CORPORATE HEALTH CARE: A RECENT ENCOUNTER
By K Vijayachandran
Efficacy of public healthcare system in Kerala was commented upon in these columns more than once. Possible policy reforms, without further straining the state treasury, were also suggested. Correcting the highly fragmented public healthcare organisation, with the involvement of local self government institutions was pointed out as the first step toward improving its cost-benefit performance. In the absence of any meaningful initiatives by State Government, public healthcare system in Kerala continue to degenerate, yielding space for corporate healthcare initiatives.
There is a mushrooming of corporate hospitals in recent years, in Kochi, challenging not only the Government and missionary hospitals, but also the fairly well established network of medium sized institutions founded as family enterprises by the famous physicians of an earlier generation. Maximising return on capital invested is naturally the first priority for the new generation corporate healthcare enterprises: that by itself should not be seen as a sin against society. Living in a backward society, neither can we blame our capitalists for being backward, despite their best efforts toward engaging modern management methods. Nevertheless, performance of corporate healthcare enterprises need to be publicly evaluated and subjected to at least a minimum of social audit.
I had a recent opportunity to observe from close quarters how a prominent corporate hospital in the emerging metro functions. My wife was taken to the causality section of a corporate hospital in our neighborhood. She was suffering from a severe attack of asthma: It was a relapse in full fury after some four decades, old age had, possibly, magnified its intensity and consequential discomfort. I was immensely relieved and pleased by the attention and warmth of reception at the causality counter. Hospital had a had a reasonably well equipped causality ward with a Trauma Intensive Care Unit (TICU) and the personal care given to the patient was quite impressive. Medical attendants popped out of the TICU and ccompanied me with smiling faces, to help me with registration, making payments at the counter and other administrative formalities.
We were very much impressed by the quality of service and even feeling a little proud about the corporate hospital in our close neighborhood. I was in a mood even to forget some earlier instances of unhappiness with the very same hospital when my grandson, brother and niece had were treated as inpatients: As I remember, we were extremely happy with the medical treatment but there were problems on the administration side like, confusion in room allocation and irritably long delays in settling of bills.
In our case also, there was so much of clearly avoidable confusion and administrative delays while allotting the room. We were asked for preference and told that non-AC rooms are not immediately available. We opted for AC room, and were then advised to pay an advance of Rs.3000. I had a personal mediclaim policy supposed to be cashless but that was not acceptable to the hospital administration: They entertained only policies taken by companies. The medical attendant who accompanied me to help in all these messy administrative formalities advised me to open a credit line by using my credit card. She helped me in getting this done with the front office and HDFC opened a credit line of Rs.5000, that was asked for by the administration. My wife was admitted as an inpatient by around 11.30 AM, and I was chasing the administration for getting the room alloted so that I could get a place to relax when the patient was in the care of the TICU.
I was repeatedly asked about my preference for AC or non AC room, whenever I approached the causality counter and finally told that, I would be contacted as soon as the room was ready: Only option was to hang around the causality lobby and, soon I realised that even though the patient was in the so called TICU, I was called in to attend to the personal needs of the patient and on one occasion I had to face even the irritating enquiry, why there was no female bystander. It went on like that for several hours till six o’clock, when the Assist Public Relations Officer (APRO) informed me that room could be alloted only when the doctor advised to move the patient out of the TICU and that there was a pretty long waiting list.
When I tried to argue my case quoting the promises made in the morning and the money already paid in advance, he curtly told me that, I had the option to get the patient discharged and go wherever I want to. When I talked to him about the concept of corporate social responsibility normally taught in MBA classes, the APRO advised me that only his boss, the PRO would be able to help me or I might see the duty doctor if I so wished. The duty doctor was the nearest available authority to handle the complaint, but she simply expressed her helplessness. With this I proceeded to meet the PRO and waited for an hour to get an appointment. When I presented my case and complained that I was waiting for an hour to get the appointment, the young PRO was very angry and unhappy. She wanted to know whose patient my wife was and who had advised me to see her. I confessed my inability to answer the first part of the question and informed that, I was seeing the PRO on the advice of her assistant in the causality department. After some quick consultations over the phone, I was dispatched to see the Chief Medical Officer (CMO) of the corporate hospital.
I waited for my turn, and within a few minutes could see the CMO, an elderly gentleman who was a total stranger to me and he was least interested in my pedigree. Despite his too many preoccupations and busy schedules, this senior doctor listened to my problem, called for my wife’s case sheet and enquired with the administration about room allotment. He explained that, he had seen the patient in the morning and there was nothing to worry according to the case sheet. He coolly came out of his consulting room, walked up to the TICU to have a second look at the patient to my great relief assured me that the room is getting alloted. We got the room by ten in the evening.
With all the worries about getting the room we had a stream of visitors during the day. My wife was happy to receive the crowd but we kept up the discipline of one visitor at a time; exemption was sought from the security guard for accompanying my two grand children. Relatives of other patients in the TICU were also generally sticking to this general discipline and everything was smooth and there was absolutely no overcrowding of TICU. Even the next day I could see that, there was good rapport between the security guard and the stream of visitors. But all these changed overnight and the security guard would not permit anybody to visit the patient without the permission from the APROs even during the visiting hours. There was an urgent need to communicate with my wife and my request for entering the TICU for a couple of minutes was turned down by the APRO in the most bureaucratic manner. I took it as my moral duty to break their law and force my entry into TICU for talking to my wife for a couple of minutes. This naturally created a scene. When I came out, three APROs had ganged up and started abusing me. They branded me an uncivilised old man, and one of them even threatened to physically assault me. The crowd was tensely watching the scene and I called it off after challenging the most virulent among the three APROs, to call in for police help.
Such encounters must be frequent, possibly even inevitable in the corporate hospitals in Kochi, which are extremely backward in management, especially with regard to customer relations and marketing. These establishments hardly face the risk of burglary or terrorist attacks. But they are under the close surveillance of large contingents of uniformed guards, hired from professional security agencies: A law and order problem could breakout in the premises, which could not be contained even by equally large contingents of in-house public relations professionals. APROs and DyPROs attend to the grievances of lay people; services of PROs are mostly reserved for VIPs and CIPs. Administration of corporate hospitals in Kochi is mostly PRO centred.
Despite the conspicuously large front offices and back offices, and then the entire organization computerized to kill, corporate management of these hospitals could hardly be called efficient. Their premises look crowded and extremely busy throughout the day, with plenty of movement of men and material as in large railway junctions. There is waiting and waiting everywhere by the patients, bystanders and other helpers of patients: at OP registration, inpatient admission, billing and discharge counters, pharmacy, lab and testing and of course at the doctors and consulting specialists who find it difficult to keep up time. Bill settlement and discharge of inpatients often take four to six hours. Bystanders and other helpers along with security guards, hospital staff and nursing students far outnumber the patient population during day time. That makes crowd management, the most important corporate management function in these establishments.
I am not an expert in hospital management. However, I wish to make a judgement here, based on my own personal inpatient experience in a corporate hospital in Thiruvananthapuram. Though not quite comparable to the healthcare institutions in developed countries, I was quite happy with the inpatient care I got there, some two decades ago. Nursing staff was in full charge of the patient, and took care of his or her personal needs as a matter of routine and the duty of the bystander was simply to stand by for exigencies. From my recent experience in Kochi, all these appears to have undergone a sea change now in our corporate hospitals: A bystander has to be something like a trained home nurse, or otherwise the patient is frowned upon by the nursing staff, and possibly even by the administration. True, we cannot expect the luxury of having Florence Nightingale in our corporate hospitals when the nursing professionals are under compulsion to flee the country in search of better compensation. Marketing strategy of corporate hospitals are heavily anchored on specialist doctors and very little on the quality of nursing staff, who continue to be grossly underpaid and unrecognized.
Productivity levels are low in our corporate hospitals thanks to mismanagement and they thrive on low wage levels and the gross failure of public healthcare institutions. With no improvement in sight in the quality of public healthcare system corporates try to make a kill. Most patients and their bystanders, whom I came across during this recent encounter with a corporate healthcare simply share these sentiments. Management culture in upcoming corporate hospitals need to undergo a sea change and some sort of social audit and regulation are already overdue in this sector, which enjoys the legal status of essential services.
What is even more important is a change in the mindset of those who own and manage these public utilities. The PRO centered management culture need to be replaced by a more wholesome corporate culture in harmony with the celebrated Gandhian ethos of doing business (see box: Customer – A Gandhian Perspective). I had first seen the Malayalam translation of this Gandhian vision displayed prominently in a Gujarati dhaba in Thiruvananthapuram. That was long time ago, and as I remember even today, owner of this small tea shop had taken great pride in living up to these ideals; possibly a far cry from the high sounding promises by modern corporates in the name of Corporate Social Responsibility (CSR)!
COSTUMER: A GANDHIAN PERSPECTIVE
A Customer is the most important visitor on our premises.
He is not dependent on us.
We are dependent on him.
He is not an interruption on our work.
He is the purpose of it.
He is not an outsider on our business.
He is a part of it.
We are not doing him a favour by serving him.
He is doing us a favor by giving us an opportunity to do so.