This is primarily because healthcare services are unlike any other service industry. The customers here are both patients and customers, they are unwell, they don’t want to be there but circumstances have forced them to seek the services of the hospital and the expenses incurred unlike say that of a restaurant or an amusement park are an unforeseen burden. Many a times, they have been compelled to travel far away from home and they are alone amongst strangers, who will have an immense amount of power over them. And to make things a lot worse is the lingering uncertainty about the medical outcomes, indeed about life and death.

People working in hospitals must understand these factors well. Medical folks because of the virtue of their training and  knowledge comprehend these facts instinctively. However service personnel, who have moved to healthcare services from say the hospitality sector are often caught by surprise and are left wondering about the interplay between patients, customers and hospital staff.

Thus, a hospital must be very careful in hiring the right people and then training them in handling customers and patients. Here is a small checklist of what I look for when hiring people in a hospital.

Empathy:

This is the single most important characteristic that I look for in an individual. It is absolutely essential that those who work in hospitals have empathy for patients and their attendants. Many years ago I heard a doctor say that she always tries to remember that it is not a tumour that she is treating, but a human being. Anyone who works in the hospital would do well to remember that. In a hospital I would like to hire people, who can connect with those in distress and interact with a measure of understanding and compassion.They must treat every patient and his problems as the only one that they have to handle that day.

Patience and Maturity:

It is imperative that a hospital hires mature people with loads of patience. This will help in managing patients, who are generally impatient-to see the doctor, get the tests done, lay their hands on that elusive report and get the hell out of the hospital. Since most people find it hard to understand matters related to their illnesses and treatment options, it is best that we have people who can explain these things patiently, without losing their cool and without showing the slightest signs of indifference.

Hunger for Knowledge:

It is a myth that in a hospital, medical knowledge should remain restricted to the medical folks and it is only they who need it. I have seen patients asking questions from patient care executives about arcane surgical procedures, about diagnostic tests prescribed by the doctors and even about their prognosis. To my mind, every individual working in a hospital should aim to acquire and benefit from basic medical knowledge. For me, part of the charm of working in a hospital has always been the immense amount of knowledge I gain by interacting with medical colleagues. In conversation with doctor colleagues, if I find myself lost, I never hesitate to ask them to stop and explain things to me in terms that I can understand. It always helps, when I am required to explain a procedure to let us say a foreign patient contemplating travel to our hospitals in Delhi.

Ability to Get Along with Doctors

It takes a special kind of skill to work with busy doctors, who are always short on time and stressed out. One needs to adapt to their work schedules and understand their pressures to put things in the right perspective. Also, one must remember that they are trained as doctors and not as professional managers, thus often their understanding of a manager’s world is not the same as that of another professional manager. In my experience it is best to always try to understand, where they might be coming from rather than articulating management dogma, which they may not understand well or may find obnoxious.

Optimistic and Cheerful Disposition:

Those blessed with an optimistic and cheerful world view do well in a hospital. A hospital needs loads of people with a sunny disposition, who always look at the brighter side of things and who are hard to put down. These are individuals, who are eager to help, who go out of their way, do that bit extra to make someone happy, because that is what makes them happy.

Rigorous training and an organisational culture based on openness and trust helps these people become good to great and transform the hospital into a wonderful place of healing and caring.

Filed under: Healthcare Marketing Tagged: Doctors, Hiring, hospitals, patients ]]> http://anasexperiences.wordpress.com/2012/01/22/hiring-right-makes-a-hospital-special/feed/ 3 anasexperiences Hosp People http://anasexperiences.wordpress.com/2012/01/03/nursing-the-big-differentiator/ http://anasexperiences.wordpress.com/2012/01/03/nursing-the-big-differentiator/#comments Tue, 03 Jan 2012 17:37:00 +0000 anasexperiences http://anasexperiences.wordpress.com/?p=1421 ]]> If someone was to ask me what truly differentiates one hospital from the other, I would unhesitatingly answer that it really has to be the quality of nursing. Yet most hospital managers pay scant time and attention to what is perhaps one of the most critical functions in the hospital. In India, nursing is perhaps one of the most under rated professions and in a hospital senior managers, who are busy driving patient volumes and revenue and focusing on delivering cutting edge medicine often forget that it is Nursing, which truly is the back bone of  hospital operations.

The last few months for me have been nothing less than traumatic. My father lost his battle with cancer and he continued to be in and out of hospitals virtually all of November and pretty much most of December. While, he gradually deteriorated and my worries and frustrations of doing battle with as implacable a foe as cancer, mounted I could clearly see the wonderful role nursing played in delivering round the clock care to him. My admiration for the profession has since multiplied many folds and it also led me to reflect on how we need to acknowledge and appreciate the role Nursing plays in the life of a patient and indeed that of the hospital.

If a hospital is about ”care”, truly speaking it is the Nursing, which is the face of the hospital. While a patient who is admitted in the hospital sees his doctor, usually twice in the day, (when the doctor is on his rounds), he sees nurses all through the day. While, the doctors have the largest role to play in achieving a cure, it is the nurses who deliver care and comfort in a hospital. Their role gets magnified many times, when the doctors know that they do not have a cure or sometimes when hope is in short supply, it is the brisk efficiency and the caring hand of a nurse, which makes a big difference. As my father grew progressively weaker and his condition deteriorated, we became more and more dependent on the nurses. We needed them to give him medicines, control his infusions, give him feeds, rub his back, sponge him, draw samples for tests, help him turn in the bed, decipher his almost incoherent speech and comfort him. Often, they bore the brunt of his ire – many a times he was petulant like an ill-mannered child, difficult to reason and get along with, yet those nurses never flinched, they never once walked out of the room in anger or said anything, which might be hurtful.

I watched all this and more play out in front of my eyes every day for several weeks over the last few months. The more I saw, the more ashamed I felt of how senior hospital managers like me treat nurses in the hospital. The doctors usually take them for granted, order them around, some pull them up for even small infarction, hospital managers just do not have time for them, they are just there, pretty much like hospital furniture.

Is this because the nurses that we have come from a socio-economic milieu, which is very different from our own? Is it because most nurses in our hospitals can not converse in fluent English, which is the undisputed currency of social mobility in our country? Is it because many of these nurses are not as well-educated as the doctors, hospital managers and probably most patients whom they care for slick private hospitals?

Whatever, be the reason we need to introspect about the critical role of nursing in our hospitals. I would surely like to believe that a hospital can easily have a long-lasting and sustainable competitive advantage over its competitors if it gets its nursing right. A bunch of efficient, dedicated and caring nurses are a far more precious asset than fancy equipment, smart doctors and smartly turned out-patient services executives.

Come to think of it, isn’t it strange that a hospital charges a fee for the doctors, there are charges for the use of the OT, the consumables and the medicines and even the hospital bed. Yet, no hospital that I know of charges a patient for nursing care!!!

PS: My father spent his last days at the Max Hospital in Saket in New Delhi

Pic courtesy http://acceleratednursingprograms101.com/wp-content/uploads/2011/07/Accelerated-Nursing-Programs-08.jpg

In the Emergency room, we got prompt attention and we quickly determined that my father had low BP and his leucocytes counts were high indicating an infection. He was admitted in the hospital under Dr. Prasad Rao, who is a specialist in internal medicine. Dr. Rao turned out to be an articulate and soft-spoken man, who explained to me the plan of treatment (basically antibiotics) and said that he was hopeful of getting my father back home in the next 2-3 days. As expected my father made a swift recovery over the next couple of days and Dr. Rao discharged him from the hospital, the entire experience being on the whole quite satisfactory. Now this is what happened at the time of finalising the discharge.

As I went through the detailed itemised billing sheet, I noticed that we had been charged two nights of hospital stay, which was correct. However, under another head something called ‘Other Services’ we have been charged for a laryngoscopy, (which was actually done) and strangely another day’s bed charges. Since Laryngoscopy is a OPD procedure, I was baffled to see the additional bed charged buried under ‘Other Services’ and thought that it must have been a mistake. Enquiries with the billing clerk however revealed another story.

Indraprastha Apollo Hospitals I was informed now has a check-out time of 9 AM, which means that anybody being discharged after 9 AM in the morning has to pay the room rent for that day as well. Strangely everyone knows that in a hospital most discharges are planned after the admitting physicians take their morning rounds, which usually begin around 10 AM in the morning. Thus, it is just not possible for a patient to be discharged from the hospital before 9AM, and hence virtually everyone has to pay the additional charges. The Billing Manager, informed me that at least 130 out of the 150 discharges that happen everyday at the hospital, lead to irate patient attendants venting their anger on him. Clearly, this is a dodgy practice as the hospital knowing fully well that discharges can not be finalised before 9 AM, charges patients for an extra day.

In most hospitals the check-out time is 11-12 noon and the hospital management usually does not charge for a delay of an extra couple of hours as they clear the discharge formalities. The intent clearly is not to bill the patient and all efforts are made to finalize the discharges before the appointed hour. At Apollo, this is clearly not the case as the 9 AM check out rule is designed to bill the patient for an extra day, even when they know that their doctors will not be able to finalize the discharge summaries before 9 AM.

Complaint Redress Mechanism

When I asked the Billing Manager, about the process for lodging a complaint, I was told that I should speak with the GM for Resources Utilization, who refused to meet me saying that if I had a problem, I could write an email to him. When I insisted that I wish to lodge a formal complaint, I was directed to speak with Dr. Priyank, who turned out to be someone who worked in the office of the Managing Director of the hospital. Dr. Priyank too was far too busy to meet me and when I questioned him on this particular practice, he explained that this was all for the benefit of the patients, as it enhanced hospital efficiency!!!

As the word got around about my complaint, I received a message that Rajeev Bahl, GM Resource Utilization has now agreed to meet me. When I sought clarifications on this, he said that this was a new practice and that the hospital felt that this will encourage their doctors to finalize discharges faster. Basically, what he was saying was that since the hospital management is chary of asking its doctors to begin discharging their patients earlier, it would like the patients to put pressure on their doctors to do so. Strange to say the least.

Peculiarly, while the hospital authorities insisted that charging for the additional day was the right practice, they agreed to not charge the same to me now that I had protested. Thus, it seems if you protest and protest hard, the hospital moves quickly to placate you by waiving off the additional charges.

Indraprastha Apollo Hospital is a JCI accredited hospital and yet it seems that there is no formal complaints mechanism. In spite of my best efforts to lodge a formal, written complaint, there appeared no process for the same. Since no complaints gets lodged, the hospital would appear to be running faultless operations and the JCI accreditation can continue unabated.

Thus, in spite of having a reasonably satisfactory medical experience the hospital goofed up at the last leg. It spoilt my overall hospital experience and I came away wondering about the greed of the hospital (150 discharges per day at an average bed charges of Rs. 7500 makes a very tidy sum indeed), its ethics and its philosophy of ‘caring with a human touch’.

Filed under: Healthcare Marketing Tagged: Apollo Hospital, Dr. Prasad Rao, Indraprastha Apollo Hospital, JCI, JCI accreditation, New Delhi ]]> http://anasexperiences.wordpress.com/2011/11/19/experiences-at-indraprastha-apollo-hospitals-i/feed/ 2 anasexperiences Apollo Logo http://anasexperiences.wordpress.com/2011/10/28/the-silent-epidemic-of-diabetes-in-india/ http://anasexperiences.wordpress.com/2011/10/28/the-silent-epidemic-of-diabetes-in-india/#comments Fri, 28 Oct 2011 11:10:34 +0000 anasexperiences http://anasexperiences.wordpress.com/?p=1406 ]]> In the middle of March earlier this year, while the work stress peaked in line with the coming closure of the financial year, a few colleagues and I decided to undergo a preventive health-check. It was one of those things that came about after a postprandial discussion over cigarettes, where someone casually mentioned that with most of us well in our middle age and it might be a good idea to check out the state of our health. None of us had any symptoms of any disease, however we certainly had risks, some of us were heavy smokers, lead sedentary lifestyles filled with high levels of stress, and some had a family history of various lifestyle diseases. Lest, we forget our discussions, I quickly booked ourselves to undergo a preventive health check at the Max Medcentre, the coming Saturday.

Finally Vinay, who is the programming director of the radio station, where I worked than and I underwent the Health Check. Max is familiar territory for me, the entire experience was wonderful. A couple of days later we turned up for our review with the internist. As I walked into the office of the doctor, I did not have any inkling of what lay in store. Dr. Kalra made me feel comfortable and then gently dropped the bombshell, my blood sugar levels and lipids were way too high. I had diabetes and it was totally out of control, the liver function was impaired and the metabolism of the lipids was extremely poor. He was alarmed enough to ask me to consider starting on insulin forthwith.

When I looked at the test results, I too found them hard to believe. I sought advise from friends who were doctors, immediately set up a meeting with Dr. Sandeep Buddhiraja presently the Director of Internal Medicine at Max Healthcare and who has been a colleague and a friend. Sandeep, asked me to repeat the tests and put me on statins as well as metformin, apparently disagreeing with Dr. Kalra on the use of insulin. He asked me to make serious lifestyle changes and consoled me by saying that the good thing was that I need not give up smoking or reduce alcohol consumption!!! (I am a non-smoker and a teetotaler)

For the past 7 months now I am learning to live with diabetes. The good thing is that I have no symptoms, don’t feel ill or constrained in any manner. I have made significant lifestyle changes, which I believe would help me live healthier. I have lost more than 10 kgs in these months, feel a lot lighter and younger than earlier, watch what I eat, regularly take my medicines and check my blood sugar using a home kit. The blood sugars and the lipids are now in control and my regular bi-monthly meetings with Dr. Buddhiraja are a great help.

I do not know why I have diabetes, we have no family history of the disease, I have always lived a fairly active life and have never smoked. I had a BMI of 27, a little more than what it should be but certainly not very high. Now that I keep an eye on the latest research on diabetes, I realize that the day is not far off, when we will have a cure for diabetes. However, awareness about the disease, its prevention and management are our best bets in combating diabetes for now.

This is also a great opportunity for healthcare and pharmaceutical companies. I now spend close to Rs. 3000 per month on medicines, tests and consultation fee for managing my disease. Last year itself India had close to 48 mn diabetics under active management. There are millions more who are not aware that they are diabetics. The total direct cost last year on the management of diabetes in India was estimated to be USD 31.9 bn. This includes the massive cost incurred on hospitalization and treatment of complications resulting from diabetes. Yet, we do not have a single chain in the organised healthcare space, which is focused on the prevention and management of diabetes. In large metropolitan cities like Delhi, there are super specialists, who are experts in managing diabetes, but in most of the country it is the general physicians or cardiologists who take care of diabetics.

The management and treatment of diabetes requires long-term and finely calibrated care, which can only be provided by trained experts. More importantly, awareness needs to be created so that people at risk, can undergo regular screening to diagnose the disease. From personal experience, I can easily say that it is completely silent and catches one totally unawares.

From the perspective of healthcare entrepreneurs there can hardly be a greater opportunity in stepping in and setting up professionally run Diabetes Management Centres, which can effectively combat the disease before and after it strikes. Presently, there are no such chains and all we have are mom and pop clinics run by individual doctors. We need an organised effort to combat Diabetes and we need it right now.

Filed under: Healthcare Marketing Tagged: ''Diabetes in India'', diabetes, Dr. Sandeep Buddhiraja, Max Med Centre ]]> http://anasexperiences.wordpress.com/2011/10/28/the-silent-epidemic-of-diabetes-in-india/feed/ 1 anasexperiences diabetes http://anasexperiences.wordpress.com/2011/09/30/medical-outcomes-and-customer-experiences/ http://anasexperiences.wordpress.com/2011/09/30/medical-outcomes-and-customer-experiences/#comments Fri, 30 Sep 2011 16:33:39 +0000 anasexperiences http://anasexperiences.wordpress.com/?p=1398 ]]> My father was diagnosed with an oral cancer last March. He had been staying with me in Delhi and fortunately, we had plenty of choice in selecting a hospital, where we could possibly have him treated. After carefully evaluating these choices, we zeroed in on two possible facilities –  Medanta Medicity, the new hospital in Gurgaon and Max Hospital in Saket. At Medanta the leaders of the Oncology team were my colleagues during my stint at Artemis Hospital in Gurgaon, and I enjoyed a great relationship with both Dr. Ashok Vaid and Dr. Teji Kataria, the medical and the radiation oncologists respectively. At Max Hospitals I did not know the doctors personally, they did not have a cancer facility when I worked there, but I had plenty of other close friends who ran the hospital and vouched for the caliber of their team of Dr. AK Anand and Dr. Anupama Hooda. Ultimately, with all things equal we chose Max, simply because it is closer to our home and the logistics prevailed.

This was in March and my father had since undergone Targeted Chemotherapy and Radiation Therapy on an IGRT machine. Post the treatment, he is doing as well as can be expected and I am extremely grateful to the oncologists at Max Hospital. In these past 6 months, I have been visiting the facility often and have become familiar with the customer handling processes at the hospital, which unfortunately still leaves a lot to be desired. While, the medical outcome of the treatment we have received at the hospital has been good, purely as a customer, my experience with the hospital services can hardly be termed satisfactory.

Here are some suggestions as to what can be done to improve the overall hospital experience.

The Issues with Group Practice

The radiation team at Max Hospital follows a group practice system and is led by Dr. AK Anand, who comes across as an extremely competent and experienced physician. He has a fairly large team of physicians, who support him in the OPD. Now, these are mostly young physicians earning their spurs under Dr. Anand’s supervision. Since, the team works on a group practice system, a patient gets seen by any of these physicians in the OPD. Thus, more often than not it so happens that one meets a new physician whenever one visits the hospital. From a patient’s point of view, it is very disconcerting to interact with a new physician and start the entire conversation right from the beginning every time one visits the hospital OPD. Also, the entire team is not of the same pedigree, many doctors are younger, less experienced and seem to be apprenticed with Dr. Anand. They often do not come across as confident and as sure as Dr. Anand, a very important factor, when the disease involved is a cancer.

The entire system revolves around a physical file, where all the doctors jot down their noting on loose sheaf of paper, which is than filed away. Each OPD visit means that the physician assigned to see the patient goes through the file, figure out what had happened in the previous visit and issues fresh instructions on the file. I submit it is quite impossible for a physician to study this file in the time that he is spending with the patient and fully understand what has happened thus far. The chances of human error are high. Max Hospital is bristling with posters on the notice boards about a state of the art e-initiative which is supposed to take care of all medical records electronically. While one goes through the tall claims about this new system, one finds it hard to reconcile it with the archaic processes in the Max Cancer Centre.

The system seems to have been designed around the physicians, one feels it should be, in this age and time around the customers. It should assign a particular doctor to a patient and he should see the patient through. If there are junior doctors involved, they should see patients along with the seniors, till they themselves feel comfortable in handling patients on their own. The physical files are ridiculous and can be done away with completely. Like in any other modern hospital, the information should flow seamlessly on a well-connected network. Reports, instructions etc. can and should be as far as possible e-mailed to patients.

The Appointment System

Strange as it may sound the appointments given to the patients have little value. Almost all patients are required to wait for a minimum of 30-40 minutes, whether they have a confirmed appointment with their physicians or not. Because of the prevalent group practice system, it is also quite immaterial whether you have an appointment with Dr. A or Dr. B.,  you can be ushered into the office of any  doctor on the team and he will see you irrespective of the fact that you have an appointment with a particular doctor. Thus, I have not really understood, why are appointments given for any particular doctor. In this system, it would make greater sense if one was to just walk in and gets seen by which ever doctor who is free at that point in time!!!

The Files

The files are the most important element in this entire process. Sometimes I have wondered what would happen if it would be misplaced. Actually it happened with us once, when the file had been requisitioned by the medical oncologist, and it took two hours, some very heated words and a few very flustered employees to find it. In the absence of the file, I would reckon the doctors too would be quite helpless. I have been assured that the paper file does have an electronic back-up, which honestly I doubt. I shudder to think that in this age and time, at Max Hospital, we might be at the mercy of a file, which changes hands every time a doctor sees us and God forbid, if somehow it is lost in the hospital.

While all this may sound strange and terribly dated, I must say that the system somehow works. We have no complaints on the medical outcome, which is the primary reason we have been visiting the hospital. As a patient and a care-giver I do not have much to complain about. However, as a modern-day paying consumer, wouldn’t I want my hospital experience to be far superior and fool-proof than what it is.

Hospitals must understand that in this age of customer experiences, it isn’t the medical outcome alone that counts. Max should know this better than anyone else.

Filed under: Healthcare Marketing Tagged: Dr. AK Anand, Dr. Anupama Hooda, Dr. Ashok Vaid, Dr. Teji Kataria, Gurgaon, IGRT, Max, Max Hospital, Medanta Medicity, New Delhi, Targeted Chemotherapy ]]> http://anasexperiences.wordpress.com/2011/09/30/medical-outcomes-and-customer-experiences/feed/ 1 anasexperiences Service Prescriptions http://anasexperiences.wordpress.com/2011/08/15/ramrati-and-some-questions/ http://anasexperiences.wordpress.com/2011/08/15/ramrati-and-some-questions/#comments Mon, 15 Aug 2011 15:48:49 +0000 anasexperiences http://anasexperiences.wordpress.com/?p=1390 ]]> I learnt about Ramrati from the pages of the Hindustan Times a few days ago. Apparently, the newspaper found her living in a urinal outside of the All India Institute of Medical Sciences (AIIMS), India’s most renowned medical facility located in the heart of the capital. Ramrati had a defective mitral valve and was seeking treatment for her medical condition.

Ramrati hails from a village in the Hamirpur district of UP. She is a mother of 5 and is 50. Needless to say that Ramrati, her husband Bhawani Din and their family lives in abject poverty and can hardly afford cardiac surgery, even at government-run hospitals, which are supposed to treat the poor free, but very often do not. Ramrati traveled to Jhansi for her treatment, from where she was asked to go to the Post Graduate Institute (PGI) of Medical Sciences in Lucknow the provincial capital. From there, she was sent to the AIIMS in Delhi, where she had been languishing in a men’s urinal for close to two and a half month hoping to have her surgery at India’s most premium medical institute.

Bhawani Din mortgaged all of his land to raise Rs. 100000 to fund his wife’s surgery. It would probably have been possible for Ramrati to undergo surgery at AIIMS, but then the hospital is over crowded and Ramrati has to wait her turn and since she has no place to live in Delhi, she found an unused men’s urinal, outside AIIMS and shared it with some other patients in a similar predicament.

Thanks to the story in the Hindustan Times, Ramrati found help. A local NGO found her room to board in a dharamshala and an eminent cardiac surgeon Dr. A. Sampath Kumar, formerly the Head of CTVS Surgery and now at a private hospital, Pushpanjali Crosslay Hospital in East Delhi agreed to operate on Ramrati free of cost.

The newspaper duly wrote about Ramrati’s good fortune also highlighting its own role in bringing succor to her. Pushpanjali Crosslay Hospital too did not miss the opportunity of grabbing headlines by positioning itself as a hospital with a heart. Dr. A. Sampath Kumar, who was part of the team of surgeons who had operated on the Prime Minister a few years ago got an opportunity to present himself as one of the ‘finest’ cardiac surgeon in the country.  Pushpanjali Crosslay Hospital, released pictures of a tired looking Ramrati being taken to the hospital for treatment and undergoing treatment at the hospital. AIIMS agreed to refund the Rs. 100000 deposit it had accepted from Bhawani Din.

Well, all this does sound like a fairy tale but it does raise disturbing questions. Why does Ramrati need to run from pillar to post to seek medical attention? Why does she need to travel to Delhi, via Jhansi and Lucknow, when the medical attention she needs can be provided to her in Lucknow? Why does Bhawani Din need to mortgage his land to raise money for his wife’s treatment? Why does Ramrati need to languish for two and half months in a men’s urinal outside India’s best hospital to get treated? What happens if she dies waiting for her turn? Who is accountable for all this? How many Ramrati’s are waiting outside AIIMS and other such facilities desperately seeking medical attention and why no one does anything about it? At the end of the day, who is accountable for Ramrati’s fate?

Now let us look at Dr. Sampath Kumar’s intervention. I would like to believe that he is a genuinely altruistic man and by responding to Ramrati’s predicament, he is only honouring the Hippocratic oath. But look at the way Pushpanjali Crosslay Hospital has gone about talking to the press about the free treatment that Ramrati has been offered by them. There are Ramrati’s photographs with the hospital ambulance serving as a nice backdrop and every mention of Dr. Kumar is followed by a statement that he is now with Pushpanjali Crosslay Hospital. It seems that the hospital wants the media spotlight firmly on itself, somehow the entire things looks way too opportunistic.

While the likes of Anna Hazare and the so-called members of the civil society prepare to commence a Gandhiji like fast, hoping to bring the government down to its knees, who is looking out for the Ramratis of the world. Why don’t we have the civil society empathizing with the poorest of our land and the callousness of our system, which does not care for them? Isn’t the right to reasonably good healthcare a fundamental right derived from the right to life? Isn’t  this something to agitate for? How can we have a shining India and a Ramrati’s India existing together and for how long?

And finally,  today as we have our netas shamelessly mouthing platitudes to our freedom from the British, we need to look inwards and ask ourselves if Ramrati is free today. Unless we get an answer in the affirmative, India will continue to struggle for real freedom.

PS: I believe Ramrati has since been successfully operated upon and is on the road to recovery

Sadly many hospitals do not want the dying to pass away while admitted in the hospital. This is as shameful as it gets, but the fact is that many smaller hospitals will refer the patient to some other facility, hoping all the time that the person will not die in their hospital. You see, a visit by the angel of death is not welcome, after-all there are hospital mortality numbers to be protected. Many hospitals will discharge a terminally ill patient informing their family that it is best that the patient dies at home surrounded by her family members, rather than in the hospital under a mountain of tubes and needles. Sounds altruistic and kind but I do believe that hospitals can handle deaths a lot better.

Here are some suggestions.

It is best not to pussyfoot around the matter of death. The senior most doctor under whose care the patient is admitted in the hospital must have a candid conversation with the patient’s attendants about the possibility of death. Giving false hope when there is a very small possibility of the science of medicine pulling off an improbable outcome is best avoided. A doctor must be honest and forthright in their assessment of the situation. This does not mean they have to be cold- empathy, warmth and honesty should go hand in hand. The hospitals must have designated patient conference rooms, where such discussions can happen. Busy OPD rooms or corridors outside the ICU are hardly the place for such conversations. Delegating this task to a junior doctor on the care team is also not right. I would be very uncomfortable with a doctor who can not look me in the eye and talk honestly about death, particularly when everyone from the nurses to the ward boys are whispering about it.

Hospitals must employ some counselors who can help patient attendants cope with the bad news. They should be trained in talking with the patient’s loved ones, prepare them for the death in the family, ask them if there is something that the hospital can do to help ease the pain. I recall a grieving husband, who wanted a sikh priest to spend sometime with his young wife dying of breast cancer in one of the hospitals I worked for. Religious ministers of various denominations must be at hand and available, for patients and their attendants who may need them.

Designated rooms for patient’s attendants to mourn their loved ones will be a good idea in a hospital. I remember once when a distant relative of mine passed away in a hospital in Delhi, there was just no place for the immediate family of the deceased to sit down together and  share their grief. Eventually, they huddled together in the hospital cafeteria with curious onlookers whispering about the misfortune of the family in having lost a member. Their personal grief was there for everyone to see, which made things a lot worse.

Hospital paperwork after the death and the release of the body by the hospital should be managed with a great deal of sensitivity. While one understands that the bills need to be settled and arrangements need to be made, hospitals should have trained staff handling this part. They should know well in advance that in the eventuality of death, who is it that they should approach for the paperwork to be completed. It would also be good if the hospital could help by recommending an undertaker or a hearse service, which most people will need once the dead body is released by the hospital.

While, it may sound macabre, hospitals must have a sound system of delivering a great experience even when the matter may be as grave as a death. In fact, a death would be an occasion, when the hospital must make a big difference.

Filed under: Healthcare Marketing Tagged: candid conversation, Death, Delhi, hospitals, indian hospitals, inevitability of death, Patient, terminal decline ]]> http://anasexperiences.wordpress.com/2011/07/31/confronting-deaths-in-a-hospital/feed/ 0 anasexperiences old woman in hosp http://anasexperiences.wordpress.com/2011/06/26/the-new-role-of-marketing-in-healthcare-organisations/ http://anasexperiences.wordpress.com/2011/06/26/the-new-role-of-marketing-in-healthcare-organisations/#comments Sun, 26 Jun 2011 13:20:43 +0000 anasexperiences http://anasexperiences.wordpress.com/?p=974 ]]> Healthcare organisations, hospitals and the like have long believed that the role of the Marketing function in their organisation is limited to organising health camps, CME’s and marketing communication, mostly of the ‘below the line’ variety. Thus the patient information literature that you see in your hospital is largely the doing of the marketing folks, who usually download the basic material from the net, rewrite some of it to make it suitable for their hospital, get the advertising agency to do a layout as per the hospital brand guidelines, get the doctors to approve the medical content and send it for printing. Marketing folks also organise a couple of advertisements usually when the hospital wishes to announce a new celebrity doctor or a new ‘state of the art equipment’, ‘which the hospital acquires. Now lest you misunderstand, this piece is not meant to disparage the role of the marketing folks in a hospital, on the contrary, I believe they have a much greater role to play than customarily assigned to them.

The Marketing function in a hospital has surely to be much more than this. I believe the Marketing team in the hospital must play a critical role in customer engagement. Now you may wonder, if the marketers were to do this, than what would medical folks do? Aren’t they the ones tasked with the responsibility of patient care? Thus, here we must make the distinction between patient care and customer care, which is critical for a hospital. Patient care is the medical care provided to patients in a hospital, which of course is the domain of the doctors, nurses and other medical staff in the hospital. Customer care on the other hand is the sum total of care that hospitals need to deliver to the patient and his attendants, at all the points, where the hospital engages with the customer. In a hospital, the elements of customer care include customer interactions over the phone, on the website, through an advertisement,  at the front office, at the billing counters, at the nursing counters, in patient rooms, in doctor’s consult rooms, in the waiting areas, in the cafeterias… really anywhere that the patient or their attendants interact with the hospital.

Most hospitals realise that their biggest asset is a satisfied customer. However, many still believe that a good medical outcome is perhaps the surest way of ensuring a patient’s loyalty. Unfortunately, the modern day patients are far more demanding to be satisfied with just a good medical outcome. In fact, many believe that a positive medical outcome for most procedures and surgeries is a given. What they are really looking for is a great hospital experience, which includes an a lot more than an expected medical outcome. Since, a lot of people still choose a hospital or a doctor based on advise from friends and family, a great customer experience becomes an essential marketing tool.  

Let me illustrate the point with a few recent experiences that I have had at Max Healthcare in New Delhi. My father has been battling an oral cancer, and was undergoing radiation therapy at the hospital. Much of the last month I took him to the hospital in the morning everyday. I had requested the hospital to give me a slot early in the morning so that I could go to work later in the day. The hospital obliged without a fuss. Now the General Duty Assistants (GDA’s), who usually wheel patients to the radiation areas report to work at around 8 in the morning and thus I would happily wheel my father over. Imagine, my utter surprise, when the security personnel at the hospital’s gate refused to allow me to do this chore and insisted that he would gladly do it. This was not a one-off, this happened everyday that we went there. A small incident in a hospital’s busy day, but it made all the difference to us, we felt welcomed and cared for. Similarly, many a times in the morning as I waited for my father to finish radiation, I was offered a cup of tea by the staff on duty in the radiation area. Again a small matter, but done instinctively and always with a smile. The fact that I remember these small incidents and write about them here, is excellent marketing for the hospital.

A busy hospital delivers thousands of these experiences every day. Each of them is delivered by individuals, who come from different backgrounds, socio-economic strata, having very differing educational backgrounds, yet they are united at work in aiming to deliver a great customer experience at the hospital. Each of these experiences must exceed customer expectations for them to talk about the hospital and its services.

Many a times a customer experience is delivered even when the customer has not walked into the hospital. These are just as important and include, the effectiveness and ease of handling of the hospital website when the log on to it, the efficiency and knowledge of the telephone operator when they call the hospital and the response of the hospital when in an emergency.

I believe in a new age hospital, the Marketing team must be the custodian of all customer experiences. It should work closely with the hospital operations team in defining the customer engagement paradigm and help them in delivering great customer experiences. The marketing team should have a single goal, to excel in delivering a great customer experience at all customer touch points, whether in the hospital, in the virtual world or outside of the hospital.

To commomorate the day, I moderated two panel discussions in New Delhi on the harmful effects of tobacco and how can one kick the habit for good. The panelists were all eminent doctors from Max Healthcare. These included Dr. Sandeep Buddhiraja, who is the Director of Internal Medicine practice at Max Hospitals, Dr. Samir Parikh, who is a well-known psychiatrist and also heads the Mental Health institute at Max Healthcare, Dr. IS Virdi, who is the director of Cardiothoracic Surgery at Max Hospitals, Dr. Harit Chaturvedi, who is a Onco Surgeon and the Director of Onco Surgery at Max and Dr. Anupama Hooda, who heads the medical oncology practice at Max. We had a packed house, a very interactive audience and some very interesting discussion.

I have known Dr. Buddhiraja for many years. He is a founding member at Max Healthcare, we worked together for almost 5 years, when I handled the Marketing function at Max. He continues to be my physician and has on numerous occasions treated many members of my family. In all these years I have known him to be a quiet, sincere and thorough professional, somebody whom you can implicitly trust. Today, I discovered another facet of Dr. Buddhiraja, that of a fiery crusader against tobacco abuse. Sandeep, had come prepared with all the facts, which pointed to a huge burden of disease, that is caused by tobacco abuse. He spoke with great passion, while talking about the harmful effects of tobacco. He is clearly much distressed about the increased use of tobacco in its myriad forms, cigarettes, gutkhas, chewing tobacco, pan masala, snuff etc., which is being impudently hawked on our streets. ”On one end of a cigarette is fire and ash and on the other a moron”, is how Sandeep succinctly put it.

Dr. Virdi, made a simple point saying that you can trace almost any lifestyle disease today to tobacco. Be it heart disease, peripheral vascular disease, a stroke and oral and lung cancers, tuberculosis of the chest, all of them are linked to tobacco. This hit home much closer, and I wondered aloud about my father’s illnesses in his almost 60 years as a smoker. He has had tuberculosis twice, a stroke last year and is currently battling with an oral cancer. So much for a puff!!!

Dr. Chaturvedi and Dr. Hooda had a field day, with oral, lung and other cancers having a clear association with tobacco. They too are passionate doctors and see enough and more cancer victims every day, who would be  healthy, if only they had stayed away from tobacco. One can feel their pain and if I may say anger at young people not realizing the grave danger of abusing tobacco, till they reach the office of an oncologist. Dr. Chaturvedi, wondered how is it that once someone is diagnosed with oral cancer, he gives up smoking without missing a beat. My father kicked a 60-year-old habit, the day we told him about his cancer, incidentally diagnosed by Dr. Chaturvedi himself. He wondered that giving up tobacco can not be all that hard.

Dr. Samir Parikh is one of those irrepressible live wires, who have a view on almost everything. Being a psychiatrist and that too one of the most well-known in Delhi, Dr. Parikh counsels and works with lots of people struggling with substance abuse including tobacco abuse. Dr. Parikh and Dr. Buddhiraja talked about how and why one starts with tobacco. Peer pressure, cultural shibboleths including smoking being ”cool”, and myths like ”I can quit anytime”, came up as the most prominent reasons for most people lighting up. Samir and Sandeep, both were emphatic in their pronouncement that tobacco abuse is not merely a habit but a disease. They cited ICD classifications on nicotine abuse and gave medical reasons for nicotine addiction and elaborated on the treatment that can help one kick the disease. They run a tobacco cessation clinic at Max Healthcare and work with smokers, who are keen to quit, but find it hard to get rid of the problem.

My colleague Saurabh Avasthi, who smoked 30 cigarettes a day and then gave up one fine day in October last year also spoke about how he started and how steadily tobacco caught him in its vise like grip and how one day, he just decided that enough was enough. He said that he symbolically buried cigarette sticks and then just never lit up again. The first ten days were hard, when the pull of nicotine, was at its worst and he would count his smoke free days. Over a period of time, he realized that the urge no longer existed and now he says that the stench of tobacco nauseate him.

In the final analysis we concluded that there is no running away from the fact that even one cigarette per day is really one too many. In over 150 people, who attended today’s panel discussion, even if one decides to give up tobacco as a result of today’s session, I would reckon, we would have achieved a lot.

I believe it is very important for family and care-givers to be well-informed about the disease and the treatment modalities being offered by the doctors. While we chose a hospital and the team that will take care of my father’s treatment, I read as much as I could about the disease. With the knowledge explosion around us and the almighty Google, at my service I found a treasure trove of information that was very handy in equipping me with managing my father’s illness and monitoring his treatment.

My father suffers from a cancer of the base of the tongue. The disease had spread to his adjacent lymph nodes, when it was diagnosed. A FNAC, wisely ordered by our internist revealed the tumour. The onco-surgeon I met ordered a PET-CT Scan to check if the disease has spread any further. I knew about the PET CT and how it worked and what it revealed, to understand why was it necessary. Once we had found the Primary tumour and settled on the treatment modalities (Radiation with concurrent targeted chemo-therapy), I read about the latest advances in these areas.

I also met medical oncologists who explained to me how the targeted therapy worked and why it was far superior to the conventional chemotherapy, which entails horrendous side-effects. The Radiation oncologists I met, explained to me about the radiation planning, the fantastic capabilities of modern-day radiation equipment and how they can deliver high doses of radiation with a great deal of precision and finesse. While, I marveled at the technology at our disposal, I knew the real test would be when we go through the therapy and how would my father cope with the like side-effects of the treatment.

Learning about the disease and the treatment options have helped me tremendously. Firstly, it has made me a partner in the fight against the disease. I am able to understand, what the medical teams are doing and how it might be helping us in dealing with the disease. This is most important as it gives me a semblance of control, a little power over a mighty foe. It also allows me to explain to my father about what to expect, to comfort him and to give him strength. Last night, as he blew his nose, a blob of blood coloured his handkerchief. Alarmed, he called me and I was able to explain to him that this was something that we would expect because of the radiation he is undergoing. A small matter, but a big reassurance for the patient.

Knowledge about the disease also allows me to hold informed discussions with the doctors treating my father. They too feel that they can explain to me in simple terms, what they are attempting and what has been the progress so far. Communicating well with your doctors is always a good idea, once they are comfortable, they can share with you a lot of information, which one can use and relate to during the course of the treatment.

Most importantly, as I sit besides my father watching the cocktail of the chemotherapy drugs drip into his forearm, I am able to supervise his treatment. This is not to say that the team of nurses and the residents are not good enough, but as we all know mistakes do happen and when one is dealing with cancer, they may prove very costly. Also, I realize the fact that for the nurses and the doctors, my father is one of the many patients they handle in a day, for me he is the only one and hence, even if I raise a few false alarms, it is worth it.

Finally, I would like to believe that a well-informed care giver, who is actively participating in patient care, while ensuring he does not get in the way, is a huge asset for the patient as well as the medical teams. I am willing to bet, medical outcomes would be far better for patients, who get this kind of support.

When faced with a sudden medical exigency it is imperative for caregivers to arm themselves with the relevant knowledge of the disease and for medical folks to encourage care-givers to do so. It really helps everyone.

Filed under: Healthcare Marketing Tagged: Artemis Health Institute, Cancer Caregivers, caregivers, Chemotherapy, FNAC, Gurgaon, IGRT, PET-CT, Radiation Therapy ]]> http://anasexperiences.wordpress.com/2011/04/30/the-advantages-of-an-aware-care-giver/feed/ 0 anasexperiences Care Givers