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Innovation in Action :Designing a niche healthcare delivery model

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Page 1: Innovation in Action :Designing a niche healthcare delivery model

Dr Vijay Raaghavan Engagement Manager I Medium Healthcare Consulting

Moderator : Dr Vivek Desai I Co-Presenters : Dr.(Col.) R R Pulgaonkar I Dr. Sachin Wagh I Dr. Vishal Beri

Page 2: Innovation in Action :Designing a niche healthcare delivery model

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 .

Page 3: Innovation in Action :Designing a niche healthcare delivery model

Class : International Health Policy

Oct 2007 , TISS Class Room

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

GOING BACK TO TISS DAYS

Page 4: Innovation in Action :Designing a niche healthcare delivery model

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

Page 5: Innovation in Action :Designing a niche healthcare delivery model

RIGHT BEGINNING

D  x  V  x  F  >  R  

DDISSATISFACTION with how things are now

VISION of what is possible

VFIRST set of concrete steps

F

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

Page 6: Innovation in Action :Designing a niche healthcare delivery model

&

RIGHT BEGINNING

Must be executable* !

* CONDITIONS DON’T APPLY  

IMPROVE QUALITY IMPROVE ACCESS REDUCE COST

QU

ALITY

+  

Page 7: Innovation in Action :Designing a niche healthcare delivery model

THE RECEPTIONIST

Lets take a case where we smell a need for innovation

RECEPTION

CASUALTY

THE DOCTOR

THE CALLER

STAFF

Page 8: Innovation in Action :Designing a niche healthcare delivery model

If we superimpose the problem

DDISSATISFACTION with how things are now

Problem / Challenge : How could care givers navigate patients when they can’t see / feel them and are stuck at remote locations ?

VISION of what is possible

FIRST set of concrete steps

Page 9: Innovation in Action :Designing a niche healthcare delivery model

Lets begin with a real life case that we cracked

FUN  

For a client of ours, we conceptualized a FAMILY MEDICINE DOCTOR CLINIC MODEL and had to scale up this model across a HUNDRED locations.

Page 10: Innovation in Action :Designing a niche healthcare delivery model

So where is the Challenge and the dissatisfaction ?

FUN  

THE CURRENT OUTPATIENT MARKET LANDSCAPE

D  

   

Personalized touch of Your GP  

an extremely difficult aspect to scale across a network

   

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 is sitting right across

HOW COULD WE BE HIGHLY PERSONALIZED AND YET BE TECHNOLOGY SENSITIVE AND MANAGE SCALE ?

D  

Page 11: Innovation in Action :Designing a niche healthcare delivery model

FUN  

PATIENT CENTERED THINKING & PATIENT has to be at the core of everything we do.

VISION of what is possible

V1

STAGE 2

Page 12: Innovation in Action :Designing a niche healthcare delivery model

FUN  

PATIENT CENTERED THINKING & PATIENT has to be at the core of everything we do.

CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY ACROSS THE ENTIRE NETWORK

V2 VISION of what is possible

STAGE 2

Page 13: Innovation in Action :Designing a niche healthcare delivery model

FUN  

PATIENT CENTERED THINKING & PATIENT has to be at the core of everything we do.

CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY ACROSS THE ENTIRE NETWORK

 DELIVER GREAT CUSTOMER EXPERIENCE THROUGH EMPATHY, DIGNITY AND RESPONSIVENESS

V3 VISION of what is possible

STAGE 2

Page 14: Innovation in Action :Designing a niche healthcare delivery model

FUN  

PATIENT CENTERED THINKING & PATIENT has to be at the core of everything we do.

CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY ACROSS THE ENTIRE NETWORK

 GREAT CUSTOMER EXPERIENCE THROUGH EMPATHY, DIGNITY AND RESPONSIVENESS

AFFORDABLE PRICE - HELP TOWARDS REDUCING HIS OVERALL SPEND ON HEALTHCARE

V4 VISION of what is possible

STAGE 2

Page 15: Innovation in Action :Designing a niche healthcare delivery model

FUN  

PATIENT HAS TO BE AT THE CORE OF EVERYTHING WE DO.

CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY

GREAT CUSTOMER EXPERIENCE THROUGH EMPATHY, DIGNITY AND RESPONSIVENESS

AFFORDABLE PRICE - HELP TOWARDS REDUCING HIS OVERALL SPEND ON HEALTHCARE

 SUPERIOR CLINICAL OUTCOME

V5 VISION of what is possible

STAGE 2

Page 16: Innovation in Action :Designing a niche healthcare delivery model

FUN  

A TECHNOLOGY PLATFORM THAT SUPPORTED ALL OF THESE

V6

PATIENT HAS TO BE AT THE CORE OF EVERYTHING WE DO.

CONSISTENCY OF EXPERIENCE/SERVICE DELIVERY

AFFORDABLE PRICE - HELP TOWARDS REDUCING HIS OVERALL SPEND ON HEALTHCARE

 SUPERIOR CLINICAL OUTCOME

GREAT CUSTOMER EXPERIENCE THROUGH EMPATHY, DIGNITY AND RESPONSIVENESS

STAGE 2

Page 17: Innovation in Action :Designing a niche healthcare delivery model

FUN  

REACH OUT TO THE PATIENT

STAGE 3

FIRST set of concrete steps

F1

Page 18: Innovation in Action :Designing a niche healthcare delivery model

STAGE 3

WE SPOKE TO 150 PATIENTS WHO VERY RECENTLY HAD COMPLETED THEIR PHYSICIAN CONSULTATION

FIRST set of concrete steps

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

F1

Page 19: Innovation in Action :Designing a niche healthcare delivery model

FIRST set of concrete steps

FUN  

70%   I

II III

The doctor understood my exact problem and so the medicines began to work

The doctor kept asking questions

He

r trea

tme

nt wo

rked

we

ll

I had throat pain and when I went to my

previous doctor – he just saw me –asked

me to open my mouth and wrote some

medicines .Even after 5 days I didn’t find

relief. I then went to Dr Sridhar – he had

some machine with light- he asked me to

open my mouth and he examined my

throat with that machine for more than

five minutes. After that – he wrote

medicines and it worked! He asked me to

come for a follow up today and even

today he spent that much time.

Reasons for Dissatisfaction

Reasons for Satisfaction /wow

The doctor did not spend time listening to my problem

The doctor was busy doing something else

The doctor did not even touch me and feel me

She just asked me one question and that’s it

It was like Doctor was

talking to the computer

and not me !

The doctor did hardly touched me to feel my health problem

The doctor was busy chatting with some other doctor and without even asking me the details of my pain – went on to write prescription

Without even listening to

me that I had the

problem in my right ear –

the doctor went on to

put the scope in my left

ear.

This doctor didn’t even ask if I was allergic to penicillin, she straight away prescribed the medicine

10%  

I

II

III

Others

STAGE 3 : What patients had to say about their physician consult experience ?

Page 20: Innovation in Action :Designing a niche healthcare delivery model

FUN  

STAGE 3 : Reached out to the other end – the Physician

F2

Page 21: Innovation in Action :Designing a niche healthcare delivery model

FUN  

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.

F2

STAGE 3 : Reached out to the other end – the physician

Page 22: Innovation in Action :Designing a niche healthcare delivery model

STAGE 3

F2.1

Can we look at using IT differently ?

DOCTORS MAY BE RELUCTANT TO USE COMPUTERS

Some leads from the Doctor interviews

PATIENTS DON’T LIKE IF WE DIDN’T SHOW CONCERN [the CORPORATE team make us type type and type] 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]

Whenever I HAVE EYE-EYE CONTACT , I am able to BUILD A RELATIONSHIP with the

patient – PATIENTS LOSE FAITH IF WE DIDN’T UNDERSTAND THEIR PROBLEM – Sometimes

patients get frustrated with US AS WE TEND TO FOCUS MORE on the monitor –sometimes patients tend to mistake us for

!  DON’T CHANGE WHAT YOU DON’T NEED TO

?

Page 23: Innovation in Action :Designing a niche healthcare delivery model

STAGE 3

F2.1

Will it be wiser to retainer doctor’s written prescription and yet get IT inside?

HOW TO RETAIN PEN & PAPER AND YET GO DIGITAL

Some Options that can give us the best of both the Worlds

!  THE TRADITIONAL WAY HELPS IN MAINTAINING THE PATIENT – PHYSICIAN EYE TO EYE CONT

?

KEYING INPUTS VOICE INPUTS

TOUCH INPUTS PEN & PAPER INPUTS

Page 24: Innovation in Action :Designing a niche healthcare delivery model

STAGE 3

F2.1 AN OPTION : BEST OF BOTH THE WORLDS

PEN & PAPER

PEN & PAPER

INPUTS

HOW TO RETAIN PEN & PAPER AND YET GO DIGITAL

? THE DOCTOR CONTINUES TO WRITE OVER IT DATA CONTINUES TO REACH THE CLINICAL HEAD PATIENT CONTINUES TO FEEL THE PHYSICIAN INVOLVEMENT  

IBALL TAKE NOTE

Page 25: Innovation in Action :Designing a niche healthcare delivery model

STAGE 3

THE ONE PAGE EMR THAT WE CREATED BECAME OUR AUDIT TOO AS WELL !

min  

1.5

min  

2

1.5

2

2

9  MINUTE/PATIENT

F2.1  

IMPLEMENTED  EVIDENCE  BASED  CARE    The  one  page  EMR  capture  system    not  only  increased  the  INVOLVEMENT  of  the  Physician  on    a  consistent  basis,  but  also  ensured  that  LOT  OF  THINKING    backed  by  EVIDENCE  BASED  MEDICINE  went  into  DECISION  MAKING.      

INCREASED  EYE-­‐EYE  TIME      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.          

 

CONSISTENCY  IN  DECISION  MAKING      Clinical  Quality  Head    could  first  Audit  Physician’s  decision  making  by  using  these  filled  forms  as  a  “PROXY”  –  and  then  could  spend  9me  with  the  Physician  on  improving  prac9ce/outcomes.    

Page 26: Innovation in Action :Designing a niche healthcare delivery model

STAGE 3

F2.2

HOW DO I ENSURE THAT I DELIVER COMPARABLE TREATMENT OUTCOMES ACROSS 100 LOCATIONS

!  SOUGHT SUPPORT FROM A PROTOCOL DEVELOPMENT FIRM.

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

The rules CLINICAL PROTOCOLS FOR 60 MOST COMMON CONDITIONS

?

Page 27: Innovation in Action :Designing a niche healthcare delivery model

STAGE 3

F2.3

HOW DO WE KNOW IF THE PATIENT LIKED US AND KNOW THAT WE CARE ?

!  WE IMPLEMENTED NET PROMOTER SYSTEM

PATIENT SATISFACTION

?

How likely is it that you would recommend this hospital to a friend or colleague?

    2   3   4   5   6   7   8  1   9  0   10  

Never   Absolutely  

   

   

   

   

   A  Net  Promoter  Score  can  be  calculated  by  subtracZng  the  percentage  of  detractors  from  the  percentage  of  Promoters.                                                                                                            

%  Promoters    -­‐        %Detractors    

                                                                                                         Net  Promoter  Score  

 

42%  

Promoter  

Passive  

Detractor  

Net  Promoter  Score  

56%  

30%  

14%  

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

Page 28: Innovation in Action :Designing a niche healthcare delivery model

   

SO , WHERE DID WE INNOVATE ?

FINANCING PROCESS

PRODUCT DELIVERY

B U S I N E S S

M

O

D

L

T

I

E

U

P

C H A N E L

B R A I D

P A T I E N T

X

P

E

R

I

E

N

C

E

YT E C N O L O G

I

A

P

T

M

S K

I

Z

E R O L

R

P

I

C

I

N

G

M A K E T I N G

GN

D

S

I

G

N

I

X

H

A

R

D

W

A

R

E

1 2

4 3 +

PATIENT CENTERED OUT PATIENT BUSINESS MODEL

EMR : PAPER & DIGITAL

PROTOCOL DRIVEN CARE

Page 29: Innovation in Action :Designing a niche healthcare delivery model

FUN  

Could retain the traditional way and yet go digital !

PATIENT  SATISFACTION  

OUTCOME ?

1 TECHNOLOGY

PHYSICIAN  SATISFACTION  

2

3

4

5

PRESCRIPTION WRITING

RECORD KEEPING

STANDARDIZING

MONITORING OUTCOMES

COMPLIANCE  

Pen and Paper helped us in keeping it low cost

Could retain a hard copy, this also became the audit tool and a bible for improvising Physician practice!

Building protocol for specific conditions – standardized the treatment plan

The protocol driven care pathway helped us in ensuring that informed decisions were made and they were consistent across locations and physician profiles

-­‐   High

High High

-­‐   -­‐  

High Medium

-­‐   Medium

Page 30: Innovation in Action :Designing a niche healthcare delivery model

   

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    

Thank You