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.

Dr. Naresh Trehan at the HT Leadership Summit

I had the privilege of listening to Dr. Naresh Trehan at the HT Leadership Summit organised by the Hindustan Times in New Delhi on Oct 30th and 31st 2009. The Leadership Summit has over the years become the marquee event in the city’s calendar and leaders like the Prime Minister, the Finance Minister and a former US President (George W Bush) addressed the gathering, which was composed of the who’s who of the Delhi elite. Dr. Trehan, who is widely regarded as one of the most accomplished cardiac surgeons in the country, was invited to speak on the challenges that the healthcare industry faces and how he saw things working out by 2020.

Dr. Trehan spoke with great passion and expressed anguish at the huge gap that exists in the supply of healthcare to the haves and ‘have nots’  in our country. “While Delhi draws thousands of patients from across the globe, 50 kms outside the city, one would struggle to find a qualified physician. India has some of the finest healthcare facilities, comparable to the very best anywhere in the world, which offer services at a fraction of the cost in the west, yet most Indians can hardly access these. The real challenge is how do we bridge this huge divide”, pointed out Dr. Trehan.

The prescription that he had for the malaise was simple enough.

Dr. Trehan, suggested a healthcare model based on Preventive, Primary, Secondary and Tertiary Healthcare centres connected with each other through a hub and spokes system. Indian villages are filthy, people do not have any sense of public hygiene and children, who are most vulnerable die of infections, which can easily be prevented if only one could improve sanitary conditions in our villages. Dr. Trehan demonstrated, how by just improving village sanitation and building a proper school in a village in North India, he and his team has been able to cut down disease and infection in the village. This he said was accomplished with financial support from a few large business houses who generously donated for this cause. One would reckon that this can just as easily be done with funds from the government. After all this is an investment in healthcare and education of the future citizens of the country and is bound to pay healthy (no pun intended) dividends.

Dr. Trehan acknowledged that no self-respecting doctor wishes to practice medicine in the hinterlands of the country. The quality of life that he expects for himself and for his family, just does not exist in Indian villages as yet. Thus, it makes no sense to have Primary Healthcare Centres in every village simply because it would be impossible to have qualified doctors functioning at these centres. Dr. Trehan instead suggested mobile clinics located in district headquarters and small towns, which can visit nearby villages on fixed schedules and offer Primary Health Care services in remote villages.

The government has a fairly vast healthcare infrastructure at the district level. The district hospitals can easily serve as good secondary care hospitals, provided they are managed efficiently and are held accountable for the quality of care they deliver. Dr. Trehan mooted a model based on a Private Public Partnership (PPP), which would allow efficient utilization of these resources and also generate a decent profit, which can be used to further strengthen these hospitals.

As far as the Tertiary Healthcare is concerned Dr. Trehan indicated access and pricing as the big issues. He felt that low-cost universal health insurance as a possible answer. Dr. Trehan also believes that tertiary healthcare costs can be significantly brought down if a hospital has a high throughput of patients. Thus, a tertiary hospital can amortize its fixed costs over a large number of patients, bringing the overall costs down. In this context he mentioned his own efforts at establishing ‘Medanta – The Medicity’ a large 1200 bed facility that he has built in Gurgaon.

Medanta, set to commence operations in a few months is a large tertiary care facility located hopes to attract patients not only from big cities but also from smaller towns and cities.  Dr. Trehan believes that more such large institutes will help bring the costs down and will allow more Indians to access world-class healthcare.

Dr. Trehan also mooted setting up a National Task Force, consisting of healthcare experts and government officials to try and put together a national level plan to rejuvenate Indian healthcare. “I had met the Prime Minister of India in the early 1990’s, with ideas on revamping our healthcare system. He agreed with most of what I had to say and promised that in a few months, things will move. Twenty years hence I am still waiting for a cohesive healthcare policy” lamented Dr. Trehan.

One hopes that with Dr. Manmohan Singh, the Prime Minister of India, talking about huge investments in healthcare to drive ‘inclusive growth’, things are finally set to move.