A few years ago, I had an experience not dissimilar to one many readers will have had too. My father had hurt his right thumb, and was in great pain. I drove him to a hospital near our home in Chennai, which we had patronised for several decades. Our family doctor was kind enough to respond to our call by reaching the hospital even before we did. On examining my father, the doctor immediately advised that we should have his thumb x-rayed.
I accompanied my father to the radiology department, when I was told to wait outside. A few minutes later, the attendant came out and handed over my father’s wristwatch saying, “Your father asked you to take care of it”. Knowing fully well that my father wore his wristwatch on his left hand, I asked him why my father’s wristwatch had to be removed. The attendant retorted, “When he places his hand for the x-ray, the wristwatch will interfere”. The conversation that followed was this:
Me: Excuse me, my father wears his wristwatch on his left hand. It is his right thumb that has to be x-rayed. That is why I asked you why you removed his wristwatch.
Attendant: There is nothing wrong with his right hand. The doctor has asked us to x-ray his left hand.
Me: I am sorry. There is nothing wrong with his left hand. It is his right thumb that he has injured.
Attendant: You are wrong.
Me: I am afraid you have got it wrong and not I. Please bring out the doctor’s instructions and I will show you.
He then brought the doctor’s instructions out and showed me a scrawled “R” that did look more like an “L”. I told him that I quite understood why he was attempting to x-ray the left hand and assured him that it was the doctor’s handwriting that was the problem. I gently cajoled him to go in and try to touch my father’s left thumb as well as the right thumb and see for himself which action produced a reaction. It took me another five minutes of pleading to get the correct x-ray taken.
The lessons to be learnt from this little anecdote are many:
First, who are the customers of a hospital? Besides patients, who are the primary customers, their relatives who accompany them ought to be viewed as secondary customers — for they are equally verbose when it comes to spreading word-of-mouth publicity about hospitals. If a hospital wishes to establish a reputation as a caring institution, they should manage the experience of these secondary customers well. It is a common sight in hospitals to observe relatives of patients hanging around, patiently waiting for some information on the state of health of the patient they had admitted. From information gleaned from attendants and nurses, they stand at strategic locations to catch the doctor on his rounds, hoping for a few seconds from the doctor, and an update on the patient’s state of health. It should be ever so simple for doctors to view communication of such information to secondary customers as an essential part of the service provided by a hospital, just as FedEx ensures information on delivery of a couriered package back to the sender.
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In a manufacturing organisation, several thousands of inanimate objects are being processed, while what is sought to be processed through a hospital system is a human being and his or her relatives who insist on coming along — and as we saw in the case described, for very good reasons too. When an inanimate object is neglected and lies unattended, it remains quiet. Not so a patient or his or her relatives. They express their unhappiness and share it with whoever is willing to listen. In a collective society like ours, such word-of-mouth publicity spreads like a forest fire, with far reaching negative consequences for the reputation of a hospital.
Thirdly, proper communication about the patient ought to travel faster than the pace at which the patient is moving through his experience. When that happens in a hospital, one would not see patients arriving at hospitals on the advice of their physicians and finding that the admission promised, let alone a room or a bed, are just not available.
Last but not the least, it should be realised that as much as 50 per cent and more of patient admission takes place in most hospitals based on referrals from physicians/general practitioners not employed by the hospitals concerned. In India, such referrals come primarily from family doctors. While they would normally prioritise the competence and reputation of the hospital’s physicians and surgeons, they also have in mind the care, courtesy and respect that the referred hospital is reputed for. When these general practitioners repeatedly get negative reports of the rude and uncaring behaviour of hospital staff, they generally tend to avoid patronising such hospitals.
What hospital administration is suffering from is exactly the same malaise that has afflicted several other service industries such as hotels, restaurants, financial services, insurance, travel, etc. Till a couple of decades ago, all of them felt they were unique and could learn only from the best practices of organisations within their own industries. Now, the best service organisations know they can tap into a generic body of management know-how that spans all service industries, supported by a vast pool of well-researched, documented information.
As one who is likely to be a secondary customer of hospitals many times and a possible primary customer (hopefully in the distant rather than near future) I hope Indian hospitals speedily expose their surgeons, physicians and all staff members to the knowledge made available through the service revolution — thus raising satisfaction levels of their customers.
The writer, a former corporate executive, was the founder-director of the Centre for Service Management at the University of Buckingham, and is now MD of Chennai-based VSM Consulting Services.
mahesh@vsmahesh.com