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.

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The Apollo Clinics-The Perils of Franchising Healthcare Services in India

I came across a piece co-authored by my former colleague Ratan Jalan in ‘Marketing Health Services’ (Eye on The Indian Market, Spring 2009 edition)of the prestigious journal of the American Marketing Association. I have known Mr. Jalan since he hired me to work for him at Apollo Health and Lifestyle Ltd., many years ago and hugely respect his scholarship and knowledge about the business of healthcare in India. However, I must confess that I do not quite agree with Mr. Jalan’s portrayal of the opportunities in franchising healthcare services in India and his conclusions about Apollo Health and Lifestyle’s successful franchising of the Apollo Clinics.

Apollo Hospitals is one of the largest chain of hospitals in India. It has in its network more than 41 hospitals and manages over 8000 beds mostly in the secondary and the tertiary healthcare space.  I met Ratan in the year 2001, when he was setting up Apollo Health and Lifestyle, which was to get into franchising of the Ápollo Clinics, the primary healthcare services chain, which were supposed to complement Apollo’s large secondary and tertiary care network. These clinics were envisaged as a franchised operations, supported by the Apollo Hospitals group. They were to leverage Apollo’s excellent brand equity and knowledge about the healthcare in India and help franchisees run a profitable enterprise.

The Apollo Clinics were well conceived. The service mix was essentially OPD consultations, a collection centre for pathology samples, radiology services (X-Ray, Ultrasound) and basic cardiology diagnostics (ECG, TMT and Echo). The clinics also had a 24 hour pharmacy and basic preventive health packages were also offered. We worked hard on the look and feel of the clinic (Ratan had Alfaz Miller design the clinic interiors), Ravi Bajaj was to do the staff uniforms, and the clinics were to hire smart and well-trained youngsters to be the face of the clinics. The consultants were to from the local areas and it was thought that Apollo Hospital’s senior consultants will also run their OPD’s from these clinics.

On the business side of things a franchisee needed to invest close to Rs. 20 MN upfront. The business plan included a fixed percentage payout by the franchisee of the revenue that he made. Apollo was to handhold the franchisee through the setting up of the clinic, purchase of medical equipment, development of the software to run the clinic, recruitment of the employees both medical and non medical, and selection of doctors. Apollo was also to provide an exhaustive set of instructions and guidelines on the management of the clinic to the franchisees and it was responsible for monitoring the quality of the services delivered at these clinics.

While on paper the model looks perfect, it has some serious infirmities.

A franchised operation by definition has to be a replication of an existing successful model. In Apollo’s case, they had nothing to show in the area of Primary Healthcare. They used to run a clinic in Mumbai, which they owned. Just about the time Apollo decided to go the franchise route, their own clinic shut shop. It was losing money hand over fist and the management decided to shut it down.

In the franchised model that was now envisaged Apollo had no financial stake. The money was to be put up by the franchisee, he was to bear all the costs including a revenue share with Apollo and it was not clear how Apollo will contribute to bringing in new patients to the clinic. It was expected that Apollo’s name itself will pull in patients. Thus the franchisee was to fend for himself as far as developing the business was concerned. Apollo could have contributed by investing in the brand ‘Ápollo Clinics’ and by forcing some of its leading doctors to run the OPD’s from the franchised clinics. Apollo made lofty promises of investing millions in the brand but just didn’t. As far as doctors were concerned, some feeble attempts were made to get Apollo doctors to attend these clinics but hardly anything materialised. The problem really was that in Apollo system the senior doctors are not paid firm salaries and they work on a revenue share model. Thus, Apollo’s control over these doctors is minimal. The senior doctors with a busy practice had no reason to sit in the newly opened Apollo Clinics, which in any case did not have any patients of their own.

The selection of the franchisees too threw up issues. The franchisees were largely businessmen with hardly any experience of healthcare. Neither did they have any particular love or passion for the healthcare business. I remember meeting and offering franchises to computer hardware merchants, aluminium dealers, a golf ball manufacturer, a real estate player and the like. All of them were driven purely by a profit motive. Some also saw healthcare as a more respectable business for their children. We sold the franchises indiscriminately, (at least in the beginning) to anyone willing to put up the money. A network was thus born that had no glue except the brand name that each franchise shared with the other.

The biggest casualty in all this was of course the quality of healthcare services that each clinic rendered. There was no uniformity as each franchisee left to fend for himself became increasingly desperate for revenue. He hired doctors on his own many of dubious quality, started offering cuts for referrals, set his own prices and started indulging in all kinds of practices that would help him get the extra money that he needed to stay afloat. As most of these franchises were not businessmen with deep pockets, they were willing to cut corners as their very survival was at stake. In-spite of all this many had to close down operations.

Apollo gradually lost control over these franchises. Since, it did not add any value to the franchise’s life he decided not to pay the monthly royalty. Many refused access to Apollo personnel on their premises and are now pretty much operating as stand-alone entities. They continue to use the Apollo name, as that is the only thing, which adds value to their operations.

Creating a franchised healthcare network is fraught with danger. Apollo failed by not first establishing a successful chain of primary healthcare centres of its own. It had no proven learnings in that space and it undertook to make money at its franchisee’s cost. It lost the trust of not only its franchisees, but also of many of its patients who certainly expected a lot better from Apollo.

Pic courtesy The Apollo Clinic website

 

The Necessity of Sunday OPDs

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

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

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

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

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

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

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

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

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

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

The Silly Question of RoI in Healthcare Marketing

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

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

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

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

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

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

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

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

My experiences at the Indraprastha Apollo Hospitals

Apollo HospitalThe other day I landed at the Indraprastha Apollo Hospitals, a stone’s throw away from my residence in New Delhi.  My wife needed a test and our doctor at Max Healthcare asked us to get it done at Apollo as the equipment at Max was out of order. The moment I walked in I felt as if I was on a railway platform.  The hospital was full of patients as everybody appeared to be in a mad rush. In the OPD area, the ladies at the reception were busy, chatting amongst themselves, while patients and their caregivers waited for their attention. They wore no uniforms and for some strange reason, they were also collecting cash from the patients (apparently for the doctor’s consulting charges) and handing out receipts scribbled on small chits, which did not even have the hospital’s name on it.

Strangely, I was than directed to a cash counter to pay for the tests.   Continue reading

The Need of Customer Experience Managers in Hospitals

Surgical GeneralI believe the time has come for hospitals to seriously look at taking on people tasked with managing the customer experience, while interacting with the hospital at its various touchpoints. The Customer Experience Manager must be an individual, who can integrate the plethora of experiences that one is likely to have in a hospital in one unique experience, even a memorable one, (which is difficult, considering one is talking about a hospital).

A Customer Experience Manager should be empowered to act on behalf of the patients in the hospital, have overriding powers and must be guided by just one consideration, which is, if I was the patient, would I expect this from my hospital. An affirmative answer to this question is what should guide the Customer Experience Manager.   Continue reading

An OPD Experience

OPD ExperienceThe other day my wife had an appointment with her doctor at one of the well known hospitals in town. We were to see her at 8PM, but what with under construction Metro line collapsing and the resultant traffic snarls bringing the city to a halt, we were running late. Hoping against hope of catching the doctor, we reached the hospital 20 mins late.

Luckily for us, as we arrived the doctor was finishing with her last patient of the day and agreed to see my wife immediately. She indicated that some tests were needed and while she went about doing those, I might run along and pay the bills as the billing counter would be closing. She scribbled the tests on a medical form and off I went to do the needful.   Continue reading