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( By Dr Aniruddha Malpani )

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Chapter 12 - How hospitals can earn patient loyalty

Mr Puri is standing outside the ICU ward with his brother-in-law and in-laws. It has been three hours since his wife's surgery, and he is worried sick. 'How is she coping?', 'Does she need anything?', 'Has she eaten something?' are some of the questions in his mind. He attempts to ask the hospital staff for answers, but they refuse to placate his fears, giving him the standard answer: 'Wait till the doctor arrives.' Frustrated, he is left with no choice but to sit in the waiting lounge outside with his family members, a 'lounge' that lacks even basic facilities like tea and coffee.

Customer Relationship Management (CRM) is a tool which all service industries employ to keep their customers happy. Since hospitals are in the business of serving patients, one would expect hospitals to use CRM routinely, but most hospitals in India still do not bother utilizing this valuable tool. Given the chronic shortage of beds, most hospitals continue to take the approach that patients do not have a choice as to where they can go for treatment, which is why most hospital staff adopt a high-handed attitude towards patients. Stories of hospital staff rudeness and arrogance are innumerable, and this is reflected in the increasing number of incidents of violence against doctors and hospitals.

On the bright side, new progressive corporate hospitals are willing to learn from the hospitality industry, and are willing to implement CRM to provide their patients with a better experience when they come to the hospital. However, another tool that needs urgent implementation is PRM. No, it is not Patient Relationship Management that is being discussed here (though a lot of hospitals do not do a good job of that either!), but Patient Relatives Management. The need for this is much more acute in Indian hospitals! When most patients come to a hospital in India, they are accompanied by a bevy of friends, neighbours, and relatives. Sadly, these people are often ignored and neglected by the hospital staff and management. Most hospital staff members consider them to be a nuisance and tolerate relatives as a necessary evil. There are very few amenities available for family members, even for those who are on a 24-hour vigil outside the ICUs. Relatives are understandably concerned and worried about their loved one's health. They are key decision makers, and need to be educated and informed about what to expect. They need to be addressed politely and kept updated about the clinical status of the patient. Unfortunately, this is rarely done. Doctors (and sometimes, the more senior they are, the worse their habits!) seem to take a perverse pride in making relatives wait endlessly and often for completely flimsy reasons. They are not willing to share information about what goes on behind the intimidating doors of the operation theatre and ICU. This is why family members often get angry with doctors, and when the patient dies, they vent their frustration by burning down the hospital or beating up the doctors.

Doctors are very busy, and many may not have enough time to talk to even their patients, let alone their relatives! This lack of communication can cause frustration, and after bottling it up, relatives will often vent their resentment when a mishap occurs, even if the doctor was not to blame. This is a systemic problem, which can be addressed proactively by the hospital management. In order to protect doctors, who are now feeling very vulnerable, the government is passing laws

and hospitals are beefing up their security. However, this is a very short-sighted fix. It is far more important that hospitals start investing time, money and energy in educating patient's relatives, so they have realistic expectations of the outcome of the medical treatment. Dissatisfaction arises when there is a mismatch between expectations and reality, and helping relatives to have realistic expectations will help in reducing dissatisfaction with doctors and hospitals!

The most effective way of doing so is by setting up Patient Education Resource Centers (PERC) in the hospital. The PERC can be run by nurses and librarians and will help to educate patients and their relatives, so they know what to expect during their hospital stay. As Indian hospitals strive to attract medical tourists and match global standards (for example, by getting JCAHO accreditation), documenting that patient education has been provided is going to be an integral and indispensable part of patient care. The PERC will become an important department of the hospital. In the Mayo Clinic, the Dept of Patient Education occupies an entire building!

Not only are PERCs important for risk management, they are also very cost effective.All these relatives are prospective future customers for the hospital (after all, everyone falls ill at some point of their lives!). If they are treated with respect, they are likely to return to the same hospital for their own medical care when they need it.

We all know that the best kind of marketing is word-of-mouth marketing. Instead of wasting money on advertising in the press, it makes much more sense for hospitals to invest it in PRM. Relatives (and the patient's visitors) are potential customers. Why not educate them about health and illness? In a hospital, everyone has a much more heightened sense of their own mortality. When people visit a friend who is sick, they are much more acutely aware of their own frailty, and are more health conscious! Questions like 'What can I do to ensure that my husband does not get a heart attack like his elder brother did?' race through their mind. Reaching out to these relatives through a Patient Education Resource Center to help them learn more about their health can reap big dividends for the hospital because they are much more likely to seek medical assistance in a hospital which has taken the time and trouble to educate them.

PERCs can also be very useful for educating and training paramedical staff. The hospital support staff (such as ward boys and the janitorial staff) plays a very important role in serving the patient's daily needs. However, they are often not very well informed about hospital procedures. The PERC can be used to educate and train them, so they are more responsive to the patient's special needs, thus improving the relationship between patients and hospitals, and reducing untoward incidents.

PERCs can be strategically located in the hospital lobby, and theyoffer an inexpensive way for hospitals to provide a value- added service that differentiates them from the competition. They cost very little to set up, and need minimum space and staff. Indeed, they are a very cost-effective investment in Information Therapy!