The Destruction of Trust – A Media Trial and a Witch-Hunt

The last couple of weeks have been a difficult time for the healthcare services providers in the NCR of Delhi. The media have been busy reporting about how Fortis and Max Healthcare ill-treat their patients and how the only thing they care about is profits. Having worked in both the hospitals, I can only say that this is completely wrong. The media-houses in their zeal to sensationalise and chase TRP’s are doing a great dis-service to these hospitals and the the medical profession in the country. The reporting is biased, short on facts and the conclusions drawn are completely unwarranted even bordering on fantasy.

The stories pertain to two cases, one at Fortis Hospital, Gurgaon where a 7-year-old child died of complications related to Dengue and the hospital is accused of over-charging and being callous. The other pertains to Max Healthcare, which is charged with negligence as one of the twins born at 23 weeks gestation was wrongly declared dead at Max Hospital, Shalimar Bagh, Delhi. The false narrative being spun is that the hospital chains are negligent, money- making machines and do not care for their patients. The outrage is completely manufactured and the stories falsely amplified and one-sided.

To make matters infinitely worse the politicians too have jumped in. They clearly want to be seen as championing the poor masses, who mostly cannot afford the services of these hospitals. The hospitals are being subject to multiple enquiries and the police has been called in to investigate the ‘murders’. The hospitals are being threatened with the cancellation of their licenses. (Strangely, a few months ago when scores of children died at a government owned hospital in Gorakhpur because the hospital ran out of oxygen supplies, no one thought of cancelling the license of that hospital)

Lest, we forget, both these hospital chains are amongst the top 5 private healthcare services providers in India. Between them they run more than 40 hospitals, treating thousands of patients every day. They are amongst the most well equipped hospitals in the country, boasting of the highest levels of technology, processes and systems and have patient outcomes comparable to the best in the world. They employ the finest of clinical talent available in the country and provide them an environment to excel. The hospitals attract thousands of patients from all over the world, who travel from across the globe seeking treatment for the most complex of diseases. Having worked in both the organisations, I can confidently say, that while there are many differences between the two institutions, both are thoroughly committed to the highest standards of patient care.

In-spite of all this, the hospitals are not infallible. No hospital in the world is. They can only aspire to do better, keep improving themselves and always try to do the best they can.We need to ponder, how these centre of clinical excellence have suddenly become pariahs overnight basis two cases, where there have been lapses. Like in any other profession or sphere of human endeavour, errors are inevitable. Tight processes, technology support and intent to weed these errors out is far more important than the errors themselves. On these, I can say without any hesitation that the hospitals compare favourably  with the very best that we have in the country.

The line between genuine errors and negligence is very thin. Doctors, while racing to save lives are required to make split second decisions, which may mean the difference between life and death to their patients. Sometimes not taking a particular decision may prove fatal and at others taking a particular decision may lead to complications. We have to trust our doctors to take the right decisions based on their experience and judgement. We also have to accept the fact that their decisions might turn out to be wrong and that these decisions can have horrendous consequences. This is just the nature of medicine. An adverse outcome doesn’t mean that the surgeon or the hospital messed up. It mostly means that they tried their best and yet didn’t succeed.

This is something very fundamental to healthcare. As patients or care-givers, we must support the doctors as best as we can. We can question, we can ask but let us not blame, at least, not every time something goes wrong. If we believe that there is a case of genuine negligence, as consumers we do have options. We can lodge a complaint with the Indian Medical Council, approach the consumer courts or go to the police. We must use these options judiciously.

Getting back to the baby, who was born at 23 weeks of gestation at Max Hospital, Shalimar Bagh. It has now been established that the decision, not to resuscitate the child was medically correct as he had a very slim chance of survival. The prognosis in case of survival too was also very poor. The decision to declare the child lifeless, without fully ascertaining the fact of death was wrong. Failure to properly communicate this tragedy to the parents too was an error. Was this negligence? Was their any malafide intent of causing harm to the child or undue pain to his parents? In my view this certainly wasn’t the case. I am not an expert in these matters and various eminent clinicians are conducting an enquiry about what happened. My view as a layman is that someone made a mistake, it was a bad mistake to make, hopefully some lessons too would have been learned and this would never be repeated again.

Does this mean that the hospital, the doctors and the administrators be called vultures, cheats and murderers and have rampaging mobs running amok in the hospitals baying for their blood?

The views expressed are personal.

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A Letter to my Readers

Dear Readers,

Many of you would have noticed that I have hardly been writing this year.

Almost a year has gone by, without a single new post on this blog. Some of you might have wondered, where have I been hiding. Well, to tell you the truth, for most of the year I have been incredibly busy, mostly chasing business for Fortis Healthcare. Till recently, I was heading Sales and Marketing there and this involved a lot of travel, a daily commute from my home to work and, which would easily top 80 kms a day and would gobble up at least 3 hours on the roads in Delhi. Now, anyone who lives in Delhi, knows what this means both on a good and God forbid on a bad day. All this added up to a 12 plus hours a day of work and travel, which left me no time to do anything else.

And than, there was travel in India and abroad. This in a given month would easily consume a minimum of 10 days. While, I love traveling and usually find it uplifting, it would still leave me with even lesser time home, where I mostly write. While on long plane journeys pretty much around the world, I learnt I could easily read, but unfortunately, I also learnt on these journeys that writing inside an aircraft  is not my cup of tea. For me it is a solitary vocation, to be pursued in the privacy of my home.

Thus, over the year, as I read and traveled and toiled at Fortis, I kept accumulating new experiences, great insights and thoughts, that I knew would one day be shared with many of you on this blog.

Last month, I left Fortis, and returned to work at Max Healthcare, which has been a happy hunting ground for me in the past too. Returning to Max Healthcare, also meant less hours commuting to work (the office is 15 minutes away from home), less travel (at least in India, all of our hospitals are in North India, most of them in the National Capital Region) and hence, I am now hopeful of putting together more posts and the output here should go up.

Well, from the point of view of the journey of this blog, this year has just run away too quickly. As I recommence this journey, I shall look forward to your usual comments, feedback and encouragement.

Sincerely,

Anas

 

Rahul’s Dilemma – A Case Study

for blogRahul Jain warily walked up the stairs to the office of the Facility Director. He anticipated much of the discussion and was not sure if he had the energy to sit through another long session on how he needed to get more revenues for the hospitals. They have been having these discussions pretty much the whole of the last week and it was apparent to him that something needed to be done. Trying small quick fixes was not going to take them too far. The only question in his mind was whether he had the courage to bite the bullet. He had been dithering for a while now, but he knew that he had to bite the bullet now.

Rahul has been the sales head of the hospital for the last 6 months. He has worked his way up from the ranks and now headed the sales team. His team comprised of 10 sales people, 4 were designated as Asst. Managers and others were front line sales executives. Two of the AM’s were recent hires, hand-picked by him and the other two were older colleagues. The sales executives were mostly people who had worked at other hospitals and two were with large pharmaceutical companies. To his mind, he had a crack team. He had been trying hard to understand, why they were than under-performing as a team.

Rahul worked at a mid-size multi-speciality Hospital in Delhi. The hospital is a part of the large Fortis Group, which is widely regarded as one of the leading healthcare enterprise in the country.

Rahul walked into the office of Dr. Sudhir Sharma the Facility Director. Dr. Sharma has been the director of the hospital for just over a year. Rahul liked him for his straightforward approach. With Dr. Sharma, he knew there was never any mincing of words or sugarcoating of the pill. As Dr. Sharma waved him down in the chair opposite him, Rahul opened his laptop and sat facing Dr. Sharma.

‘Rahul, how are things?

‘Sir, things are improving. It is just that we need more time to reach to our full potential’.

‘Rahul, I know, but look at the numbers. The cash sales is tracking below par, the TPA channel is also below par, while the PSU and the government piece is ahead of the budget, which I am not sure is a good thing. We must drive our cash sales higher.’

Rahul too peered at the numbers, which in any case he now knew by heart.

Budget July 2014 (In Cr) Actual July 2014 (In Cr.) Budget YTD (in Cr.) Actual YTD (in Cr.)
Cash Sales 6.8 4.7 23.6 19.8
TPA/Pvt. Corp 3.2 2.4 12.8 10.4
PSU/Govt. 2.6 3.5 10.1 12.5
ECHS
CGHS 1.2 1.5 5.5 6.4
International Sales 2.2 1.9 8.5 8.1
Total 16.00 14.00 60.5 57.2

‘Rahul, at about 95% overall achievement in the first four months, we have been barely able to keep our heads above water, but these numbers are hiding a big problem. The Cash and TPA sales are just above 80%, which is pulling down everything and the EBITDA numbers are in a very sorry state. We can perhaps prop up the EBITDA temporarily by reducing and deferring cost, but to reach an EBITDA of 22%, I need the sales channels to fire. To make matters worse, the CGHS and the other low priced business is ahead of the budget. Rahul, we must set this right and we have no time to lose’

Rahul also looked at the speciality wise distribution of the sales numbers. He felt that in these numbers were hidden some of the answers that he was seeking.

Budget July 2014 (In Cr) Actual July 2014 (In Cr.) Budget YTD (in Cr.) Actual YTD (in Cr.)
Cardiology 2.6 2.7 9.5 10.4
Cardiac Surgery 1.6 1.7 6.5 6.9
Orthopaedics 2.8 2.1 11.1 7.9
Neuro and Spine Surgery 1.3 .85 5.8 4.6
Urology and KTP 2.3 1.8 8.5 7.9
MAS and GI Surgery 1.8 2.0 6.5 8.1
Int. Medicine 2.6 1.65 10.2 8.9
Others 1 1.2 2.4 2.5
Total 16 14.00 60.5 57.2

‘Sir, if you look at the speciality wise data, we are clearly struggling with Orthopaedics. You know the team is new and we are trying our best to get the new doctors to connect with the referring physicians, it is taking time. Our other big problem is Neuro and Spine Surgery, where we just don’t seem to be getting the traction. And our bread and butter Internal Medicine is falling off the radar because of the internal team issues. While I am hopeful, that the dengue season, which is round the corner will help improve the volumes and revenues next month, we must have a longer term solution’.

‘Leave the Internal Medicine piece to me, Rahul. You know we are working on this and should get this sorted out in a couple of weeks, tell me how are you going to ramp up ‘Orthopaedics and Neuro Surgery pieces, what do we do there. You must look at the Urology piece as well; we are struggling there as well’.

Rahul took a deep breath and started narrating the outline of a plan that had been forming in his mind.

‘Sir, we have to attack these problems from multiple angles. To do that we must understand the levers that drives various parts of the business. We must have a comprehensive plan for Orthopaedics, Neuro and Spine Surgery and Urology. Let us identify these as our core specialities that we will drive across channels’.

‘Yes, Rahul but, where is the plan and when are we starting’. Rahul realized that Dr. Sharma was really running out of patience. He soldiered on.

‘Sir, as far as Orthopaedics is concerned, let us push the doctors both in the b to c space as well as b to b space. We need to re-launch the department. The Marketing folks must come up with a plan for the b to c piece. I shall speak with Manika in Marketing today itself. They need to pay us some serious attention. On the b to b front, I am working hard with the team to increase our coverage. Currently, we are meeting 300 doctors regularly; we need to push this up to 600. The A category doctors out of this lot must be regularly met every week’.

‘Rahul, I know but do tell me what you guys tell these doctors in your meetings. Do you have a plan for each meeting?’

Rahul winced; he knew he was on slippery territory here.

‘Sir, we have very little to engage with the doctors. We need more material, engaging stuff you know, interesting case stories, technically challenging cases, some nice giveaways…we have nothing’.

‘Rahul, please get what you need, the stories must come from the hospital itself. Get Jobi, to regularly source these from the doctors. Let me know, if you get stuck.

‘Right Sir, we will similarly develop detailed plans for Neuro and Spine Surgery as well Urology and come back to you.’

‘Rahul on the channel front too, my sense is that we are drifting. Please identify the top 10-15 clients in each channel and focus there. Can you come up with a Corporate Engagement Program, which allows us to connect with the corporates in a sustainable manner?’

‘Also Rahul, look at conversions, we have 500 OPD walk-ins every-day, I would like to know how many are recommended admissions and how many actually get admitted. Can we develop a system for tracking and improving conversions?’

Dr. Sharma in the flow and Rahul did not cut him short. In his mind he was also evaluating possibilities of introducing new clinics and new branded services, developing a robust plan for community activities in the neighbourhood and working out some local promotions to drive revenues in the short term.

‘Sir, allow me to put together a clear plan and come back to you in the next couple of days’. Rahul felt excited, even happy after his interactions with Dr. Sharma. He admired the man for his drive and ability to motivate. He secretly nursed a hope of becoming the facility director one day.

‘Thanks Rahul let us see the plan and let us get this beast moving quickly’.

Rahul walked out of the room, and called for a team meeting.

This is a fictitious case study written by me for a sales training session. Happy to share it here.

Marketing a Cancer Service

cancerCan a cancer service be effectively marketed?

Well, to someone who has dealt with cancer either as a patient or a caregiver, the very idea of marketing a cancer service is appalling, even grotesque. Cancer is often looked upon as the ultimate misfortune, a death sentence if ever there was one and juxtaposing a ‘commercial’ term like marketing with it sounds revolting. Yet, we know that in India there are cancer hospitals aplenty, many of them with great expertise and technology at their disposal, but sadly not many effectively engage with their patients beyond the mandatory sessions of chemo or radiation therapy.

Yet, I believe good cancer centres, need to have an effective engagement program with cancer patients and the care-givers. More than anything else, they need to connect with patients and help them understand their disease better, engage with them as partners in the fight that lies ahead and inspire them to beat the great odds  stacked against them. They also need to connect with the care-givers, help lighten their burden of fear and doom at the likely loss of a near and a dear one. Most of all, cancer centres need to give hope and courage to both the patients and care-givers in a world suddenly drained of light and good health.

A good cancer service should aim to constantly engage with its local community. It should help educate about the preventive aspects of the disease. Many oral cancers are completely preventable. Shunning tobacco, eliminates cancer – a simple message if communicated effectively can prevent almost all oral cancers. Extended exposure to known carcinogens such as pesticides, heavy metals or radiation also causes cancers. Avoiding these by taking sensible precautions can help reduce the incidence of cancer.Similarly, the chances of having cervical cancer can be significantly reduced by early vaccination against the disease.

Yet, I have not come across many hospitals running effective mass campaigns against tobacco use or creating awareness about cervical cancer vaccinations. I believe, in the fight against cancer, that is an opportunity wasted.

There are of course, cancers, which have nothing to do with lifestyle factors. They can hit unexpectedly (like the Germ Cell Carcinoma, that ravaged Yuvraj Singh) and there is little one can do to prevent them. However, in our arsenal are now medicines that can effectively combat these deadly cancers, if only we could diagnose and treat them early. Fortunately, we now also have advanced scanners that can detect tumours the size of a few cells, and raise a red flag. Yet, not many cancer services talk about early detection and encourage people to go for regular testing. A good cancer service must connect with the local community and relentlessly drive home the point that a cancer can be beaten by detecting it early.

The cancer service must also understand the fear that the word cancer causes in a person. Many people have an irrational fear of getting themselves screened for cancers. Good cancer services should develop engagement programs, which gently nudge people to shed their fear of the unknown and go for these screenings.

Fighting cancer requires true courage, uncommon grit and determination. The treatment regimen is often debilitating and painful. More than the physical pain, the sheer magnitude of the struggle against a deadly foe, with unknown odds is often difficult to bear. Cancer patients undergoing therapy, need hope and courage to overcome the disease. A good cancer service must realize that even if the disease succeeds in breaking a man, it must not be allowed to break his spirits. A cancer service, which offers hope and a steady hand is the one, which will connect with cancer patients the best.

Cancer Hospitals owe it to themselves as well as their local communities to constantly engage with each other and fight cancer. At Fortis Hospitals in Mumbai, we have for the last couple of months been doing exactly that. The hospitals recently completely a very successful campaign on cervical cancer screenings called ”Teal to Heal” (http://www.fortishealthcare.com/india/Teal_to_Heal.php), are presently running a cancer campaign, which features cancer survivors, sharing their inspiring stories of early struggle and success in beating back cancer. The stories are true and full of hope. The next phase of the campaign, will take up the fight against tobacco.

I do wish, there were more hospitals joining the fight against cancer by engaging their local communities. We can only win, if we fight together.

The Story of a World Record on the World Heart Day

World Heart Day was on Sept 29th this year and I was on tenterhooks.

Fortis Healthcare was aiming to create a Guinness World Records (GWR) record of the maximum cholesterol tests done in a city on a single day and I was nervous. We had been preparing for this day for the last four weeks and the day of reckoning was here.

The previous night I had slept late, mentally going through a check-list of things that we had closed, wondering about all that which may go wrong and hoping for the best the next day. Once, I had ticked off most things on  my mental check-list, I slept well and was up bright and early. It was time to see how the last 4 weeks of intense effort would now fructify.

The idea to attempt a world record of cholesterol tests came from Dr. Ashok Seth, the Chairman of Cardiac Sciences, at Fortis in New Delhi. Dr. Seth knows how to throw a challenge to the team. My colleague Jasrita and I had met him to discuss about the World Heart Day and Dr. Seth immediately threw down the gauntlet. He got us excited and committed. He got us thinking and wondering. A simple cholesterol test can serve as a warning sign for heart disease, we can use the test as a marketing device to create awareness about the disease. We hoped to get a few thousand people to come (fasting) to our hospitals on a warm Saturday morning to get their cholesterol levels checked.

Jasrita, Arnab and I got down to serious work. We had to plan and organise the campaign, get the hospitals excited and aligned, find a media partner who can drive home the message and have a diagnostic lab join hands with us in doing the physical testing. Fortis has more than half a dozen hospitals in the National Capital Region, who had to come on-board to participate in the activity. Most importantly, we had to find the money for a big campaign like this.

The Partners

Crayons

We roped in our advertising agency in Delhi as the key partner in developing the communication and for media planning. Crayons, has been working for many years and the CEO of Crayons, Ranjan has been a personal friend for over a decade. The Fortis team and the Crayons team met in their office for a detailed briefing. We took them through the idea, they loved it and saw great possibilities. They were raring to go. Two weeks later, Jasrita and Arnab trooped into my office with the first set of creatives, neatly printed and mounted on boards. The agency was surely putting its best foot forward. Also, they had churned out a lot of work. We had 4 different communication routes and tonnes of creatives. Jasrita, Arnab and I went through all the material calmly, debated and discussed each route and decided to sleep on it. I also asked Arnab to leave it lying around in my office overnight. We also agreed that, while we were attempting a World Record, it would not be appropriate for us to talk about it in our advertising.

The next morning we again went over the entire pile. We discarded two routes and shortlisted two for further discussions with Dr. Seth and Ashish, who is the Chief Operating Officer (COO) of Fortis. We met them on a Wednesday afternoon in Ashish’s office and took them through the ideas and the creatives. We unanimously agreed on a creative route. The die was now cast. Jasrita, Arnab and I would later fine tune the communication, pour over commas and full stops and agonize over every word written in the copy of the communication. We needed to get it just right and we knew that even a single word left out-of-place can leave a bad taste in the mouth.

The Hindustan Times

The Hindustan Times group is the second largest media company in the country and they rule Delhi. We called in the HT team for a briefing early on. They loved the idea as well. Of course, they were keen on our business as these are lean times for folks in the media business, but I would like to believe that they liked the idea more than the commercials. I have always believed that a partner delivers the best, when they buy in an idea. This is exactly what we did with the HT team. Of course, it helped that I knew them well as HT is my former employer and these guys are friends. While we negotiated hard, they eventually gave us a great deal.

SRL Diagnostics

SRL Diagnostics is a subsidiary of Fortis and is the largest diagnostic chain in the country. Jasrita worked hard with them to agree to collecting more than 10000 samples from 20 odd locations spread across the NCR. They were really a difficult bunch and the logistics of the exercise had to be meticulous. The last thing we wanted was to have people having a bad experience while giving samples, or the samples getting mixed up or reporting going haywire. Jasrita nailed everything down. Our favorite term during these days was ”idiot-proof”. We planned to make the entire process idiot-proof, dumb it down so that even the last person in the line should have no difficulty in understanding the process and following it. We meticulously calculated the number of phlebotomists needed at all the sample collection facilities, provided each of them with clear directions and fervently hoped that all will turn-up at the appointed hour. Jasrita wrote mails after mails detailing out a simple process over and over again so that everyone understood.

Guinness World Records (GWR)

Guinness World Records has a process for every record. They sent us reams of information about what all they needed to certify our record. They made us go nuts with their demands about arranging assessors, video-recording of all the sessions, the strict time-keeping, physical inspections of the sites and finally collection and evaluation of all the data. Boy, they are really thorough. They made us go through hoops but we complied on every single count. Jasrita, handled them adroitly, understood their detailed instructions and passed them on faithfully to the operations team. We were always fearful that we may fall foul of their elaborate process and miss out on the record on a technicality. What a pity that would have been.

The BTL Folks

We had a couple of ”Below the Line’ marketing agencies supporting us. They promoted the concept of a free cholesterol test directly to consumers. They went around parks looking for morning walkers, spread awareness in the hospital neighborhoods by distributing pamphlets and getting people to sign on for the test. Thus, one afternoon my wife and I were accosted by a young man at a Barista Coffee Shop, who explained to me what a cholesterol test was and how I can get one done free on Sept 29th at a Fortis facility. Bravo!, we both gladly registered.

Salt Mango Tree

You may wonder, what they are. Salt Mango Tree is in fact our agency for digital advertising. They trawl the internet for us. They also run our digital campaigns. For World Heart Day they promoted us on the Google sites, Facebook and Twitter. They created excitement in the digital world and got us a huge fan following on the net.

While, we had the partners lined up, a big challenge was to get each hospital charged up. We called meetings of the sales people from all the hospitals and, explained to them what we were attempting and asked them to contribute. Each hospital came up with ideas on getting folks to come to the hospital to give their samples. We met many times as a group, discussed progress, new ideas and revised plans. Goals were set, targets were mutually agreed upon and shared. The teams came together. The Corporate Sales teams too joined in. The word spread. We loved it. Aditya Vij, who is the CEO of Fortis Healthcare spoke with me. His big concern understandably was not the record but the customer experience that we were geared to deliver the next day. I assured him that we were ready.

Sept 29th 2012

I reached Fortis Escorts Heart Institute at around 0630 in the morning. I ran into Ashish, who too was wandering in. We had asked him to be the first donor of the day. The program was to begin at 7 in the morning and end at 1230. Even at 0630, we had the waiting area full, with people waiting for the tests. We began with Ashish and there was no looking back. Soon, I started receiving reports of a large turnout at almost all our facilities. The campaign had created a huge amount of excitement. We had people trooping in everywhere. Yet, the processes held up. We did not encounter any chaos anywhere.Everything went according to plan and by 11 we knew we were ahead of the existing record.

By the time we stopped at 1230, we were confident of having set a new GWR record. The GWR assessor took the entire afternoon in ascertaining our claims. He went through reams of physical data, the forms that we had collected and footage from across all our 20 locations. It was a mammoth exercise.

In the evening we assembled for a small function. The GWR representative asked Ashish to hazard a guess about the number of people who came for the test. Ashish who is usually ahead of the curve answered with a broad smile ”14161”. The GWR assessor looked a little abashed, smiled and said ”a very well-educated guess indeed”.

Where are the Healthcare Innovators?

When did you visit a hospital last and found a process, which made you sit up and take serious notice?

Hospitals in India are crying for serious innovations, yet we see so little of them. While, one keeps hearing about mind-boggling advances in medicine and technology, yet very little of that is reaching our hospitals. The largest and the most modern hospitals in India at best pay lip service to serious innovation. They do not even have innovation teams, which can identify and adopt innovative practices, which help cure faster, keep people healthy and provide a better customer experience at the hospital.

The reason for this are not far to seek.

Healthcare services in India are still in their infancy. While, large hospital chains like Fortis, Apollo and Max Healthcare have the latest equipment and the most sought after doctors, they are still not customer focussed. Innovations happen, when the customer is the focus of the organisation. Our healthcare services organisations are still mired in pandering to the egos of their senior doctors, guarding them like mother hen, lest they fly the coop. Since, there are only so many ‘star doctors’ and they are mostly responsible for pulling in the patients, one can not really fault the hospitals for focusing on their crown jewels rather than on patients. To make matters worse, most of these star doctors are older, quite often set in their ways, it is virtually impossible to make them innovate. They are wildly successful individuals, who have been at the top of their game for many years and see no reason to do things differently. Thus, in a Max Hospital in Delhi, you will have the younger doctors, using the Hospital Information System, the older and more senior ones, would still prefer a pen and paper, mindless of the fact that this means that every-time the patient comes to visit them, he would be carrying the past prescriptions and records in a file. And, this when Max has spent a fortune in putting in place a state of the art HIS!!!

The other driver of innovation is competition, which in the Indian context is sadly lacking. While, there are millions of mom and pop nursing homes and down the street clinics, good hospitals are few. With India growing close to 9%, many Indians can now afford good quality healthcare services. With health insurance also contributing its might, we have a situation, where there are too many patients chasing too few hospital beds. As the economy grows further and we see the benefits of our growth percolate down deeper, people would continue to move up from small and dodgy nursing homes to swanky, well organised hospitals. Thus, at the top end of the Indian healthcare market, serious competition is a long way off. This does not augur too well for healthcare innovations.

Health Insurance companies can drive serious healthcare innovations. They are always on the lookout of shaving costs and innovations often do that. However, in India, health insurance is still largely controlled by the state-owned general insurance behemoths, whose health insurance portfolio is a tiny fraction of the general insurance business that they handle. They themselves are riddled with inefficiency and corruption and can hardly be expected to drive healthcare innovations. The standalone health insurance companies in the private sector are still wobbly and are trying to find their feet. They too are quite clearly a long way off from driving innovations at our hospitals.

The only way we can possibly drive innovation in healthcare services in India is by becoming more demanding as patients. Impatient patients can bring about change in the delivery off at least the non medical services at our favourite hospitals. Thus, if a doctor is running late with his OPD appointments, patients can ask the hospitals to send sms’s in advance to patients, who are scheduled later in the day. If the hospital queuing system is inefficient, a patient can always suggest another system, which works better. (Check-out the new system at Max Medcentre in New Delhi, it is simple and efficient).

As far as bigger innovations are concerned, the hospitals and their various stakeholders have to drive those. Change inevitably brings pain in the shorter run, however those organisations, who have their eyes set on the horizon, cannot but embrace change. Even though, in India, the external circumstances may not be very conducive to innovations, we must remember, all great innovations are internally driven, largely rooted in a desire to be more efficient, more customer friendly, more differentiated and more profitable.

Indian hospitals must innovate to compete with themselves and to be better than what they were yesterday. That is the only way to long-term success.

Thank God we have Private Healthcare in India

Last week I came across a piece by Sopan Joshi in Tehelka. The story titled ‘No Place to be Sick’ (http://www.tehelka.com/story_main48.asp?filename=Ne050211coverstory.asp) appears to be a shallow piece intent on maligning private healthcare in India. Mr. Joshi’s central point ‘even if you could afford it, a private hospital may be the last place you would want to be in’ is completely flawed. While Mr. Joshi, cites a case of a cancer patient, who died at Max Hospital in New Delhi, after receiving chemotherapy, quotes the relatives and employers of the deceased, who believe that the hospital knowing well that the patient was unlikely to survive went ahead with chemotherapy and ran a bill of close to Rs. 8Lacs, which coincidentally was close to the insurance limit enjoyed by the patient. Basically Mr. Joshi is saying that Max Hospital unnecessarily treated a dying man because they wanted to make money.The hospital of course has denied the charge.

Now here is my point, who decides whether a patient should be treated or not? Isn’t it the job of his doctor to take this call? Isn’t the patient and his caregivers supposed to trust their doctors and if they do not trust the hospital or the doctor, isn’t it best that they find another doctor or a hospital for their treatment. In my many years in hospitals, I have seen patients and their attendants asking the doctors to do whatever they can to save a life of a loved one, they beg and plead that the doctors do something, anything to prolong a life. Now if the doctors, try something and the outcome turns out to be negative, how correct it is to say that the hospital deliberately over-treated just because it is a commercial enterprise and making money is in its DNA. Suppose in this particular case, had the doctor turned away the patient, wouldn’t that have left him open to the charge of not admitting and treating a seriously ill patient because no hospital wants a high mortality rate. From the hospital’s perspective this really is a catch 22 situation.

It is not my case that private healthcare services in India are perfect. They are not. However, by highlighting stray cases of wrong diagnosis and hospital borne infections, Mr Joshi can hardly make a sweeping conclusion that all private healthcare in India is driven by greed and little else. While, I would be the first to admit that there are many hospitals, who try to fleece patients it certainly does not mean that most private healthcare service providers are out to rob the patients blind. In fact corporate hospital chains like Max, Apollo and Fortis (to name a few) are trying hard to provide world-class healthcare services and while they are expensive by Indian standards, they still are amongst the cheapest in the world.

The problem with private healthcare in India is that it is completely amorphous and unregulated. While there is world class medical services being offered by some hospitals, there are millions of mom and pop shops, usually owned by a doctor and his family, which also provide healthcare services. These so-called nursing homes usually have very basic facilities and since they are completely unregulated, they get away literally with murder. This huge underbelly of private healthcare in India is the soft spot, which the government needs to fix immediately. To make matters worse, the average Indian consumer knows very little about his rights as a patient and is too overawed by the highly educated, English sprouting doctors to ask too many questions and ends up getting a raw deal. What we really need is a much more organised and accountable healthcare services.

Let us now look at what the government has to offer. In the city of Delhi, the government owns many hospitals, which are all large tertiary care centres. These are incredibly filthy, overcrowded (often two patients on a bed), stinking and staffed with callous government employees, who care two hoots about a patient. The doctors, while extremely competent, are under such a huge workload that its is just not humanly possible for them to provide good quality care to so many. My words may seem harsh, but the reality is much worse. Most people seeking care in the government-run hospitals use their ‘contacts’, with the powers that matter, to secure a bed and a surgery for themselves. In smaller towns and cities the situation is much worse, with the district hospitals being poorly equipped, saddled with obsolete equipment and with doctors who consider their responsibilities as punishment postings.

The solution really lies in a Public Private Partnership and increased regulation. We must have a healthcare services regulator (pretty much like the insurance or telecom regulator), who should lay down guidelines and rules for private and public hospitals and ensure that these are stringently followed. Hospitals outcomes, its systems and processes and its people must be periodically audited for quality. The regulator should be empowered to act without fear or favour to weed out the laggards and the unscrupulous.

And now to revert to Mr. Joshi again, let me ask a simple question,  God forbid if he or someone in his family needs a hospital, where will he go-to a private hospital or to a government-run public hospital? To me the answer is quite obvious, we need more Max, Fortis and the like.