From the Crucibles of
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Category Archives: Patient Care
Are Clinical People more Patient Care Sensitive than Non Clinical Staff ??
From The Crucibles of JPS Customer Value Academy
Just Plain & Simple
….. Helping Create Customer Value
Just a hypothesis that I recently developed during my visits to one of the most premium and top end hospitals of South Delhi. A few months month back, my father had to be hospitalized and operated upon due to an emergency. The few weeks of pre and post-operative stay at this hospital brought up so many dimensions of patient care …..
Interaction with the diagnostics staff in laboratories was really nice and comforting, I must say. From guiding around the place, to being extra caring while taking samples/conducting tests ….. everything was very efficient and smooth. One was full of admiration, for the courtesy, skill and professionalism of everyone involved in the diagnostic labs.
The difference, however, was so stark and glaring when I went to pick up some test reports at the pre-scheduled time. No reports were available at the ‘delivery desk’ and they had no information about when they would come. ‘You can go and check in the X-ray lab ?’, I was told. So much for all the premium charges and service levels that are promised. On checking at the X-ray lab, I was told that they had already sent the report to the ‘central dispatch’ section. So I went to the ‘central dispatch’ section, where I was told to wait till they ‘searched’ for the report …..
On the other hand, for sure, our experience with paramedical staff and doctors was really good. Not only did they carry out their own functions nicely and courteously, they actually went beyond their normal routine role and tried to guide us even regarding administrative issues.
A total contrast, however, were the inpatient admissions, billing and discharge sections. The waiting time was not due to any length of queued up patients, but due to total apathy and lack of interest to speed up and ‘make it easy’ for patients. On the contrary, they were actually trying to ‘make it difficult’ for the patients and attendants. Needlessly slow paperwork, long delays in ‘photocopying’, absence of staff from the counter ….. all that one would expect at a third rate government hospital (and I had actually taken my father to this hospital to avoid all these issues).
On one occasion, I was shuttled ‘to and fro’ between two counters thrice. One counter was having some ‘maintenance repairs’ and the other one ‘did not have the specific department under its jurisdiction’ ????? I had to finally go to the supervisor, to seek her intervention in sorting out which counter would finally process our papers !!!!!
Then there were these super priced ‘private rooms’ with rates higher than the rooms at the adjoining five star hotel (surgery and procedure charges vary with room rental by the way). The ‘call bell’ in the room, however, did not work and the request for food, water, tea or medicines would take anything from 45 minutes to one hour (after several reminders) ….. and when I approached the attending floor staff to point out that there were too many delays in service, there was a general amusing and mocking exchange of glances amongst the staff, as if to say ‘why is this guy getting agitated ??’.
One could have actually stayed at the neighbouring five star (right next door) at lower room rates and come in daily for checkups at much lower ‘related’ procedure’ charges, with better service and comfort !!
At the time of discharge, they make it a point to tell you that the process can take anything up to three hours (?????), as if to prepare you for further systemic inefficiencies. One learnt though, that their estimate was not wrong, because the staff had to actually grapple with issues like ‘so and so is not in his seat’ and ‘the printer is not working’ and ‘the system is down’. These are not cooked up, but actual reasons given out one by one, ‘sequentially’, at the time of discharge. Hence the ‘promised’ three hours did elapse, at the end of which the nursing superintendent came to take ‘our feedback’ on the hospital’s service levels !!
But yet again, this was the difference I want to highlight. The nursing staff again was very efficient, courteous and professional. Immediately after I gave the superintendent a download of our experience and my strong comparisons on the five star parameters, I could see her having a session at the nursing station and genuine concern on the faces of all nurses.
Is it that the ‘clinical’ people have been closer to human suffering and can therefore understand and feel human pain a lot more. Being involved in the actual healing process probably makes their approach different from the so called administrative staff ?
I am sure the administrative staff at this premium and most expensive hospital would be getting sufficient compensation and training to enable them to deliver great patient care. But somehow, the salary levels and training and development inputs seemed ineffective. Maybe, at the most, there was a superficial generation of patient care related awareness. But what the system definitely failed in creating, was an awakening, realisation, internalisation, motivation (desire) and action to be sensitive to genuine patient care.
This is where design and methodology of development programmes need to be built on strong experiential foundations, so as to be able to ignite the requisite passion and awakening. Probably what the management missed is to establish a connect and a holistic appeal to the senses through aesthetics, storytelling, empathy, feelings, pleasure, creativity and meaning …..
J.P.Singh,
Justplainandsimple Consulting Pvt. Ltd.
Website : www.justplainandsimple.com
Twitter : @jpsingh55
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The Indian Health Care Growth Story ….. A Perspective
From the Crucibles of JPS Customer Value Academy
Just Plain & Simple
….. Helping Create Customer Value
The Indian Optician, September-October, 2010 Issue
Health care in India is clearly poised to grow. The last decade has seen the growth curve take a definite upward swing.
With the growth opportunity in an industry, needless to say, also comes entry of new players. So also has been the case in India. The industry has seen an increase in players in the direct domains of health care service delivery, as also related stakeholders in insurance, funding agencies, manufacturers, consultants, manpower outsourcing etc..
Each stakeholder brings a background and knowhow and definitely adds valuable contribution to the growth story. Each also has its own perspective and its own strategy on how to ‘create value’.
One is reminded of the story of five blind men (or men in a dark night situation) and the elephant, from school days. This needs to be taken in the right context of the meaning and the lesson it offers please.
There were five blind men who came upon an elephant.
“What is this?” asked the first one, who had touched its side. “It’s an Elephant.” said the elephant’s owner. The man ran his hands up and down the elephant’s side and said “It is like a huge wall”.
The second man, touching the elephant’s leg, said, “This is like a pillar”.
“An elephant is just like a snake. It’s wrapping around my arm” said the third man, stroking the elephant’s trunk.
Said the fourth man pulling the elephant’s tail, “This is not a snake, it’s more like a rope.”
The fifth man had touched the elephant’s ear and declared, “This is like a husking basket”
And they moved on along the road, arguing as they went ahead.
One way this story is used is to illustrate the principle of living in harmony with people who have different belief systems and that truth can be stated in different ways. This is the theory of Manifold Predictions.
Rumi, the Sufi poet, uses this story as an example of the limits of individual perception.
Each stakeholder has his/her view and rightly so. Each will try to use his/her own strategies and decisions to maximise his/her value creation.
With multiplicity of players in health care, there will be increased competition and that should be, for sure, good for the customer. Hence, Customer Value Offering will necessarily become extremely critical.
Survival of the fittest will therefore be linked to whoever is able to master ‘what the customer really wants’ & ‘what adds most value to the customer’.
Latest technology will be a key element, but may not be the only factor in winning this game. India needs ‘appropriate’ technology as well, to cater to the huge mass of population. And for that matter, there is money to be made at all levels of the income hierarchy and geographic spread. But how does this get unlocked ?
Strategically, a key differentiator that will emerge is operational efficiency. This is also a key element in customer satisfaction, be it for service providers, health insurance companies (portability/cashless debates included), suppliers, medical tourism or outsourcing agencies. Operational Efficiency includes cost, process efficiency, service cycle times, continuous improvement etc..
However, one point which is probably not getting enough attention in this whole excitement over growth, is the importance of Right People and Right People Processes. It is people, across all stakeholders and across all domains, functions and levels, who fundamentally drive all the strategies, decisions and operations. Ability to select, develop, retain and grow The Right People will probably emerge as the single most important Success Factor.
Any of the players in this industry, definitely spends a large percentage of its revenue in people cost (and it will be comparatively higher in pure service led businesses). This is the biggest expense after cost of goods ….. and just consider how much attention goes behind purchase (and annual maintenance contracts) of inanimate goods compared to selection, development, retention and growth of The Right People !!
Development of skills and talent, specific to health care itself, maybe an investment worth making in the business. There are organisations doing it, but very often it is seen as a social sector activity. However, this one activity could be the biggest value and profit enhancer, from the top end paying customer to a no frills primary centre in rural areas, where also, as they say, there is a lot of fortune lying !!
It is people at all levels who will become critical to success.
Leadership Challenge is to build bridges into the future.
For those who think operational efficiency may not be as important, it may be appropriate to share here that “Fielding historically has been seen as a Service Function in cricket for too long, till Jonty Rhodes changed the game and showed that a Fielder can win matches !!”
J.P.Singh
Justplainandsimple Consulting Pvt. Ltd.
JPS Consulting
Just Plain & Simple
….. Helping Realise Potential
JPS Customer Value Academy
Just Plain & Simple
….. Helping Create Customer Value
Website : www.justplainandsimple.com
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What is One plus One really equal to ??
4Ps Business and Marketing Sept., 2009
As a child, I used to be a pretty good student of mathematics. I guess grilling on sums and tables, which is the norm of Indian school curriculum, contributed tremendously to it. Practice sessions, mental maths as they also used to be called, expected one to rattle off answers to a barrage of questions like 2X2= ?, with lightning speed. 4 !! Yes !! You would be ridiculed in class if your answer happened to 3 or 5 …..
And then, after I finished my engineering education, where the ‘exactness’ of these practice sessions really helped, during my management education I was to exposed to something ‘illogical’. A ‘Holistic’ approach could actually make ‘Whole greater than the Sum of Parts’ according to Gestalt, I was told. Now what was this new mathematics ?? We were to unlearn some of the ‘exactness’ of mathematics and were told that when systems operate synergistically, a ‘resonance’ effect actually can lead to such a phenomena. Business, I realised, is not mathematics. It is philosophy, an approach, a mindset.
It was quite obvious all over. Practical observations confirmed the validity of such a phenomena. Management Gurus & literature continued to reinforce the effects of synergistic operations. Related expansion and diversification made sense. Unrelated diversification would naturally tend to be less efficient as there would be consumption of effort, resources, time (energy ??) towards keeping the unrelated parts of an enterprise together ….. different particles (?) to be held together by the application of external energy. Unless each particle or business in this case, of its own volition, gives up some of its own energy and contributes to The Bonding Energy !! But this ‘contributory’ Bonding Energy or Force never really happens without the so called ‘Common Thread, Knitting, Synergy or Interest, that can lead to A Clear Differential Advantage’ and gain for all units. If The Kinetic Energy of each unit is higher than The Bonding Energy, they would tend to move apart releasing this energy into the environment, somewhat like in a nuclear ‘fission’ reaction. However, if The contributory Bonding Energy is higher, due to a ‘common interest or desire to stay’ together, you get a unified organisation where ‘Whole is greater than the Sum of Parts’ !!
Primarily, organisations exist only for two reaons 1) To create Value for The Customers & 2) To create Return on Investment for the Owners ….. and in that order. In social organisations also these remain valid, but maybe expressed as 1) ) To create Value for the Beneficiaries & 2) To create a ‘Surplus’ through efficiencies.
The world is one continuum of energy, represented by different frequencies manifesting as particles. The higher the frequency of a ‘wave particle’, higher is its mass as manifested in the ‘particle’. Business units also replicate such energy continuums and particle duality in a similar way. When they resonate with the same frequency they are one particle of existence. Different frequencies will have them vibrating as separate particles, obviously connected by a weak energy flow, which exits in the cosmos in any case, between diverse entities as well. What then is the purpose of ‘applying autocratic force’ to have them together ?? Doesn’t everyone love to be a free body !!?? Well the only two reasons to be together are 1) We build greater Value for The Customer together and/or 2) We operate in a manner that our operations gain from each other. Under these conditions, particles (business units) contribute the very essential Bonding Energy and ‘Whole is greater than the Sum of Parts’, as that is the only reason that makes sense for these particles to stay in ‘dance’ together !! In the absence of these conditions the system will become less efficient as there would obviously be an energy loss rather than a gain, by forcing togetherness.
That brings me to another version of this 1+1 mystery. Over the last few years, just before the recession hit, ‘valuation’ was in vogue !! Every new start up or even existing organisations started talking ‘valuation’. Rather than Creating Value for The Customer, Valuation became the buzzword. A simple mind like mine got quite confused frankly. How do valuations shoot up like this ? I felt quite miserable at not being able to comprehend all this. And then, one day, it hit me like a thunderbolt ….. I really DID NOT understand this new game. This was, when someone mentioned ‘Sum of parts is greater than the Whole’. Now what does this mean ?? All this while I was living happily having understood the ‘Whole is greater than the Sum of Parts’ logic (which also had taken me quite a while to grasp) …..
What is this ? At this stage in life, do I have to learn my maths again ? Sure that was not a very great and encouraging thought. Do I live in ignorance for the balance of my life ? It was a very depressing feeling. And then, after a long phase of close to depression, I saw the picture …..
‘The Bonding Energy’ should be contributed willingly by constituent particles only, towards efficiently aggregating together in the collective sefishness of “1) We build greater Value for The Customer together and/or 2) We operate in a manner that our operations gain from each other 1) To create Value for The Customers & 2) To create Return on Investment for the Owners ….. in that order”. That is the key towards ‘Whole is greater than the Sum of Parts’ !! In cases where ‘Sum of Parts is greater than the Whole’, it is not that ‘Whole’ is less. It is just that the full impact of ‘Whole’ was never realised and nurtured to ‘flower and blossom’. Eureka !!
No wonder when businesses get reduced to being seen as distinct particles, with no ‘Bonding Energy’, when they have no reason for being together in the first place, ‘Sum of parts will be higher than the Whole’. It is this irony, driven by ‘Valuation’ rather than ‘Value Creation’, compounded by greed and short term results that lead to businesses being managed as MF portfolios rather than with an approach of ‘organisation building’ and ‘Value Creation for The Customer’. Value for the Owner is a natural outcome.
That is one flaw that the famous BCG matrix can lead to. Businesses are seen as delinked, independent entities in this approach, without looking at the ‘synergistic’ or ‘complimentary’ roles they may actually be playing in the ‘dance’. This race for ‘Valuation’ rather than ‘Value Creation for Customer’ in some cases gets particularly pronounced in the ‘portfolio’ treatment and approach followed by some PEs. However, it is an area of caution only. Airtel and Max are cases where PE support, without losing track of Customer Value Creation led to extremely positive results. Quick valuations and selling off of parts of organisations like cattle or treating multiple organisations as merely elements of a portfolio, can be obstacles in organisation building or in creating value for the customer or even for the owners ….. examples of this also are many. This can be dangerous at any stage in an organisation’s development, but sometimes quick valuations expected in early growth stage can ring a premature death knell for your business ….. delivering a ‘still born’.
I realised that :
- 1+1=2 is maths; can also be used by business accountants
- ‘Whole is greater than the Sum of Parts’ is sound business approach, philosophy, mindset
- ‘Sum of Parts is greater than the Whole’ is Value Destruction in the search for Valuation
QED
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