Advances in Health Care Management is a research annual that publishes state-of-theart reviews and research on special topics in the field of health care management. Coverage includes: The series provides a forum for leading research on health care management. Volumes 1-3 offer reviews of the field, research on selected topics, and best papers from the Health Care Management Division of the Academy of Management. In contrast, volumes 4-7 focus on a range of special topics, from bioterrorism to international health care management to entrepreneurship to patient safety. Benefits and features • The series offers state-of-the-art reviews which orient new and established scholars about current themes within an area of research. • Selected volumes in the series address hot topics within the field.

1. by MOHAMMED YASER HUSSAIN
BPHARM-MBA (HEALTH CARE MANAGEMENT)
APOLLO HOSPITALS SENIOR EXECUTIVE
PHARMACY

2.  Improving patient satisfaction, customer service and the customer experience, and, of
course, HCAHPS scores: Here are seven bullet points. I find myself emphasizing
frequently (as a consultant and professional keynote speaker) in hospital and other
healthcare environments.
 1. Strive to deliver service on the schedule of your patient, not just a schedule that
happens to be convenient for your institution.
 Examples:
 • Avoid unnecessarily long waits for lab results to be distributed; this practice is
disrespectful and even cruel.
 • Consider implementing something along the lines of the Vocera Communications Badge
where the patient speaks the name of the nurse and is directly in communication with
her instead of waiting on a response to a call light. [I have, of course, no affiliation with
Vocera.]
 2. You’ll make the most progress on HCAHPS, and as an institution, by taking a
relatively broad approach to the subject. Being too selectively focused on the individual
HCAHPS questions can actually backfire. A more effective and powerful goal is to create
an organization-wide halo effect that raises your scores as well as your actual rate of
referral — not just the hypothetical “willingness to recommend.” (For a longer piece of
mine on HCAHPS and company culture, you may want to spend a minute with this recent
article.)
 3. Great customer service means systems as well as smiles. When Mayo Clinic
overhauled their scheduling system they employed (according to the great Leonard L
Berry) industrial engineers using stopwatches to time wheelchairs between appointment
locations in order to ensure that correct scheduling algorithms were

3.  4. Not-for-profit hospitals and institutions in healthcare can benefit by
recognizing and embracing their inherent organizational advantage over for-
profit institutions, as follows: It is easier for the employees to identify with
the aims of an organization that doesn’t have profit at the center. If you’re
not for profit, be aware of this advantage and make the most of it.
 5. This just in: Bullying and disrespect lead to turnover. According to a recent
study, working in an environment characterized by bullying increases turnover
intentions of nurses, and employees report high turnover intentions whether directly
bullied or simply in a work unit with bullying. (You didn’t need a study to tell you
this, so search out and destroy bullying before it destroys you.)
 6. Every single employee needs to know how to handle customer complaints and
concerns. Even if handling the concern means “I’m finding you someone right now
who can address this” it’s far better than “I can’t help you, I’m the wrong person.”
 7. Much of what’s wrong in patient satisfaction and customer service is related to
poor use of language, and to nonverbal “language” cues (such as hospital
employees avoiding eye contact with civilians in the hospital, and acting like they
are “other” from us).
 8. A blame-free environment leads to improved transparency, improved systems,
and, ultimately, to better results. This has worked to make The Ritz-Carlton a
great culture, and it can do the same for your hospital. Horst Schulze, founder of
the modern-day Ritz-Carlton brand (and now Capella and Solis), frequently says “If a
mistake happens once it may be fault of employee. If it happens twice, it is most
likely the fault of the system.” So, they get to work fixing the system.

4.  1. Develop and implement national standards for examination by which doctors, nurses and
pharmacists are able to practice and get employment.
 2. Rapidly develop and implement national accreditation of hospitals; those that do not comply
would not get paid by insurance companies. However, a performance incentive plan that targets
specific treatment parameters would be a useful adjunct.
 3. Obtain proposals from private insurance companies and the government on ways to provide
medical insurance coverage to the population at large and execute the strategy. It is healthy to
have competition in healthcare, and provide health insurance to the millions who cannot afford it.
 4. Utilise and apply medical information systems that encourage the use of evidence-based
medicine, guidelines and protocols as well as electronic prescribing in inpatient and outpatient
settings. This is possible though the implementation of the EHR; this will, in time, encourage
healthcare data collection, transparency, quality management, patient safety, efficiency, efficacy
and appropriateness of care.
 5. Perverse incentives between specialists, hospitals, imaging and diagnostic centres on the one
hand and referring physicians on the other need be removed and a level of clarity needs to be
introduced.
 6. Develop multi-specialty group practices that have their incentives aligned with those of
hospitals and payers. It is much easier to teach the techniques of sophisticated medical care to a
group of employed physicians than it is to physicians as a whole. It is also important that doctors
are paid adequately for what they do.
 7. Encourage business schools to develop executive training programmes in healthcare, which will
effectively reduce the talent gap for leadership in this area.
 8. Revise the curriculum in medical, nursing, pharmacy and other schools that train healthcare
professionals, so that they too are trained in the new paradigm.
 9. Develop partnerships between the public and private sectors that design newer ways to deliver
healthcare. An example of this would include outpatient radiology and diagnostic testing centres.
 10. The government should appoint a commission which makes recommendations for the
healthcare system and monitors its performance.

5.  1. Rural Versus Urban Divide: While the opportunity to enter the
market is very ripe, India still spends only around 4.2% of its
national GDP towards healthcare goods and services (compared
to 18% by the US) [2]. Additionally, there are wide gaps between
the rural and urban populations in its healthcare system which
worsen the problem. A staggering 70% of the population still lives
in rural areas and has no or limited access to hospitals and clinics
[3]. Consequently, the rural population mostly relies on
alternative medicine and government programmes in rural health
clinics. One such government programme is the National Urban
Health Mission which pays individuals for healthcare premiums, in
partnership with various local private partners, which have
proven ineffective to date.
 In contrast, the urban centres have numerous private hospitals
and clinics which provide quality healthcare. These centres have
better doctors, access to preventive medicine, and quality clinics
which are a result of better profitability for investors compared
to the not-so-profitable rural areas.

6.  2. Need for Effective Payment Mechanisms: Besides the
rural-urban divide, another key driver of India’s healthcare
landscape is the high out-of-pocket expenditure (roughly
70%). This means that most Indian patients pay for their
hospital visits and doctors’ appointments with straight up
cash after care with no payment arrangements. According
to the World Bank and National Commission’s report on
Macroeconomics, only 5% of Indians are covered by health
insurance policies [3]. Such a low figure has resulted in a
nascent health insurance market which is only available for
the urban, middle and high income populations. The good
news is that the penetration of the health insurance
market has been increasing over the years; it has been one
of the fastest-growing segments of business in India.

7.  3. Demand for Basic Primary Healthcare and Infrastructure:
India faces a growing need to fix its basic health concerns in the
areas of HIV, malaria, tuberculosis, and diarrhoea. Additionally,
children under five are born underweight and roughly 7%
(compared to 0.8% in the US) of them die before their fifth
birthday. [4] [5]. Sadly, only a small percentage of the population
has access to quality sanitation, which further exacerbates some
key concerns above.
 For primary healthcare, the Indian government spends only about
30% of the country’s total healthcare budget [6]. This is just a
fraction of what the US and the UK spend every year. One way to
solve this problem is to address the infrastructure issue… by
standardising diagnostic procedures, building rural clinics, and
developing streamlined health IT systems, and improving
efficiency. The need for skilled medical graduates continues to
grow, especially in rural areas which fail to attract new graduates
because of financial reasons. A sizeable percentage of the
graduates also go abroad to pursue higher studies and
employment.


8.  4. Growing Pharmaceutical Sector: According to the
Indian Brand Equity Foundation (IBEF), India is the
third-largest exporter of pharmaceutical products in
terms of volume. Around 80% of the market is
composed of generic low-cost drugs which seem to be
the major driver of this industry [7].
 The increase in the ageing population, rising incomes
of the middle class, and the development of primary
care facilities are expected to shape the
pharmaceutical industry in future. The government
has already taken some liberal measures by allowing
foreign direct investment in this area which has been
a key driving force behind the growth of Indian
pharma.

9.  5. Underdeveloped Medical Devices Sector: The
medical devices sector is the smallest piece of India’s
healthcare pie. However, it is one of the fastest-
growing sectors in the country like the health
insurance marketplace. Till date, the industry has
faced a number of regulatory challenges which has
prevented its growth and development.
 Recently, the government has been positive on
clearing regulatory hurdles related to the import-
export of medical devices, and has set a few
standards around clinical trials. According to The
Economic Times, the medical devices sector is seen
as the most promising area for future development by
foreign and regional investors; they are highly
profitable and always in demand in other countries.
