Great Experiences and Brand Promises – Lessons from Indigo Airlines

Indigo”It is time you packed-up and left for the airport. You are on Indigo and they always leave on time”, said my colleagues at work. I was in Bangalore and had a busy day at work. I was trying to cram in as much as I possibly could in the day and I guess, I was getting late for my flight to Delhi. In any case, with the way the Bangalore traffic these days is, reaching the airport is akin to a lottery.

The Gods were kind that day, Mr David managed to get me to the airport well in time and, sure enough, Indigo boarded right on the dot. However, much to our chagrin we learnt that there would be some delay before we took off. Soon after being air-borne we had the captain on the PA system, proudly telling us that though we had departed Bangalore 10 minutes behind schedule (and it was all because of the congestion at the airport), he was quite hopeful of getting us into Delhi on time. He explained the benefits of a friendly tail-wind assisting us in the journey and also how he would try his best to get us on ground in Delhi on schedule.

It was soon evident that we had a chatty captain, who would tell us that we could see the lights of Hyderabad towards our right and that we were over Jaipur and were cruising over 33000 ft. The captain kept us engaged. He was never intrusive, but I did observe that in almost all announcements that he made, he did refer to the fact that we were likely to reach our destination on time. The crew also kept reminding us that an ón-time’ performance was their paramount goal. They urged us not to leave any waste around, so that they can turn around the aircraft faster for the next flight. It seemed that the crew was really focused and keen to get us to Delhi on time.

As soon as we touched down in Delhi, the crew announced that we have indeed arrived a little before schedule. They seemed to be genuinely pleased with their performance and wore big smiles. As I headed out of the aircraft, I noticed the captain standing just outside the door of the flight deck, wishing passengers the time of the day and amicably chatting with his crew. The captain and the crew looked like a wonderful team to me, who had enjoyed flying us to Delhi that evening and were genuinely happy that they managed to get us to our destination well in time.

This episode left me wondering how difficult it really is to conjure up this kind of experience every time Indigo takes flight, day in and day out. This would mean hundreds of flights everyday, flying thousands of passengers and ensuring a steady and consistent experience delivered through thousands of employees. No wonder, Indigo is one of the most successful airline in the country and their brand promise is synonymous with timely flights.

And since, I work for in healthcare, where a great experience is perhaps so much more important, it left me wondering, why most hospitals in India fail to deliver a consistent experience that can become their calling card. Unfortunately, we still do not have hospitals, which can deliver some if not all experiences in a pre-defined and consistent manner. Is there any hospital in India, which can claim that the OPD’s in its hospitals always begin on time, or where patients with prior appointments don’t have to wait or where physicians see off patients at their doors? Or, where patients are uniformly greeted by the staff at the front office, always treated with courtesy and where compassion counts for more than anything else?

I am aware that this is no easy task. Unlike passengers in an aircraft, patients are sick people, some are in life threatening situations, many are in the hospital for the first time in their lives and are truly unsure of what to expect. I also understand that unlike the airline, patients in a hospital will be staying for several days, they will be interacting with a multitude of people (doctors, nurses, paramedics,housekeeping, F&B services, general maintenance, billing etc.) and it is so much more difficult to synchronize all of these interactions into one great experience, which can be crystallized into a succinct and powerful brand promise.

However, hospitals, which hope to build a brand for themselves must start looking at ways and means of doing this. They must meld their varied customer interactions into one great experience that a customer can expect even before she enters the hospital. The true power of a hospital brand will only be unleashed, when it will learn to deliver that one experience again and again, every time that a patient walks through its door.

Confronting Deaths in a Hospital

I have often wondered how ill prepared Indian hospitals are, when they are confronted with dying patients. When the inevitability of death looms large over a terminally sick patient, our hospitals tend to pretend that death does not exist. Most folks assigned to take care of a patient who is in terminal decline, find it hard to communicate either with the patient or the grieving relatives. Many including the doctors do not know what to say and inanities such as ”we will keep trying right till the last breath” or a barely muttered ” I am sorry, but his chances are really slim’ escape the lips of the care-givers. For some reason everyone seems to talk in low hushed tones, when they know that death is round the corner.

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.

The Opportunity in Geriatric Care in India

Old age in India is looked upon as a time meant for quiet contemplation, remembering the almighty and spending time harmlessly pottering around with ones grandchildren. While this idyll exists for some, the sad reality is that old age often means deteriorating health and illnesses. As one grows older the mind loses its agility, the body loses its vigour and diseases set in.

With nuclear families and double incomes being the norm in urban India, children caring for their parents find the going tough. It is not that they do not wish to look after the elderly, the problem is that juggling careers, children and parents needing constant medical attention becomes a difficult task. The situation gets further compounded if the elderly require constant medical attention.

Home care hardly exists in India. Even in a city like Delhi, getting adequate nursing care at home is next to impossible. While a handful of nursing services exist, their services are unreliable and offer dubious quality of care. These centres do not employ nurses trained in geriatric care, most of them are rejects from big hospitals and land up in these places because no one else is willing to hire them. Trusting, them to look after the elderly at home is a huge risk.

Old age homes too are hard to find.  A quick look up on Google threw up just 5 centres in Delhi, most run by NGO’s as not for profit centres. These homes too are more in the nature of shelters for the aged and are not equipped with round the clock medical care. If this is the state of affairs Delhi, one can easily assume the situation to be a lot worse elsewhere in the country.

To my mind this is a significant business opportunity, which can only grow.

Specialised Geriatric Care centres, will provide comprehensive care to the elderly. This would include day care as well as residential care centres. These centres need not be hospitals in the strictest sense of the word but specialised care centres equipped to take care of the day-to-day medical needs of the aged. Unlike hospitals these centres will not be only for those who are sick with a debilitating or terminal illness but for all those who need assisted living. Thus these centres will offer continuous care both in terms of managing day-to-day chores as well as state of the art medical care.

These centres can also run home care services for the elderly. They can provide trained people to look after the aged at their homes, particularly when the children are at work or traveling on business. This can work well for folks, who  have family around them and would like to spend their remaining days at home with them. It would also take away the feeling of guilt that most children, unable to take adequate care of their elderly  parents, suffer from.

A business model can be developed along these service lines and may include monthly charges for the stay in the centre and using its facilities and separate charges for medical interventions as and when needed. While these centres should be ‘for profit’, one has to handle the business sensitively. Compassion, kindness and a missionary sense of doing good must be critical business drivers along with profits.

I am of the view that these aims can be easily balanced and a ‘for profit’ organisation with compassion and kindness at its heart can be built and sustained.

Hospital Pricing Must be More Transparent

Most people in India are scared of hospitals, more for the unpredictable financial implications that hospitalisation engenders than anything else. While most folks stoically accept the medical outcome, many find accepting the hospital bill far more difficult. This should not be the case.

Hospital pricing in India continues to be shrouded in mystery and one pays pretty much whatever the hospital asks. Most people do not even have elementary knowledge about how the hospital charges. At the time of admission, the hospitals proffer an estimate of expenses for what they assume would be an uneventful stay in the hospital. The patients expect that the hospital bill would be around the indicated estimate and plan accordingly. They do not realise that a hospital estimate has a large number of  variables, which can often lead to a higher bill and what the hospital is indicating is the best case scenario and what they need to be prepared for is perhaps the worst case scenario.

While there are often legitimate instances where one can understand the initial estimate going haywire, sadly their are also cases where the hospitals deliberately mislead the patient to make a fast buck. When my mother underwent a bypass surgery, she also contracted a serious chest infection and we had a very difficult time. The hospital did its best to see her through and the expenses mounted. However, in this instance since I was aware of the risk of infection, and had decided to go ahead with the surgery, paying more did not bother me and I certainly never felt that the hospital had cheated us.

While a few good, well established hospitals do not try to ‘reel in’ patients by indicating a lower than expected expense at the time the patient is making up his mind about the hospital, many unfortunately deliberately mislead the patient. This is a pernicious practice and actually amounts to taking undue advantage of the patient. Some hospitals also quote a higher price if a patient has an insurance cover and a much lower one if they are paying on their own. This is unfortunate and self defeating as insurance companies will soon start tightening the screws and once they have sufficient strength, they will drive a very hard bargain, which will have the hospitals cutting corners and the hapless patients paying the price literally and figuratively.

In the mad scramble for patients, hospitals have also started bargaining. As the patient walks in the hospital, the executives will discuss the likely expenses and if they find that the patient is likely to go ‘shopping’ to other hospitals, will make an instant offer much lower than quoted initially. This is largely to entice the patient to choose their hospital. It works well as the patient is spared the hassle of going to other hospitals and he believes he has got a bargain. What he does not know is that at that price the hospital is likely to compromise on consumables like implants, which may later on have serious medical consequences. I remember a few years ago we had a patient at Artemis Hospital from Bangladesh for a cardiac valve replacement surgery, for which the hospital had quoted an estimate and explained to the patient in detail the implants it proposed to use and all the other associated costs. The patient went shopping and landed at another hospital in Delhi, where he was quoted a price roughly 50% of what we had quoted. He had no idea of the quality of the implant proposed by this hospital but felt he could trust the doctor and the hospital (in that order). He went ahead with the surgery not knowing that he would probably require corrective surgery in a few years, which would be a lot more expensive and riskier.

The answer to all this madness lies in a better educated customer and more hospitals with a conscience. Hospitals must spend in educating customers about the likely costs, the risk factors, which can push the costs up and explain the possible consequences of choosing a cheaper, though a sub optimal treatment option. Transparency and honest intent are the key to winning a patient’s confidence. And of course they should be driven by a motive, which is more than profits at all costs.

Pic courtesy http://content.bored.com/comics/snap01636.gif

The Apathy of Delhi Hospitals Towards the Poor

Poor PatientsThe Delhi High Court has been after private hospitals in Delhi to honour their commitments regarding the treatment of the poor, but sadly to no avail. The hospitals are just not willing to treat poor for free, a condition that they agreed to while accepting land from the government at hugely subsidised rates. In-spite of the Delhi high court directing the hospitals time and again to fill up the beds for the poor, the hospitals are dragging their feet by hiding behind every legal loophole that they can find.

For the uninitiated here is the story. As many as 38 private hospitals in the city managed to get land at subsidised rates from the government under the condition that they will treat certain number of poor patients free of cost. The list of these hospitals today read the whose who of the hospitals in the city. However, once these hospitals commenced operations, they never honoured their part of the bargain. Thus the poor continue to be unwelcome in these hospitals, while beds reserved for them either remain empty or are filled up with full paying patients. This needless to say is criminal.   Continue reading

So much for my ‘Indian Hospital Experience’

Doctor WhoWhile trawling the net I came across a blog (http://www.travelblog.org/Asia/India/National-Capital-Territory/Delhi/blog-440604.html) about the travails of an American, getting treated for a mole/wart/skin cancer in New Delhi. The experience narrated in this post is exactly the kind of stuff we do not want. I am amazed at some of the narration and the stereotyping this does of the Indian doctors and medical system.

The blog has a semi mad sardarji (sikh) as a doctor who speaks and understands no English, laughs at his own jokes in Hindi and does not understand the difference between a mole and a pimple. The doctor has never heard of the United States and knows America, a country whose citizens are rich and ripe for fleecing. The doctor prescribes lotions and creams for treating the mole, which are not available at his own pharmacy and the patient (the author) walks out, having parted with Rs. 500 and nothing to show for it. Astoundingly, this gentleman returns to the clinic of the mad sardarji, encounters a ‘wildeyed’ patient on a wheelchair, and asks the doctor to burn off the offending mole in the emergency room next door.   Continue reading

The Hindustan Times and the Hospitals in Delhi

HT Report 1The 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?   Continue reading