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.

Marketing With In

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

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

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

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

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

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

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

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

Pic courtesy www.flickr.com

Wither New Hospitals???

The other day I was with a friend who works for a hospital in New Delhi. While we chatted, he casually mentioned that the expansion plans of the hospital chain he worked for have been put on hold. This reminded me of another former colleague of mine who had had a particularly hard time with fickle minded healthcare companies, who will hire him as their director of new projects and he will sit idle twiddling his thumbs for many months as the new projects would just not materialise. Unbelievably, this happened with him twice and each time he had to relocate to a new city with wife and family in tow!

Rewind to almost two years ago.  Some of the biggest corporate houses in the country were keen on investing in healthcare in the country. The feuding Ambani brothers of the Reliance were all set to commence their big healthcare play. Both of them had announced mega plans with billions of dollars of investments. Anil Ambani was reported to be in talks with Analjit Singh for a majority stake in Max Healthcare. The Economic Times ran a story about the proposed deal adding a certain legitimacy to the rumours . While, Mr. Singh kept strenuously denying the reports the rumours would just not go away. Fortis, the healthcare major controlled by Mr. Singh’s nephews (Shivinder and Malvinder Mohan Singh of the Ranbaxy fame) had announced a joint venture with DLF, India’s largest real estate firm. They were reported to be planning to set up hospitals across the country with an investment of USD 1.5 bn.  

Incubating New Ideas in a Hospital

New Product and service lines always provide an opportunity for healthcare marketers to reconnect with their customers. A good marketer must always be on his toes looking for opportunities to connecct and communicate with his customers. Sometimes in the course of the evolution of the hospital’s services such opportunities present themselves, often the marketer has to create and then sustain them.

A new hospital keeps adding new services in the first few years and these provide the opportunities for the marketers to talk about them. For example Artemis Health Institute in Gurgaon opened a ultra modern blood bank a year after its formal launch and added a Lasik in the Ophthalmology service. These are occasions for the healthcare marketer to communicate with its customers. As the hospital matures and grows older, the addition of new services slackens and thus the marketers need to create these for continuous engagement with its customers.  

The PR Story

As I wearily settled into the cramped seat of a Spicejet flight to Mumbai this morning, I pulled out the Metro Nation a tabloid format newspaper and started flipping through the pages. Suddenly an image of my former colleague Dr. Deep Goel, the head of Laparoscopic and Bariatric Surgery at Artemis Health Institute, Gurgaon caught my attention. Dr. Goel was featured in the story along with a 200 kg Canadian patient, whom he had successfully operated upon (performing sleeve gastrectomy) and discharged from the hospital with in 24 hours. The story albeit poorly written (the journalist appears to be totally ignorant about medicine, medical procedures, surgeries et al), did manage to inform the readers about Dr. Goel’s superlative skills and about the Bariatric Surgery at Artemis.

Last week I had come across the story of a successful heart transplant in Chennai, when the donor was in Bangalore a team of surgeons from Chennai successfully harvested a heart in Bangaloreand transplanted it in a policeman in Chennai. Stories about Pakistani children being successfully treated for congenital heart diseases at Narayan Hridyalaya in Bangalore and undergoing liver transplants at Apollo Hospital in Delhi have routinely appeared in national media. Celebrities being treated at Leelawati and Breach Candy hospitals in Mumbai are also commonplace.  

Doctors and Grassroots Marketing Initiatives

 During my many years as a healthcare services marketer, my biggest challenge has been to  involve doctors in the marketing of their service lines. I have tried to think through this.  How can I possibly have a greater and an in depth involvement of doctors in the marketing  of a program. It seems that many are just not interested and consider getting involved in  something as prosaic as grassroots level marketing beneath their dignity as doctors.

Frankly, as a marketer I would hate to start a marketing program, without a complete buy in from the doctors concerned. That unfortunately happens rarely. I recall my efforts at starting a relationship program for individuals with a high risk of cardiac diseases as well as those, who are currently under medication for the treatment of heart disease.    

Catch them Young: Healthcare Marketing to School Kids

Schools have become new battle grounds for all kinds of marketers pushing soaps, candies, cosmetics, toothpastes, music and a new exhilarating lifestyle to the youngsters. The schools view most of this as frivolous and wholly unnecessary and often resist it. Sometimes the marketing effort is cloaked in interesting events, which are entertaining and educative.  Schools allow these and healthcare marketers are able to reach out to school kids through School Health Quizes,  talks on diet, exercise, hygiene and healthy lifestyle habits.

Some may be wary of allowing healthcare marketers to reach out to school kids. Children are generally healthy, it is a carefree time and weighty matters like healthcare should really be no concern to them. I am not sure I agree with this line of thinking. I would have a kid grow up in an environment, which helps him make ‘healthier’ choices. As a kid I was taught the benefits of ‘early to bed and early to rise’. I still swear by it.

Healthcare Marketers can reach out to schools, with specially designed programs, which educate and inform about how healthy choices made early, allow for a healthier lifestyle later on. This should really be looked upon as an investment by the hospital in a long relationship. To expect instant monetary rewards from a school program is expecting the moon. Persistence is the key here.

Some of the engagement programs that hospitals can run with schools are highlighted here.