The Advantages of an Aware Care-Giver

My father started Chemotherapy and concurrent Radiation therapy for an oral carcinoma earlier this month. Cancer is a scary disease and putting a loved one through the ordeal of  cancer treatment is not easy. The disease is a devious one, you beat it back in one place, it pops up somewhere else, you get rid of it for a few years, and you never know when it will turn up again. Now while I have worked in hospitals and am familiar with terms like Chemotherapy and Radiation Therapy and things called IGRT (Image Guided Radiation Therapy-the first machine in Delhi was installed at Artemis in Gurgaon, where I was employed), it is only now that I am discovering how little I knew about the disease and its treatment.

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.

The Necessity of Sunday OPDs

The other day a colleague called on a Sunday morning. He was hoping to meet a doctor in a hospital OPD and was seeking directions to the hospital. The colleague, whom I will call Sanjay here, had recently joined work and was for some reason feeling a little under the weather. Nothing serious, but the usual stresses, which are so familiar to sales people in the month of March. When he shared his symptoms with me, I advised him to see a doctor and on this Sunday morning he was headed to the hospital.

However, much to his dismay I informed him that hospital OPD’s are generally closed on Sunday mornings and he might as well head back or he was really unwell he could visit the emergency services. ‘Listen, I really do not think I need to go to the ER, can you help me find a hospital, where in a physician can examine me, check my BP and hopefully start me on some medication that can take care of my niggling symptoms?’ hollered Sanjay over the phone.

Here is why I believe Sunday OPD’s are a great idea.

Most people like Sanjay, who lead busy overworked lives find it difficult to take time off from work and visit their physicians, particularly for small niggles except on Sundays. A lingering cough, a bad cold, a running nose, a painful joint, a niggling back ache are pretty much part of the power packed 9 to 9 week. Most people ignore these or try self medication to keep going till the weekend. (I know they shouldn’t, but they do). If things haven’t taken a turn for the better by then, Sunday mornings are the time to see the doctor. Thus, for a hospital running Sunday OPD’s, would mean offering a great convenience to its customers.

Saturdays are generally the busiest in a hospital. The simple reason is that in many work places, Saturday is a holiday and customers get an opportunity to visit the hospital to see their doctors, get the pending diagnostic tests done, get the physiotherapy they need and attend to their own and their families healthcare needs.  For the same reason, Sundays can be even busier.

While I worked at Artemis Health Institute in Gurgaon, we had started doing a “Public Forum’, on Sunday mornings. This involved inviting our customers and pretty much the public in general to come to the hospital and listen to doctors discuss common medical conditions in layman’s terms. Post the presentations we had an interactive session, where the doctors took questions from the audience. The sessions ended with brunch, which afforded opportunity for people to interact with the doctors one on one. When the idea was first mooted, I must confess, I was not sure of the kind of public response to expect. My fears evaporated on the morning of the first day that we held the forum. We had a house-full with people standing in the aisles of the 270 seater auditorium we had in the hospital. We not only generated a full-house, we also generated lots of goodwill from the local community.

Thus Sunday OPD’s are not only a revenue opportunity, they also are a wonderful opportunity to generate the goodwill of the local community. It is also an opportunity for the hospital to communicate that it cares.

With all this going for a Sunday OPD, why do hospitals are still chary of having a full-fledged Sunday OPD?

The answer is that they can not get the doctors to come out and work on Sundays. Most doctors love their Sunday mornings as much as you and I do and hate to work (just like you and me, I guess!) Sundays. Hospitals have tried cajoling and even forcing them to attend to Sunday OPD’s but have met with no success. They have offered other weekdays as holidays in lieu of Sundays, which too hasn’t worked.

The only way to convince the doctors to do a Sunday OPD is to convince them of its immense value both from a business as well as a customer need point of view. The hospitals must also make it worth the while for the doctors by handsomely rewarding them for attending OPD’s on Sundays. Last but not the least the hospitals must spend big bucks in marketing the Sunday OPD’s. Once the patients start trickling in, the doctors too will not mind spending their Sunday mornings in the hospital.

The Silly Question of RoI in Healthcare Marketing

The other day I was with Dr. Jadhav who heads the Marketing function at the well known Narayan Hrudayalaya in Bangalore. Dr. Jadhav was keen to use radio for his hospital’s communication needs and I was hoping to persuade him to advertise with Fever 104, the radio station owned by The Hindustan Times, my current employers. Narayan Hrudayalaya, which is a well-known cardiac hospital thanks to the famous Dr. Devi Shetty and his pioneering initiatives, has recently started a Cancer Centre as well as a Multi Speciality hospital and wanted to promote these. The aim of the communication was to tell the citizens of Bangalore about these services available at Narayan Hrudayalaya and to drive ‘footfalls’.

While I discussed the plans with Dr. Jadhav, I could not help but notice his concern about the RoI on his marketing spends. Dr. Jadhav was very clear that if he spent Rs. 100, he needed 3 times the  sum in revenue, which could be directly attributed to this activity. I could easily relate to this because this is exactly the kind of  expectations the management teams had of me, when I headed the Marketing function at Max Healthcare and Artemis Health Institute.

I wish calculating RoI on healthcare spends was this easy. While there are many websites, which help one calculate RoI on marketing spends using complex formulae and spreadsheets involving the lifetime value of a customer, the cost of capital and what have you, I believe quite often the best way forward is a subjective gut feel and patience.

Measuring the success of a healthcare marketing campaign by merely counting the number of queries/walk ins generated in the hospital OPD is a great folly. The hospital business is unlike any other business and one must remember that exciting marketing communication alone will not lead to people walking in to check out the services of the hospital. This can happen for a new restaurant or a movie theatre,  but for someone to visit a hospital he must have a pressing need.

Tactical communication involving discounts, freebies and the like should be handled with care. I am not sure I would prefer to go to hospital for cardiac surgery because there is a discount being offered on the surgery, or I would like to go under the knife at a particular time just because the hospital is offering a deal. Come to think of it, I would be downright suspicious of the hospital if it tries to hustle me into a medical procedure by making a commercial offer.

Marketing spends in a hospital must be looked upon as an investment in the hospital brand and the values it stands for. The customers should be informed about the services of the hospital, the experience and training of its doctors, the robustness of its systems and processes and above all the promise of the experience the hospital hopes to deliver to its customers. It can highlight its ease of access, competitive pricing vis-a-vis other hospitals and superior services.  The hospital must showcase medical excellence, send out stories of success against great odds and constantly remind its customers what it truly stands for. It needs to communicate all or some of these over time before it should even attempt to measure the RoI.

A hospital’s brand equity is built over many years and much as hospital marketers would like to hurry this up, there are just no shortcuts. A hospital must set aside a small sum of money (7% of sales in the first years tapering to 2-3% in later years) year on year to spend on connecting with its patients and the local communities it hopes to serve. It should diligently spend this money informing, educating and reinforcing its brand values.

A few years later, the hospital will find itself buzzing with patients and no one would really be interested in the RoI on marketing spends.

Indian Healthcare 2010

Here is a list of 10 things one would like to see happen in healthcare services arena in India in the New Year.

1. Healthcare Service providers should move faster towards recognising the patient as a customer and focusing on delivering ‘Total Patient Care’. This would include better medical care as well as much superior levels of hospital services. Hospitals need to invest heavily in people and process improvements to achieve the goal of ‘Total Patient Care’.

2. Investment in the hospital brand. Most hospitals in India are chary of investing in the brand and whatever little marketing communication that happens is purely tactical, meant to drive traffic or communicate the commencement of a new service or the addition of another doctor. This must change. Hospitals must find a credible and differentiated positioning in the consumer’s mind and move quickly to occupy it.

3. Develop an information resource pool that allows patients and caregivers to check out the hospital services, compare doctor’s qualifications, training, specialisation and years of experience.

4. Focus on wellness rather than illnesses. Indian hospitals are mostly about sickness and ordinary folks dread visiting hospitals. It would be a lot better if our hospitals also incorporated wellness services and promoted them aggressively. Prevention and community medicine should become critical areas of focus.

5. Develop sustainable and high quality outreach programs by seeking local community participation. I live next doors to Indraprastha Apollo Hospitals in New Delhi and I often wonder, wouldn’t it be great if this hospital ran a community health program in our area. The local community can offer space for the hospital to run and manage a small clinic with a round the clock nursing coverage and doctors (family physicians and specialists) visiting for a couple of hours everyday. Imagine, all major hospitals running maybe 5 such clinics in areas abutting them. The hospitals will not only get more patients, they will earn tremendous goodwill of the local community.

6. Use social media to create patient communities and facilitate constant exchange of thoughts and ideas. Let medical experts join in to provide guidance and keep the community interactions at an even keel. We had tried something like this at Artemis Health Institute in Gurgaon. Unfortunately it fizzled out once I moved on. More hospitals need to remain connected with their patients in a meaningful manner, even when they do not need the hospital. It is an investment in a relationship, which will pay dividends in the long term.

7. Improve Emergency services. I recall calling Apollo Hospitals once to rush an ambulance to my residence to pick up my wife who had accidently hurt herself and was bleeding profusely. I explained that I was at work and was on my way as well. I reached home before the ambulance and brought my wife to the Emergency in my car. The ambulance never reached my place because the Emergency services at the hospital kept calling my wife at our home landline phone to confirm whether she was really hurt!!!

8. Government run hospitals treating the poor are models of sloth, inefficiency and corruption. It would be great if private enterprise forges some kind of a win-win partnership with these hospitals and improves services. I am sure the savings from reducing crippling systemic inefficiencies will itself ensure decent profits for the private healthcare enterprises. The government must take initiatives in inviting a few carefully selected private healthcare organisations to participate in this experiment.

9. Health Insurance must penetrate deeper and wider. The claims processing should become less cumbersome. In this age of instant communication, hospitals and insurance companies manually fax documents, seek patient histories and look for loop holes to wriggle out of paying claims. This must end. Insurance companies and hospitals must connect with each other seamlessly and exchange information that helps patients get better service.

10. Rural and semi urban India must get its due share in the development of healthcare infrastructure. The government must encourage investments in primary and secondary care  in these areas. Unless we have more and more people accessing reasonably good quality healthcare services close to where they live, the India growth story will remain a big sham.

Here is wishing everyone a happy and healthy 2010.

Pic courtesy http://www.muhealth.org

Marketing With In

Memorial HospitalHere 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 http://www.flickr.com

CT scan at Rs. 1500!!!

CT LungOn May 31st, which happened to be the World No Tobacco Day, I was holidaying in Kashmir, when I received a strange sms. Since I had decided not to carry my mobile phone on my vacation, I saw it only once I returned to Delhi.

The message, which I reproduce verbatim said ‘On the occasion of the World No Tobacco Day Artemis offers Lung CT at Rs. 1500 only. Offer valid only for My 31 2009 only. For registrations, please call’.

Needless to say that I was quite shocked. This is exactly the kind of lazy and insensitive marketing communication that puts off consumers from hospitals and makes them extremely suspicious of hospital communications.   Continue reading

Helping Turn the Clock Back-Thoughts on Cosmetic Surgery

plastic-surgeryPlastic Surgeons are a rare breed. With in the medical circles they are known as the artists ( in comparison, Cardiac Surgeons are the plumbers and the orthopaedicians the carpenters), those who sculpt the human body, try and turn back the clock by the magic of their scalpel. While plastic surgery can be cosmetic as well as reconstructive, the plastic surgeons are mostly identified with cosmetic surgery.

They are also the ones who routinely get celebrities under their knives. Filmstars often owe their longevity to these very skilled surgeons, whose deftness ensures a flawless visage. In India, cosmetic surgery is still considered something of a luxury, meant for the super rich, with tonnes of money to burn. The association of this art and science with womenfolk also continues. It is commonly believed that women like to go for cosmetic surgery be it liposuction or a tummy tuck or a nose job, they just love to get under the knives of a plastic surgeon.   Continue reading