1. Project Title: Factors Affecting Cardiac Conversions
Submitted by: Neha Bhilare,
Wockhardt Hospital, Nashik.
Purpose Of Study: “To identify the various factors affecting Cardiac conversions at Wockhardt
Hospital, Nashik.”
Objectives:
1) To study the functioning of Cath Lab and cardiac OPD.
2) To study the current scenario (Procedure volumes, pricing, competition, no of walkins vs
referrals, doctor wise performance).
3) To calculate the conversion rates of different procedures over a period of time.
4) To identify factors for leakage or low conversion rate if any.
5) To give valid recommendations to improve the conversion rate
Materials & Methods:
The major stake holders of the study were: Patients (Prospective & Detracted) , Consultants,
Competitors, OPD staff and Cath Lab staff. The methodology used to collect data from these
sources was mainly through: Questionnaires (Close ended & open ended) , Face to face
interviews, Telephonic interviews and through Observation. The study involved the following
activities:
a) Voice of the customer: Telephonic follow up of patients post Coronary Angiography (CAG) .
Also a questionnaire was given to patients (n=50) after a CAG to assess the likelihood/
willingness to continue treatment at our facility.
b) Market study: By visiting different hospitals in the region, data for competitor analysis was
collected. Data collected involved their volumes, conversion rates, pricing, empanelments,
average occupancy rates etc.
c) Benchmarking: External and internal.
Data Analysis & Interpretation:
Having studied the procedure volumes at our facility and calculated the conversion rates for CAG,
PTCA and CABG. It was observed that the conversion rates for CAG and PTCA were lying in the
range of 30% to 75% and that of CABG were still less showing deviation from the expected
figures. Also from the data collected for doctor wise performance analysis, there were distortions
in the conversion rates per doctor, with majority done by full timers and meager cases done by
part timers, leading to poor conversions. Overall when conversion rates were compared to that of
our competitors there was a clear indication that there is some leakage in the conversions. To
further identify the reasons for the low conversion rate, a thorough root cause analysis was
performed. The RCA showed the following interpretations stake holder wise:
1) Patients :
a) The patient population at Nashik is highly price sensitive as majority of the drainage
area lies in the semi urban & rural region, due to which patients exhibit low paying
capacity (70% population showing income of less than Rs. 20,000 p.m (data taken from
questionnaire))
b) Perception & Act of Window Shopping : Many patients have this perception that ours is
a frill hospital is meant only for the rich. With this in mind many are completely
detracted. But a few of them have the habit of window shopping, taking our price list and
getting the procedure done from the other party at a price lower than ours.

2. c) Alternative mode of treatment - A significant no of patients go for treatments like that of
Ayurveda, ECP, chelation therapy etc.
d) Change in preferred destination of treatment: The affording class is migrating to Pune,
Mumbai for further treatments. And the BPL card holders go to Shirdi (charitable trust).
e) Reluctance: This is mainly due to financial problems or fear of getting the procedure
done.
2) Consultants: Their contribution to the low conversion is due to: poor consultant’s
satisfaction (small payouts), the full timers are unable to do all the procedures, surgeons
unavailability poses a problem and fails to exhibit on the spot conversion, poor counseling
by a few consultants and lastly poor referrals are observed by part timers.
3) Competitors: Within a 6 km radius of Wockhardt, there are 4 cath labs. This gives rise to
aggressive market with price wars and competition for empanelments. Some of them
largely enjoy the position due to good will in the market.
4) Department ( internal causes) : Rigid pricing strategy, lack of tie ups with a few state and
central government organizations ( like Railways, Maharashtra Police etc) , Lag in follow up
activity by the TMT department ( which the first point of contact for cardiac patients)
After the RCA was designed, there was a need to identify the exact distribution of the
detractors. This detractors break up was obtained through a telephonic follow up ( 120
calls). The top five reasons for detraction were: Patients had changed the consultant, Got
the procedure done at Sai Baba heart care, not willing to do due to financial reasons,
patients were not reachable due to wrong registration of numbers, went to Shirdi.
Recommendations:
1) An efficient patient tracking system ( which is in practice): A 45 day conversion cycle
0 to 14 days: In which a patient who is advised CABG/ PTCA/ Others post CAG is
tracked within the 1st
week .Here he/ she is identified as a promoter ( Willing to come) or
detractor (has gone elsewhere).
14 to 21 days: Keep track of the promoters and give him reminder calls, use marketing
strategies to attract the patients through discounts, benefits, schemes etc.
21 to 45 days: A dedicated patient will certainly plan a surgery by now is converted.
The follow up activity is being done efficiently at the Cath lab , but there is a need for
a dedicated follow up activity from the TMT department.
2) Patient Counseling is a grey area. Efforts to improve the same have been initiated
3) Patient Education: There is an urgent need to improve the awareness level of the
patients (53% population indicated low information about cardiac diseases and
treatment required.)
4) Need to Tie up with a few more state and central govt organizations( Maharashtra
Police, Parivahan Mandal Jeevan Dai, BSNL etc.)
5) There is a need to tackle Consultant satisfaction ( Payouts)
6) Consultants’ availability and his effective counseling to the patient would prove
beneficial to improve on the spot conversion.
7) Too much work load on full timers who are unable to do all cases.
8) Need to address the meager cases done by part timers which leads to low volumes.
9) Effective registration of contact numbers needs to be done as a significant patient
group remains unreachable (during follow up activity 25% patients could not be
contacted)
10)There is a need to revise package rates, due to the aggressive competition, price
sensitive market.
11)There should be flexible pricing system since other facilities are practicing differential
pricing strategy.