Vivek Shukla, Healthcare Strategy and Business Development Consultant, suggests that hospitals involved in medical tourism would benefit from a health check and he identifies some of the symptoms that are characteristic of poorly performing hospitals
How healthy is your hospital
Health is synonymous with vigour and vitality. A healthy individual or organization is more likely to survive the attack of disease or infection. However, it is ironic that some hospitals who deliver healthcare are sick themselves!
In “diagnosing” hospital problems, how do you identify the symptoms that point towards the health of a hospital. Here is what you should be looking for when you undertake a health check for your own or someone else’s hospital.
Customer Base: This goes without saying. If you have enough people who trust you to treat them, you are in business. The required patient flow for break even must be there. This not only includes inpatients but outpatients as well. Although outpatients may not appear to be adding a lot of value to revenue, they are very important nevertheless. It is from these patients that many of your inpatients will be generated.
Staff Engagement Level: A healthy hospital has highly inspired staff. People are willing to go that extra mile even if they are not paid extra for it. The staff turnover rates must be lower than industry levels. It shouldn’t be difficult to find a nurse or a driver who has been working there for many years.
If the management feels that it has nothing to do with staff issues and it is the HR department’s job to manage the ‘crowd,’ it is a bad omen. Top management has every resposibility to inspire and galvanize the workforce towards attaining the vision of the hospital.
People who Re-visit: A healthy sign for any hospital is the percentage of people who keep their repeat appointment with the doctor. Far too many patients wander away into oblivion without the hospital ever noticing it. Many times a patient has been given an admission date for an operation. Does anyone measure what percentage of times the patient actually gets admitted?
Take an example of a lady who tests positive for pregnancy on her first visit. How many times does a hospital take the trouble to find out whether she is coming for her follow up visit every month. After nine months, she is ready to deliver the baby. Thereafter, the new born undergoes the vaccination cycle for about 18 months. Not only this, the lady may also bring along with her a friend who is also pregnant. She may also encourage her father, who may be a diabetic, for a consultation with a physician. If this lady was lost’ after her initial diagnosis and never came back, without the hospital ever noticing, consider the amount of overall loss that would happen.
Clarity of Vision: What is it that you are aiming to achieve? Which direction are you headed towards? There is often ambiguity about this. The vision statement is created just for the sake of it. The management wants the statement to be mounted in an expensive frame on the wall. But the statement itself does not mean anything to many people. If that is the case in your hospital, you are not in good health.
The vision needs to be communicated right down to every nook and cranny of the hospital. Everyone not only should be clear about it, they should also be going that extra mile to deliver the vision. A set of core values along with the vision is often helpful.
Working Capital: The ability to meet day to day expenses is crucial for the health of the hospital. Revenue cycles have to be managed diligently. Nowadays, expenses come today and the returns come when the payer or TPA pays the money. This poses a challenge. Managing supplier payments and other expenses to create a favourable revenue cycle is a must.
Inventory Levels: Stock piling is a habit which more common than it seems. The pharma company offers a scheme, the pharmacy manager and the purchase jump on to the deal thinking they will save a lot of money. The stock is then gathering dust for many months in the warehouse or in the pharmacy. If you look further, you will hear similar stories about laboratory reagents, OT consumables and other areas. It is important to ascertain the daily/weekly/monthly usage and re-order levels for your stock keeping units.
This helps in dealing with the cash flow issues discussed in the previous point and restores the health of your hospital.
Consultant Alignment: Most hospitals have visiting doctors who operate for a fee. It is a great model if you think in terms of reducing your fixed costs. However, this model is found wanting when we consider the commitment levels of these doctors to fulfilling the vision of the hospital. They are working for themselves and I don’t have any problems with that. However, the hospital marketers seldom make any efforts to align the visiting doctors to the value system and vision of the hospital.
We can extend this further to all agencies that provide services to a hospital. If some functions are outsourced, it is a must that the ‘outsourced’ staff are aligned to the vision.
Capacity Utilization: Some facilities and equipment are under used in many hospitals. A healthy hospital uses its resources optimally. If you see a lot of facilities or equipment that is under used, you should know it is not a healthy sign.
One of the major reasons why facilities are under utilized in hospitals is that hospitals widen their scope too much. They want to do everything for everyone. This leaves a lot of scope for a lot of specialities not doing well. Here is the mantra: the wider you stretch yourself, the weaker you become. It usually works better to do a few things and do them well.
This list is not exhaustive, but it covers the key areas for assessment. If you can consider a few areas from this list and work on them, the health of your hospital will be better.
Prevention, after all, is better than cure!
Vivek Shukla is a leading healthcare marketing professional in India. Vivek completed his MBA from Lal Bahadur Shastri Institute of Management, New Delhi in 1998, a premier management institute in India. With over 6,000 hours of research and study, he has gained an ingenious access to tackle the challenges faced by the promoters and top management of hospitals.
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