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Dr Vijay Raaghavan Engagement Manager I Medium Healthcare Consulting
Moderator : Dr Vivek Desai I Co-Presenters : Dr.(Col.) R R Pulgaonkar I Dr. Sachin Wagh I Dr. Vishal Beri
Who are we
We are a niche healthcare consulting firm, driven by the challenge of new possibilities
in healthcare and the translation of these
ideas into reality. Our goal, very simply, is to make a difference, which may explain why we tend to go beyond research and analysis to adopt a more pivotal role in the manner in which we help our clients execute various interventions .
Class : International Health Policy
Oct 2007 , TISS Class Room
The need for innovating
something for someone
must begin with a strong
justification on
“ Why Ever Do It “ and
“How will it change the life
of the patient tomorrow,
the day after and the year
after”
Dr Ramila Bisht, My teacher , Mentor
GOING BACK TO TISS DAYS
WRONG BEGINNING
“All too often, innovation starts from the wrong end“ Companies develop a particular technology and then try to find a customer who wants to buy it. Instead they should start by identifying a need before they think about technology.”
Ray Avery, founder and CEO of Medicine Mondiale
RIGHT BEGINNING
D x V x F > R
DDISSATISFACTION with how things are now
VISION of what is possible
VFIRST set of concrete steps
F
Gleicher proposed a simple formula for validating if innovation was required / worth undertaking If Dissatisfaction X Vision X First set of Concrete steps product is > RESISTANCE , then Innovation is possible
&
RIGHT BEGINNING
Must be executable* !
* CONDITIONS DON’T APPLY
IMPROVE QUALITY IMPROVE ACCESS REDUCE COST
QU
ALITY
+
THE RECEPTIONIST
Lets take a case where we smell a need for innovation
RECEPTION
CASUALTY
THE DOCTOR
THE CALLER
STAFF
If we superimpose the problem
DDISSATISFACTION with how things are now
Problem / Challenge : How could care givers navigate patients when they can’t see / feel them and are stuck at remote locations ?
VISION of what is possible
FIRST set of concrete steps
Lets begin with a real life case that we cracked
FUN
For a client of ours, we conceptualized a FAMILY MEDICINE DOCTOR CLINIC MODEL and had to scale up this model across a HUNDRED locations.
So where is the Challenge and the dissatisfaction ?
FUN
THE CURRENT OUTPATIENT MARKET LANDSCAPE
D
Personalized touch of Your GP
an extremely difficult aspect to scale across a network
The drawbacks of a highly IT led initiatives
Doctor so close ,yet so far with doctor so
engrossed into inputting the data into the system, there is very little he has left with the patient who is sitting right across
HOW COULD WE BE HIGHLY PERSONALIZED AND YET BE TECHNOLOGY SENSITIVE AND MANAGE SCALE ?
D
FUN
PATIENT CENTERED THINKING & PATIENT has to be at the core of everything we do.
VISION of what is possible
V1
STAGE 2
FUN
PATIENT CENTERED THINKING & PATIENT has to be at the core of everything we do.
CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY ACROSS THE ENTIRE NETWORK
V2 VISION of what is possible
STAGE 2
FUN
PATIENT CENTERED THINKING & PATIENT has to be at the core of everything we do.
CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY ACROSS THE ENTIRE NETWORK
DELIVER GREAT CUSTOMER EXPERIENCE THROUGH EMPATHY, DIGNITY AND RESPONSIVENESS
V3 VISION of what is possible
STAGE 2
FUN
PATIENT CENTERED THINKING & PATIENT has to be at the core of everything we do.
CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY ACROSS THE ENTIRE NETWORK
GREAT CUSTOMER EXPERIENCE THROUGH EMPATHY, DIGNITY AND RESPONSIVENESS
AFFORDABLE PRICE - HELP TOWARDS REDUCING HIS OVERALL SPEND ON HEALTHCARE
V4 VISION of what is possible
STAGE 2
FUN
PATIENT HAS TO BE AT THE CORE OF EVERYTHING WE DO.
CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY
GREAT CUSTOMER EXPERIENCE THROUGH EMPATHY, DIGNITY AND RESPONSIVENESS
AFFORDABLE PRICE - HELP TOWARDS REDUCING HIS OVERALL SPEND ON HEALTHCARE
SUPERIOR CLINICAL OUTCOME
V5 VISION of what is possible
STAGE 2
FUN
A TECHNOLOGY PLATFORM THAT SUPPORTED ALL OF THESE
V6
PATIENT HAS TO BE AT THE CORE OF EVERYTHING WE DO.
CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY
AFFORDABLE PRICE - HELP TOWARDS REDUCING HIS OVERALL SPEND ON HEALTHCARE
SUPERIOR CLINICAL OUTCOME
GREAT CUSTOMER EXPERIENCE THROUGH EMPATHY, DIGNITY AND RESPONSIVENESS
STAGE 2
FUN
REACH OUT TO THE PATIENT
STAGE 3
FIRST set of concrete steps
F1
STAGE 3
WE SPOKE TO 150 PATIENTS WHO VERY RECENTLY HAD COMPLETED THEIR PHYSICIAN CONSULTATION
FIRST set of concrete steps
IN SOME CASES THE FOLLOW UP AND WERE VERY FRESH TO SPEAK ABOUT THEIR EXPERIENCE. THIS INCLUDED A MIX OF CORPORATE , NON – CORPORATE , STAND ALONE CLINIC SETUP
F1
FIRST set of concrete steps
FUN
70% I
II III
The doctor understood my exact problem and so the medicines began to work
The doctor kept asking questions
He
r trea
tme
nt wo
rked
we
ll
I had throat pain and when I went to my
previous doctor – he just saw me –asked
me to open my mouth and wrote some
medicines .Even after 5 days I didn’t find
relief. I then went to Dr Sridhar – he had
some machine with light- he asked me to
open my mouth and he examined my
throat with that machine for more than
five minutes. After that – he wrote
medicines and it worked! He asked me to
come for a follow up today and even
today he spent that much time.
Reasons for Dissatisfaction
Reasons for Satisfaction /wow
The doctor did not spend time listening to my problem
The doctor was busy doing something else
The doctor did not even touch me and feel me
She just asked me one question and that’s it
It was like Doctor was
talking to the computer
and not me !
The doctor did hardly touched me to feel my health problem
The doctor was busy chatting with some other doctor and without even asking me the details of my pain – went on to write prescription
Without even listening to
me that I had the
problem in my right ear –
the doctor went on to
put the scope in my left
ear.
This doctor didn’t even ask if I was allergic to penicillin, she straight away prescribed the medicine
10%
I
II
III
Others
STAGE 3 : What patients had to say about their physician consult experience ?
FUN
STAGE 3 : Reached out to the other end – the Physician
F2
FUN
WE SPOKE TO 35 PHYSICIANS ON THEIR EXPERIENCE OF WHAT THEY FELT WERE THE GOOD POINTS , PAIN POINTS OF THE CONSULTATION.
WE SELECTED FACILITIES THAT HAD IT INFRASTRUCTURE – IN MOST CASES A LAPTOP / DESKTOP WITH A HIS.
F2
STAGE 3 : Reached out to the other end – the physician
STAGE 3
F2.1
Can we look at using IT differently ?
DOCTORS MAY BE RELUCTANT TO USE COMPUTERS
Some leads from the Doctor interviews
PATIENTS DON’T LIKE IF WE DIDN’T SHOW CONCERN [the CORPORATE team make us type type and type] THE TOP MANAGEMENT IS MORE WORRIED ABOUT DATA [less worried about patient’s problems – the system of computerization is good, but it cant be at the cost of a patient’s time]
Whenever I HAVE EYE-EYE CONTACT , I am able to BUILD A RELATIONSHIP with the
patient – PATIENTS LOSE FAITH IF WE DIDN’T UNDERSTAND THEIR PROBLEM – Sometimes
patients get frustrated with US AS WE TEND TO FOCUS MORE on the monitor –sometimes patients tend to mistake us for
! DON’T CHANGE WHAT YOU DON’T NEED TO
?
STAGE 3
F2.1
Will it be wiser to retainer doctor’s written prescription and yet get IT inside?
HOW TO RETAIN PEN & PAPER AND YET GO DIGITAL
Some Options that can give us the best of both the Worlds
! THE TRADITIONAL WAY HELPS IN MAINTAINING THE PATIENT – PHYSICIAN EYE TO EYE CONT
?
KEYING INPUTS VOICE INPUTS
TOUCH INPUTS PEN & PAPER INPUTS
STAGE 3
F2.1 AN OPTION : BEST OF BOTH THE WORLDS
PEN & PAPER
PEN & PAPER
INPUTS
HOW TO RETAIN PEN & PAPER AND YET GO DIGITAL
? THE DOCTOR CONTINUES TO WRITE OVER IT DATA CONTINUES TO REACH THE CLINICAL HEAD PATIENT CONTINUES TO FEEL THE PHYSICIAN INVOLVEMENT
IBALL TAKE NOTE
STAGE 3
THE ONE PAGE EMR THAT WE CREATED BECAME OUR AUDIT TOO AS WELL !
min
1.5
min
2
1.5
2
2
9 MINUTE/PATIENT
F2.1
IMPLEMENTED EVIDENCE BASED CARE The one page EMR capture system not only increased the INVOLVEMENT of the Physician on a consistent basis, but also ensured that LOT OF THINKING backed by EVIDENCE BASED MEDICINE went into DECISION MAKING.
INCREASED EYE-‐EYE TIME Pa9ent Par9culars ,Illness Summary, Vitals , Observa9ons and Drug Therapy also meant that we could steal close to 8.5-‐10 minutes’ of the care givers 9me to the pa9ent.
CONSISTENCY IN DECISION MAKING Clinical Quality Head could first Audit Physician’s decision making by using these filled forms as a “PROXY” – and then could spend 9me with the Physician on improving prac9ce/outcomes.
STAGE 3
F2.2
HOW DO I ENSURE THAT I DELIVER COMPARABLE TREATMENT OUTCOMES ACROSS 100 LOCATIONS
! SOUGHT SUPPORT FROM A PROTOCOL DEVELOPMENT FIRM.
ONCE WE GOT HERE , WE REALIZED THAT IT WAS VERY CRITICAL TO ENSURE THAT WE ATTAINED CONSISTENCY IN CLINICAL DECISION MAKING. THIS IS WHERE WE SOUGHT THE HELP OF A PROTOCOL DEVELOPING FIRM AND CUSTOMIZED THE SAME
The rules CLINICAL PROTOCOLS FOR 60 MOST COMMON CONDITIONS
?
STAGE 3
F2.3
HOW DO WE KNOW IF THE PATIENT LIKED US AND KNOW THAT WE CARE ?
! WE IMPLEMENTED NET PROMOTER SYSTEM
PATIENT SATISFACTION
?
How likely is it that you would recommend this hospital to a friend or colleague?
2 3 4 5 6 7 8 1 9 0 10
Never Absolutely
A Net Promoter Score can be calculated by subtracZng the percentage of detractors from the percentage of Promoters.
% Promoters -‐ %Detractors
Net Promoter Score
42%
Promoter
Passive
Detractor
Net Promoter Score
56%
30%
14%
Ultimately, the theory behind the Net Promoter Score metric is that a facility will experience long-term and sustainable growth only if the Percentage of Promoters is greater than the percentage of Detractors
SO , WHERE DID WE INNOVATE ?
FINANCING PROCESS
PRODUCT DELIVERY
B U S I N E S S
M
O
D
L
T
I
E
U
P
C H A N E L
B R A I D
P A T I E N T
X
P
E
R
I
E
N
C
E
YT E C N O L O G
I
A
P
T
M
S K
I
Z
E R O L
R
P
I
C
I
N
G
M A K E T I N G
GN
D
S
I
G
N
I
X
H
A
R
D
W
A
R
E
1 2
4 3 +
PATIENT CENTERED OUT PATIENT BUSINESS MODEL
EMR : PAPER & DIGITAL
PROTOCOL DRIVEN CARE
FUN
Could retain the traditional way and yet go digital !
PATIENT SATISFACTION
OUTCOME ?
1 TECHNOLOGY
PHYSICIAN SATISFACTION
2
3
4
5
PRESCRIPTION WRITING
RECORD KEEPING
STANDARDIZING
MONITORING OUTCOMES
COMPLIANCE
Pen and Paper helped us in keeping it low cost
Could retain a hard copy, this also became the audit tool and a bible for improvising Physician practice!
Building protocol for specific conditions – standardized the treatment plan
The protocol driven care pathway helped us in ensuring that informed decisions were made and they were consistent across locations and physician profiles
-‐ High
High High
-‐ -‐
High Medium
-‐ Medium
Medium is a healthcare consulZng firm. Our services include Business Strategy, MarkeZng & Sales, Quality & PaZent Experience, Performance TransformaZon, Healthcare Franchising. and Public Health. We are innovaZve, passionate and performance-‐driven. But, most of all, we are commided to delivering significant and tangible business impact for our clients. Our clients have ranged from large hospital chains and single-‐specialty hospitals to primary care clinics, medical equipment manufacturers and private equity.
www.med-‐ium.com
Thank You