Monday, September 27, 2010

Hospitals, CRM and PRM

CRM ( customer relation management ) is a tool which all service industries to keep their customers happy. While one would expect hospitals to use CRM routinely, unfortunately, most hospitals still do not bother. Given the large patient:hospital bed ratio in India, most hospitals continue to take the approach that patients do not have a choice as to where they can go for their treatment, which is why most hospital staff adopt a high-handed attitude towards patients . Stories of hospital staff rudeness and arrogance are innumerable - and this is reflected in the increasing number of incidents of violence against doctors and hospitals.

Progressive hospitals are willing to learn lessons from the hospitality industry , and are willing to implement CRM to help their patients have a better experience when they come to the hospital. However, when I am talking about PRM, I am referring not to Patient Relationship Management ( something which all hospitals need to learn to do, but most still do badly !), but rather to Patient Relative Management.

The need for this is much more acute in Indian hospitals ! When most patients come to a hospital in India, they are accompanied by a bevy of friends, neighbours and relatives ! These people are extremely important in India, but sadly, they are often ignored and neglected by the hospital staff and management. Most hospital staff members consider them to be a nuisance and tolerate relatives as a necessary evil - and there are very few amenities available for family members , even for those who are on a 24-hour vigil outside the ICUs !

This is a very short-sighted approach ! Relatives are understandably concerned and worried about their patient's health. They are key decision makers, and need to be educated and informed about what to expect. They need to be addressed politely and kept updated about the clinical status of their patient.

Unfortunately, this is rarely done. Doctors ( and sometimes, the more senior they are, the worse their habits !) seem to take a perverse pride in making relatives wait for ever and ever ( often for completely flimsy reasons). They are not willing to share information about what goes on behind the intimidating doors of the Operation Theater and ICU. This is why family members often get angry with doctors, and when their patient dies, are eager to vent their frustration by burning down the hospital or beating up the doctors.

Doctors are very busy - and many may not have enough time to talk to even their patients, leave alone their relatives ! This lack of communication can cause frustration; and after bottling it up, relatives will often vent their resentment when a mishap occurs - even if the doctor was not to blame.

This is a systemic problem, which can be addresses proactively by the hospital management. In order to protect doctors, who are now feeling very vulnerable, the government is passing laws and hospitals are beefing up their security. However, this is a very short-sighted fix.

It's far more important that hospitals start investing time, money and energy in educating patient's relatives, so they have realistic expectations of the outcome of the medical treatment.
Dissatisfaction arises when there is a mismatch between expectations and reality - and helping relatives to have realistic expectations will help in reducing dissatisfaction with doctors and hospitals !

The most effective way of doing so is by setting up Patient Education Resource Centers in the hospital. The PERC will be run by nurses and librarians; and will help to educate patients and their relatives, so they know what to expect during their hospital stay.

As Indian hospitals strive to attract medical tourists and match global standards ( for example, by getting JCAHO accreditaion), documenting that patient education has been provided is going to be an integral part of patient care. The PERC will become an important department of the hospital . In the Mayo Clinic, the Dept of Patient Education occupies an entire building !

Not only are PERCs important for risk management, they are also very cost effective. All these relatives are prospective future customers for the hospital ( after all, we are all going to fall ill some day !) If they are treated with respect, they are likely to come back to the same hospital for their own medical care when they need this !

We all know that the best kind of marketing is word of mouth marketing . Instead of wasting money on advertising in the press , it makes much more sense for hospitals to invest it in PRM ! Relatives ( and the patient's visitors ) are potentially a captive customer base - why not educate them about health and illness ? In a hospital, everyone has a much more heightened sense of their own mortality. When you visit a friend who is sick, you are much more acutely aware of your own frailty - and much more health conscious ! ( What can I do to make sure my husband does not get a heart attack like his elder brother did ?) Reaching out to these relatives through a Patient Education Resource Center to help them learn more about their health can pay big dividends for the hospital , because they are much more likely to seek medical assistance in a hospital which has taken the time and trouble to educate them !

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