Doctors and Healthcare Advertising in India

Many years ago when I worked at a hospital chain, our advertising agency had come up with a campaign featuring happy patients. The hospital wanted to showcase their doctors. The objective of the advertising was to showcase the hospital’s expertise and superior services and position it on the ‘care’ platform.

The advertising agency and the hospital had been at loggerheads on this. The agency was dead certain that showing hospital doctors in ad visuals was a bad idea. They had come up with the images of happy people, who had had wonderful experiences at the hospital. The copy proceeded to narrate the experience in glowing terms, capturing the essence of the hospital and making a point about its medical and other services. I had liked the ads, though I found them a little run of the mill. Nothing very extraordinary but steady communication, which made its point. It however never saw the light of the day.

In those days (and I suspect in many hospitals even today) the brand manager had to run the ads past the medical folks. The prevalent thinking was that the medical people will be able to spot bloomers and also come up with great suggestions and those could be incorporated in the communication. However, I quickly learnt that the reality was usually very different. Most medical folks had very little understanding of consumer facing communication, and most wanted themselves featuring in the ads. Many also wanted images of them operating on patients and were keen to showcase all the gory details of their glorious profession. Some even had suggestions on how ad copy headlines and even hospital logo was to be arranged. The advertising agencies hated this mutilation of their advertising and the brand manager had the task of balancing the demands of the doctor, the agency and the brand itself.

As I gained in experience, I realized that a lot of hospital advertising had very little to do with end consumers. Now, this may sound absurd, but let me explain. Often hospitals would hire high profile doctors committing huge marketing spends on promoting them and their specialities. This would be the understanding between the hospital bigwigs and the doctor concerned. Thus, a significant purpose of the advertising will be to keep the doctor in good humour and honour a commitment made to him. Thus the doctor would legitimately expect to feature in the communication and try and showcase his skills.

Unfortunately, even now one rarely comes across real ‘brand’ advertising in healthcare in India. Most hospitals still prefer to bet on individual doctors and shy away from investing in the hospital brand. New hospitals do a little ‘launch’ related advertising, however there too quite often one encounters a well known doctor prominently featured in the communication.

Recently I came across advertising for Alchemist Hospital in Gurgaon, featuring the well known cardiac surgeon Dr. P Venugopal. He was till recently the director of the All India Institute of Medical Sciences and has now joined Alchemist Hospital in Gurgaon. Max Healthcare announced the commencement of their cancer services leading in with the doctors they have hired. They also ran ads featuring Dr. Pradeep Choubey, a well known laparoscopic surgeon who has joined them from Sir Gangaram Hospital.As a consumer, why do I need to know how Dr. Choubey looks to understand that he has now moved from Sir Gangaram Hospital to Max Hopsital. Yes, as a consumer I would like to know how Dr. Choubey’s expertise and services makes Max Healthcare a better hospital.

Seeing these ads recently reminded me of my struggles as a young brand manager. Even after so many years, it seems in healthcare communication nothing much has changed.

Here is wishing everyone a Merry Christmas!!!

Pic courtesy www.istockphoto.com

The Importance of Small Things in Hospitals

Here are a bunch of ’small’ things I noticed during the 3 days I attended on my father, who underwent prostate surgery in a South Delhi hospital a couple of weeks ago. On their own, they really do not count for much and I am sure they did not impact the care my father received during his convalescence. However, do they add up to a less than satisfactory customer experience, I leave you to draw your own conclusions.

1. Right behind my father’s pillow, on the wall there were stains, which looked like congealed blood. In two places in the room, the plaster had pealed off.

2. The walls had marks, most probably made by the patient beds rubbing against them particularly when the patients are transferred from the room. The walls look like they need a fresh coat of paint.

3. The patient beds had mechanical controls requiring a lever to raise or lower them. The lever jutted out from under the bed and when not in place, one could safely conclude that it had been borrowed by the patient in the next room.

4. There were for some reason no curtains around the patient’s bed.

5. The sofa cum bed meant for the attendants had a ragged worn out handrest.

6. There appeared to be hoards of people in the in patient areas. The hospital corridors were always humming with either hospital staff or patient attendants. Many whiled away their time at the bustling nursing station, which also appeared to be the hospital staff’s favourite spot for socialising. Attendants merrily browsed through patient files, their own as well as anyone else’s.

7. All the trolleys used for transporting food, medicines, linen etc. squeaked to high heavens. Someone just forgot to have their wheels greased in a long time.

8. There is nothing called ‘Do not Disturb’ sign in the hospital room. On a particular day we had 16 different set of people requesting permission for something or the other. When does a patient get to rest?

9. Newspapers were never delivered in patient rooms, while a huge bunch lay about at the Nursing station.

10. The F&B services really take the cake. On day 01, my father was served soup and sandwiches 5 times. The same soup and the same soggy sandwiches all the time. The next day, he did not get anything to eat till lunch because the dietitians thought that he was to undergo a surgery that day, never mind that that the surgery was scheduled the next day! The rice was served on the tray mats and one was to eat straight from there. In spite of requesting for a non-vegetarian diet, he received a vegetarian meal and the best of all, even after clearly indicating his allergy to egg (boldly mentioned on his medical file for all to see except the dietitians!), he did manage to get an omelet for breakfast.

11. The hand sanitizer was empty and was removed on my request. The new one never materialised.

12. My father was taken for an ultrasound. He was wheeled out on a wheel chair and taken to the radiology department and was kept waiting there for 40 minutes, with his bladder full. Apparently no one coordinates this. The OPD and the IPD patients are taken down Radiology and than they await their turn, without anyone knowing how the system works. (Strangely, when I screamed at a lady sitting in one of the offices adjacent to the Ultrasound room, my father had his ultrasound on the double).

13. Finally, I pointed out a small mice which ran around in the area occupied by the hospital’s TPA executive.

Looked in isolation these incidents perhaps do not amount to much. Some may even accuse me of nitpicking but the fact remains I did notice all this and it made me immensely sad. This is a hospital I was involved with during its early days and I am fully aware of its founder’s commitment and the high standards he had set towards patient care.

While my father had a uneventful surgery and a quick recovery for which I am immensely thankful, the customer experience was really not something to write home about. I wish someone, somewhere is listening.

Why some of our doctors have such poor bedside manners?

I have often thought about, why some of our doctors have such poor bedside manners and never more so since my father’s surgery.

My father underwent an urgent Prostate Surgery earlier this week. The surgery was conducted at one of the most well-known and if I may add, sought after hospitals in South Delhi. The hospital and the surgeon are familiar to me from many years and yet this is what happened one evening.

The surgery in the morning had been uneventful and the surgeon was happy with my father’s progress. In the evening as my wife and I sat in his room in the hospital, two gentlemen barged in and started examining my father. They lowered his pyjamas for the examination, chatted with each other, assured him that all was well and walked off. As they were leaving I asked them who they were and one of them introduced himself as an associate of my father’s surgeon and left.

Now here is my problem.

I have no idea who these people were. They wore no surgeon’s gowns, they had no telltale stethoscope around their necks. They marched into our room without a knock and proceeded to examine a patient, without his permission. They removed his pyjamas for an examination, with two people sitting in the room and the door wide open. I was shocked to witness this humiliation and I could feel my father’s acute discomfort.

To the doctors, strangely nothing appeared to be amiss! When I stepped out to have a word with these gentlemen and pointed out their completely unacceptable behaviour, they appeared surprised that a patient’s attendant has the gall to question them and arrogantly dismissed me saying that if I had any complaints I needed to address those to my surgeon! They did not deem it fit to utter a word of apology for their appalling conduct.

All this at as I said earlier at one of Delhi’s finest and most expensive hospital.

Why do some doctor’s treat their patients as if they do not exist or matter? I believe this is primarily because we patients allow them to. In India, a career in medicine enjoys tremendous social prestige and doctors are treated with enormous amount of respect. We bestow on our doctors God like powers of life and death and since in our eyes they are Gods, we refuse to see their shortcomings and failings. Gods afterall can treat us, the mere mortals, as they please.

To make matters worse, most of our doctors receive their training in government hospitals, where the poor and the uneducated see these doctors in their shiny white coats and stethoscopes as people from another world. In these hospitals overflowing with people from ‘darkness’ (to borrow a word from Arvind Adiga’s ‘The White Tiger’) they are treated as the lords and the masters of all whom they survey. These doctors from an early stage in their training imbibe these behavioural patterns and one assumes that in later life, in different hospitals and while treating educated folks, the old habits refuse to die.

Lastly I also believe, that parental and peer pressure force many a youngster to choose medicine as a career, while they just do not have the calling. The admission procedures are also flawed as they test knowledge but not aptitude. Thus we have doctors, who have no business being doctors. They are trapped in a glorified profession from which there truly is no escape. Can we really blame them for (mis)treating patients the way they do?

How do we cope with such arrogant and errant doctors? Well, I see no reason why we cannot simply ask them to treat us better. Their ego may stand in the way of apologising or showing contrition, but I am sure they will think twice about being discourteous the next time around.

And that should be a good enough start.

PS:Lest this sounds like a diatribe against doctors I hasten to add that I also know many very competent doctors who treat patients with great courtesy and professionalism. They are warm individuals, love their profession, have great compassion for the sick and look upon their profession as nothing less than a calling. They not only treat but heal and that is where the real difference lies.

PicCourtesy: http://thyroid.about.com/b/2008/08/19/six-rules-doctors-need-to-know-and-six-ways-to-be-a-better-patient.htm

Marketing a Breast Cancer Screening Program

Breast Cancer is one of the most common cancers in India. Latest data indicates that the incidence of Breast Cancer in India is on the rise and is currently pegged at 30 per 100000 women. While this is much lower than what the US reports (100 per 100000 women), one suspects that considering India’s abysmal rural healthcare infrastructure, the actual incidence of Breast Cancer would be much higher.

Experts agree that the best way to treat breast cancer is to detect it early. Technology now allows for detection of very small tumours. Mammography, which essentially is an X-Ray of the breast allows for early detection of the tumour. It is recommended that women in India must undergo a breast cancer screening every year after 40 years of age. There has been some debate on whether the right age for screening should be 40 years or 50, most experts agree that in India, 40 years is the right age for breast cancer screening.

A Breast Cancer program must revolve around breast cancer screenings. The biggest barrier to a screening program is the fear of the disease itself. This may sound ironical and completely irrational but most women do not undergo a breast cancer screening because they fear the outcome of the tests. Not knowing about the disease seems to be a lot better than confronting the reality. Unfortunately, this ostrich like attitude leads to late detection of the disease – many a times it is just too late.

Breast Cancer related communication should be handled with empathy and care. One of the key tasks of the communication should be to educate women to come in for regular annual mammograms. The communication should sensitively address the fear of the disease and highlight early detection as the biggest weapon against it. It should be subtle yet powerful enough to get women to come in for regular screenings. Many hospitals make the mistake of trying the ‘fear’ route by highlighting the horrific aspects of the disease in their communication. This I believe is futile and may end up scaring women further. I have also come across Breast Cancer related communication, which is frivolous and in bad taste. Needless to say it serves no purpose.

Involving Breast cancer survivors in helping spread the message is a great way of attracting women for screenings. At Artemis Health Institute in Gurgaon we worked with organisations like ‘Can Support’ on Breast Cancer awareness programs. Many of these organisations are run by cancer survivors and they bring an uncommon zeal (borne perhaps by their personal experiences in dealing with cancer) to the task of creating awareness and fighting the battle against cancer.

It would also help if the hospitals can organise frequent breast cancer awareness programs and invite women to come in for screenings. The hospitals should also organise sessions for women, where in trained experts can demonstrate and impart ’Self Breast Examination’ techniques. Hospitals should also publish literature offering information about the disease, common symptoms, benefits of early screening and also the treatment of the disease.

In order to attract more and more women to breast cancer screenings hospitals should bring down the cost of a mammogram. The cost per scan of the machine is negligible and hospitals should try to amortize the capital cost over a larger number of screenings. Hospitals today charge Rs. 1500-Rs. 2000 for a scan. This can be easily halved if the patient volumes go up.

Breast Cancer is a dreadful disease. No one knows what exactly triggers it. There is no scientifically proven method of avoiding it. The only way to fight the disease is by detecting it early. Technology today allows early detection and a complete cure.

This is the simple message, which a good Breast Cancer Communication program must deliver over and over, again and again, ad- nauseum.

Indian Hospitals Need New Online Initiatives

Websites of Indian hospitals are hardly something to write home about. They are mostly poorly done, difficult to navigate and usually the information lies buried so deep that it tests ones patience to get the relevant information . The other day, it took me close to 20 minutes and numerous clicks to locate the address of a hospital from its website. I needed the address to send a Diwali card to a friend who works at the hospital and try as I might, I just did not seem to find the address of the hospital.

Almost all of the hospital websites that I am familiar with are largely static. Thus, they do not interact with patients or caregivers looking for specific information. They do not allow one to book appointments, download reports, interact with doctors taking care of ones loved ones, send good wishes or chat with the patients. They do not support e-commerce. Thus if I was an NRI living abroad and wanted to buy my parents an annual health check or if I wanted to pay their hospital bills on line, I just can not.

In the era of burgeoning medical travel and with Indian hospitals attracting a sizable chunk of patients from all over the world, this does seem strange. For some unfathomable reason, Indian hospitals have not invested too much on their websites or for that matter on online marketing per se. I believe it is high team someone woke up and used the net better.

It is indisputable that a certain kind of Indian consumer has fully embraced the e-revolution and their tribe is growing by leaps and bounds. With the broadband penetrating deeper, more and more Indian consumers will look at the internet for information, entertainment and commerce. They would seek information about doctors, medical facilities and would like to compare medical outcomes across hospitals. They would like to chat with doctors and customer experience executives in the hospital before making a choice. A hospital aspiring to attract these kind of patients must consider significant investments in their websites and in enhancing their online visibility.

The entire gamut of social media on the net can also be used by hospitals in interacting with their patients. At Artemis, we tried creating an online community of patients and caregivers, where members could post their hospital experiences, their recovery post discharge from the hospital, photographs showing their progress and interesting pieces of information on their disease and latest advancements in medicine. We also encouraged hospital doctors to interact with members of this community. Unfortunately the hospital discontinued this initiative once I left. The hospital was cutting costs and building an online community was considered too ‘long term’ for investments to continue.

The next level of online presence would require hospitals integrating their Hospital Information Systems (HIS) with their websites allowing patients and their relatives on line interactivity. This will facilitate hospitals inviting second opinions from experts anywhere in the world, keeping the patients family and relatives (who might be half way around the world) in the loop on the patient’s progress, interaction with their doctors and online payments. The big issue here is the online security of patient information. The hospitals will have to invest in a foolproof system, which guarantees authorised access to medical data. It would be a disaster if a hospital integrates its website with HIS and leaks confidential data.

With the current level of IT advancement, this and more is certainly possible. Indian hospitals have to look at these opportunities seriously and start investing. The returns would quickly follow

Service Design Prescriptions for Indraprastha Apollo Hospitals

A couple of weeks back I had written about my experiences at the Indraprastha Apollo Hospitals. Following the publication of that post, I received a call from the hospital. I must say I was very surprised. The caller was a lady who said she looked after service quality and was calling to learn more about my experiences at the hospital. While apologising for what we had to go through the hospital, she wanted more details and appeared keen to fix the problem. Subsequently I also received a call from my former colleague Usha Bannerjee, who presently heads nursing at the hospital. She too admitted that they have been having ’service’ issues and they are trying their best to rectify these.

I would like to believe that Apollo’s problems are those typical of enterprises, who have more customers that they can possibly handle. To compound matters, they are stuck with poorly trained people and processes, which make matters infinitely worse. That they are committed to better services is great. However, the problems will not go away in a hurry.

The problem of plenty in a hospital is just as bad as the problem of having very few patients. Apollo Hospitals attracts patients from across the country and pretty much from the whole world. ( I literally live in the hospital’s shadow and keep running into enrobed Arabs, staying in rented digs in Sarita Vihar, where many an enterprising landlords have converted their flats into makeshift guest houses). The sheer numbers mean that the hospital staff is unable to give enough time and attention to each patient and there is always a rush at hospital counters. Thus, the service folks at the hospital are not interested in looking after individual patients, all that they do is ensure that the patient is lobbed in another direction, away from the counter they man. This is all too common in service establishments where there are a surfeit of customers (bus and railway stations, government hospitals, etc.)

Apollo gets away with this because it is a healthcare establishment, which has some of the best known doctors working for it. The patients flock to the doctors looking for succor and inevitably get sucked into the Apollo system. The other thing that works in Apollo’s favour is the simple fact that most Indians still consider doctors and medical establishments as demi Gods and rarely challenge small service failures, lest they offend their doctors who they believe hold the power of life and death over them. I am sure if Apollo was a hotel, its customers would be a lot more demanding and a lot less forgiving of its follies.

How can Apollo improve its services. Here are a few suggestions.

The management team at Apollo Hospitals should be clear in its customer experience goals. They must set the agenda for service excellence and establish clear and measurable goals. They must also demonstrate their willingness to bring about serious change and the ability to stay the course.

Apollo needs a complete makeover in terms of service processes and their flow. While the hospital has embraced the JCI processes, they seem to be more from the perspective of getting a certificate rather than genuinely improving customer experiences. Each process needs to be carefully studied and calibrated in terms of the delivery of the right customer experience.

The hospital needs to look at its people dispassionately and put them in a matrix based on their ’service’ orientation. Any other consideration such as the number of years they have spent working in the hospital should not matter (there is no such thing as loyalty). Only those who demonstrate adequate customer orientation, empathy for patients and the willingness to go the extra mile to ensure patient satisfaction must be retained. Others, who have the potential and need training should be taken through a structured training program focussed on delivering the right customer experience. This process would lead to the elimination of a lot of employees, particularly those who have been with the hospital for long. This should be viewed as an opportunity to induct fresh talent, young and bright people more in tune with the needs of the present-day customers.

The change towards a better customer focus, will also entail a new cultural orientation. The hospital should aim to embrace a more open, customer friendly culture, which rewards team members going out of their way in delivering great customer experiences. The new culture should be transparent, encourage team play and the senior management should lead by example.

I know these prescriptions are easy to suggest. However, the real challenge lies in implementing these and managing the transition. Great customer service must be driven with great force and alignment of every individual including medical folks is a must.

For Apollo Hospitals, I reckon it is really high time they began.

The Future of Medical Education in India – The Way to Go

The Union Health Minister Ghulam Nabi Azad appears to be busy shooting the breeze by announcing vague policy changes involving setting up of Medical Colleges through private capital and in collaboration with government run district hospitals. The minister who is well known for putting his foot in the mouth, recently announced at a FICCI conference that the government is considering relaxing the norms for setting up medical colleges by the private sector. He also announced that these colleges can be affiliated with the government owned district hospitals, thus doing away with the requirement of a teaching hospital to be attached with the medical college.

The minister is seeking private equity participation in rural, backward and far-flung areas of the country. He believes that the private players can be attracted to set up medical colleges in these parts of the country by offering concessions such as access to district hospitals.

Doesn’t this sound completely hare brained?

Why would a private entity invest money in backward and far flung areas? The minister must know that what passes for District Hospitals is a sham. The hospitals are poorly equipped, have limited resources and are dens of corruption. Many are old and decrepit, some even falling apart with peeling plaster and leaking roofs. How will these private medical colleges attract students when they will be offering their students medical training in these hospitals? Will these students learn cutting edge medicine in hospitals, where high tech might mean an X-Ray machine? Why would they pay hefty fees to go to attend these medical colleges, knowing fully well what lies in store for them in the future? And if the students don’t find this proposition attractive, how will the medical colleges make money and generate a return for their investors?

India needs more doctors. According to the current planning commission estimates India needs 600000 doctors, a million nurses and more than 200000 dentists. The only way this shortage can be met is by investing in medical education. The government must find the resources to set up more medical colleges and teaching hospitals across the country. The bulk of the investment must come from the government. After all, this is an investment in the future of the health of the citizens.

The private sector can be roped in to partner in this effort, where in some of these colleges can be set up in collaboration with private players. The government can facilitate these investments by offering tax breaks, land at concessional rates, soft loans, duty concessions on buying high tech equipment, and by developing allied infrastructure like power, roads and telecom in these areas. The teaching hospitals established along with the medical school can than serve as regional/district level referral centres for far flung Primary Health Centres. The teaching hospitals can also run outreach programs, touching lives of people in remote areas through regular camps and mobile hospitals.

These state of the art medical colleges and teaching hospitals will than be able to attract bright students and dedicated faculty. Many of them will come hopefully, not from far off places but also from local areas and will be happy to serve their own communities. Thus, they will form the backbone of a medical network that will extend its reach into the farthest nooks and corners of our country, making it possible for our citizens to access high quality healthcare nearer to their homes.

The minister must find a way to make a clean break from the past, think afresh and find the resources to get this going. More importantly he needs clear thinking and resolute will to bring about the change in the way healthcare is delivered in our country.

My experiences at the Indraprastha Apollo Hospitals

The other day I landed at the Indraprastha Apollo Hospitals, a stone’s throw away from my residence in New Delhi. My wife needed a test and our doctor at Max Healthcare asked us to get it done at Apollo as the equipment at Max was out of order. The moment I walked in I felt as if I was on a railway platform. The hospital was full of patients as everybody appeared to be in a mad rush. In the OPD area, the ladies at the reception were busy, chatting amongst themselves, while patients and their caregivers waited for their attention. They wore no uniforms and for some strange reason, they were also collecting cash from the patients (apparently for the doctor’s consulting charges) and handing out receipts scribbled on small chits, which did not even have the hospital’s name on it.

Strangely, I was than directed to a cash counter to pay for the tests.

Since my wife needed some injections we were asked to go to the pharmacy and buy them, bring them back to the treatment room in the OPD area, where a nurse would help us with the shots. As we wound our way back to the Pharmacy we discovered that buying medicines is a huge chore. We submitted our prescription at a counter in the pharmacy and were handed over tokens and asked to wait. There was no place where one could even stand, without being pushed around. After being jostled around for 30 mins, we managed to buy the medicines, only to discover that we also needed to buy the disposable syringes, which the doctor had forgotten to mention on the prescription. So lo and behold the charade of the tokens was repeated.

During all this I counted 18 people inside the pharmacy store and the two guys who handed me the medicines and accepted my cash kept chatting with each other in a south Indian tongue, without bothering to pay any attention to me whatsoever.

We returned to the OPD and were directed to room no. 15 for the shots. This room was locked and we were than directed to a paediatric immunisation room full of anxious parents and bawling kids. This is where my wife managed to get the shots she needed. We wasted more than an hour in all this and ran around the hospital OPD trying to get some very basic services. The staff was uniformly disinterested in us, poorly trained and too busy to attend to us. Fortunately, the test my wife needed was routine and she is in good health. I can just about imagine the plight of patients and their care givers flocking to this hospital and being shunted around by a callous system, which barely works.

And now here is what happened when I came to collect her reports two days later.

I called up the hospital to check if the reports were ready. On being informed that I could collect these by 8 PM, I agreed to stop by to pick these up. As I walked in at about quarter to 8 in the evening I discovered a security guard merrily locking up the report collection area. He directed me to take another door into the radiology reception and 5 minutes later, when I walked in I found the lights switched off, the guard had also disappeared and there was not a soul to be found. Perplexed, I walked into another adjacent room and found someone busy on the phone.

As I explained my predicament, this gentleman informed that I was late and that the staff usually left 15-20 minutes earlier than closing time! Amazed and incensed at all this I asked to be directed to someone, whom I could lodge a complaint with. Much to my disbelief I was told to approach the Emergency Medical Officer in the Emergency!

At the reception in the Emergency, I found myself explaining my situation to a young man, who was simultaneously trying to answer questions from an anxious gentleman, whose father had just been brought in with severe chest pain!!! The emergency medical officer, who was supposed to record my complaint was predictably busy with a patient and I was asked to wait. After about 30 minutes of watching the bedlam of a busy Emergency room with no one paying me the slightest attention, I raised my voice (and in the process added to the chaos) and demanded to see the highest ranking hospital official to record my complaint.

I was than informed that the Night Duty Manager will now attend to me soon. Another wait of about 15 minutes followed and yet no one showed up. I again screamed at someone and in another 10 mins a nurse walked out looking for me. She understood my problem, asked me to wait and went to fetch my reports. She returned in a while with my reports and gently admonished me for being so late and irresponsible in collecting my documents.

This is a true story of Delhi’s only JCI accredited hospital. God help us all!!!

The Apathy of Delhi Hospitals Towards the Poor

The Delhi High Court has been after private hospitals in Delhi to honour their commitments regarding the treatment of the poor, but sadly to no avail. The hospitals are just not willing to treat poor for free, a condition that they agreed to while accepting land from the government at hugely subsidised rates. In-spite of the Delhi high court directing the hospitals time and again to fill up the beds for the poor, the hospitals are dragging their feet by hiding behind every legal loophole that they can find.

For the uninitiated here is the story. As many as 38 private hospitals in the city managed to get land at subsidised rates from the government under the condition that they will treat certain number of poor patients free of cost. The list of these hospitals today read the whose who of the hospitals in the city. However, once these hospitals commenced operations, they never honoured their part of the bargain. Thus the poor continue to be unwelcome in these hospitals, while beds reserved for them either remain empty or are filled up with full paying patients. This needless to say is criminal.

The reasons for this, however are not too difficult to fathom. The business of healthcare is a capital intensive business and the cost of real estate in Delhi is a prohibitively high expense. Thus, getting land from the government at very cheap rates against a commitment of treating the poor once the hospital starts, seems to be a good way of grabbing land. I seriously doubt that any of these private hospitals had any intention of treating the poor to begin with. This was just a ploy to grab land to build the hospital.

Now with the hospital up and running they had to find excuses to wriggle out of the commitment made. Here is a sample of what the hospitals have been saying. A large 600 bed hospital sitting on prime land in south Delhi and part of the largest hospital chain in the country claims that they are unable to treat the poor because they can not find them! As per them the government needs to refer poor patients to the hospital, and since there has hardly been any government referrals, they can not fill up the beds reserved for the poor. They further claim that ‘free’ to them means a free bed and the patient has to pay for all other expenses, thus making the hospital out of reach of the poor. (Mercifully, this claim has now been thrown out of the window by the high court). Other hospitals too advance similar claims. Strangely many do not offer any reason for not filling up these beds.

A recent report in The Times of India indicates that 16 of these 38 hospitals have not even bothered to submit details of the status of their free beds to the government. Hospitals like Dharmshila Cancer Hospital and the Jaipur Golden Hospital have submitted that all their free beds are empty. The Times of India report also alludes to a nexus between the health officials of the government and these hospitals. The health officials refer their kith and kin or their political masters to these hospitals and they are treated free against the beds meant for the poor.

While all this has been going on for many years, some public spirited Non Governmental Organisations have moved the courts. The high court has made all the right noises but justice is yet to be done. While the cases against these hospitals meander in our courts, the poor, as always continue to suffer silently.

Pic courtesy http://www.flickr.com/photos/9019392@N08/552358084/

So much for my ‘Indian Hospital Experience’

While trawling the net I came across a blog (http://www.travelblog.org/Asia/India/National-Capital-Territory/Delhi/blog-440604.html) about the travails of an American, getting treated for a mole/wart/skin cancer in New Delhi. The experience narrated in this post is exactly the kind of stuff we do not want. I am amazed at some of the narration and the stereotyping this does of the Indian doctors and medical system.

The blog has a semi mad sardarji (sikh) as a doctor who speaks and understands no English, laughs at his own jokes in Hindi and does not understand the difference between a mole and a pimple. The doctor has never heard of the United States and knows America, a country whose citizens are rich and ripe for fleecing. The doctor prescribes lotions and creams for treating the mole, which are not available at his own pharmacy and the patient (the author) walks out, having parted with Rs. 500 and nothing to show for it. Astoundingly, this gentleman returns to the clinic of the mad sardarji, encounters a ‘wildeyed’ patient on a wheelchair, and asks the doctor to burn off the offending mole in the emergency room next door.

Can you really believe this? A dermatologist who knows no English, does not know what the US is, prescribes lotions for treating moles and does strange surgery in his ER. All this in Delhi. To me this sounds stranger than fiction.

One can not study medicine in India unless one knows English as the language of instruction in medical schools across the country is English. I refuse to believe that there exists a dermatologist, who can’t differentiate between a pimple and a mole and if I ever encountered, will I let him treat me not once but twice! Come to think of it, will I let someone operate on me if their was a serious language barrier, when I am not sure if the doctor/surgeon understands the problem. If I agree to all this, than it is me who is playing with fire and taking completely unacceptable risks.

I am willing to grant that the author might have been lured to a quack’s place by someone. However, his complete gullibility and his willingness to try out this kind of treatment, which one would instinctively recoil from appears to be a product of his imagination. This as I said earlier only reinforces Indian stereotypes of a land of great mystery, faith healing, strange medical practices and half crazy doctors.

I am sure this makes for great reading back home.

However, what it also does is that it mocks at the great advances India has made in medicine. It paints a very distorted picture of Indian healthcare. India has some of the most modern hospitals and qualified medical personnel, which attract thousands of foreign patients every year. While, there is no denying that there are quacks and the like who exist, not going to a qualified dermatologist for the removal of a mole and continuing with the treatment of a doctor/quack who does not understand ones language will be considered foolhardy anywhere in the world.

Let us have none of this kind of crap.

Pic courtesy http://www.flickr.com/photos/robotalphabet/2693142482/

Chasing Immortality

Immortality seems to be staring the human race in the face. If one was to believe the ‘futurist’ (never knew what this meant till recently) Mr. Ray Kurzweil, mankind will find a permanent solution to the scourge of dying and that too, not in too distant a future. Mr. Kurzweil believes that by 2029, that is in just 20 more years, man will conquer the final frontier in medicine and will be able to continue to live forever.

Ray Kurzweil has been a thinker, author and entrepreneur. He has done pioneering work in developing optical character reading technology as well as developed a text to speech synthesizer way back in the 1960’s and 1970’s. Of late he has been researching and writing on Artificial Intelligence and how life as we know it is on the verge of extinction, thanks to what Kurzweil calls ‘The Law of Accelerating Returns’. Kurzweil believes that we are on the verge of a technology explosion, which will grow human knowledge exponentially by a billion times in the next 25 years or so.

Armed with this kind of knowledge and technology, mankind will be able to reverse aging, turn the clock back permanently and maybe bring the dead back to life using their DNA. In fact Kurzweil is on record stating that one of his goals is to ‘resurrect’ (or shall we say reboot) his late father using some of his DNA. All this it seems will be made possible by rejuvenating body organs using the ‘nanobots’, very small nano sized robots , which will be able to identify and destroy disease causing micro organisms, tumour cells and aging cells, thereby curing and restoring humans to good health.

While, this may seem completely futuristic and the figment of somebody’s very fertile imagination, the truth is that many scientists today believe that the day is not very far, when nano particles will be in use in medicine, destroying tumours, opening blood vessels, rebuilding necrotic tissue and healing horrendous injuries. This leads us to the inevitable question- Is the ultimate goal of all the advances in medicine ‘immortality’ or is it to prolong and enhance the quality of life to a reasonable degree?

At a more philosophical level we must ask ourselves, whether man should even endeavour to live forever. In our quest for a longer and healthier life are we really going overboard by chasing immortality? Resurrecting the dead? Does any of this make sense? And where does God fit in this scheme of things? Are we aiming to be Him?

These are questions that need to be pondered by people with intellect much higher than mine. All that I can say that while man mulls over the possibility of attaining immortality in the next few decades, he must be very very careful. Disturbing the inherent equilibrium of the cycle of life and death is fraught with unknown risks and dangers. Playing God is very dicey (apologies to a certain Mr. Albert Einstein) and honestly life would hardly be as much fun if we knew it would never end.

Pic courtesy http://www.flickr.com/photos/duncan

The Dilemma of Single Speciality Hospitals

A recent cover story in Business World highlights the growing influence of Single Speciality Hospitals (SSH) in India. I read the story carefully. First and foremost, I was delighted to see a cover on healthcare in Business World. It is not often that the business of healthcare gets prominence in a widely circulated and highly respected business weekly. That, BW decided to do this story is a testimony to the growing importance of the private healthcare sector, which is something to cheer about.

SSH’s make good business sense at least in some specialities. The investment required is low compared to a large Multi Speciality Hospital (MSH), funds can be accessed through PE firms and financial institutions, the hospital can be set up quickly and if one ropes in a well known medical luminary of that particular field, it is not too difficult to fill up the beds. Once the operations stabilise, one can consider franchising or expanding by setting up super specialised centres in large multi speciality hospitals. Specialities like Ophthalmology, Dentistry, Obs and Gynaecology (remember the neighbourhood mother and child centre) have always had Single Speciality Hospitals and clinics. The trend is now towards large SSH for Oncology, Urology and even Day Care Surgeries.

These hospitals are presently being set up by eminent doctors, who are partly putting in their own money and getting PE funds and financial institutions to invest in their ventures. Thus these SSH’s are hugely dependent on the goodwill and equity of the owner-doctor. Also one is not sure, how capable these hospitals are of attracting the best medical talent and thus providing high standards of care to patients. Typically, in a doctor owned SSH set up, it is rare to find other doctors of similar or higher capabilities than the owner. The fear of always being eclipsed by the owner-doctor drives other talented doctors to MSHs, where the canvas is bigger and the environment less claustrophobic.

From a consumers perspective SSH’s are a huge dilemma.

My father, now in his seventies suffers from an enlarged prostate. This is a problem that most elderly men are likely to have. Like most people he is terrified of surgery and has been on medication for the last few years. However, we know that surgery can only be postponed for a while and sooner than later he will have to go under the knife. Now should I choose a RG Stone Clinic, which is a well known SSH for Urology, or do we go to the multi speciality Max Hospital. While RG Stone may have better and more advanced equipment for the treatment of his condition (some fancy lasers), I am not sure they are equipped to handle complications, which may happen. The last thing one would want to deal with is an emergency requiring shifting him to a larger hospital after the surgery.

Also, I am not sure about the credentials of the doctors in RG Stone clinic. On the other hand MSHs like Max and Fortis and Apollo are well established brand names, have systems and processes (Apollo is JCI accredited and the others are in the process of accrediatation) and some of the most well known surgeons in the city are associated with these hospitals. From a cost perspective RG Stone might be cheaper, but if the patient is fully covered by health insurance (as my father is), expenses are the least of ones concerns.

Thus, in a situation like this, I will be inclined to go to the bigger MSH and I would reckon most of you will do the same.

And here is than the lesson for the SSH’s. They need to establish themselves as a far superior option in their chosen speciality. They need to invest in the brand, move away from the perception of being owner-doctor driven centres, hire the best talent by offering a great work environment and competitive salaries and establish systems and care protocols comparable to the best in the business.

SSH’s must convince me, the consumer, that they really are super experts, before I can seriously consider entrusting them with my care.

The Hindustan Times and the Hospitals in Delhi

The whole of the last week The Hindustan Times carried a series of stories highlighting incidents of 'negligence' in high profile private hospitals in Delhi. The hospitals featured included Fortis Escorts Hospital, Max Hospitals, Apollo Hospital, Sir Gangaram Hospital and Rajiv Gandhi Cancer Hospital. Now these hospitals in Delhi are the best that we have. While, Hindustan Times has a right to expose cases of negligence in hospitals I am still not sure what purpose was served by these reports.

Here are a couple of points I would like to make about these 'exposes'.

The cases reported highlighted horrific experiences consumers had in these hospitals. Most people featured in the story lost a loved one because the hospital failed to deliver adequate care and refused to take responsibility for what went wrong. These I am afraid were random cases picked up by intrepid journalists and made for riveting reading. However, the journalists doing these stories did not investigate the reason for these failures. The question why did these hospitals fail in their duty towards their patients remains unanswered. Was the failure a result of a doctor not discharging his duties properly, or was it a failure of the hospitals processes or both? Or was it negligence or an error of judgement on the part of a doctor? Did he deliberately mistreat a patient, was callous in discharging his duties, wilfully deviated from standard medical practices or just did not care enough?

The reports also did not establish a trend. By picking up five hospitals in the city and highlighting these horrific cases, I am not too sure the point that the newspaper has made. Are all these hospitals equally bad? Do we run a huge risk to life and limb if we trust these hospitals with our care? The stories were short on data. For example the story featuring the eminent cardiologist Dr. Ashok Seth, presently the Chairman of the cardiac program at Fortis did not establish how many times has he messed up an angioplasty. By highlighting a single botched up case amongst the thousands that Dr. Seth does every year, I believe the journalist has been less than fair to him. I would like to know Dr. Seth's success rate in deciding whether I trust him or not rather than go by a sensational story of an angioplasty and the subsequent care going haywire.

As consumers we must understand an ugly truth. There is no running away from the fact that cases of utter negligence and mind boggling errors are a part and parcel of life in a hospital. Even the best hospitals, will have some people who would take their work casually, be negligent in their duties and cause terrible suffering and yes loss of life because of their actions. At best a hospital can try to minimise these as best as it can. It can systematically identify such people and eliminate them, it can put in place systems and processes, which allow it to act before the damage is done. However, it is next to impossible to completely do away with error and negligence.

I just do not understand what point has been established by The Hindustan Times in doing these stories. Yes, it establishes the fact that some of our best hospitals in Delhi have been at times negligent in the discharge of their duties causing untold suffering to people, who trusted these hospitals.

But isn't it something that all of us know and isn't that true of all the hospitals in the world?

Wouldn't it make more sense if the newspaper clearly established a trend of deficient care  in one or all of these hospitals over a period of time and compare the hospital's record with that of other similar hospitals across the world. It would than stand to reason for citizens to avoid the hospital and for the management of the hospital to fix its people and systems.

Coping with Swine Flu in India

Swine flu has finally arrived in India.

So far 4 people have died and 782 people are confirmed to be infected with the virus and are undergoing treatment in designated government hospitals. The deaths have been in Pune, Mumbai and Ahmedabad, while Pune seems to be the worst hit. Strangely, school children appear to be seriously affected and many schools have shut down for a week or more.

Last week when I was in Mumbai a colleague called up in the evening. His 8 years old daughter was having a high fever and flu like symptoms. He had taken her to Max Hospital in Saket in New Delhi and he had been referred by the paediatrician to a government owned facility in Malviya Nagar for suspected swine flu. ‘The doctor did not even touch her, heard us while we explained the symptoms and promptly referred us to the government hospitals for tests. The government hospital admitted her for observation and now we do not know what to do. I fear even if my kid does not have swine flu, she is likely to catch it in the hospital’ explained my colleague Vijay Jain.

Another colleague in Mumbai, who was coughing and sneezing, had a bad throat and a fever decided not to come to work for a few days. He felt that it wasn’t right for him to put others in office at risk.

These are tough calls. It is difficult for doctors to diagnose Swine Flu from the symptoms a patient presents. If the flu like symptoms are a little severe thay have no choice but to refer patients to the designated hospitals for tests, which means a patient has to visit a hospital, which has confirmed cases of Swine Flu and is therefore exposed to the disease. It is really a catch 22 situation.

In this situation the best thing to do would be to avoid going to busy public places, which are closed, particularly malls, airports, cinema theatres and yes offices and schools.

It would also help not to panic if one develops flu like symptoms. Afterall flu, that is the normal flu is a lot more prevalent than the swine flu and kills many more people every year. Mortality rate due to swine flu is still quite low, less than 7 per thousand. Statistically this is not a big cause of concern.

The government on its part must involve some private hospitals in combating the epidemic. It would help if a few private hospitals were allowed to test blood samples for the disease and admit patients in secluded wards. Large private hospitals are certainly more than capable of maintaining the records, treating the patients and ensuring that the disease remains in check. Additional testing and treatment centres will also help in instilling greater confidence in the public.

The government must also embark on a public awareness campaign. It must use mass media to educate the public about the disease, its symptoms, diagnostic procedure, treatment and prognosis. While I have noticed some advertising, it is hardly adequate.

Finally, the media must behave responsibly. In a situation like this it is indeed easy to create panic and cause mayhem by irresponsible journalism. It is the duty of all journalists to report objectively without resorting to unnecessary sensationalism and devoting too much media space to stories related to the spread of the disease.

Last but not the least, let us spare a thought for folks in the medical profession. They are at great personal risk in handling infectious patients. However, this is part and parcel of their calling. They must take all possible precautions, while providing succor and care to all those who seek their helHospital,p.

At the end of the day all of us are at risk. It is really up to us to exercise caution and help in whatever small way we can to fight the disease.

Pic courtesy www.flickr.com

Some names have been changed to protect privacy

Marketing With In

Here is an interesting exercise that I recommend hospital marketers to try out with their colleagues in the hospital. Select a group of 30 individuals working in the hospital, preferably those who handle customers. Include in the group a few medical folks, doctors, nurses, front office executives, billing executives, F&B personnel and a few guys from housekeeping. Ask them simple questions on what the hospital brand means to them.

You would be surprised with the variety of answers you are likely to get.

All marketers try and look for a unique customer proposition for their hospitals, one which they believe the hospital delivers to its customers. The proposition is carefully selected after many a long ‘brain storming’ sessions involving the hospital’s leadership team, the branding and communications experts from advertising agencies pitching for the lucrative account. After these hectic sessions what often emerges is a positioning statement, which is than condensed into the hospital baseline, which is than incorporated in the logo of the hospital. It is in essence the consumer promise, which than is communicated to the external world in right earnest. However, what they fail to do is communicate this promise with the same vigour and zeal with customer facing employees, who are actually tasked with delivering this promise.

Let me take examples from two hospitals, where I used to work.

Artemis Health Institute in Gurgaon says that it is all about the ‘art of healthcare’. Max Healthcare similarly professes to be ‘caring for you …for life’. Artemis believes that its services are differentiated from other hospitals because it focuses on the softer side of medicine. The arguement is that the best infrastructure and world class medical faculty is a given, and easy to replicate. What really distinguishes this hospital from others is not what it delivers but how it delivers. Similarly Max Healthcare is all about superlative care, what the hospital calls ‘patient centric care’. It prides itself in delivering great patient care at all customer touchpoints and at every patient interaction.

Now these are indeed lofty goals. I would even go ahead and aver that when these hospitals were being conceived and set up, the founding teams did believe in these ideals. The hospital communication program was designed to put across these differentiations and a fair amount of energy and effort was expanded in developing communication, which helped establish the hospital’s core values. However, and here is the nub of the matter, these hospitals just did not do enough to communicate these values to their own folks down the line who were actually supposed to deliver these sterling objectives.

In the initial days of commencing operations the hospitals did make an effort to train people in handling and treating patients as customers. However, the initial enthusiasm waned soon enough, competition poached many a well trained individuals and somewhere in the hurly burly of running large hospitals the idealism of the past gave way to an all pervading cynicism. Training individuals in the ideals and core beliefs of the hospital became a chore and the trainers too lost their passion.Thus the marketing promise, the all important differentiator remains only in the minds of resolute brand managers who faithfully continue to reproduce these lines with the hospital logos and the colours.

Unfortunately, this is true of most hospitals I know. A brand promise must be delivered unerringly and all the time. For, which hospitals must spend time and serious effort in keeping the promise alive amongst those who are supposed to deliver it a million times everyday.

Pic courtesy www.flickr.com