This document discusses a healthcare consulting firm and its approach to innovation. It begins by introducing the firm and its goal of making a difference through healthcare innovations. It then discusses the firm's approach, which involves identifying dissatisfactions in the current system, envisioning potential solutions, and developing initial concrete steps. The document uses a case study to illustrate its approach. It analyzes the dissatisfactions patients and physicians reported with outpatient consultations. It then develops a vision for improving the patient and physician experience. Its initial concrete steps included gathering patient and physician feedback and developing a one-page electronic medical record system and clinical protocols. This helped improve various metrics like physician involvement, decision consistency, and patient satisfaction.

1. 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

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. 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. 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. 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. RIGHT BEGINNING
Must be
executable* !
QUALITY
+
&
IMPROVE QUALITY IMPROVE ACCESS REDUCE COST
* CONDITIONS DON’T APPLY

7. Lets take a case where we smell a need for innovation
THE DOCTOR
CASUALTY
STAFF
THE RECEPTION
RECEPTIONIST
THE CALLER

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. 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. 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. 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. 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. 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. 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. 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. 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. STAGE 3
FIRST
F1 set of concrete steps
REACH OUT
TO THE PATIENT
FUN

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. STAGE 3 : What patients had to say about their physician consult experience ?
The doctor d
id
touch 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 find
It was like Doctor
was proble tor went o left e to open my
after 5 days I
di
talking 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
trea
chatting with some
other doctor and
without even asking
tme
me the details of my
pain – went on to
write prescription
Others
nt w
orke
FUN
we d

20. STAGE 3 : Reached out to the other end – the Physician
F2
FUN

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. STAGE 3
Some leads from the Doctor interviews
F 2.1
PATIENTS DON’T LIKE IF WE DIDN’T SHOW CONCERN
[the CORPORATE team make us type type and type]
Can we look at
using 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. STAGE 3
Some Options that can give us the best of both the Worlds
F 2.1
Will it be wiser to retainer
doctor’s written KEYING INPUTS VOICE INPUTS
prescription and yet get IT
inside?
?
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. STAGE 3
AN OPTION : BEST OF BOTH THE WORLDS
F2.1
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. 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/PATIENT
TOO AS WELL !

26. STAGE 3
F2.2 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. STAGE 3
PATIENT SATISFACTION
F2.3 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. 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. OUTCOME ?
PATIENT
SATISFACTION
PHYSICIAN
SATISFACTION
COMPLIANCE
1 TECHNOLOGY Pen and Paper helped us in keeping it low cost
-­‐
High
2 PRESCRIPTION Could retain the traditional way
and yet go digital ! High High
WRITING
3 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
m
5 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. 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