HEALTH CARE AND HOSPITAL MANAGEMENT

UPDATES by MOHAMMED YASER HUSSAIN

BPHARM-MBA (HEALTH CARE MANAGEMENT)APOLLO HOSPITALS SENIOR EXECUTIVE

PHARMACY

7 WAYS TO IMPROVE PATIENT SATISFACTION, CUSTOMER SERVICE, FROM CONSULTING IN HOSPITALS AND HEALTHCARE

Improving patient satisfaction, customer service and the customer experience, and, of course, HCAHPS scores:  Here are seven bullet points. I find myself emphasizing frequently (as a consultant and professional keynote speaker) in hospital and other healthcare environments.

1. Strive to deliver service on the schedule of your patient, not just a schedule that happens to be convenient for your institution.

Examples: • Avoid  unnecessarily long waits for lab results to be distributed; this practice is

disrespectful and even cruel. •  Consider implementing something along the lines of the Vocera Communications

Badge where the patient speaks the name of the nurse and is directly in communication with her instead of waiting on a response to a call light. [I have, of course, no affiliation with Vocera.]

2. You’ll make the most progress on HCAHPS, and as an institution, by taking a relatively broad approach to the subject. Being too selectively focused on the individual HCAHPS questions can actually backfire. A more effective and powerful goal is to create an organization-wide halo effect that raises your scores as well as your actual rate of referral — not just the hypothetical “willingness to recommend.”  (For a longer piece of mine on HCAHPS and company culture, you may want to spend a minute with this recent article.)

3. Great customer service means systems as well as smiles. When Mayo Clinic overhauled their scheduling system they employed (according to the great Leonard L Berry) industrial engineers using stopwatches to time wheelchairs between appointment locations in order to ensure that correct scheduling algorithms were

4. Not-for-profit hospitals and institutions in healthcare can benefit by recognizing and embracing their inherent organizational advantage over for-profit institutions, as follows: It is easier for the employees to identify with the aims of an organization that doesn’t have profit at the center. If you’re not for profit, be aware of this advantage and make the most of it.

5. This just in: Bullying and disrespect lead to turnover. According to a recent study, working in an environment characterized by bullying increases turnover intentions of nurses, and employees report high turnover intentions whether directly bullied or simply in a work unit with bullying.  (You didn’t need a study to tell you this, so search out and destroy bullying before it destroys you.)

6. Every single employee needs to know how to handle customer complaints and concerns. Even if handling the concern means “I’m finding you someone right now who can address this” it’s far better than “I can’t help you, I’m the wrong person.”

7. Much of what’s wrong in patient satisfaction and customer service is related to poor use of language, and to nonverbal “language” cues (such as hospital employees avoiding eye contact with civilians in the hospital, and acting like they are “other” from us).

8. A blame-free environment leads to improved transparency, improved systems, and, ultimately, to better results. This has worked to make The Ritz-Carlton a great culture, and it can do the same for your hospital. Horst Schulze, founder of the modern-day Ritz-Carlton brand (and now Capella and Solis), frequently says “If a mistake happens once it may be fault of employee. If it happens twice, it is most likely the fault of the system.”  So, they get to work fixing the system.

10 WAYS TO IMPROVE INDIAS HEALTH CARE SYSTEM 1. Develop and implement national standards for examination by which doctors, nurses and pharmacists

are able to practice and get employment. 2. Rapidly develop and implement national accreditation of hospitals; those that  do not comply would not

get paid by insurance companies. However, a performance incentive plan that targets specific treatment parameters would be a useful adjunct.

3. Obtain proposals from private insurance companies and the government on ways to provide medical insurance coverage to the population at large and execute the strategy. It is healthy to have competition in healthcare, and provide health insurance to the millions who cannot afford it.

4. Utilise and apply medical information systems that encourage the use of evidence-based medicine, guidelines and protocols as well as electronic prescribing in inpatient and outpatient settings. This is possible though the implementation of the EHR; this will, in time, encourage healthcare data collection, transparency, quality management, patient safety, efficiency, efficacy and appropriateness of care.

5. Perverse incentives between specialists, hospitals, imaging and diagnostic centres on the one hand and referring physicians on the other need be removed and a level of clarity needs to be introduced.

6. Develop multi-specialty group practices that have their incentives aligned with those of hospitals and payers. It is much easier to teach the techniques of sophisticated medical care to a group of employed physicians than it is to physicians as a whole. It is also important that doctors are paid adequately for what they do.

7. Encourage business schools to develop executive training programmes in healthcare, which will effectively reduce the talent gap for leadership in this area.

8. Revise the curriculum in medical, nursing, pharmacy and other schools that train healthcare professionals, so that they too are trained in the new paradigm.

9. Develop partnerships between the public and private sectors that design newer ways to deliver healthcare. An example of this would include outpatient radiology and diagnostic testing centres.

10. The government should appoint a commission which makes recommendations for the healthcare system and monitors its performance.

5-THINGS-TO-KNOW-ABOUT-THE-INDIAS-HEALTHCARE-SYSTEM

1. Rural Versus Urban Divide: While the opportunity to enter the market is very ripe, India still spends only around 4.2% of its national GDP towards healthcare goods and services (compared to 18% by the US) [2]. Additionally, there are wide gaps between the rural and urban populations in its healthcare system which worsen the problem. A staggering 70% of the population still lives in rural areas and has no or limited access to hospitals and clinics [3]. Consequently, the rural population mostly relies on alternative medicine and government programmes in rural health clinics. One such government programme is the National Urban Health Mission which pays individuals for healthcare premiums, in partnership with various local private partners, which have proven ineffective to date.

In contrast, the urban centres have numerous private hospitals and clinics which provide quality healthcare. These centres have better doctors, access to preventive medicine, and quality clinics which are a result of better profitability for investors compared to the not-so-profitable rural areas.

2. Need for Effective Payment Mechanisms: Besides the rural-urban divide, another key driver of India’s healthcare landscape is the high out-of-pocket expenditure (roughly 70%). This means that most Indian patients pay for their hospital visits and doctors’ appointments with straight up cash after care with no payment arrangements.  According to the World Bank and National Commission’s report on Macroeconomics, only 5% of Indians are covered by health insurance policies [3]. Such a low figure has resulted in a nascent health insurance market which is only available for the urban, middle and high income populations. The good news is that the penetration of the health insurance market has been increasing over the years; it has been one of the fastest-growing segments of business in India.

3. Demand for Basic Primary Healthcare and Infrastructure: India faces a growing need to fix its basic health concerns in the areas of HIV, malaria, tuberculosis, and diarrhoea. Additionally, children under five are born underweight and roughly 7% (compared to 0.8% in the US) of them die before their fifth birthday. [4] [5]. Sadly, only a small percentage of the population has access to quality sanitation, which further exacerbates some key concerns above.

For primary healthcare, the Indian government spends only about 30% of the country’s total healthcare budget [6]. This is just a fraction of what the US and the UK spend every year. One way to solve this problem is to address the infrastructure issue… by standardising diagnostic procedures, building rural clinics, and developing streamlined health IT systems, and improving efficiency. The need for skilled medical graduates continues to grow, especially in rural areas which fail to attract new graduates because of financial reasons. A sizeable percentage of the graduates also go abroad to pursue higher studies and employment.

4. Growing Pharmaceutical Sector: According to the Indian Brand Equity Foundation (IBEF), India is the third-largest exporter of pharmaceutical products in terms of volume. Around 80% of the market is composed of generic low-cost drugs which seem to be the major driver of this industry [7].

The increase in the ageing population, rising incomes of the middle class, and the development of primary care facilities are expected to shape the pharmaceutical industry in future. The government has already taken some liberal measures by allowing foreign direct investment in this area which has been a key driving force behind the growth of Indian pharma.

5. Underdeveloped Medical Devices Sector: The medical devices sector is the smallest piece of India’s healthcare pie. However, it is one of the fastest-growing sectors in the country like the health insurance marketplace. Till date, the industry has faced a number of regulatory challenges which has prevented its growth and development.

Recently, the government has been positive on clearing regulatory hurdles related to the import-export of medical devices, and has set a few standards around clinical trials. According to The Economic Times, the medical devices sector is seen as the most promising area for future development by foreign and regional investors; they are highly profitable and always in demand in other countries.