futurechat

Further to my earlier post, Health on her fingertips, where I explored the need of Sumita, a poor young woman to find out more information on basic health care, I have built up my thoughts on the need for universal, transparent health information accessible by phone.

• A Central repository of health information + local health information is added in to make it more relevant
• People can access the information through a Call desk and through SMS
• A national health number is created that is manned by people who speak the local language. SMS menu is readily available that gives basic information (in language of choice to subscribers)

Public health services in India are woefully short of reaching the urban poor let alone the vast rural population. While institutional health frameworks for urban poor and rural poor exist, they could greatly be strengthened though this simple mechanism.

A. There are 5 dimensions of access to health services (Obrist et al. 2007: 0002)

1. AVAILABILITY: The existing health services and goods meet client’s needs - What types of services exist? Which organizations offer these services? Is there enough skilled personnel? Do the offered products and services correspond with the needs of the poor? Do the supplies suffice to cover the demand?
2. ACCESSIBILITY: The location of supply is in line with the location of the clients - What is the geographical distance between services and homes of the intended users? By what means of transport can they be reached? How much time does it take?
3. AFFORDABILITY: The prices of services fit the client’s income and ability to pay - What are the direct costs of the services and the products delivered through the services? What are the indirect costs in terms of transportation, lost time and income, bribes, and other “unofficial charges”
4. ADEQUACY: The organization of health care meets the clients’ expectations - How are the services organised? Does the organizational setup meet the patients’ expectations? Do the opening hours match with the schedules of the clients, e.g. daily schedule of workers? Are the facilities clean and well kept?
5. ACCEPTABILITY: The characteristics of providers match with those of the clients - Does the information, explanation and treatment provided take local illness concepts and social values into account? Do the patients feel welcome and cared for? Do the patients trust in the competence and personality of the health care providers?

In India none of the above parameters are remotely met when it comes to the poor. Health services have poor availability, are seldom accessible due to absence of doctors, medication, infrastructure. Most poor people are illiterate and unaware of what to demand from the government health centers, therefore even inadequate and unacceptable services are accepted with gratitude.

B. Mobile phones could serve as a simple, cost effective empowerment tool. Information on the phone could help people empower themselves and solve basic issues that occur due to paucity of information and availability. At a basic level Mobile phones could give relevant information on the following:

1. Methods of identifying, preventing & controling health problems
2. Appropriate treatment of common diseases & injuries
3. Maternity & child health (including family planning)
4. Prevention and control of locally endemic diseases
5. Immunization
6. Availability and sourcing information of essential drugs
7. Health education

C. This in itself is a large body of information. This would need to be converted into a simple information architecture which is accessible on voice call as well as SMS.

To simplify this further, information could also be broken up into information by need.

I. Questions on personal and family Health and wellness

• Personal & Family Hygiene
• Prevention – Malaria, TB
• What will keep my children healthy?
• Protection

II. Questions on Cost of care

• for emergencies
• for doctor visits
• for medicine
• for surgery
• for tests and medical needs and insurance cover for each

III. Questions on Treatment

• Diseases
• Types of treatments
• Caring for chronic illnesses
• Doctor details
• Hospital information
• Types of tests
• Complaint numbers
• Blood banks
• Organ donors

D. The above method of information access would help the government by reducing the burden of health care in some ways by increasing transparency and empowering the bottom of the pyramid people who are frequently short changed because they know no better.

The information dissemination would of course need to be in multiple Indian Languages to ensure penetration and access..

Going back to the 5 dimensions, mobile services would solve some of the issues outlined above:

1. AVAILABILITY: The poor can know what is available, how they can help themselves
2. ACCESSIBILITY: Instant information increases the ability to access health services as patients can now know who to contact and where.
3. AFFORDABILITY: Overcharging and corrupt practices can be curtailed to some extent.
4. and 5. ADEQUACY and ACCEPTABILITY: Better information, means more knowledge of what to expect and therefore a bottom up pressure on service providers to give better care.

E. The issue of funding also needs to be looked at critically. Funds will be required fundamentally for the following:

1. Seed capital to establish the information databases and technology infrastructure as well as hookups to the various telco’s
2. Ongoing costs to update information, services, staff costs and technology

While a simple model would be to make this government funded, I believe that for this service to be sustainable a public private partnership would be a better idea. The revenue generation from incoming calls, SMS interactions alone could be substantial. Other revenue streams could also be explored. For example a rating system for doctors, hospitals, nurses could be set up. Doctor and hospital references could be given on the basis of their track record and customer / patient feedback.

Who do you go to if…

• You have a neck pain or a back problem
• You puled a muscle while playing tennis
• You are recovering from knee surgery or a fracture
• You have just had surgery and find moving around difficult
• or you are a certain age and face reduced mobility

The Answer

Most Indians would visit a Ortho, Neuro or Cardiac specialist in addition to their GP.

Visiting a Physio or Sports Injury doctor is seldom done.

The Gap

Physio clinics are in a low value trap as most Physio clinics are not branded. Services are generic and not differentiated. Patients are also seldom educated on procedures, why they need to do certain things and how they can hurt themselves if they dont take care.

Physiotherapy clinics are also not provided enough referrals by specialists as specialists run the risk of losing patients. For example in many hospitals, Physio and Ortho OPD exists side by side but very few recommendations are actually sent to the Physio. According to some estimates as many as 50% of ortho patients at some point or the other need Physio help. However, referrals are seldom more than 10 to 15% (see slides 13,14,15).

Other specialists such as Cardio, Pulmonary, Geriatric, Neuro and Pediatric only refer patients in severe distress. The perception of Physio as a wellness centre in a hospital does not exist.

The Opportunity

A large opportunity exists in creating branded Physiotherapy and Sports Injury clinics in India.

Over the course of  many conversations with learned and experienced people on Twitter, here is a list of though provoking posts that one can refer to : 

Innovation 

1. 10 No’s Blocking Business Innovation – Mike Brown
2. The potential of Open Innovation with Frank Evans from ninesigma and Business Week’s Jessie Scanlon – Business Week
3. Forget “Creativity”, embrace “Creativeness”- A workforce strategy for the future! – Strategy Driven Innovation
4. State of Innovation in India 2009 – Bernard Lunn
5. 10 lessons for organisations about supporting more networked innovation – Roland Harwood
6. Young at Heart: How to Be an Innovator for Life – Tom Kelley
7. 2009 Will Be an Economic Engine for Change – Jeff Stibel
8. Innovating for Sustainability: What’s Your Heresy? – Andrew Winston

Customer Experience

1. Becoming a Customer Experience-Driven Business – Peter Merholz
2. Who in CRM 2.0 will help VRM 0.1? – Doc Searls
3. Creative solutions in tough times – Alice Rawsthorn
4. Joseph Pine asks, what do consumers really want? 

          

Healthcare

1. Ethics and patient safety: Should you tell patients they can get better care elsewhere? – Heather Comak
2. Disruptive Innovation, Applied to Health Care – Janet Rae-Dupree
3. Serenity In Emergencies – Beth Baker
4. Health Care Needs More Mavericks at Work. Here’s Why. – Martin Trussell
5. How Do Hospitals Get Paid? A Primer – Uwe E. Reinhardt
6. A Simply Better – Saul Kaplan
7. 10 Things Hospital CEOs Won’t Tell You - Angie C. Marek
8. E-Prescribing: Green Means Generic; Red Means Pricey Brand – Sarah Rubenstein 
9. Semantic Web and Translational Medicine – Vipul Kashyap
10. Easing into technology: Alternatives to a full EMR – Pamela Lewis Dolan
11. Disruptive Innovation, Applied to Health Care – Janet Rae-Dupree ( registration required )

Just read a very sad post about a mistake in a hospital. You can read it here

There are three key issues here

1. The loss for the family of the patient is irreparable and does cast a shadow on the hospital. I am sure the study into the incident will highlight corrective measures . The implementation of these would be of utmost importance.

2. The fact that the hospital chose to be truthful and transparent is heartening. It takes brave leadership to be as transparent as this. Hopefully this transparency standard will become the benchmark in not just reporting but also in day to day interactions with patients.

3. How does the message of transparency get communicated to other participants in the healthcare .. other hospitals , testing centers , doctors etc?

Thinking of healthcare, Tom Peters has strong views on some of the issues in the healthcare system in the US. He is fairly critical about things there. His views and suggestions can be found here.

I came across this post at Branding Strategy Insider . The author is concerned by the message  ”Business comes before brand – economics before equity” and has explained the same with examples.

Managers in sectors such as healthcare, financial services , airlines etc are more likely to face this choice.  What is a better solution , doing what is right for the customer or the company ? 

The choice is obvious.  The reality however is a bit different. Why ?

While reading a post on Internet in the developing world, some thoughts came to mind..1. While there are more mobile phones than PC’s , Internet on the mobile is not ready. At the simplest level, there are awareness issues on making usable and accessible sites for the mobile plus the issue of languages.2. Internet access on the mobile is an added cost on an existing service. This too has usage implications.3. SMS/MMS may play a greater role to begin with.4. Healthcare is likely to be addressed bya. Education to local aid workersb. Information proactively delivered directly to people who need it the most.c. Information could be delivered via MMS or phoneouts integrated with IVR to ensure retention.d. One might consider the  ability to raise aid directly at the health center or hospital. At its simplest level information on the person requiring assistance can be sent directly to the aid organisation and thus making it more transparent to aid donors.  It is simply a matter of innovating on the technology that is available and make the best use possible of the internet.5. Others have commented on the need for education. I came across an address by Jacqueline Novogratz at TED on patient capital. It is also not simply a matter of aid but of dignity.6. Innovating with digital technologies to empower. What could be better. It is here I would point you to a pioneering effort that is now a case study. ITC’s E-choupal project leveraged technology to empower the farmer to reach remunerative markets.7. Further on the topic of empowerment and microfinance, one must consider the pioneering work done by Grameen Bank in Bangladesh . Beyond the empowerment through microfinance , Grameen is seeking to provide internet via the phone through its telecom and phone initiatives.

Mrs K took to Pranayam and morning walks ever since she tested positive for breast cancer. Alternating between despondency and healthy optimism she procrastinated between seeking nature cures and getting the lump surgically removed. After long ponderous discussions the lump was removed and all seemed to be well.

Then came the next step, how should one prevent the recurrence of such a problem again? Should she get Chemo or Radiation or a combination of both or just take medication? For an ordinary person these are just words with no real meaning. The only idea that most people have is that if you do chemo you lose all your hair! The course of treatment for longterm problems is normally very complex. The doctors try to do their best and the patient tries to understand what they are saying and what it means for them. In this case, Mrs K with a prior history of heart disease and stroke needed someone who could give her wholistic advice on what it would mean for her to undergo any of the possible treatments and which one would be the best choice. 

The private hospital doctors she visited normally recommended doses of chemo and radiation followed by long term medication. The government hospital doctors typically recommended just medication. While I am no expert on medicine and I am sure that each one of them took a decision they thought was best. But doesn’t, this situation cause doubts in the mind of a patient? The patients mental state is typically confused, insecure and wary. 

At a moment like this one needs support both from family and medical institutions.When you hear a private hospital doctor recommend a more expensive course of treatment the immediate reaction is that “the private hospitals are out to make money, they don’t care about me”. Private hospitals would look at the situation and clearly point out that they are more susceptible to lawsuits and would prefer to err on the side of caution, threby recommending a stronger treatment “so what if it is more expensive, the patient can afford it”. We all know that the business of health is complex and with no clear answers on either side we tend to take whomsoever’s side depending on what suits most of us. If we believe that Government hospitals are so wonderful why do we visit the private hospitals? 

If we do go to the private hospitals can we really expect zero cost premium service? Aren’t our hospitals going down a dangerous path by recommending stronger treatments just to protect ourselves? While these questions have varying viewpoints my only submission is that “Why are we forgetting the patient in all this?Even if healthcare is a business, isn’t the customer our first priority? Who should take responsibility for making the customer feel comfortable?If the private hospital had answered these questions well, they could have built trust in the customer, who would have visited them regularly. 

Instead, the customer chose not to believe them and went to a government hospital.The private medical establishments must rethink the business in the context of patients and customers. Post operative care and medical treatment is the long tail of business generation. A surgery is a business transaction that yields revenue in the same way that Eureka Forbes water purifier when sold generates bulk amounts.

The hard facts are that Eureka Forbes has built a strong brand around the regular servicing and maintenance visits. Their presentations proudly proclaim that they are “your friend for life”. Isn’t that what a hospital should be too? The care in healthcare can only come through if we genuinely exhibit the desire to make our customers well. This means going beyond medical procedures and addressing the concerns and questions that are faced by Mrs K. 

While the time we spend in answering her questions will be scoffed at by many who read this article, I am confident that if you have ever been on the other side as a patient or a family member, this time will mean more to you than any medical procedure you may ever experience.

Let me ask you a couple of questions – How much will you pay for life threatening surgery? 

Compare this to – How much will you pay for a cola? Just asking these questions in the same breath sounds absurd, doesn’t it? 

I agree, the perception benefit in case of the surgery is so high that you will pay almost anything were you to get better after the surgery. Unless you are a cola addict you can forego the drink, were it to get too expensive.The perception of value in most product categories is either driven by cost of comparable products or perceived benefits from ownership. In healthcare our perception of value is largely coloured by our emotions.

So will you pay more to be treated by a dotor who is perceived to be the best ? Most probably! 

However if you do get the surgery done at hospital, where this doctor is available and you are treated badly I guarantee that the value perception will be the reverse. 

Both you and I will probably scream about expensive private hospitals, bad doctors, uncaring nurses and wrong billing. In healthcare just as in hospitality business service drives customer perception. As service is prone to be non standard and varible, any slip up perceived or genuine is viewed by the customer with trepidation. 

More so in healthcare where the customer perceives his / her wellbeing at risk. Emotions run high not just of the patients but attendants as well and you have a dissatisfied customer. What does this mean for hospitals? 

Should product pricing be high, low, medium? What will determine the emotional state of the customer? Is there any way to gague what customer are willing to pay? I’ve added a presentation in this post as well… 

Branding in the traditional sense is expected to generate more awareness and thereby more customers having an orientation to buy the product. 

Applied to a tertiary care heart hospital this could mean telling customers about your great facilities and doctors and asking them to visit you for surgeries. It would also imply that you want more customers to have heart problems that would lead to more surgeries and business for you!It is therefore needless to add that traditional communication does not really work when you have to promote a hospital, clinic or nursing home.

Let’s see if direct communication principles would work here instead. While running various direct marketing programs for a car company, you could send a mailer telling them about the features of the new car that your company may be launching. If applied directly here it could mean “Please visit us again for your next heart surgery” or a “Great limited offer with 25% discount for your next surgery. Act Now”. 

These offers don’t just sound ridiculous, they could be very hurtful instead. A nursing home recently sent a birthday card to a patient who had expired a month back!Does this mean that branding a healthcare facility is impossible? Not at all! Several healthcare facilities have shown us the difference branding can make in developing a successful healthcare business.Successful branding for a hospital is a function of Sensitivity and Empathy. It is about communicating care through your staff, facility and collateral.
A new presentation..  
 

Think of hospitals and one surely does not want to even dream of going to one. The reasons are obvious.What would you say to a hospital that is promoting a concept of a dream hospital. My first thought ofcourse was why this…However on a closer look, it is a unique approach to inform people of the new Moolchand Healthcare. At the same time, the company would get a direct insight on expectations with regard to hospital care.This concept raises the expectation of the person who visits Moolchand. Now the key task ahead is to deliver on those expectations and deliver well…