multiple billing requirements and rules that need to be followed. The billing is thus rarely accurate and lot to be billed is left out. The hospitals take a hit and in meetings after meetings these points are highlighted, audit committees get to have a field day and the head of operations and the head of IT a great fight.

The clinical systems are even a worse nightmare. The nurses who are supposed to use them are completely ill equipped to handle them. They have been trained all their lives to use neatly filed multi coloured charts to monitor the condition of a patient. To force them to use laptops and state of the art HIS is pretty much like asking me to try my hand at surgery. This is just not going to work till we have nurses far more educated and better trained than what we have now. Rushing them through a typical two weeks or less training programs and  expect them to master all this is unfair.

The surgeons are far more comfortable in the OR rather than in front of a computer screen filling in post operative notes or dictating in a Dictaphone, which will be transcribed by a guy whose knowledge of medicine will fit on a postage stamp.

The HI system is also touted as a great management tool as it can spew out all manner of reports. The HIS sales team merrily demonstrates the system's capabilities by generating sample reports during their sales presentations. The managers usually fall for this. Once the system is implemented the reports become the first casualty. The system usually produces raw data, which is than manually analysed and reported. What fun!

This piece is not meant to deride the HIS systems per se. On the contrary it is a lament on how the systems are used in modern hospitals in India. The way forward can not happen without HIS smoothly running the hospitals of the future. However, to reach there we need better and more Indianised Hospital Information systems, tightly defined hospital processes, and IT savvy doctors and nurses and a bottoms up approach.

The image is from www.flickr.com

Healthcare Marketing to the Elderly

Healthcare Marketers instinctively know that their largest customer segment is the elderly. Healthcare spends increase significantly in the older people and they need a wide range of healthcare services. As life expectancy increases across the globe the burden of disease also seems to be increasing at least in the burgeoning population of the older people.

The real challenge now is to ensure that while we live longer, we also live healthier. Lifestyle choices have an important role in determining the state of our health in the twilight years. However, as we grow older it is only natural for us to fall prey either to the ravages of time or to silently lurking diseases, which remained at bay earlier when our body's ability to withstand their onslaught was higher.   

Healthcare Marketers attempt to connect with the elderly in many ways. In India, most hospitals have failed to put together an effective CRM program, which addresses the needs of the elderly in a systematic manner. The reasons for this, in my experience are many.  

Hospitals in India look at the elderly as a group of people, who constitute a short term opportunity. They rarely look at investing in a relationship with the individuals in this group. A large amount of effort is concentrated in short term promotions targeted at the elderly. These usually include discounts and basic screening health checks, which are a thinly disguised ruse to get them to the hospital once. Almost all the hospitals pay lip service to the elderly by offering 'senior citizen discounts', which to my mind is the tool of the lazy marketer.

Very few hospitals realise that to successfully build a relationship it takes time, resources and tenacity. More so with the elderly as they usually are a lot more suspicious of strange institutions (particularly banks and hospitals) making unsolicited overtures.

A good relationship program must be designed in a manner that alley the natural fears of the folks, for whom the program is being designed. The program content and communication should be such as to reassure the elderly that the reason for the program is to provide better and customised care.

A good relationship program should evaluate the needs of the elderly carefully and offer tailor made solutions. For a large number of older people access to hospital is a big issue. Can a hospital offer a pick-up to the elderly people who join the program? Many elderly people need regular testing and need to have samples collected from home. Can a hospital do this on a regular basis? Can medicines required on a monthly basis be sent home on a pre appointed day of the month, month on month? Can a hospital dedicate a physician to take care of the minor day to day problems of the elderly, without they going through the routine OPD system? Can the signages be printed in bold and larger fonts to allow the elderly to navigate the hospital without assistance? Can they have separate counters, where they are served on priority? Can their be an executive dedicated to greet the elderly and offer assistance?

All this and more must be a part of the relationship program.

The real challenge lies in the execution of the program, which entails a seamless integration of medical expertise, technology and above all well trained individuals with the right attitude. CRM technology is quite advanced and allows one to slice and dice the data in multiple layers and directions. The greater the ability to slice the data, the more customised will be the program.

Apart from technology the most important element in the success of the program are people, who have genuine empathy, are passionate about their work and genuinely committed. Training goes a long way in ensuring a good customer experience, however a great customer experience gets delivered when the people managing the front end of the program really believe in it.

Nurturing the elderly in the twilight of their lives is a worthy goal in itself. A good relationship program allows the hospital to connect with them in their hour of need and ensure that they are recognised and treated with respect and dignity. The program more importantly should also connect with them, when they do not need medical care.

The patients in turn will always reciprocate.

Pic courtesy www.flickr.com

Hospital Marketing to those Next Doors

Marketing a hospital to those in the neighbourhood is often looked upon as the 'low hanging fruit' by many a marketer. The thinking goes something like this. 'We have just started a great hospital and those in the neighbourhood cannot help but notice the swanky chrome and glass exteriors and the blazing signages on the top of the 10 floor edifice. We have world beating technology and some of the most competent and respected doctors joining us. We are streets ahead of all those who have been in this neighbourhood for years and we really do not consider them as competition. All those who have been living in this community will now flock to us.'

Honestly, this is a recipe for disaster, yet so many of us marketers are so blinded by our spanking new hospital that we do not see anything beyond it.

Members of the local community are not going to queue outside a hospital just because it has opened its doors in their community. They have existing relationships, habits and healthcare consumption patterns that they have been comfortable with for years. A new hospital needs to make a serious effort to engage with them and persuade them to give the new hospital a try.
Some of the things that I have learnt, while being involved in the launch of 5 hospitals in the last few years in and around Delhi involve strategies for creating awareness, engagement and a uniquely differentiated experience to those in the neighbourhood.

Local communities will start taking an interest in the hospital if the hospital takes the initiative to engage with them. At the Artemis Health Institute in Gurgaon we started a program, which involved conducting a healthcamp in the condominiums in the neighbourhood of the hospital. The camps were held with clockwork regularity for more than a year. In the initial stages I would often go myself and hang out with the residents, while they met the doctors and underwent basic tests. I and other members of my sales team would talk about the hospital's facilities, services and the like without making it apparent that we were actually delivering a sales pitch. I would also meet the office bearers of the the local condo associations and discuss over a cup of tea as to how the hospital can be a part of the life of the local community. Since most of them were elderly folks who would need healthcare, this was generally a topic of great and often personal interest.

We soon hit upon an idea that in communities where the numbers of the elderly were large, we may set up small clinics with in the community. The clinic was run from a small room provided by the community and we would send a doctor for a few hours per day. The community also allowed us to advertise the clinic, which created greater awareness about the clinic and by association of the hospital. Soon we started getting referrals from these clinics and the emergency calls too increased. Buoyed by the success of the experiment we set up a few more clinics and with in a year we were getting calls from various communities asking us to open these clinics in their communities. The good word spread quickly.

At Artemis we also started awareness programs called 'Public Forums', which were lectures delivered by our doctors. We would advertise the lecture let us say on 'back ache' through print ads in local newspaper supplements and handbills. We would hold the lectures on Sunday mornings in the hospital auditorium and would typically have over 200 people from local communities attend. The sessions will include a lecture followed by a lively question and answer session with the experts and end with a light lunch. We discovered that many people would stay back to consult with the doctors. We believed that an aware customer will find it easy to choose us for his surgical needs. The success of Public Forums branded 'Let's Talk' were an example of how the Medical teams in the hospital worked with the sales and marketing teams to engage with the local residents.

Soon we also introduced an interactive website, uploaded the content of these lectures for people to download and also allowed them the freedom to write to the doctors, create their own pages and share relevant content with each other. The effort was to create a community of people, who suffered from a particular condition and to allow them to interact with each other as well as with the hospital.

While at Max Healthcare, we initiated a branded Neighbourhood Program for the adjacent South Delhi localities, which offered special benefits to folks living around the medical centre. The benefits included discounts on the hospital's regular charges, priority services and a dedicated family physcian to take care of day to day needs of the residents. The local residents were required to enrol for the program and were issued nicely designed cards, which served to identify them at the hospital counters.

To remain top of the mind and ensure good relations with the local communities we supported by advertising in the local resident directories, sponsoring local events and signing up advertising space with in the communities.

The engagement with the local communities is an investment that a hospital should not think twice about. It brings returns much faster than big ticket advertising and fancy launch parties. It also costs a lot less.

All it takes is dogged persistance, patience and a bit of luck.

The images are sourced from www.flickr.com

Around the World For a Cure

Medical Tourism is a much reviled word, in many ways an oxymoron. Tourism is all about holidays to be enjoyed with family and friends, while 'medical' connotes ill health, hardly conducive to travel. Maybe Medical Travel might be a more appropriate word.That as it may, medical tourism has gained wide currency and captured the world's attention.

It is viewed as the next big opportunity for countries like Thailand, Malaysia, India, Singapore in Asia and Costa Rica, Panama, The Bahamas and Peru in Latin America.

The reasons for Medical Travel are not difficult to understand.

People travel in search of good quality medical care. In the past business tycoons, politicians with ill gotten wealth, businessmen, aging filmstars and shaikhs from the Middle East would typically travel to foreign shores seeking high quality medical care. Most of them traveled from the lesser developed countries like Middle East, India and Latin America. The destination usually was the United States.

As medical technology and skills globalise and become available in lesser developed countries often at prices, which are a fraction of those in the Western World, Medical Travel seems to coming full circle.

Reasons for travel today include an inability to afford expensive healthcare in the USA, a long waiting list in government run facilities in Canada or the notorious NHS in UK and lack of facilities for advanced medical care (as in countries like Oman, Yemen, Bangladesh, Fiji, Mauritius, Nigeria and Kenya). Many individuals also travel for elective essentially cosmetic procedures. The humongous difference in the costs of medical procedures in countries like India and say the US and very little difference in the quality of care is also driving medical travel.
The number of people traveling around the world for better medical care at the moment seems to be low. McKinsey in a recent article on Medical Travel estimated that annually about 65000-85000 people traveled for medical care to destinations far away from home. In India apart from Apollo Hospitals and to a certain extent Wockhardt Hospitals, there are not too many hospitals who are attracting a significant number of medical travelers.

However the potential for growth is huge and there lies the opportunity for hospitals in India.
In my experience almost all the people who have come for medical treatment to hospitals like Max and Artemis have had had great experiences. Friends in Apollo, Fortis and Wockhardt also tell me that foreign patients generally have a great experience. Most of these hospitals go out of their way to ensure that the patients coming from foreign shores are well taken care of. They have specially trained staff taking care of their various needs, from airport pick ups to bedside admissions, arranging for laptops and mobile phones, accommodation, sight seeing, choice cuisine and even shopping for attendants, everything is arranged by the hospital. The nurses and the doctors too go out of their way to make them comfortable.

Patients contrast this sharply with their experiences of the hospitals back home. On their return they spread the word around. This seems to be the most effective Marketing strategy at the moment. The only problem with this approach is that it takes time for the good word to spread. Most Indian hospitals do not have the wherewithal to buy expensive print or electronic media in foreign countries. They mostly rely on medical travel facilitators a new breed of travel operators who connect individual patients with hospitals on their network. They check out the hospitals, meet individual doctors in these hospitals and than help patients who contact them through their website or offices choose the right hospital. They also make arrangements for their travel and have their representatives visit the hospital while they are recuperating. Medical facilitators earn a commission from the hospitals and I am sure also charge the patients.

Many hospitals are now looking at using the Internet to market themselves. Advertising on the net appears to be a cost effective solution. Many hospitals are busy with SEO's, PPC and other forms of internet advertising to reach out to foreign patients.

My belief is that Indian hospitals will have to bet big on this opportunity by opening facilitation centres in foreign countries, send doctors abroad to meet foreign patients ( A US board certified Indian surgeon can meet 20 pre-selected patients in NewYork or elsewhere and try and convince them to travel to India for surgery) and hire sales people who can try and generate business from large US corporates and foreign insurance companies.

For large US corporates burdened with huge and potentially back breaking healthcare spends on present and retired employees and their families medical travel seems to be a Godsend. They can significantly cut their costs by persuading employees to sign up for healthcare plans, which allow for treatment of certain conditions in select hospitals in countries like India and Thailand. They can even offer cash rewards to those employees who sign up as incentives. They will still end up reducing their costs significantly.

The Insurance Companies must view this as an opportunity to sell a low premium product to 45 million or more people presently uninsured or underinsured in the US. They can offer an insurance product at very low premiums, which allows for treatment in certain hospitals in third world countries. Currently all of them are waiting and watching for someone to take the plunge.
In countries like UK and Canada, the government can try and reduce the waiting periods by offering patients the choice to travel for their treatment.

All this and more is possible only when all the stakeholders (Corporates, Payors,Governments) believe that healthcare services in countries like India are at par if not better than those in their own countries. With JCI and NABH accreditations guaranteeing quality in many hospitals in these countries, the claim appears to be true.

The big question is that how many are today willing to trust and put their lives in the hands of doctors in a strange country?

A Hospital Experience by Design

Dr. Anil Bhan is an accomplished cardiac surgeon based in New Delhi. He was till recently the director of Cardiac Surgery at the upscale Max Hospital and has now moved to Batra Hospital, which is an older establishment and certainly no match for Max Hospital in spit and polish and customer service. The staff is not as well trained, or smartly turned out and lacks the quite efficiency, which characterises patient service at Max Hospital.

Recently the father of a close friend of mine needed bypass surgery. I unhesitatingly recommended Dr. Bhan. We went to see Dr. Bhan at his office at Batra hospital. As usual he inspired confidence and my friend and his father were both in agreement that Dr. Bhan was the best bet for them. We checked out the room where he was to stay after the surgery, enquired about the critical care support, blood bank and the nursing care. As we were stepping out my friend whispered that he wished Dr. Bhan was operating at some other hospital.

This of course is all in the mind. There was nothing that we found wrong with Batra Hospital. It was just that the hospital experience that he was hoping for seemed a long way off.

Traditional thinking has always held that patients will be happy to choose a hospital that offered the best clinical care and other factors such as location and ease of access, friendliness of the hospital staff, food, billing, amenities for the attendents of the patients and pricing are not really important determinants in the choice of the hospital.

I suspect this does not hold true in the fast evolving 'experience economy'.

The customers today believe that 'clinical excellence', (which includes medical care, nursing, infection control and hygiene) at the hospital is a given. A hospital, which does not offer the best medical care possible does not make it into their consideration set. Most hospitals today will have top notch physicians and surgeons all of them trained abroad, will have sophisticated equipment sourced from companies known for their high standards and will have medical processes that allow them to deliver medical care, which can be compared with the best in the world.

A hospital will have to have a lot more going for itself than just clinical care if it is to differentiate its services from its competitors. The new age hospital will have to deliver a unique and complete customer experience combining both medical and non medical parameters.
The delivery of this experience will have to be controlled and aligned with the brand promise of the hospital.

A new McKinsey research published last year surveyed more than 2000 patients in the US about their attitudes towards patient's experience. The research revealed that most of these patients were willing to switch hospitals for better service and amenities and many asked their physicians to refer them to specific facilities. (' A Better Hospital Experience, McKinsey Quarterly, Nov 2007, Grote, Newman and Sutaria).

I have identified 6, essentially non medical parameters, which I believe are singularly important from the perspective of a satisfied customer. A hospital must aim to deliver great experiences in these areas if they hope to have a delighted customer.

Punctuality: The patients hate waiting for doctors, to get done with all the paperwork and be escorted to their rooms, for someone to collect a blood sample, for the food to be served or the bill to be ready. This is in my experience of healthcare services in India one of the biggest causes of customer grievance. To a patient this reflects a callous, devil may care attitude, the last thing a hospital professing to provide great care would want !

The Communication with their Doctor: I have seen in my experience that patients always speak well of doctors who communicate well, who talk to them on a one on one basis and in a language that they understand. Moreover, they appreciate if nothing is hidden from them and the doctors keep them abreast with whatever is happening to them. Bad news might be a setback but it is always better than the suspense of no news and ceratinly better than discovering something disconcerting after the doctors have constantly assured the patients to the contrary.

The Admission Process: In many hospitals the admission process is cumbersome and involves filling multiple forms in duplicate or worse, signing consent forms written in language, which would be incomprehensible to all but the lawyers who wrote them. Sometimes it takes hours to get through all this and have a room assigned only to be told that the room is not ready and is being prepared. This can really be a big put off as a patient would like nothing better than to move to the assigned room quickly and rest.

The Patient Room: Patients spend a lot of their time in the room assigned to them. A nice, warm, cheerful room not only helps the patient get into a better mood, quite often I reckon it helps them recover faster.

The Hospital Food: The hospital food is a bugbear that most hospitals struggle with. Patients are usually very demanding about their food. The quality of the food, the presentation, how warm or cold it is, the time of the day it is served and the quality of food all have a very significant impact on the customer experience in the hospital. many hospitals these days offer a choice of cuisine. I would be happy if the food is simple and nutritious, served well and on time by a smiling individual. Goes a long way in ensuring a happy patient.

Billing: Billing practices in a hospital must be transparent and a running bill should be available for a customer to inspect, as and when he wishes to see it. Insured patients have to wait for hours in suspense for Third Party Administrators to authorise the bills so that they may leave the hospital. This can be tortutous for a patient once advised discharge from the hospital wants nothing more than to leave the hospital as soon as possible. Very often the hospitals goofs up here and the customer goes away with a bad experience at the fag end of his interactions with the hospitals thus spoiling all the good work done earlier.

These are 6 touchpoints, where a hospital must never allow a bad experience. Individuals responsible for these services must be selected carefully, groomed well and trained to ensure that all patients interacting with them have a great experience.

The designer experience is no longer a luxury. It is the pressing need of the hour.