Innovation in Action :Designing a niche healthcare delivery model

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Innovation in Action :Designing a niche healthcare delivery model

  1. 1. Dr Vijay Raaghavan Engagement Manager I Medium Healthcare ConsultingModerator : Dr Vivek Desai I Co-Presenters : Dr.(Col.) R R Pulgaonkar I Dr. Sachin Wagh I Dr. Vishal Beri
  2. 2. Who are we We  are  a  niche healthcare consulting firm,   driven   by   the  challenge   of   new possibilities in   healthcare   and   the   translation of these ideas into reality.   Our   goal,   very   simply,   is   to  make a difference,  which  may  explain  why   we tend to go beyond research and   analysis   to   adopt   a   more   pivotal   role   in   the   manner   in   which   we   help our clients execute various interventions .
  3. 3. GOING BACK TO TISS DAYS Oct 2007 , TISS Class Room Class : International Health Policy The need for innovating something for someone must begin with a strong justification on “ Why Ever Do It “ and “How will it change the life of the patient tomorrow, the day after and the year after” Dr Ramila Bisht, My teacher , Mentor
  4. 4. WRONG BEGINNING “All too often, innovation starts from the wrong end“ Companies develop a particular technology and then try to find a customer who wants to buy it. Instead they should start by identifying a need before they think about technology.”  Ray Avery, founder and CEO of Medicine Mondiale
  5. 5. RIGHT BEGINNING D V F DISSATISFACTION VISION FIRST with how things are now of what is possible set of concrete steps Gleicher proposed a simple formula for validating if innovation was required / worth undertaking If Dissatisfaction X Vision X First set of Concrete steps product is > RESISTANCE , then Innovation is possible
  6. 6. RIGHT BEGINNING Must be executable* ! QUALITY +   & IMPROVE QUALITY IMPROVE ACCESS REDUCE COST * CONDITIONS DON’T APPLY  
  7. 7. Lets take a case where we smell a need for innovation THE DOCTOR CASUALTY STAFF THE RECEPTION RECEPTIONISTTHE CALLER
  8. 8. If we superimpose the problem Problem / Challenge : How could care givers navigate patients when they can’t see / feel them and are stuck at remote locations ? D DISSATISFACTION VISION FIRST of what is possible set of with how things are now concrete steps
  9. 9. Lets begin with a real life case that we cracked For a client of ours, we conceptualized a FAMILY MEDICINE DOCTOR CLINIC MODEL and had to scale up this model across a HUNDRED locations. FUN  
  10. 10. So where is the Challenge and the dissatisfaction ? D   THE CURRENT OUTPATIENT MARKET LANDSCAPE The drawbacks of a   highly IT   led initiatives Doctor so close ,yet so far with doctor so engrossed into inputting the data into the system, there is very little he has left with the patient who D   is sitting right across Personalized touch of Your GP   HOW COULD WE BE HIGHLY PERSONALIZED     AND YET BE TECHNOLOGY SENSITIVE AND an extremely difficult aspect to scale across a MANAGE SCALE ? network FUN  
  11. 11. STAGE 2 V 1 VISION of what is possible PATIENT CENTERED THINKING & PATIENT has to be at the core of everything we do. FUN  
  12. 12. STAGE 2 V 2 VISION of what is possible CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY ACROSS THE ENTIRE NETWORK PATIENT CENTERED THINKING & PATIENT has to be at the core of everything we do. FUN  
  13. 13. STAGE 2 V 3 VISION of what is possible  DELIVER GREAT CUSTOMER EXPERIENCE THROUGH EMPATHY, DIGNITY AND RESPONSIVENESS CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY ACROSS THE ENTIRE NETWORK PATIENT CENTERED THINKING & PATIENT has to be at the core of everything we do. FUN  
  14. 14. STAGE 2 V 4 VISION of what is possible AFFORDABLE PRICE - HELP TOWARDS REDUCING HIS OVERALL SPEND ON HEALTHCARE  GREAT CUSTOMER EXPERIENCE THROUGH EMPATHY, DIGNITY AND RESPONSIVENESS CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY ACROSS THE ENTIRE NETWORK PATIENT CENTERED THINKING & PATIENT has to be at the core of everything we do. FUN  
  15. 15. STAGE 2 V 5 VISION of what is possible  SUPERIOR CLINICAL OUTCOME AFFORDABLE PRICE - HELP TOWARDS REDUCING HIS OVERALL SPEND ON HEALTHCARE GREAT CUSTOMER EXPERIENCE THROUGH EMPATHY, DIGNITY AND RESPONSIVENESS CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY PATIENT HAS TO BE AT THE CORE OF EVERYTHING WE DO. FUN  
  16. 16. STAGE 2 A TECHNOLOGY PLATFORM V 6 THAT SUPPORTED ALL OF THESE  SUPERIOR CLINICAL OUTCOME AFFORDABLE PRICE - HELP TOWARDS REDUCING HIS OVERALL SPEND ON HEALTHCARE GREAT CUSTOMER EXPERIENCE THROUGH EMPATHY, DIGNITY AND RESPONSIVENESS CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY PATIENT HAS TO BE AT THE CORE OF EVERYTHING WE DO. FUN  
  17. 17. STAGE 3 FIRST F1 set of concrete steps REACH OUT TO THE PATIENT FUN  
  18. 18. STAGE 3 FIRST F1 set of concrete steps WE SPOKE TO 150 PATIENTS WHO VERY RECENTLY HAD COMPLETED THEIR PHYSICIAN CONSULTATION IN SOME CASES THE FOLLOW UP AND WERE VERY FRESH TO SPEAK ABOUT THEIR EXPERIENCE. THIS INCLUDED A MIX OF CORPORATE , NON – CORPORATE , STAND ALONE CLINIC SETUP
  19. 19. STAGE 3 : What patients had to say about their physician consult experience ?The doctor d idtouch me and not even FIRST Reasons for Reasons for feel me Dissatisfaction Satisfaction /wow set of concrete stepshardly The doctor did She just asked me one touched me to feel my king questions question and that’s it health problem The doctor kept as The doctor did not spend time listening to my problem The doctor understood my exact problem and so the This doctor didn’t even ask if I was allergic to penicillin, she medicines began to work straight away prescribed the medicine listenin g to I ut even the Witho t I had ear – 70%   I in and when I went to my I had throat pa – he just saw me –asked m e tha in my right previous doct or rote some m n to mouth and w dn’t findIt was like Doctor was proble tor went o left e to open my after 5 days I ditalking to the co mputer oc the d scope in my II m medicines .Eve n Sridhar – he ha d 10%   ent to Dr and not me ! p ut the II relief. I then w with light- he as ked me to some machine and he examined my The doctor was busy doing ear. III III open m y mouth r more than at machine fo rote throat with th r that – he w Afte something else Her five minutes. d it worked! He asked me medicines an w up today and even to llo come for a fo much time.The doctor was busy today he spent that treachatting with someother doctor andwithout even asking tmeme the details of mypain – went on towrite prescription Others nt w orke FUN   we d
  20. 20. STAGE 3 : Reached out to the other end – the Physician F2 FUN  
  21. 21. STAGE 3 : Reached out to the other end – the physician F2 WE SPOKE TO 35 PHYSICIANS ON THEIR EXPERIENCE OF WHAT THEY FELT WERE THE GOOD POINTS , PAIN POINTS OF THE CONSULTATION. WE SELECTED FACILITIES THAT HAD IT INFRASTRUCTURE – IN MOST CASES A LAPTOP / DESKTOP WITH A HIS. FUN  
  22. 22. STAGE 3 Some leads from the Doctor interviewsF 2.1 PATIENTS DON’T LIKE IF WE DIDN’T SHOW CONCERN [the CORPORATE team make us type type and type]Can we look atusing IT differently ? THE TOP MANAGEMENT IS MORE WORRIED ABOUT DATA [less worried about patient’s problems – the system of computerization is good, but it cant be at the cost of a patient’s time]? DOCTORS MAY BE RELUCTANT TO USE COMPUTERS Whenever I HAVE EYE-EYE CONTACT , I am able to BUILD A RELATIONSHIP with the patient – PATIENTS LOSE FAITH IF WE DIDN’T DON’T UNDERSTAND THEIR PROBLEM – Sometimes!   CHANGE WHAT YOU patients get frustrated with US TO FOCUS MORE on the monitor – AS WE TEND DON’T sometimes patients tend to mistake us for NEED TO
  23. 23. STAGE 3 Some Options that can give us the best of both the WorldsF 2.1Will it be wiser to retainerdoctor’s written KEYING INPUTS VOICE INPUTSprescription and yet get ITinside?? HOW TO RETAIN PEN & PAPER AND YET GO DIGITAL TOUCH INPUTS PEN & PAPER THE INPUTS!   TRADITIONAL WAY HELPS IN MAINTAINING THE PATIENT – PHYSICIAN EYE TO EYE CONT
  24. 24. STAGE 3 AN OPTION : BEST OF BOTH THE WORLDSF2.1 PEN & PAPER? HOW TO RETAIN PEN & PAPER THE DOCTOR CONTINUES AND YET GO DIGITAL TO WRITE OVER IT DATA CONTINUES TO REACH THE CLINICAL PEN & PAPER INPUTS HEAD PATIENT CONTINUES TO IBALL FEEL THE PHYSICIAN TAKE NOTE INVOLVEMENT  
  25. 25. STAGE 3 min   F2.1   IMPLEMENTED  EVIDENCE   min   1.5 BASED  CARE     The  one  page  EMR  capture  system    not  only  increased  the   INVOLVEMENT  of  the  Physician  on    a  consistent  basis,  but   2 also  ensured  that  LOT  OF  THINKING    backed  by  EVIDENCE   BASED  MEDICINE  went  into  DECISION  MAKING.       INCREASED  EYE-­‐EYE  TIME   1.5     Pa9ent  Par9culars  ,Illness  Summary,  Vitals  ,   Observa9ons  and  Drug  Therapy  also  meant  that  we   could  steal  close  to  8.5-­‐10  minutes’  of  the  care  givers   9me  to  the  pa9ent.           2   CONSISTENCY  IN  DECISION   MAKING       2 Clinical  Quality  Head    could  first  Audit  Physician’s   decision  making  by  using  these  filled  forms  as  a  “PROXY”   9 –  and  then  could  spend  9me  with  the  Physician  on   improving  prac9ce/outcomes.    THE ONE PAGE EMR THAT WE CREATED BECAME OUR AUDIT  MINUTE/PATIENTTOO AS WELL !
  26. 26. STAGE 3F2.2 ONCE WE GOT HERE , WE REALIZED THAT IT WAS VERY CRITICAL TO ENSURE THAT WE ATTAINED CONSISTENCY IN CLINICAL DECISION MAKING. THIS IS WHERE WE SOUGHT THE HELP OF A PROTOCOL DEVELOPING FIRM AND CUSTOMIZED THE SAME? HOW DO I ENSURE CLINICAL THAT I DELIVER The rules PROTOCOLS FOR 60 COMPARABLE MOST COMMON CONDITIONS TREATMENT OUTCOMES ACROSS 100 LOCATIONS SOUGHT!   SUPPORT FROM A PROTOCOL DEVELOPMENT FIRM.
  27. 27. STAGE 3 PATIENT SATISFACTIONF2.3 How likely is it that you would recommend this hospital to a friend or colleague?   Never   Absolutely  ? HOW DO WE   0   1   2   3   4   5   6   7   8   9   10   KNOW IF THE PATIENT LIKED US AND KNOW THAT WE CARE ? A  Net  Promoter  Score  can  be   Promoter     56%   calculated  by  subtracZng  the   percentage  of  detractors  from   the  percentage  of  Promoters.     Passive     30%                                                                                                         %  Promoters      -­‐        %Detractors     WE                                                                                                        !   Detractor     14%   IMPLEMENTED Net  Promoter  Score     NET PROMOTER SYSTEM   Net  Promoter  Score   42%   Ultimately, the theory behind the Net Promoter Score metric is that a facility will experience long-term and sustainable growth only if the Percentage of Promoters is greater than the percentage of Detractors
  28. 28. SO , WHERE DID WE INNOVATE ? FINANCING D PROCESS T E C N O L O G Y T S P I I T A S K M E G I PATIENT CENTERED O U N M OUT PATIENT BUSINESS MODEL P I D B U S I N E S S Z L R O L E EMR : PAPER & DIGITAL 1 2 4 +3 P A T I E N T H X P A P M A R K E T I N G PROTOCOL DRIVEN CARE R E I I D R X C W I   I A E B R A N D I N G R C H A N N E L G E C E DELIVERY PRODUCT
  29. 29. OUTCOME ? PATIENT  SATISFACTION   PHYSICIAN  SATISFACTION   COMPLIANCE  1 TECHNOLOGY Pen and Paper helped us in keeping it low cost -­‐   High2 PRESCRIPTION Could retain the traditional way and yet go digital ! High High WRITING3 RECORD KEEPING Could retain a hard copy, this also became the audit tool and a bible for improvising Physician -­‐   -­‐   practice!4 STANDARDIZING Building protocol for specific conditions – High Mediu standardized the treatment plan m5 MONITORING The protocol driven care pathway helped us in ensuring that informed decisions were made and they -­‐   Medium OUTCOMES were consistent across locations and physician profiles FUN  
  30. 30. Thank You     Medium  is  a  healthcare  consulZng  firm.  Our  services  include   Business  Strategy,  MarkeZng  &  Sales,  Quality  &  PaZent  Experience,   Performance  TransformaZon,  Healthcare  Franchising.  and  Public   Health.       We  are  innovaZve,  passionate  and  performance-­‐driven.  But,  most   of  all,  we  are  commided  to  delivering  significant  and  tangible   business  impact  for  our  clients.       Our  clients  have  ranged  from  large  hospital  chains  and  single-­‐ specialty  hospitals  to  primary  care  clinics,  medical  equipment   manufacturers  and  private  equity.   www.med-­‐ium.com    

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