Akkriti Bhatia and healthcare services in our Schools

Here is the tragic case of Akkriti Bhatia, a 17 year old  school girl, who died yesterday after collapsing in her school. The Hindustan Times reports that Akkriti complained of breathlessness to her classmates, who then called her mother to send a car to fetch her. Apparently when the car arrived, Akkriti requested her teacher’s permission to go home. The teacher realising that she was seriously ill sent her off to the nearby Holy Angels Hospital, where she was declared ‘brought dead’. Akkriti, it seems died on her way to the hospital.

This is a tragedy that could have been easily averted. Akkriti was an asthamatic child. This was known to the school authorities. Yet it seems there was no one in the school, who had the sense to realise that the girl was in acute respiratory distress and someone needed to call an ambulance. Apparently the school by way of medical support had a medical room and a nurse, and the young girl was administered oxygen in the medical room. Curiously enough when her mother’s car came to pick her up, she was taken off the oxygen cylinder and was sent to the hospital gasping for breath accompanied by the school nurse and another student!  

Hospitals are all about People’s Skills

I have rarely come across an industry, which requires a range of skills, which are wider than what one sees in the people, who work in hospitals. A hospital actually is an amazing aggregation of skills and talent, which one would hardly see in any other human enterprise.

Among the medical folks, there are doctors who are hugely knowledgeable, highly educated and supremely skilled in the art and science of medicine, there are nurses and paramedics, who symbolise compassion and care and there are support folks who provide critical support for running the medical function in the hospital.

Amongst the managerial teams, there are managers who handle the front office and interact with patients and their attendants. They are the face of the hospital, well trained, well groomed very presentable folks, who help put patients at their attendants at ease. They usually have very good communication skills, are people with immense patience and a sunny optimistic disposition.

A hospital also needs a lot of technical support and thus you find high tech bio medical engineers, who ensure that all the equipment in the hospital works flawlessly. Imagine what can happen if an equipment in the OR or in the ICU malfunctions at a critical moment. Much like doctors, their role requires quick thinking, complete mastery of  technical matters and planning for any eventuality.  Most bio medical engineers are rarely seen and heard in the hospital but behind the scenes they control the levers of the hospital.

These days a modern hospital runs on state of the art software, which connects every hospital function. A doctor can not write his notes or ask for medicines till the orders have been punched in the Hospital Information System (HIS). The nurses can not dispense medicines unless requisitioned through the HIS. A patient can not be admitted or treated unless the relevant files and records have been created in the HIS. While most hospitals do have a back-up manual system, it is rarely used largely because an IT team employed by the hospital ensures that the HIS is rarely down. These people are often quintessential techies, with very sound knowledge of hospital systems and processes.

At a 180 degrees of separation from these folks are people who look after functions such as Food & Beverages, Housekeeping and Security. They are all trained individuals as much an expert in their areas as any techie. They interact with patients and their attendants and hence also have superb skills in handling patient grievances. 

While all of those mentioned above contribute towards keeping the hospital humming, another set of people are those who manage the business side of things and have a completely different set of skills. These include the sales and marketing folks, who represent the hospital to an external environment, purchase managers and store keepers, who ensure that the hospital is well stocked with all the essential supplies and the finance guys, who keep an eye on how the money is being spent. People in all these functions have unique strengths. The finance guys are very good with numbers, the sales people drive innovation and have good communication skills and the purchase folks have tremendous negotiation skills and an uncanny smell for a deal.

A good hospital will always have good Human Resources and training personnel. They are the ones who ensure harmonious working relationships amongst a very varied and highly skilled workforce. They make the rules, which govern the conduct of individuals in the hospital, play a critial role in rewards and recognition systems, act as agony aunts and handle conflicts. To my mind the most important skill they bring to the table is an ability to get on with people, understand differing point of views and manage aspirations of a very diverse bunch of people. 

If I was to select two critical skills, which an individual who aspires to work in a hospital must possess it has to be compassion and communication skills. Anyone, who works in a hospital must have loads of compassion towards fellow human beings, an innate ability to see things from the patients perspective and take decisions with empathy and  with an utmost regard for the plight of the patients. The ability to communicate well with language or through a meaningful silence or by just a touch, would be a close second. Be it a doctor, a front office manager or a sales person the ability to communicate the right thing at the right time to the right person is an immensely valuable gift.

Pic courtesy www.flickr.com

The Power of a Compelling Story in the Marketing of a Hospital

Many years ago, when I worked at Max Healthcare, I met an elderly man whose grand daughter had had a major cardiac surgery and was admitted in the hospital. The child was on her way to recovery and the old man was profoundly grateful to Dr. Anil Bhan, who had operated on the child. The old man narrated a very interesting tale.

The old man and his wife lived in Roorkee, a University town about 150 miles from Delhi. His son worked in a nationalised bank in Delhi and he had two grand children, twins as a matter of fact, a grand daughter and a grand son. The children now aged 11 years lived apart, the son in Delhi with his parents and the daughter with them in Roorkee.  The daughter from the time of her birth had been a sickly child and had required heart surgery, when she was 9 months old. Being a girl child and that too a sick one, her parents had entrusted her care to the old couple and they had brought her up. Clearly, the old man and his wife were extremely attached with this child and she was the apple of their eyes.

The child too enjoyed living with her grand parents and they clearly doted on her. They ensured that she received the best medical care and would regularly bring her over to AIIMS, the premier medical institute in Delhi for regular monitoring and check ups. About two years ago, when the child was 9, they had noticed that she would become breathless after a little exertion. Initially they did not worry too much, however things grew steadily worse and they became quite alarmed and brought her to Delhi.

The paediatric cardiologist at AIIMS, who has been taking care of the child in all these years told them that the child needed another surgery, an extremely rare and very risky procedure and she needed it fast. They were also told that without the surgery the prognosis was very poor. Dr. Anil Bhan, who was the paediatric surgeon who had operated on her as a eight month old infant had now moved to Max as their chief of cardiac surgery.

The old couple brought the child to Dr. Bhan, who examined her carefully and pronounced that while the surgery was extremely rare and very risky he was willing to do his best. The old couple let things in the hands of Dr. Bhan and prayed to the almighty to save their grand daughter. Dr. Bhan operated on the child and she was wheeled into the Paediatric ICU after the surgery. Soon post surgical complications set in and hopes of her survival dimmed. Dr. Bhan, however approached the old couple again and requested permission to try surgery once again. The old couple with nothing to lose, told him to go ahead.

The child was again wheeled into the OR and Dr. Bhan and his team once again made a heroic attempt to save her life. She survived the surgery and spent the next 9 days in the ICU under the watch of some very dedicated doctors. The child was than shifted to a ward and when I met the old man, he was preparing for her discharge from the hospital.

The gratitude this man had for Dr. Bhan and his team, the ICU staff and for the hospital was immense. He showed me a poem he had composed in Dr. Bhan’s honour. He could not help narrate the wonderful things that happened to him in the hospital, about the extraordinary skills of the doctors, their commitment and their indomitable spirit in not giving up on them even in the face of unbelievably daunting odds.

There can be no greater hospital marketing tool than a powerful and a compelling story narrated by the patient or a patient attendant about his experiences in the hospital.

 

PS: Dr. Bhan and his team has since moved to Batra Hospital in New Delhi

 

Pic courtesy http://www.flickr.com

 

The Changing Face of the Neighbourhood Chemist

Unlike the western world, pharmacy retailing in India is largely unorganised. We are all familiar with the friendly neighbourhood chemist, who is able to meet a family’s needs for  prescription as well as OTC medicines. The chemist is is usually a ‘mom and pop’ outlet, which stocks medicines in boxes all stored neatly in glass cupboards. The owner is the manager, who runs the store, manages the supply side of things, interacts with customers and builds enduring relationships. He usually employs a couple of low skilled helps to fill orders and at times do the billing.

This model has worked well for decades. However, with the advent of modern retail in the country some entrepreneurs have been experimenting with organised pharmacy chains. In Delhi, one can see outlets of Guardian Pharmacy, the 98.4 stores, Apollo Pharmacy, Fortis Healthworld and CRS Health outlets.      

In the South East borough of Sarita Vihar in New Delhi where I stay, I have been noticing interesting changes in the market place. The main market in this residential area had 5 pharma stores catering to the needs of nearly 2000 households. About a year and a half ago a branded outlet of the chain 98.4 commenced operations and recently an Apollo Pharmacy too opened its doors.

I have been a regular with a mom and pop pharmacy called Medicare located in the same market. After the advent of 98.4, Medicare underwent a renovation, an air conditioner was installed, the interiors were redone, a new signage was put up and the billing changed from the old fashioned bill book to a computerised printout. I had always found the store to be well stocked and the owner hospitable. He would typically chat up while one waited for the order to be filled, would offer to send medicines home if ordered over the phone and by and by I liked the guy.

However, when 98.4 opened I decided to try them out as well. With their smart interiors, uniformed and trained staff and a glitzy information newsletter, they did appear to be promising a lot more. Here I must confess that my experiences with the new store has been uniformly bad. The store has never been able to fill my prescription completely. They are invariably short of medicines on my prescription and to make matters worse they do not have a system by which they can instantly procure medicines from a neighbouring store. Thus invariably one has to go to Medicare, where even if they are out of the medicines, the owner happily sends his boy around to the next store to get the medicines and fill the prescription. If that too fails, he readily offers to send the medicines home later in the day. As a customer I appreciate his efforts and the value that he puts on my business.

Last month, when Apollo Pharmacy started, I walked in with a prescription from a local family physician and they too could not fill the prescription. Medicare readily did.

The lessons for the fledgling organised pharma retailing are simple enough. If they wish to compete with the local mom and pop stores, they must find a way to ensure that they stock enough popular brands as well as those most often prescribed by the local physicians. In other words they need to have their ears glued to the ground.

Loyalty Programs (98.4 runs one), customer feedback forms, uniformed staff, an obliging doorman and computerised billing are all add ons and will work well only if the basic service is reliable and fast. The store managers and the staff must be authorised to do whatever it takes to ensure that a customer’s order is filled. Empowerment of the front line executives is a must for them to effectively compete with the mom and pop stores.

Finally, these stores need to train their staff in offering solutions. If a particular brand is not available, they can offer a substitute or promise to have it delivered at the customer’s home later in the day or try something else, which makes a customer feel that his business is valued by the store. 

Organised retailing of pharmaceuticals in the country is its infancy in the country. It can only succeed if these early entrants pay attention to these details and ensure a great customer experience at all touch points and every time a customer walks in.

 

Pic courtesy http://www.flickr.com and http://www.globalhealthline.com

 

 

The Hospitalphobe

My wife is one of the many people I know who have a mortal fear of hospitals. While I spent many hours happily at the hospitals I worked for, my wife would never venture near them. In fact, she would often wonder how could I spend so much time at the hospitals, particularly when I am not even a doctor. Many of my friends would also come out with similar barbs about my unlikely life in the hospitals. This made me wonder about this curious species that I will call the Hospitalphobe.

The Hospitalphobe is the one who is terrified by all things medical. Be it the doctors in their pristine aprons, the equipment, the sight of people hooked up to IV lines, the ICU, and the fear of fears the OR.

I believe the fear of hospitals in the hospitalphobe largely emanates from losing control. In hospitals, an individual loses his identity, is at the beck and command of doctors and nurses, has little choice but to comply with the instructions, subject oneself to what many would consider severe indignities and still be very grateful for it all.

Then there is the uncertainty of it all. There is nothing in a hospital, which can be called a ‘certain’ outcome. Even the most simple and minor procedure carry a risk. The hospitalphobes are acutely aware of these risks and worry endlessly about even a prick. My wife would certainly fall in this category.

Hospitals are also looked upon by the hospitalphobe as places full of infectious pathogens and they fear that by just breathing in the air they are exposing themselves to an unacceptably high risk of catching something. While, it is true that hospitals have a relatively higher concentration of microbes and what have you, I can easily vouch for them not bringing me to any grief ever. The hospitalphobe I know, would not agree.