The Healthcare Marketer’s Life

Yesterday evening while I was returning from work a friend called. He has recently taken over as the Head of Marketing Communications at an upcoming hospital. I had met him a few weeks ago to congratulate him on his new assignment and he seemed quite kicked about his new role. He had grand plans of changing the way the hospital communicated with its patients and other stakeholders, he wanted to run customer facing programs, drive relationships with patients through effective engagement and deliver uniformly great experiences to those who touched the hospital.

Yesterday over the phone Ajay felt he had made a big mistake by joining the hospital. I was quite flummoxed by this turn-around. Further inquiries revealed a familiar story. The hospital has a brand new CEO, someone who has worked for many years in hospital operations but have no knowledge or appreciation of communication. However, like most folks he too believes that marketing communications is hardly something to be left to experts. In fact the CEO believes that he knows exactly how a piece of advertising or a brochure should look like. Download the text from the web, adapt it by rewriting some of it, slap a few images downloaded from the net and include the mandatory images of some if the hospital doctors, run it past a few senior hospital bigwigs and, voila the ad or the brochure is ready. As far as hospital signage are concerned, the CEO feels that they really are meant to provide legible directions to the patients and fussing over them, their aesthetics and design is a gross waste of time, energy and money. Well I might be exaggerating a little here but this is really the long and short of what Ajay felt his CEO was doing and no wonder he had started feeling frustrated in the set up.

Marketing folks in hospitals always grapple with the problem of every one who is anyone coming up and advising them on how to create a piece of communication. Some doctors love to see their pictures in the ads and some other feel great if gory images of them operating heroically could be included in the communication. The CEO’s love to mutilate the advertising copy, insist on correcting perfectly well written text, increasing or decreasing the font and of course having the logo bigger, bolder and always 2mm to the right! Many a times the marketing communication executive has to sweat many hours trying to accommodate the conflicting wishes of the CEO, the star surgeon and his favourite flunky. All in a day’s work for the intrepid marketing guy, who can be forgiven for wondering if he is the only one who knows nothing about marketing communications.

Those who have worked in hospitals long enough know how to maintain a fine balance. They will wait till the last-minute, before asking a doctor to go through the text and approve the ad, they will sneak it past a doctor who they know is not too interested in the brochure’s finer details, they will get the mailer made and when a livid doctor would approach them on their failure to show it to him, they will deftly show an e-mail sent a few days ago knowing fully well that the doctor rarely checked the mail. Tricks of the trade, which one learns on the job.

Well, while all this may sound hilarious, the fact is that a hospital marketer’s life is not easy. If the hospital is doing well, his budgets are the first to be cut (why do we need to spend money on advertising, we have hardly a bed to spare!) and God forbid, if the hospital is not doing too well, the marketer knows that the hospital can hardly spare cash to blow its own trumpet. The doctors and particularly who head various departments are always after his life to see their ads in the newspapers, whether the marketer has the budget for such advertising is of course none of their concern. The CEO is always looking to pinch a few more pennies from a meager budget and he insists on stretching the money to impossible levels.

Such is than the life of a healthcare marketer.

Usually, in all this the silver lining is a boss, who understands the inner dynamics of the hospital, who knows how to work with medical folks without unnecessary confrontations, who lets the marketing guy go about his job without much hindrance and steps in to resolve conflict as it arises. He is the one who understands the aspirations of a good marketer as well as the concerns of the medical folks in the hospital and strives to achieve a balance.

At the end of the day, and in like most other things in life, a fine balance is the key.

The Perils of Standardized Health Care

Can healthcare delivery be standardised? This is the question, which has been bothering me this week.

The thought itself was triggered by a report in ‘Mint’ earlier this week titled ‘Government plans common healthcare standards’. (http://www.livemint.com/2010/08/24233218/Govt-plans-common-healthcare-s.html)

While the report portrays the benefits of standardization of care with millions of patients receiving standard care prescribed by the government thus saving them from being shortchanged by unscrupulous doctors and mercenary hospitals, there is also a flip (and a more real) side of the argument that we must understand.

While the government pushes through the Healthcare Standardization agenda, one wonders how can the delivery of healthcare be standardized across all medical facilities in the country? Every individual is different, reacts differently to treatments, the doctors are required to take decisions based on their experience and training and not on the basis of a set of guidelines decided upon by the government. If I was to fall sick, I would want my doctor to treat me based on his knowledge and experience and do what he feels is the best for me rather than stick to a standard set of guidelines mandated by the government. All doctors and medical establishment should have one guiding principle – the interest of the patient must be supreme and if there is a situation of uncertainty, I would want my doctor/hospital to always err on the side of caution.

Also, the healthcare delivery model in the country is hugely diversified. In its current form with poor regulation and monitoring it just does not lend itself to any standardization of care.The government-run tertiary care hospitals in large cities are filthy and over-crowded with patients and over-worked and under-paid doctors. The government run district hospitals as well as Primary Health Centres are even worse off with out dated equipment, poorly trained doctors, who often do not even show up for work. The private healthcare is dominated by secondary care establishments (usually called nursing homes), which have 10-50 beds and are usually owned by a doctor or a group of doctors. These are mostly mom and pop establishments, where owner doctors reign supreme and are answerable to none. Quality of care in these establishment is of dubious standard and these are neither properly regulated nor monitored vis-a-vis outcomes or treatment protocols. Christian missionaries and other charitable institution also run a large number of hospitals and now we have a nascent category of corporate style hospitals coming up in large cities offering cutting edge care. My point-all these hospitals are differently equipped, have differing goals (for profit, non-profit, govt. owned etc.), have vastly different resources at their disposal, have different cultures and widely varying medical expertise available to each of them. How on earth can they all provide standardised, similar quality care to their patients?

Last December my father underwent a prostate surgery in a hospital in Delhi. Elderly men usually require this surgery at some point in time in their lives. Now, while I researched the treatment options for him and took surgeon’s opinions I discovered that we had several options. Our surgeon felt that the best and the safest alternative for him would be a laser surgery involving a cutting edge holmium laser. Now, this option is not available at most of the hospitals even in a city like Delhi, thus it can safely be ruled out from the ‘standardised treatment guidelines’ that are being framed by the government. In a situation like this, will it mean that patients like my father will be denied this option and he will have to endure the conventional surgery with its attendant risks of infection, excessive bleeding and a much longer hospital stay?

Let us now also look at the genesis of all this.

The health insurance companies (mostly state-owned) want treatment protocols for some common diseases to be standardised so that they can fix a rate for these procedures, irrespective of the hospital and the doctor one chooses to go to. For the insurance companies this will lead to a state of nirvana, as they would be required to pay a fixed lump sum to the hospitals irrespective of the bill a patient runs up. They can then squeeze the hospitals further and make greater profits. Now, I am not against profits, however the problems that I see in this arrangement is that the patient will suffer, the quality of care will go down as hospitals will try to manage the delivery of care with in the financial limits set by the insurance companies (after-all they also need to be profitable). This is clearly hazardous.

One buys a health insurance cover to ensure that in the time of need, financial constraints do not come in the way of accessing the optimum quality healthcare. The operative words here are ‘optimum quality’ and not ‘standard quality’ as mandated by the government. To equate these two will be a great folly. If the insurance companies believe certain hospitals are taking advantage of the situation by excessive billing (which I submit happens), they must put in place strict monitoring mechanisms including peer group reviews of treatment provided by the hospital. A healthcare regulator needs to be set up by the government to arbitrate between insurance companies and the hospitals. The regulator can possibly frame broad treatment guidelines, which can serve as references in case a dispute arises between a patient, the hospital and the insurer.

Standardizing treatment protocols in a healthcare environment as complicated and as unregulated as ours is a dangerous and mostly an impractical idea. We need to first standardize our healthcare delivery systems before even thinking about standardizing treatment protocols. Paying hospitals based on these standardized treatment protocols because it makes health insurance companies profitable is inviting hospitals to cut corners. Once this happens, it will lead to serious erosion in the quality of care and even more importantly a big trust deficit between patients and hospitals will emerge.

That would really be the ultimate irony, for if a patient does not trust his doctor or hospital, he really would have nowhere to go.