Fortis is focusing on quality care as a key differentiator for its healthcare business
Bhavdeep Singh, the chief executive of Fortis Healthcare, recently got a letter from a patient. He was full of praise for the nurse who served him. At night, after visitors were asked to leave his room, she would come and play cards with him. That kept him in good cheer — research shows that a patient’s lowest point comes in the evening once family and friends call it a night. Singh, 48, didn’t know what to tell the nurse. Playing cards on duty is simply not on. But her gesture made a patient happy with the care he got. He may go to Fortis again when he needs medical attention.
As hospital chains gain scale in the country, Fortis has started to look for a differentiator and a long-term sustainable growth strategy. That differentiator, it has decided, will be quality: The clinical outcome, the interface with doctors and nurses, and the quality of the infrastructure. The final delight could be the price. Singh claims that Fortis has held on to its price lines in most treatment categories in the last five years. “Taking care of the patient means a value proposition which remains intact throughout. Whatever the time and place, the value proposition must remain the same,” says Singh.
Singh’s background comes in handy. Born in India, he worked for 20 years in the US in Great Atlantic & Pacific Tea Company, a $12-billion retailer. He started at the bottom unloading trucks and cleaning the bathrooms and went on to become the president of a $3-billion division. Four years later, he returned to India and signed up with Reliance Retail. In early 2009, he moved to Fortis. Apart from aggregation at a large scale, the biggest learning from retail that can be used in healthcare, says Singh, is customer (patient in healthcare) delight. But there is a difference. While there is voluminous data on consumer satisfaction in most product categories, Indian hospitals are not in the habit of capturing any such data. Singh had to start from scratch.
Tracking satisfaction
In fact, most doctors keep no track of clinical outcomes. Fortis’ record in categories like pediatric cardiac surgery and knee replacement is as good as the global best practices, claims Singh, though in other categories it has some catching up to do. According to Krishna S Iyer, the director of pediatric & congenital heart surgery at Fortis’ Escorts Heart Institute and Research Centre in New Delhi, 98 per cent of the surgeries in his department are successful. “There will be zero tolerance for bad care,” adds Singh.
To gauge customer (patient) satisfaction, Fortis has placed women patient welfare officers in all its hospitals. They not only troubleshoot with the patients but also get their feedback. This is then tabulated and each hospital is given a score out of 100. According to Singh, the average score across the chain has improved from early 80s a year ago to late 80s now. The feedback form for patients is being upgraded and will now have subjective assessment as well. This, Singh believes, could bring the scores down.
All in all, Singh and his team have identified 150 touch points between the patient and the hospital — how much time did it take to check in, was the bill different from the estimate given to the patient and so on. Benchmarks have been provided for all of them and all cases are rigorously monitored. There are people stationed in all hospitals who ensure the data is captured accurately. According to Singh, the average score here is 88 per cent, which means that in 88 per cent of the cases, the actual performance is within the prescribed norms. “When we started two years ago, we were in the 60s,” says Singh. “The key result area for all leaders is that every hospital should be above 90 per cent.” To counter the negativity and gloom around hospitals, Fortis has begun to celebrate the birthday of a patient if he happens to be admitted in the hospital at that time. Its hospital in Mumbai gives a certificate of bravery and a souvenir to all patients who complete the chemotherapy for cancer. Fortis has also started training sessions for attendants who come with patients on the dos and don’ts.
Quality commitments
Fortis has also begun to assess if it has the right workforce to deliver high-quality healthcare. For example, worldwide there is one nurse for five patients; in Fortis, there are two for five patients. “Efficiency wouldn’t necessarily mean we cut our strength by half. I am happy with any number so long as we can give good quality care to the patient,” says Singh.
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What about the quality of the infrastructure? Ten months ago, Singh started Sparkle Day in Fortis — a concept straight out of retail. It is a 16-week hospital cleaning and disinfecting plan. “We go piece by piece. Every single corner is looked at, item by item, line by line,” says Singh. Dust swabs are collected from fans, fingernails of nurses are checked, and even the cupboards of top doctors are opened to check if files are kept in order. All Fortis hospitals scored between 82 and 90 in the first round, and are now in the second round. New hospitals that carry no infection raise the bar for all.
But Indians are value conscious, even in healthcare. Singh is aware of it — he needs to keep his costs under check. He has started negotiations with suppliers of consumables (syringes, stents and so on) to bring down prices from global standards to Indian standards, in line with the paying ability of Indians, without compromising on the quality.
Rivals and sector experts refuse to comment because Fortis’ initiatives are not well known. What have been the results so far? There is no third-party data on patient satisfaction, nor does Fortis have a fix on how many of his patients come back to when they need treatment. “The feedback from our doctors suggests that we are holding on to our patients,” says Singh. One proxy could be occupancy of the 10,000-plus beds in its hospitals. It is about 75 per cent, according to Singh, and rising quarter on quarter. Fortis’ average annual yield from a bed is almost 30 per cent higher than the industry average. But Singh’s focus at the moment is not on financial numbers. “These are all lag indicators, not lead indicators,” says he. “We are focused on lead indicators like clinical outcome and patient experience.”