Process and Perception

 This is a debate which is really the crux of the battle of the organisations providing services. By services we are differentiating selling basic products vs creating experiences. Even though this definition of product versus service is crudely defined as a simplistic difference between giving standard goods like basic articles of daily living against providing experiences which create customer delight the lines between both are blurring. Today, articles like underwear banians, detergents, soap, humble stationary items are also marketed as an experience rather than a simple article of use for daily living. The classic example of at the humble tea/coffee served at roadside tapori stalls in glasses vs the franchisee Cafe chain restaurants and the ultimate coffee experience at a 5 star hotel book launch or art exhibition all go up the value change because of perceptions. 

In healthcare the traditional approach is that hospitals and doctors are all about curing and providing a favourable clinical outcome. The old dictum and the Hippocratic oath talks “First do no harm” which implied that the remedies were many times worse than the cure and so to ensure that patients had no great expectations. Doctors were for some strange reasons not allowed to advertise their results and the only way patients were informed about their skills was by showing them published results in peer reviewed journals full of medical jargon that was impossible to understand. Public hospitals were overcrowded and sheer mass of suffering humanity and pressure on the infrastructure gave hospitals the right to make people believe that they were being doled out favours in the form of free medical care. The richer classes were offered literally hotel like 5 star facilities and here clinical medicine was shackled by commercial considerations. Investigations were conducted the more the better, fanciful diagnosis based on these led to more investigations and treatment and increased cost to the patient. The doctor patient relationship became a commercial relationship and the respect, trust and understanding in this regard started rapidly declining precipitously.

The things are definitely changing and there is a middle ground or a sweet spot which needs to be created. The old method of medical practice where processes and standardisation based on evidence based treatment were given no importance and medical practice was romanticised as an art are no longer accepted. Today even the smallest of health care providers and facilities are urged to adhere to standards laid down by regulators. These are mandated by Government or quality accreditation agencies which though are voluntary but become almost compulsory as insurance companies incentivise the hospitals who have received these certificates of accreditation. So willy nilly everyone scrambles to get these and use all means to get this stamp of approval. However today my experience is that almost all hospitals are scrambling to mimic each other and create processes and facilities based on their perception of competition. 

The three main models of healthcare are the public sector, free services providers who are often associated with medical teaching facilities, private charitable hospitals who are run by trusts, religious groups or even by companies through their foundations and the for profit corporate hospitals which are commercial entities. The government organisations are very strong in emergency services and also by virtue of having great residential doctors support also can provide excellent outcomes. The sheer variety of clinical materials and quantity of the same helps students to innovate and develop their skill sets to the highest possible levels. However, since students are learning and teachers are teaching and honoraries are honing their skills and the poor are getting free treatment there is a clear power asymmetry leading to suboptimal and even distavorous outcomes at times. So it is a mixed bag and is dependent on individual brilliance and leadership which can make or mar an institution. The second group the private charitable trust hospitals cater to the middle class but aspire to have a fair number of paying patients but often lose sight of charitable objectives. These hospitals also compete with corporate for profit sector but need support of Trustees, CSR funds and Rotary clubs and Lions for capital expenditure as the cost of the higher but not absolutely essential technology is prohibitively expensive and return on Investment is not easy especially with them being surrounded by unethical large players who run health care like sales driven business targets leading to indirectly compelling doctors to do unindicated investigations and worst still procedures. The last player is the Private player where profit is the motive and these organizations bring professional management with a ruthless attitude and often doctors get caught in the web and become tools of the pharmaceutical, medical equipment, implants and consumable manufacturing companies. 

My bias has always been in favour of strengthening the public sector and the genuine charitable trust hospitals. In this scenario the most important thing for the leadership of the hospital is to have clarity of purpose. The defined objectives to provide affordable (defined as value for cost and not free) quality care (defined as the best possible standard of care with gold standard reliable technology meeting standard treatment guidelines) to everyone (in the normal course the lower middle class and the rich) must be met. The outliers the very poor and the very rich may also avail of the services by the poor being paid for by charitable trusts or donors and the rich being  charged premium rates.

Very often this clarity goes as typically very few hospitals have such differentiators that attract patients and the choice of the hospital the patient chooses is primarily based on the choice of the treating doctor. So the hospital needs to design every service and make every touch point for the user an experience to remember. But for that to happen we need to satisfy the influencer in this case the treating physician by giving him good monetary return for his effort, but more important facilitate his work by ensuring that the patient he has sent to the hospital gets the best possible memorable experience. This in turn can occur if every person in the team providing service works to ensure that in the process of following the productivity and profitability they do not lose sight of giving care with a genuine compassion and empathy which goes beyond the call of individual duty. This is based on an ability to anticipate and meet the customers requirement before he asks for help. Covering and helping different departments and working like team (an ensemble orchestra like feel) creating unforgettable experience. Genuine empathy acknowledging and respecting all and ensuring excellent communication and explanation for everything happening. 

So perception is created by individuals who are constantly playing the roles assigned to them much like actors who cease to act but by habit create an atmosphere of genuine compassion and care. 

So is this utopia or a figment of imagination? Maybe yes in this cynical and distracted world but just like the spiritual quest for for Self realization can occur by the techniques of meditation which with persistent efforts give rise to initially a few moments and later continued experiences of being one with the divine, a culture of genuine empathetic compassionate care can create value in a hospital far beyond good clinical outcomes. 

I am optimistic that if the highest authorities can facilitate this culture we can achieve utopia in the hospitals we serve in.

Vispi Jokhi