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!!!

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 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.