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.

The Sales Vs. Marketing Conundrum in Healthcare

The Sales and Marketing functions in many hospitals in India still work independently of each other. There are invisible boundaries that separate the two and often it is considered heretical to get the twain to meet. The Marketing folks are the smart and savvy guys, who sit in their cloistered offices working on the holy grail that is called ‘strategy’, while the sales guys are the lowly folks, who need to sweat it out in the ‘field’. They are the ones who chase ”numbers” and perpetually suffer from their tyranny, while the Marketing folks grapple with the subtle nuances and the neat turns of phrase of advertising communication and the like. The sales folks are street smart, the Marketing guys worldly wise, the sales folks are rough at the edges, the Marketing guys are all suave and well rounded, the sales folks are the ones with their sleeves rolled-up and with their hair in the eyes, while the Marketing guys are impeccably turned out with neatly gelled hair, all in the right place…you get the drift.

Well, while one can go on in this vein, citing their differences, the fact remains that unless the Sales and Marketing folks work together, neither can really achieve great success. Yet, in many hospitals they hardly interact, leave alone work together.

The blame for this sorry state of affairs lies at both the ends of the spectrum. The sales people are programmed to chase, they are given no respite from the continuous and if I may add mind numbing quest for revenues. They do not have the time and even the inclination to sit back and think. A sales person, sitting idle, would soon enough invite the wrath of his supervisor. He would be labeled as a lazy day-dreamer who lacks ‘drive’ and ‘initiative’. On the other hand a Marketing person will have all the time in the world to think through each and every piece of communication that passes through his hands. He will weigh the pros and cons of the ‘copy’ and the way it is laid out in the ad. He will hold forth on the relevance of the ‘image’ that adorns the ad and of course the smallest detail like a misplaced comma or the uneven size of the font will not escape his attention. After all, he has been taught that God lies in the details.

In all this he will forget that the purpose of the advertising is perhaps to help the sales person drive in a few more customers through the hospital doors!

On the other hand this is what happens when sales guys try their hands at Marketing. Some time back I had the occasion to attend a sales review meeting at a hospital. The sales guy was holding forth on launching a few specialized clinics and the idea was to create communication informing the local community about the introduction and the benefits of these clinics. I recall one of the clinics to be launched was the ‘Heart Failure Clinic’, which offered specialized advise and support to patients in Heart Failure. The sales head briefed the Marketing team about the clinic and requested an ad. The Marketing team, sent out an ad, which talked about Heart Failure and exhorted patients suffering from heart failure to come to the clinic. The communication failed to inform the readers how to identify their condition as ‘Heart Failure’ and when exactly to approach the clinic. Strangely, it was also not very clear as to how a ‘Heart Failure Clinic’ was different from a routine consult with a cardiologist! ”If I am having a Heart Failure, wouldn’t I call the Emergency and rush to the hospital rather than wait for an appointment at the Heart Failure Clinic” asked a baffled HR person sitting in the review.

It was a mindless piece of communication done at the behest of the sales person, who was in a hurry to launch the clinic and a lazy Marketing guy, who wasn’t too bothered with the outcome of such inane advertising.

Now if only the Sales and Marketing teams had sat down together and looked at the issue at hand, which was how to drive cardiac patient volumes in the hospitals and come up with a plan, things could have been very different. Maybe a ”Heart Failure Clinic” might still have come up and the Marketing guy would have pointed out that it was best to market a Heart Failure Clinic to referring doctors rather than consumers in general. After all, isn’t Heart Failure a condition that will be identified by a local community doctor and would subsequently be referred to a ”Heart Failure Clinic” in a larger hospital.

If only the Sales and Marketing teams in hospitals forgot their differences and worked together, they could achieve so much more…together.

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.

The Perils of Standardized Health Care

Can healthcare delivery be standardised? This is the question, which has been bothering me this week.

The thought itself was triggered by a report in ‘Mint’ earlier this week titled ‘Government plans common healthcare standards’. (http://www.livemint.com/2010/08/24233218/Govt-plans-common-healthcare-s.html)

While the report portrays the benefits of standardization of care with millions of patients receiving standard care prescribed by the government thus saving them from being shortchanged by unscrupulous doctors and mercenary hospitals, there is also a flip (and a more real) side of the argument that we must understand.

While the government pushes through the Healthcare Standardization agenda, one wonders how can the delivery of healthcare be standardized across all medical facilities in the country? Every individual is different, reacts differently to treatments, the doctors are required to take decisions based on their experience and training and not on the basis of a set of guidelines decided upon by the government. If I was to fall sick, I would want my doctor to treat me based on his knowledge and experience and do what he feels is the best for me rather than stick to a standard set of guidelines mandated by the government. All doctors and medical establishment should have one guiding principle – the interest of the patient must be supreme and if there is a situation of uncertainty, I would want my doctor/hospital to always err on the side of caution.

Also, the healthcare delivery model in the country is hugely diversified. In its current form with poor regulation and monitoring it just does not lend itself to any standardization of care.The government-run tertiary care hospitals in large cities are filthy and over-crowded with patients and over-worked and under-paid doctors. The government run district hospitals as well as Primary Health Centres are even worse off with out dated equipment, poorly trained doctors, who often do not even show up for work. The private healthcare is dominated by secondary care establishments (usually called nursing homes), which have 10-50 beds and are usually owned by a doctor or a group of doctors. These are mostly mom and pop establishments, where owner doctors reign supreme and are answerable to none. Quality of care in these establishment is of dubious standard and these are neither properly regulated nor monitored vis-a-vis outcomes or treatment protocols. Christian missionaries and other charitable institution also run a large number of hospitals and now we have a nascent category of corporate style hospitals coming up in large cities offering cutting edge care. My point-all these hospitals are differently equipped, have differing goals  (for profit, non-profit, govt. owned etc.), have vastly different resources at their disposal, have different cultures and widely varying medical expertise available to each of them. How on earth can they all provide standardised, similar quality care to their patients?

Last December my father underwent a prostate surgery in a hospital in Delhi. Elderly men usually require this surgery at some point in time in their lives. Now, while I researched the treatment options for him and took surgeon’s opinions I discovered that we had several options. Our surgeon felt that the best and the safest alternative for him would be a laser surgery involving a cutting edge holmium laser. Now, this option is not available at most of the hospitals even in a city like Delhi, thus it can safely be ruled out from the ‘standardised treatment guidelines’ that are being framed by the government. In a situation like this, will it mean that patients like my father will be denied this option and he will have to endure the conventional surgery with its attendant risks of infection, excessive bleeding and a much longer hospital stay?

Let us now also look at the genesis of all this.

The health insurance companies (mostly state-owned)  want treatment protocols for some common diseases to be standardised so that they can fix a rate for these procedures, irrespective of the hospital and the doctor one chooses to go to. For the insurance companies this will lead to a state of nirvana, as they would be required to pay a fixed lump sum to the hospitals irrespective of the bill a patient runs up. They can then squeeze the hospitals further and make greater profits. Now, I am not against profits, however the problems that I see in this arrangement is that the patient will suffer, the quality of care will go down as hospitals will try to manage the delivery of care with in the financial limits set by the insurance companies (after-all they also need to be profitable). This is clearly hazardous.

One buys a health insurance cover  to ensure that in the time of need, financial constraints do not come in the way of accessing the optimum quality healthcare. The operative words here are ‘optimum quality’ and not ‘standard quality’ as mandated by the government. To equate these two will be a great folly. If the insurance companies believe certain hospitals are taking advantage of the situation by excessive billing (which I submit happens), they must put in place strict monitoring mechanisms including peer group reviews of treatment provided by the hospital. A healthcare regulator needs to be set up by the government to arbitrate between insurance companies and the hospitals. The regulator can possibly frame broad treatment  guidelines, which can serve as references in case a dispute arises between a patient, the hospital and the insurer.

Standardizing treatment protocols in a healthcare environment as complicated and as unregulated as ours is a dangerous and mostly an impractical idea. We need to first standardize our healthcare delivery systems before even thinking about standardizing treatment protocols. Paying hospitals based on these standardized treatment protocols because it makes health insurance companies profitable is inviting hospitals to cut corners. Once this happens, it will lead to serious erosion in the quality of care and even more  importantly a big trust deficit between patients and hospitals will emerge.

That would really be the ultimate irony, for if a patient does not trust his doctor or hospital, he really would have nowhere to go.

The Government’s Apathy to Healthcare in India

The Union budegt presented last month by the finance minister, Pranab Mukherjee, is hugely disappointing for the healthcare sector in the country. For many years now people associated with healthcare in the country have been waiting for big-ticket reforms in the sector, but the government has been turning a deaf ear. This year too, the story is no different.

The healthcare services in the country are not only woefully inadequate but also unevenly distributed. The healthcare industry, which is hugely dependent on private enterprise is just not attracting enough investments. Setting up and managing a hospital till it breaks even and makes money requires huge upfront investments. Presently, India has 860 beds for a million people, way below the WHO’s norm of  3960 beds for a million people. Studies by E&Y and KPMG have indicated that India needs to add 100000 beds per year for the next 20 years to reach close to this figure. This alone entails a spend of Rs. 50000 Cr. per annum. Compare this with what the government proposes to spend on healthcare in the next financial year, Rs. 22300 Cr. While this is 14% more than what the government spent last year, this amount is clearly insufficient.

The National Rural Health Mission, the flagship government programme for providing healthcare services in rural areas is riddled with inefficiencies. The government-run Primary Healthcare Centres are usually understaffed, ill-equipped and provide the most basic level of healthcare. Rural and semi urban India also needs good professionally managed secondary and tertiary care hospitals, which provide reasonably good quality healthcare at affordable rates. It seems that the government does not have the will power or the resources to usher in healthcare reforms.

Amazingly, the private sector entrepreneurs are willing to step in and bridge the gap.  All they need is a little help from the government in the form of tax holidays, duty reduction or abolition of duties on medical devices, easy availability of funding from government institutions at soft rates, longer payback periods and land at concessional rates. The government should also set up a regulatory body, a watchdog, which will keep an eye on hospitals being set up through this mechanism. The watchdog is critical as it will establish guidelines for setting up the hospitals, monitor progress, ensure quality through regular audits, lay down a fair pricing mechanism and in general ensure that the private sector, while availing of government policy benefits delivers on the promise of efficient, good quality and easily accessible care.

This is really not too difficult to achieve. Look at how private participation has revolutionized telecommunications in our country. Today India has more than half a billion mobile phone connections, the tariffs are the lowest in the world and even remote, far-flung and fairly inaccessible areas are connected (I had my phone working in the Nubra valley in Laddakh). The phones generally work, the services are efficient and the private sector companies, who had the foresight to start early are making profits. Some are even planning to go global and compete with the best in the world. The TRAI, which is the government watchdog is seen as an impartial and fairly efficient body, doing its job of advising the government on policy matters and ensuring compliance and a level playing field amongst all the operators.

No country can progress and aspire to be an economic superpower unless its citizens have access to good quality healthcare services. Considering India’s size and a population of over a billion people, (the majority living in rural areas), it is imperative that the government kick-start  reforms in this critical area sooner than later. If no significant policy initiatives have been announced this year, can the healthcare industry bodies (like those associated with CII and FICCI) lobby with the government, initiate debate and fuel informed discussion amongst all stake holders so that public opinion can be rallied in favour of these reforms.

Healthcare services impact the health of the nation. It is time all the healthcare stakeholders including the government sat together to prepare the blueprint for the next generation healthcare services for the country. This is very important because, unless we have robust, universally accessible, reasonably priced healthcare services for our citizens, all our claims about being an economic superpower will remain hollow and truly meaningless.

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