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. 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

4. 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

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* !
&
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. SO , WHERE CAN 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
O U N M
D P I
B U S I N E S S Z
L R O L E
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
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

10. 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

11. 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

12. STAGE 2
V VISION
of what is possible
1
PATIENT CENTERED THINKING & PATIENT
has to be at the core of everything we
do.
FUN

13. STAGE 2
V VISION
of what is possible
2
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 VISION
of what is possible
3
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

15. STAGE 2
V VISION
of what is possible
4
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

16. STAGE 2
V VISION
of what is possible
5
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 2
A TECHNOLOGY PLATFORM
V THAT SUPPORTED ALL OF
THESE
6
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

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

19. 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

20. STAGE 3 : What patients had to say about their physician consult experience ?
FIRST
Reasons for Reasons for
Dissatisfaction Satisfaction /wow
set of concrete steps hardly
The doctor did
She just asked me one touched me to feel my
question and that’s it health problem
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 I
70%
I
I
%
0
1
I I
The doctor was busy doing I III
I
something else I
I
The doctor was busy
chatting with some
other doctor and
without even asking
me the details of my
pain – went on to
write prescription
Others
FUN

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

22. 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

23. STAGE 3
Some leads from the Doctor interviews
F 2.1
PATIENTS DON’T LIKE IF WE DIDN’T SHOW
CONCERN
Can we look at [the CORPORATE team make us type type and type]
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
DOCTORS MAY
? BE RELUCTANT
TO USE
COMPUTERS
time]
Whenever I HAVE EYE-EYE CONTACT
, I am able to BUILD A RELATIONSHIP with the
patient – PATIENTS LOSE FAITH IF WE
DON’T DIDN’T UNDERSTAND THEIR PROBLEM –
CHANGE
! WHAT YOU
Sometimes patients get frustrated with US
WE TEND TO FOCUS MORE on the
AS
DON’T monitor –sometimes patients tend to mistake us for
NEED TO

24. 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

25. STAGE 3
F 2.1
AN OPTION : BEST OF BOTH THE WORLDS
PEN & PAPER
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

26. STAGE 3
m
F2.1 IMPLEMENTED EVIDENCE min i
1.5
BASED CARE n
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
Patient Particulars ,Illness Summary, Vitals ,
Observations and Drug Therapy also meant that we
could steal close to 8.5-10 minutes’ of the care givers
time to the patient.
2
CONSISTENCY IN DECISION
MAKING
2
Clinical Quality Head could first Audit Physician’s
decision making by using these filled forms as a “PROXY”
– and then could spend time with the Physician on
improving practice/outcomes.
THE ONE PAGE EMR THAT WE CREATED BECAME OUR AUDIT
9 MINUTE/PATIENT
TOO AS WELL !

27. 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 THAT I
DELIVER
CLINICAL
PROTOCOLS FOR 60
The rules
MOST COMMON
CONDITIONS
COMPARABLE
TREATMENT
OUTCOMES
ACROSS 100
LOCATIONS
SOUGHT
! SUPPORT FROM
A PROTOCOL
DEVELOPMENT
FIRM.

28. 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
? KNOW IF THE
PATIENT LIKED US
0 1 2 3 4 5 6 7 8 9 10
AND KNOW THAT
WE CARE ? A Net Promoter Score can be Promoter 56%
calculated by subtracting the
percentage of detractors from
the percentage of Promoters.
Passive 30%
% Promoters
- %Detractors
WE Detractor
! IMPLEMENTED
NET PROMOTER
Net Promoter Score 14%
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

29. SO WHERE DID WE INNOVATE !
FIRST
F set of concrete steps
SCALE
ROLE AUGMENTATION
PROTOCOL DRIVEN
CARE
EMR : PAPER & DIGITAL
PATIENT CENTERED
OUT PATIENT BUSINESS
MODEL

30. 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

31. It’s time for YOU to Innovate

32. Thank
You
Medium is a healthcare consulting firm. Our services include
Business Strategy, Marketing & Sales, Quality & Patient Experience,
Performance Transformation, Healthcare Franchising. and Public
Health. We are innovative, passionate and performance-driven.
But, most of all, we are committed 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

33. 1 INNOVATION FOCUS WORKSHOP
8
4 EXPLORE
2 CORE TEAM INTRO MEETING PREPARATION
WORKSHOP OBSERVE &
LEARN
FULL STEAM AHEAD WORKSHOPS
3 KICK OFF WORKSHOP
OBSERVE & LEARN
EXPLORE
5 TRENDS & TECHNOLOGY
7
6 DISCOVER
CUSTOMER EXPLORE
FRICTIONS INNOVATION
OPTIONS
9
NEW
PRODUCT
RAISE IDEAS
10
1ST
CONCEPT
IMPROVEMENT
WORKSHOP