Experiences at Indraprastha Apollo Hospitals – I

Indraprastha Apollo Hospitals in New Delhi is our neighbour. Thus, one morning earlier this month, when my brother-in-law called urgently that my father was unwell, extremely lethargic, drowsy and a little disoriented, we decided to call an ambulance from Apollo and rushed him to the hospital.

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’.

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.    

The Hindustan Times and the Hospitals in Delhi

The whole of the last week The Hindustan Times carried a series of stories highlighting incidents of ‘negligence’ in high profile private hospitals in Delhi. The hospitals featured included Fortis Escorts Hospital, Max Hospitals, Apollo Hospital, Sir Gangaram Hospital and Rajiv Gandhi Cancer Hospital. Now these hospitals in Delhi are the best that we have. While, Hindustan Times has a right to expose cases of negligence in hospitals I am still not sure what purpose was served by these reports.

Here are a couple of points I would like to make about these ‘exposes’.

The cases reported highlighted horrific experiences consumers had in these hospitals. Most people featured in the story lost a loved one because the hospital failed to deliver adequate care and refused to take responsibility for what went wrong. These I am afraid were random cases picked up by intrepid journalists and made for riveting reading. However, the journalists doing these stories did not investigate the reason for these failures. The question why did these hospitals fail in their duty towards their patients remains unanswered. Was the failure a result of a doctor not discharging his duties properly, or was it a failure of the hospitals processes or both? Or was it negligence or an error of judgement on the part of a doctor? Did he deliberately mistreat a patient, was callous in discharging his duties, wilfully deviated from standard medical practices or just did not care enough?  

The 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.  

Healthcare Advertising on Radio

Now that I work for a radio station I have been applying some time figuring out the feasibility of healthcare advertisements on Radio Stations.  In India the private FM radio stations are only allowed to play music and things like News, Sports, General Entertainment are not allowed. Most stations thus offer a mix of music interspersed with Jock Talk, audience bites, station sweepers, contest promos and of course advertising.    

The Marketing of a Hospital

Before I get into the business of writing about the Marketing of a Hospital in India I must establish my credentials.

I have been working in the arena of Marketing of Heathcare Services for the last 8 years or so. I have been involved with Apollo Health and Lifestyle Ltd., which is the franchisor of Apollo Clinics part of the Apollo Hospitals Group, headed the Marketing and later the Corporate and International Sales for Max Healthcare a large healthcare services company based in Delhi and for the last two years have been heading the Sales and Marketing function at Artemis Health Institute, a tertiary care hospital based in Gurgaon and promoted by the Apollo Tyres group.

When I started working for Apollo Hospitals as the Marketing Manager for The Apollo Clinics and later at Max Healthcare I was often asked the question as to what really a Marketing person did in a hospital. Marketing of hospitals was understood to be a big no no. If you had a good hospital infrastructure and some well known doctors working for you the conventional wisdom dictated that the patients will follow.