March 20, 2013 BOMBAY HOSPITAL, INDORE

FINAL REPORT

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INTRODUCTION

BOMBAY HOSPITAL

Bombay Hospital was established over five decades ago, in 1952, as a result of the enormous philanthropy displayed by Shri Rameshwardas Birla, Founder Chairman of the Bombay Hospital Trust. It began as a 440 bed hospital whose objective was, in its founder’s words, “to render the same level of service to the poor that the rich would get in a good hospital.”

Today, the hospital has grown to house over 830 beds, some of the country’s most advanced diagnostic & surgical equipment, and offers a comprehensive range of specialized medical services. The objective however, remains unchanged, which is why 33% of the patients treated are in the general ward and pay only for their medicines and consumables. The free OPD at the hospital successfully treats in excess of 1, 00,000 patients each year. It is on this sound foundation that the hospital has based its pursuit of excellence in every field of medical specialization. This has seen fruition in the form of the Medical Research Centre now known as the M P Birla Medical Centre.

The Bombay Hospital presently ranks among the finest multi-specialty tertiary level medical centers in the country. The internationally renowned panel of doctors and consultants in every field of specialization have, at their disposal, cutting-edge equipment. Supported by a highly trained and professional nursing staff

Vision: “To render the same level of service to the poor that the rich will get in a good hospital” Mission “Bombay Hospital shall provide the best possible medical treatment, delivered most efficiently, in the shortest possible time, at minimum cost, to all sections of the society, irrespective of caste, creed or religion.”

INDUSTRIAL VISIT TEAMS

. BUSINESS PROCESS IMPROVEMENT – GROUP 58 . CUSTOMER RELATIONSHIP MANAGEMENT – GROUP 59 . COMMUNICATION OF STRATEGY TO THE PEOPLE – GROUP 60

A firm is managed when the different parts of functions to maximize the collective effort and not individual ones. In our analysis we have mentioned them separately but worked together which was instrumental in pulling the veil off certain intricate yet noteworthy aspects of running a business in healthcare industry. Hence we begin by analyzing the industry.

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Growth factors of the healthcare delivery market

To be able to design a proper strategy in the healthcare industry it is important for us to understand the key factors of growth. We would need to address the problems on these parameters. The major factors for growth in the healthcare delivery market would be:

Increasing health awareness

Rising income Change in levels disease profile

Growth in Healthcare Industry

Health Change in insurance demographics coverage

Medical tourism

Change in demographics

As the population and the life expectancy is expected to grow, we expect a higher health coverage in India. The India population is expected to grow from around 1.2 billion in 2011-2012 to around 1.5 billion by 2026.

The current number of beds per 10,000 persons is 9 while the global median is 24 beds per 10,000 persons.

Thus the aging and increasing population along with the deficit of number of beds is an opportunity which hospitals must harness and if backed with a proper strategy, it must try to expand aggressively in this domain.

These are the projections of the population growth of the Indian population and as we can see, the total population of India tends to increase to 1.55 billion by the year 2026. This opens up more opportunities for the healthcare sector and a program of expansion is highly recommended for the healthcare industry.

Currently there are around 11 Lakh beds and by 2017 we would need 72000 more beds if we need to maintain a mere 9 beds per 10,000 people.

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Since the life expectancy is increasing, the proportion of population above 60 years is on the rise and is expected to rise over 12 percent by the year 2026; currently the level is at around 8 per cent. This would increase the requirement for the healthcare delivery for the senior citizens. This is a demographics that we need to look at for a greater coverage of the healthcare in the years that are to come.

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Quality healthcare through rising income levels

Although healthcare should not be considered to be discretionary expense, in India the high-quality healthcare facilities are not affordable to a major section of India’s population.

The next 5 years show that those who fall in the lowest income bracket – below Rs 1 lakh per annum – and this is expected to fall from 56 per cent to 41 per cent by 2016-17. While the share of the households in the income bracket of Rs 2-5 lakhs is expected to increase up to 31 per cent in 2016-17 and indicates the rising disposable income.

Thus increasing the purchasing power which in turn stimulates the growth of the industry.

Health awareness rise to boost hospitalization

With the new literacy initiatives at work we can expect the awareness level of the disease to increase and that would increase the awareness of preventive and curative healthcare. This would increase the demand for the healthcare services.

Primary research data indicate that this rise will be from the current 83 percent in 2011-12 to a stronger 88 per cent in the year 2016-17.

Lifestyle diseases increase

The illness caused due to improper lifestyle habits are increasing rapidly in India. These habits are shown to be more in the higher income level groups and thus we can expect the increasing income bracket groups to exhibit a higher need for the hospitalization needs.

Those who are in the 5 lakhs and above income bracket are expected to have a share in lifestyle diseases of 5 per cent by 2016-17 from the current 3 per cent in the year 2011-12. Demands in the areas associated with cardiac ailments, diabetes and oncology can be expected to rise in the coming years.

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Health coverage increase to increase demand

WHO’s World health statistics show that over 86 per cent of India’s private healthcare expenditure is incurred through out of wallet expenditure for of India’s population only 5 per cent subscribes to health insurance. The increasing penetration due to hospitals and increasing rates of hospitalization are due to increase.

The health checkups which is a compulsory part of health insurance coverage are expected to lead to an increase in the healthcare industry.

Medical tourism in India

Over the years the medical tourism industry has increased and India is a major destination for the health tourism. Associated Chambers of Commerce and Industry of India (ASSOCHAM) the number of medical tourists visiting India are due to increase to 32 lakh per annum by 2015; the current figures stand at 8.5 lakh tourists per year.

Due to lower healthcare costs in India it has become extremely lucrative for those living in developed countries tend to come to India to get treated. India offers many advanced medical facilities in areas of cardiology, joint replacement, ophthalmology, urology, organ transplant and orthopedics.

These are the critical factors which would attract more tourists to India.

As we can see the future prospects of the Indian Medical Industry looks bright and has a lot of potential for rapid growth. Hospitals should take this in to account while devising their long-term strategy. Such aggressive expansion would need bolstering facilities and investments to maintain the quality of the healthcare provided.

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BUSINESS PROCESS IMPROVEMENT

Identification and removal of bottleneck in the discharge process The procedure of discharging a typical self pay patient may take as long as six hours, and this proves to be strenuous to the recovering individual as well as to the members of his/her family. As a result, the hospital has been experiencing heightened frequency of complaints by both patients and the members of their families. Additionally, the lengthy discharging process limits the bed capacity thereby making it difficult to admit new patients. This is detrimental to the society and, besides, it ends up decreasing the amount of revenue making it difficult to grow or acquire new technologies. The most time consuming processes are: returning of medicines and processing of discharge papers.

The Principle Bottlenecks that Lead to Delayed Discharge The first bottleneck among those that undermine the optimal operation in this hospital is the delayed commencement of the discharging process. This is attributable to the failure of the management to create care plans with clearly spelt out lengths of stay as well as projected date of discharge. It is common to find the discharging process being set off unpredictably, in fact, just after the consultant declares the patient to be fit for discharge. This happens during the routine rounds, and it proves to be intriguing as the discharge was evidently unforeseen or, at least, predictable.

Secondly, an additional challenge during discharge is experienced during the completion of the patients’ discharge cards. This happens because most of these cards are handwritten, and the process of filling them begins just after the consultant has a signoff during the day of discharge. Furthermore, there are instances when, even after being approved for discharge, the patient is delayed at the facility since the relevant signatories cannot be traced in time. Some consultants, for instance, delay signing of the discharge cards; and these results into a situation where the cards are unnecessarily held in an office or two.

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Likewise, there is a delay in the preparation of the final bill which is occasioned by tendency of the wards delay until the billing files have increased to a certain number before they are forwarded for processing at the billing counter.

Finally, there is a considerable delay during the financial clearance. This problem is brought about by the failure to immediately inform the attendants that the final bills are ready for computation. As a result there is usually late entry of charges, and this may lead into an increase in charges in the interim making the final bill questionable.

RECOMMENDATION FOR THE ELIMINATION OF THE BOTTLENECKS In order to reduce the time taken during the discharge of patients, certain steps ought to be considered by the management. First, the management ought to device a system where the planning for discharge begins soon after the patient has been admitted. To this effect, therefore, the management of the facility should strive to put into place a care plan for all elective patients within 24 hours of admission. As such, the patient, his/her family, as well as the entire care team would be in a position to prepare for discharge when it is due. This will orient all the parties involved to start off the discharge predictably 24 hours before the discharge day arrives. It would be of great benefit if the management enforced a daily updating of the discharge cards. This would alleviate the challenge that the medical staff goes through on when discharge day arrives. In order to maintain a high level of efficiency, those tasked with the responsibility of completing discharge summary should be required to accomplish their tasks within the shortest time possible, say, 10-15 minutes after discharge has been approved. The management should ensure that the patients’ case files are updated daily. This will ensure that the case files are in the required state when discharges are approved. The hospital administration should also ensure that discontinued medications are returned to the wards on a daily basis. To this effect, therefore, there is a need to minimize the role that the pharmacists have to play soon after the patient has been discharged. This is because a significant amount of time is wasted when the patients are acquiring drugs at the hospital pharmacy. Eliminating the need to secure medication from such locations would significantly cut down on the duration of time that the patient spends during the discharge process.

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In addition, it is recommendable for the charges to be recorded at the very time and point that they have been accrued. This will undoubtedly help in the speedy generation of up-to-date interim bills. Besides the elimination of the errors that often occurs when the computations are hurriedly completed, the patients would find it convenient as they would not be delayed unnecessarily.

Finally, it is recommended that the hospital administration embraces technology so as to realize quicker bill settlement. This can be achieved through the integration of an automatic SMS or email system that would enable the patients or their relatives to be updated on the developments as well as the outstanding bills. However, caution should be taken on this so that the hospital does not share the patients’ medical data with unauthorized parties. Should this happen, the hospital management may be tasked to answer charges in a court of law; and this would, in effect, result into time wasting and further derailment of service delivery at the facility. Therefore, the telephone numbers and emails should be those that have been provided and authorized by the patient or close family members.

IMPLEMENTATION The implementation plan should be devised in a manner that facilitates its division into phases as such phases do act as milestones that boost the morale of those who are involved in the discharge process. Firstly, there is a need to conduct an interim discharge process in a ward using the existing resources with, possibly, minimal modifications to the health information that is normally handled at the hospital. This interim process would deliver significant improvements that would then act as the basis for implementing larger programs. Such an arrangement would ensure that the final process meets the target efficiently. It is, however, imperative for the hospital management to keep on evaluating the discharging process for the purpose of improving it. This is because new challenges arise with time, and neglect or delays may, actually, result into detrimental consequences to the entire hospital fraternity.

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Identification and Removal of Functional bottlenecks Functional bottlenecks are caused by services that have to cope with demand from several sources. Radiology, pathology, radiotherapy, and physiotherapy are often functional bottlenecks in healthcare processes. Functional bottlenecks cause waits and delays for patients because:  One process, such as ENT surgery, might share a function, such as imaging with other processes, e.g. orthopedic surgery, and medicine  A surgeon may be called to theatre when he is also needed in outpatients. This type of bottleneck causes a disruption to the flow of all patient processes. Functional bottlenecks act like a set of traffic lights, stopping the flow of patients in one process while allowing the patients in another process to flow unheeded. Where you have a bottleneck, there is usually a queue i.e. a delay that the patient will experience.

Methods for reducing the effect of bottlenecks  Ensure that the bottleneck has no idle time, for example, have a list of stand by patients who can be called at short notice in the event of idle capacity  Put inspection or checking tasks in front of the bottleneck (e.g. if the bottleneck is the doctor in clinic, check that all test results are available at the clinic)  Don't allow the room or clinical area to be the bottleneck  Distribute the work amongst the clinical team so that everyone works to their highest level of skill and expertise, for example take administration away from rehabilitation nurses and give it to appropriate clerical staff  If experts are the bottleneck they should only be doing work for which an expert is needed e.g. the development of nurse initiated transfer from critical care  Separate responsibilities for clinical care and paper flow  To increase the capacity of the bottleneck, give some of the work to non bottleneck areas, even if it is less efficient for these areas  Having improved the situation at one bottleneck, others may emerge as rate limiting steps in the patient journey. Bottleneck management is, therefore, a process of continual improvement.

BOMBAY HOSPITAL, INDORE | 1 0 Effective Capacity utilization of the hospital Bombay Hospital has seen an increase in admissions. In addition, the hospital's emergency department volume has risen. To accommodate this burgeoning volume while avoiding a similar increase in costs, Bombay Hospital has had to invest in capacity management strategies that optimize efficiency.

Capacity management links to strategy Capacity management can have a significant impact on the hospital's financial strength, as it involves the purchase and distribution of high-cost resources, including staff and supplies. Utilization affects more than just finances, however; it contributes to quality and patient satisfaction.

Five strategies Bombay Hospital can use to improve capacity management.

1. Right size the organization: When a hospital has sustained efficient operations for a period of time, its leaders should assess the amount of space available and patient demand and right size the organization. For example, if a hospital has three 30-bed units each consistently running 20 patients daily, the hospital may consider closing one unit and consolidate the patients into the two remaining units. The hospital can reassign the staff from the closed unit to any open positions in the organization, which can reduce the expense of overtime for employees in shorthanded areas. Hospitals also have the option of closing and opening units temporarily as needed depending on patient volume. Hospitals may opt for this choice if they experience significant swings or seasonal changes in patient volume.

2.Develop organization-wide awareness: There should be awareness among leaders and employees of the need to improve utilization and streamline care and this will lead to greater efficiency and savings. This can be achieved by creating a multidisciplinary patient throughput committee that evaluates throughput and creates initiatives to improve it.

BOMBAY HOSPITAL, INDORE | 1 1 3. Establish a patient logistics department: Another change that could make a great impact on capacity management at Bombay Hospital would be to establish a centralized patient logistics department. The department should be run by a director of patient logistics who has the tools to monitor the status of beds — whether dirty, in the process of being cleaned, available or occupied. The director also need to have a transport notification system that showed where people were moving in the hospital, allowing the organization to efficiently assign patients and staff to different areas of the hospital based on availability.

4. Communicate clearly and often: Communication is essential in ensuring safe and timely transfers of patients between levels of care. Improved communication between the Bombay Hospital staff and receiving units would help lower length of patient’s stay.

5. Engage hospitalists: Bombay Hospital's hospitalists would be a valuable resource in improving capacity management. Their expertise in inpatient care and the hospital's case robust management program would help to reduce the average length of stay.

 Streamline the pharmacy process( Medicine distribution) Initiate a pharmacy improvement program to enhance hospital pharmacy systems and processes to support safer, more efficient and cost effective medication management and patient care in the hospital. This programis to introduce to optimize business processes and provide access to increased functionality such as Highly Specialized Drugs (HSD) online claiming and future e-healthsolutions. The new systems and processes will bring greater efficiencies, freeing hospital pharmacists to work with their medical peers to ensure better outcomes for patients.

The new program should thrive to achieve the following:  Provide ongoing system (application deployed at the pharmacy) support and streamline system solutions and future upgrades.  Improve patient safety and simplify procurement through the development of a Hospital pharmaceutical products list.

BOMBAY HOSPITAL, INDORE | 1 2  Standardize the way in which data is captured, viewed and reported across Bombay Hospital  Increase procurement and reporting efficiencies  Improve the ability to report on clinical functions and pharmaceutical spending  Improve information accessibility across sites, e.g. tracking records and scripts for patients transferred between hospitals  Reduce waiting time for people waiting in queue for medicines by applying concepts of operations management for waiting lines in service systems. Determine the variables namely, number, type (e.g...- 2 types of machines or combination of people and machines that would produce different service rates), configuration of servers (dedicated servers or server catering to all types of customers), queue capacity and number of queues required. Accordingly apply principles of queuing systems for efficiency. Multi-server systems having exponential service times are advisable in Bombay Hospital’s case.  Efficient way to solve wheelchair problem In hospitals, wheelchairs are just as commonplace as patients. Unfortunately, due to budget and space concerns, there are not enough wheelchairs for each patient. This means wheelchairs areused only during patient transport, and then made available to anyone once no longer utilized. In an ideal world, this method works perfectly. However, since the supply is low while demand is high,wheelchairs are constantly being pushed around to different parts of a hospital; making it difficult to immediately locate one when needed. In addition, hospital workers adopt a behavior where theyattempt to plan for upcoming needs, leading to wheelchair hoarding and hiding as a commonoccurrence.

Initiate a program enables users to locate a wheelchair within their vicinity basedupon the chairs availability. Hidden wheelchairs cannot help patients. Enabling staff to locateavailable wheelchairs quickly and easily resolves this issue by making availability and locationavailable to anyone who needs a wheelchair. This not only reduces the hoarding of wheelchairs, but also reduces the time it takes to locate a wheelchair and return it to a patient who needs it. Also, bykeeping track of a wheelchair’s location theft levels may reduce as well.

BOMBAY HOSPITAL, INDORE | 1 3 CUSTOMER RELATIONSHIP MANAGEMENT

Objectives 1. To develop an understanding of the issues related to the customer relationship management during our visit to the Bombay Hospital, Indore. 2. To study the best practices followed in Hospitals around the World to provide a solution to the issues identified Identification of Problems CRM as a tool is generally used to maintain better relationship with the customers which are already served. However we have looked at customers with a broad view point of the Hospital. For that reason, we have included staff, the attendants along with the patients as well as the person involved in entire admission process as our customers. With this view we identified some issues as a part of customer relationship management for Bombay Hospital, Indore. These issues are as stated below: 1. Reducing no. of attendants along with the patients 2. Reducing attrition rate of the staff workers 3. Proper way to communicate the admission process to the incoming patient/Attendant Major Stakeholders in Healthcare In Healthcare, the definition of quality can be complex and controversial because of the different views of people with a stake in good Healthcare.

 Providers: Providers are those employees who provide the actual services which includes the Doctor, Nurses and the support staff which conducts various tasks. They tend to view quality in a technical sense – accuracy of diagnosis, appropriateness of therapy, resulting health outcome.

BOMBAY HOSPITAL, INDORE | 1 4  Payers: Payers are either patients or their attendants who makes the payment on behalf of the medical service provided. They focus on cost-effectiveness of the services provided to them, along with no compromise on the quality of the services.

 Employers: Employers want both to keep their costs down, and to get their employees back to work quickly. They want low attrition rates among the employees, and also expect them to go out of their normal responsibilities to help the patients.

 Patients: They want compassion as well as skill with clear communication. They want clear information on the kind of diagnosis that they have been put through. Also their own life is at stake and they cannot tolerate any negligence on the part of the hospital or medical service provider.

Potential areas of conflict Patient and employer:

 Patients expect an employer to offer a wide variety of options for health coverage that can be customized to their specific needs. They also look for the employer to fund the majority of the cost of health insurance. Basic premise is to provide the most options, and the least out-of-pocket cost to the employee.

 Employers want to maintain or lower their cost contribution. They want the patient/employee to seek only needed care, follow providers’ instructions, and recover quickly to full utility. Patients should also seek to reduce their health risk behaviours, i.e. diet, exercise and smoking cessation.

BOMBAY HOSPITAL, INDORE | 1 5 Providers and payers:

 Providers want to provide the best service using the most accurate and newest tests and treatments (also likely most expensive). They also want to provide preventative care which the insurance company (payer) may not cover. Payers also want providers to follow a clear, evidence based, diagnostic plan and reach an accurate diagnosis and treatment plan with the fewest visits and least number of tests.

Customer Relationship Management in Healthcare One of the most interesting aspects in healthcare management is how to manage the relationship between a healthcare provider and its customers (patients) in order to create a greater mutual understanding, trust, and patient involvement in decision making. A good relationship between a healthcare provider and its customers will lead to improve customers’ satisfaction, which in turn make them loyal customers. A good relationship between a healthcare provider and its customers does not only improve customer’s satisfaction, but also helps in fostering effective communications between them, which may help to improve their health and health-related quality life and more effective in chronic disease management. On the other hand, failure in managing the relationship will create dissatisfaction of customers, which may lead to distrust towards the system. In addition, bad or unmanaged relationship with customers will make them feel alienated during a treatment; in summary, the business sustainability of the healthcare provider will be threatened by sour relationship with its customers. Therefore, a good relationship between a healthcare provider and its customers is crucial and the relationship must be managed effectively to sustain the business.

BOMBAY HOSPITAL, INDORE | 1 6 HEALTHCARE VALUE CHAIN: It is important to examine each business process as a layer of value to the service. Patients place a value on these services according to quality of outcome, quality of service, and price. The value of each layer depends on how well they are performed. When a healthcare provider cannot achieve its strategic objectives, it needs to reengineer its activities to fit business processes with strategy. If the business processes do not fit the strategy, it will diminish the value. For example, the value of a health education is reduced by a delay respond of patient’s query or poor communication skills. The value of service is reduced by a poor schedule of physician.

Registration Patient Discharge Marketing Service

Fig: Value Chain for Healthcare

CUSTOMER SERVICE IN HEALTHCARE: As a business, healthcare organization stands in need of the same standards of customer service as other industries or business organizations. The fact that customer service expectations in healthcare organization are high poses a serious challenge for healthcare providers as they have to make exceptional impression on every customer. Healthcare organizations strategies should transform customer strategies and systems to customer engagement. Proactive strategies will improve customer services. And great customer support will increase loyalty, revenue, brand recognition, and business opportunity.

Reacting to problems after they happen is usually more expensive than addressing them proactively. History provides a good lesson that the healthcare organization is not able to manage the relationship with their patients. Moreover, the hospitals should be able to manage conversation with the patients which is missing in the case of poorly implemented CRM.

BOMBAY HOSPITAL, INDORE | 1 7 METHODOLOGY OF STUDY Initially the Methodology that we used in this study is by surveying different people (Patients/Their relatives) coming to the hospital. This survey majorly consisted of four major parts. They are  Design  Sampling  Data Collection and  The Data Analysis

Design: Since the data needed from different groups of people varies, hence we majorly designed our survey into three major groups to collect different data. They are  Quantitative data  Qualitative (descriptive) data  Both Quantitative and Qualitative data

Sampling: Since we cannot consider the entire hospital customers (All the patients) as our sample, hence we considered different mix of patients in our sample. They are  Patients joining in the hospital (In Patients)  Regular Patients coming for consulting the doctor (Out Patients)  Patients coming for second reference

Data Collection: We collected both Quantitative and Qualitative data depending on the type of patients. We generally collected Quantitative data from patients coming for second reference and Qualitative data from Out Patients and both types of data from In Patients. We collected both types of data from In Patients because these patients stays in hospital for longer time compared to other kind of patients, hence we can have information in different areas.

BOMBAY HOSPITAL, INDORE | 1 8 Data Analysis: After collecting the data, we carefully analysed it. One interesting thing what we found here was that the patient’s feedback or Survey during the treatment time and after the treatment is widely varying. The major reason for this is that once the treatment is over and the patients are cured, they say that hospital and facilities are good but they cost higher or some other reason. This happened with many people. Hence we changed our Methodology from this ‘Survey’ type to discussing with various teams in the hospital where patients have interactions. We discussed with many people working in reception, where every patient will interact with them continuously. We had class room discussion with different departments say it with people from marketing team, people working in the pharmaceutical department where medicines are issued to the patients. We discussed with people from insurance department. We interacted even with people working in the Lab department where they collect the samples of patient’s blood and other required things and finally with the team who takes care of the keeping the “Patients illness history/record”.

Schedule of Activities:

Day 1: We met our guide (Feroz Sir) on day1. We discussed with him the need for this Industry Visit. Later part he introduced us to the different departments in Bombay Hospital. Also he gave a clear picture of the functioning of any hospital and in particular Bombay Hospital. We also discussed with him the game plan on how we want to go ahead in the coming weeks of our Industrial Visit.

Day 2: We discussed with the group and with our guide about how to go about with Customer Relation Management and Designed a Survey for the same. We gathered some information (Surveyed) from different patients.

BOMBAY HOSPITAL, INDORE | 1 9 Day 3: On day 3 also, we gathered some more information from other patients. We also got introduced to some more departments like ‘Patients Record Keeping’ department and some other departments like ‘Hospitals Laboratory’ etc.

Day 4: We finally analysed the data based on the past two weeks information that we collected. Then based on the results we came to a conclusion that we need to change our Methodology of study because the data that we collected is not showing consistency. We also worked on why that is happened and found that patient’s priorities in terms of satisfaction changes before the treatment and after the treatment (from doctor’s service to cost of the treatment). We then discussed with our guide and decided to change our strategy in terms of the methodology of study. Then we decided to discuss with different teams in the hospital where patients will interact with them directly or indirectly.

Days 5, 6, 7, 8: We met people from Marketing department, discussed with them on various aspects. Then we met people from Pharmacy department, discussed and understood various problems involved in their department. One major issue is that at peak times they are facing a lot of trouble in distributing the medicines. We also met people from departments like “Medicines Inventory Control”, “Hospital Laboratory”,“Reception”,“Food Serving” and various other departments and discussed with them on the same lines. Day 9: On the last day, we discussed with our guide on each and every aspect of what we found during the last eight weeks of our Industry Visit. We got suggestions from him on different aspects and we modified the report accordingly.

BOMBAY HOSPITAL, INDORE | 2 0 Bombay Hospital– Indore:

•Fire fighting system: On the roof of each room or hall, sprinkles are attached so that whenever any emergency occurs (like anything in the room catching fire, or smoke coming out) these sprinkles automatically start throwing water in all the directions. •Laundry: The hospital has self-automated washing machines. These machines automatically get the water and surf for the type of cloth present in that machine. •Supply of Electricity: The hospital campus has got 2 DG sets, which starts automatically whenever there is a power cut. In case the first DG set fails, the other one automatically starts up. •Physician Credentials and Experience: The Medical Staff sets the standards for those who may practice in the hospital and monitors the performance of each physician. The ability to practice at Bombay Hospital is granted by the Board of Directors on the recommendation of the Medical Staff. There are approximately 45 consultants who practice regularly at Bombay Hospital. •Electronic Medical Record: The results of laboratory studies are posted to the electronic record as soon as the lab completes them. In addition, physicians may view the patient's X-ray studies on the computer monitor along with the radiologist's expert interpretation of the study. Allows physicians to order medications by computer. All discharge summaries are accessible on- line and physicians even sign their reports electronically. Types of facilities: 1. Out-patient facilities 2. Free OPD 3. Paid OPD 4. Executive health check-up 5. Consultation 6. Investigation 7. Minor Trauma 8. Vaccination 9. Health scheme 10. Psychotherapy 11. Dialysis, etc.

BOMBAY HOSPITAL, INDORE | 2 1 In-patient facilities: The hospital offers comprehensive tertiary healthcare facilities, is centrally air-conditioned, has 10 Operation Theatres, offers services for all super specialty to the neuro-surgery, urology, neurology, cardio thoracic surgery etc., and 36 Intensive care beds (Medical, Surgical, Cardiac, Neuroscience, Paediatric, Neonatal and High dependency units). In-Patient rooms are of six different categories: 1. General Ward 2. Deluxe Room 3. First Class 4. Private Room 5. Semi –Private 6. Economy Ward

Specialties available: 1. Cardiology a. The Cath lab is state of art Integris Allura, The machine has special filters to protect the patient from harmful radiations. b. Special filters are provided in the machine to minimize radiation. c. Uncompromised Cardiac and vascular applications d. Positioning Speed up to 50 º/sec e. Very High frame rates - up to 50 / 60 fps

2. Urology a. Department has highly qualified Urologists, performing all types of Urology surgeries, both planned & emergency. Especially Endourology (PCNL, Ureteroscopy, Endopyelotomy, TURP etc.) b. All types of Laparoscopic Urology Surgery including Lap-nephrectomy, Lap Adrcnelectomy, Lap-Pyeloplasty etc, and Female Urology Surgeries. All Paediatric Urology Surgery and Andrology(male Erectile dysfunction and male Infertility) 3. Cardiac Surgery 4. Cancer Surgery a. Surgeons have had extensive experience in the field of cancer surgery and have been doing high quality work. Successfully treated cancers of Oral cavity, Throat, voice box, Salivary gland, Breast, food pipe, Lungs, Stomach, Colon, Uterus and Ovary.

BOMBAY HOSPITAL, INDORE | 2 2 5. Neurology a. Department has treated all types of acute and chronic neurological diseases and emergencies specially Brain stroke, Myasthenia Gravis, GB Syndrome, meningitis, Encephalitis, Epilepsy and headache. b. Round the clock availability of three super specialist Neurologists. c. Injuries & other acute and chronic Neurological illness are being treated successfully d. EEG / EMG facility available under single roof e. All Neurological investigation facilities including - CT Scan / MRI / DSA f. Well-equipped Neuro intensive care unit maintaining 1:1 patient nurse ratio and ventilator with each bed. 6. Ophthalmology a. Consultants are using advanced German operating microscope for all Eye surgeries, department has got world class, state of art equipments like Phaco emulsification machine, tonometer and refractrometer. b. Surgeons are trained in all types of eye surgery, both anterior & posterior segments of eye. 7. Neurosurgery a. Dedicated Neurosurgery OT, equipped with international standard of equipmente.g. German Operating Microscope. b. Department is supported by well-trained nursing staff who can take care of patients peri- operatively and are capable of delivering high quality critical care along with most advanced Radiodiagnosis like CT Scan and MRI. c. Centre is carrying out surgery of ruptured aneurysms. In past one year, successfully operated more than 225 major cases like: i. Vascular-AV malformations and Angiomas ii. Skull base surgeries iii. Spinal surgeries d. OT is specially equipped for carotid endarterectomy and Epilepsy surgeries for intractable Temporal lobe Epilepsy

BOMBAY HOSPITAL, INDORE | 2 3 8. Surgical Gastro-enterologist a. Department has successfully treated patients of pancreas, Liver, Esophagus, Stomach, Intestine, Colon, and Rectum diseases. b. Does all types of Laparoscopic surgery for Gall Bladder, Appendix, Hernia, Intestine and Liver cyst. 9. General Medicine a. Dept has specialized in management of complicated patients who have multi-organ failure as a result of Falciparum Malaria, Dengue fever, Septicemia, Chest infections, HIV, Cancers etc. b. Diagnosed patients having problems like pyrexia of unknown origin, connective tissue disorders, chronic and acute respiratory disorders, multiple drug resistance TB. 10. ENT a. Department has managed different types of ENT cases, especially FESS (Endoscopic surgery for sinuses), Micro-laryngeal voice conservative surgery, Mastoid surgery and Tympanoplasty. b. Department has tackled different ENT emergency cases successfully such as foreign body removal from respiratory passage as well as from food pipe. 11. General Surgery 12. ICU a. Has 36-bedded state of art unit with sophisticated equipment. b. Personnel available for 24 hours of the day - at least 4 doctors in every shift c. Patient to nurse ratio for critically ill patient is 1:1. d. Equipped with 15 modern touch screen ventilators and with 36 bedside monitors with different modules to monitor vital parameters of patients like BP, pulse, temperature, respiratory rate, blood oxygen levels etc. e. ICU has got one Arterial Blood Gas machine, which can give electrolyte levels as well as ABG reports of patient within 1 minute. Blood sample need not be sent to laboratory. f. An excellent laboratory and a blood bank with component lab also support the ICU 24 hours of the day.

BOMBAY HOSPITAL, INDORE | 2 4 g. Treated different types of critically ill patient such as malaria with multiple organ involvement, septicemia with multiple organ failure, poisonings, Medical Oncology emergencies, poly trauma etc. 13. Gastro Enterologist a. Dept has successfully treated patients of pancreas, Liver, Esophagus, Stomach, Intestine, Colon, and Rectum diseases. b. Does all types of Laparoscopic surgery for Gall Bladder, Appendix, Hernia, Intestine and Liver cyst. 14. CT / MRI a. Department of CT scan is equipped with state of the art Siemens multi slice spiral CT scanner that allows performing a wide variety of CT procedures with a high degree of diagnostic accuracy. b. Tesla MRI machine provides excellent picture quality. Life supporting systems like ventilator, and equipment to give anesthesia is also available in the department. 15. Nephrology a. 24 Hour Dialysis facility b. Consultant Nephrologists available in hospital premises for all dialysis. c. All dialysis on machines with facility of sodium profiling. d. World class R.O. water treatment plant. e. Dialysis of serious patients on ventilator in ICU also done. 16. Pathology a. In hematology section, the hospital has top of the line HMX Coulter cell counter that provides 5 part differential blood counts. b. Bombay hospital is the first in MP to bring closed system fully automated biochemistry analyzer. c. Has Bactec Blood culture system, which can grow bacteria in shortest time period that helps treating patients with appropriate antibiotics. d. Separates blood into its components, so that a patient gets required component.

BOMBAY HOSPITAL, INDORE | 2 5 17. Orthopedics a. Orthopedic OT equipped with remote controlled German Fracture table, C-Arm with 9 inch eye, b. Ortho surgeries: accident & injuries being operated with state of art fixation techniques like interlocking nail etc. c. Joint replacements (both hip & knee) d. Sterile OTs. 18. Radiology a. The multispecialty radiology department is equipped with the latest ultrasound machine Philips ALT HDI 5000 with sono CT that has the advantage of superior resolution and clarity as comparable to CT. The vast array of probes enables performing specialized ultrasounds in addition to the routine. b. Routine abdominal, crynec robs, paediatric sonography. c. Small parts (Thyroid, Scrotac ophthalmic, transcrainas. d. Color doppler (Carotid, Peripheral arterial/venous, penile). e. Interventronal ultrasound -(FNA, Biopsey, Pigtail insertion, nepheostony, Abscess dramage, Asutes/Pleural aspiration). f. X-Ray department has 300ma & 500ma machine with image intensifier. g. Does various special procedures such as barium studies, HSG, INP's, MCU, ascending urethrography, fistulograms. 19. Pediatrics 20. Physiotherapy a. Provides physiotherapy round the clock, in all chemical specialties. such as : Cardiothoracic , Orthopaedics, Neurology, urology, paediatrics, Geriatrics, Oncology, Sports, Gynaecology-Obstetrics, General Surgery, General Medicine and many other common conditions. b. Advanced Physiotherapy treatment available for hypertension, Diabetes, Insomnia, Anxiety Neurosis, Obesity. Depression and many other physical disabilities.

BOMBAY HOSPITAL, INDORE | 2 6 21. Gynaecology & Obstratics a. Department has successfully managed all high risk pregnancies like Pregnancy with DIC, Toxemia, cardiac diseases, TB, Asthma, and DM. b. Anaesthetists are specially trained to conduct painless delivery. c. Department routinely does scar less surgery for removal of uterus (NDVH), and surgery for infertility. d. Department has got Gynaecologist trained specially for Gynaecological cancer. e. Department has got Coloscope (telescope for examining cervix) which can detect cancer of cervix (one of the commonest cancers in women and curable if detected at very early stage). 22. X-Ray / Ultra sonography / Color Doppler a. Department has got 4 X-Ray machines, 2 are fixed and 2 are portable. One machine has got TV Image Intensifier. b. The Philips Ultrasound machine is called Sono CT because it gives pictures of CT scanner quality 23. Plastic & Cosmetic surgery a. Operating theatre are equipped with international equipment such as German microscope b. Department is supported by trained nursing staff who can take care of patients peri- operatively and are capable of delivering high quality critical care along with most advanced Radiodiagnosis like CT Scan and MRI. c. Provides full range of plastic surgery starting from 24 hours emergency micro vascular reconstruction to sophisticated day care cosmetic and LASER surgery like hair transplant, liposuction. 24. Bariatric/Diabetes Surgeries 25. Emergency & Trauma Services: a. Air conditioned intensive care ambulance well equipped for Cardiac and trauma care with trained medical team on board b. Blood bank c. Pathology d. Casualty Medical Officers are available 24 hours a day

BOMBAY HOSPITAL, INDORE | 2 7 e. Burn unit f. NICU (Neonatology ICU) g. Physiotherapy h. All investigation available under one roof i. Super specialist doctors available 24 hrs. j. Qualified Intensives working in the ICUs are available 24 hours a day

Support Services: a. Dedicated feeder line of 7.5 km from Manglia which bestows superior power quality and availability b. Two DG sets of 750 KVA each, either one of them capable of taking load of whole hospital. c. Most modern automatic Milnor laundry plant imported from US & Denmark to provide best quality of linen after each wash. d. Laundry chute facility provided (Fully Automated Imported Laundry). e. Latest and modern fire detection & fire fighting system f. Central AC plant of 800 ton capacity g. Separately dedicated elevators for patients & doctors, with discrete service areas to ensure smooth vertical movements h. 24 Hrs. pharmacy with online drug demand system i. Self-catering facility to provide hygienic & tasty food for patients, as well as RMOs / Nurses and Consultants. j. Cafeteria for attendants of patients k. Bank of India’s branch & ATM facility at premises to ensure smooth & safe money transactions l. Reception- front office executives giving guidance to all 24 hours a day m. Travel and accommodation assistance in main lobby

BOMBAY HOSPITAL, INDORE | 2 8 Types of Illness faced by the hospital: Manageable: For illness that are manageable, the hospital offers services such as services Neuro surgery, urology, neurology, cardio thoracic surgery, cardiology, Gastroenterology, nephrology, endocrinology and oncosurgery, specialty like General Medicine, pediatrics, general and laparoscopic surgery, orthopedic and joint replacement, physiotherapy, etc., a. Chronic illness b. Acute illness c. Sensitivity/allergy Non-manageable: For illness that cannot be managed, such as paediatric cardiac surgery (congenital diseases), Bombay hospital follows the principal of saying “No” and providing as much details as possible. Patient History: a. Background b. Area from which the patient is c. Financial condition d. Family status e. Community and cost f. Social link g. Medico-legal case Prescription Drugs: Doctors give written instructions to a pharmacist concerning the form and dosage of a drug to be issued to a particular patient. Medicines once issued are not taken back by the hospital for safety reasons. Generally followed conventions while writing prescriptions: a. OD – one time daily b. BD – Two times daily c. TDS – Three times daily d. HS – At bed time e. SOS – If needed f. TSF – Tea spoonful (each tea spoonful = 5 ml, each table spoonful = 15 ml, each ml = 20 drops)

BOMBAY HOSPITAL, INDORE | 2 9 Flowchart – IPD: The office of the CMO (casualty medical officer) is located in the ground floor of the hospital. For emergency cases, the patients are directly transferred to the ICU. For non-emergency cases, the patient is examined for further information and advised by a doctor relevant to the particular case (consultation). The following are done at the reception: a. Information on payment types of the patient (directly by patient, insurance, paid by corporate) are acquired b. Information on ward preference is collected and procedures for getting pass, visiting time, attendants allowed, food, etc. are instructed c. Patient is finally admitted in a ward as per class/preference.

TRACKING PATIENT THROUGHPUT Patients in a hospital can be divided into two categories- Emergency Department patients and Inpatient. The problem of patient throughput is a systemic problem which is caused due to operational inefficiencies, inefficient processes, lacking or underutilized IT systems, and poor communication throughout the hospital. The key parameters to be measured are as follows:

ED INPATIENT

 Percent of patients that leave the ED without  Length of stay for medical- being seen surgical patients, hospital,

 Hours of ED diversion physician, service, top volume

 Average ED length of stay DRGs

 Average ED length of stay for admitted patients  Average patient admission and

 Average ED length of stay for discharged patients discharge time by nursing unit

 Average lab turnaround time (order to result)  Avoidable days

 Average diagnostic imaging turnaround time by  Percentage of patients that key modality (order to first read) are outliers

 Average minutes from admission order written to  Inpatient bed utilization by patient placed in an inpatient bed hospital and nursing unit

 Patient satisfaction scores  Average bed turnaround time

BOMBAY HOSPITAL, INDORE | 3 0 Essential Elements to prevent Problems

Reduction in Attrition-While talking about problems of attrition, it can be twofold for hospitals. 1. Attrition among patients 2. Attrition of staff The following points serve as the essential elements in ensuring patient retention- 1. Communicating effectively to all the stakeholders- Every stakeholder including patients, other healthcare practices that are referral sources, vendors and suppliers, insurance company representatives, etc. are important in the effectiveness of delivering services. Thus, effective communication and relationship building is a key parameter to build brand 2. Treating patients with respect- Patients, visitors and family members of the patients should be dealt in a calm manner without letting them feel to be an intrusion in the busy office environment 3. Attention to the concerns of patient- Hear the concerns of the patient and advice accordingly. Spend some time informally chatting with the patient and his family members for relationship building 4. Anticipate problems and obstacles- A proactive strategy might be adopted. For example-  If a number of patients are from a particular company, changes in insurance policy of the company might be expected  If any particular patient is a frequent customer, the decrease in satisfaction level is expected 5. Reduce waiting times- A clear message of “indifference” spreads when patients have to suffer long waiting times 6. Confirm appointment in advance- The schedule of the patients should be respected and they should be reminded of their appointments. This will not only help in showing concern but will also help in proper planning for physicians 7. Reach-out when visits are overdue- Taking an extra step by enquiring about the missed visits of patients and confirming the good health of patients helps 8. Survey- Surveying through proper feedback forms at different points of time, for e.g.- when a patient has been in the hospital for a day, when the patient is in waiting line,

BOMBAY HOSPITAL, INDORE | 3 1 when the patient has been treated effectively and when the payment has been made can help in knowing the differences in responses and the factors for it

To prevent attrition of workers- 1. Cultural Alignment- The vision of the workers should align with the mission and vision of the organization. This can be checked by analysing situation based approaches of the workers 2. Match in the expectations- The recruiting organization and the physician need to agree on the physician's measurement criteria early in the recruiting and interviewing process so that physicians are aware of what is expected of them 3. Family involvement- The involvement of family members of physicians and other workers to boost their morale. It can be done by inviting the family members to volunteer for certain activities, by catering to their requirements and holding sessions for their entertainment at intermittent intervals 4. Keeping the staff professionally challenged- Staff should be engaged in various committees to provide them challenges 5. Controlling the rumours- Staff should maintain proper communication among themselves be it in the hierarchy or across the organization to avoid spread of rumours

Reduction in no. of attendants required- The requirement of attendants can be reduced by adopting the following measures- 1. Involvement of independent physicians in hospital operations- Develop a culture so that the independent physicians involve themselves in the hospital operations. This will not only help in dealing with the problem but will also allow better understanding of problems of patients and hospital in general 2. Using Trainees in the hospital operations- The trainees can be involved in the operations to make them better understand about their responsibilities and to develop a healthy culture 3. Involve Medical Students- The medical students can be involved in day to day operations from their second year to provide hands on training

BOMBAY HOSPITAL, INDORE | 3 2 4. Partnership with medical schools and management schools- Involve in partnerships to utilize the strength of students and in return find the best recruits from campuses Communication Problems- Following factors have been identified for effective communication- 1. Complete- It answers all questions asked to a level that is satisfactory to those involved in the exchange of information 2. Concise- Wordy expressions are shortened or omitted. It includes only relevant statements and avoids unnecessary repetition 3. Concrete- The words used mean what they say; they are specific and considered Accurate facts and figures are given 4. Clear- Short, familiar, conversational words are used to construct effective and understandable messages 5. Accurate- The level of language is apt for the occasion; ambiguous jargon is avoided, as are discriminatory or patronising expressions. Meeting the following requirements of customers can help in achieving effective communication.

Admission Process 1. Inform patients of their rights 2. Identify the patient’s preferred language for discussing health care 3. Identify whether the patient has a sensory or communication need 4. Determine whether the patient needs assistance completing admission forms 5. Collect patient race and ethnicity data in the medical record 6. Identify if the patient uses any assistive devices such as walker, wheel chair, service animal 7. Ask the patient if there are any additional needs that may affect his or her care 8. Communicate information about unique patient needs to the care team

Assessment Process 1. Identify and address patient communication needs during assessment

BOMBAY HOSPITAL, INDORE | 3 3 2. Begin the patient–provider relationship with an introduction 3. Support the patient’s ability to understand and act on health information 4. Identify and address patient mobility needs during assessment 5. Identify patient cultural, religious, or spiritual beliefs or practices that influence care 6. Identify patient dietary needs or restrictions that affect care 7. Ask the patient to identify a support person 8. Communicate information about unique patient needs to the care team

Treatment Process and Discharge Process 1. Address patient communication needs during treatment 2. Monitor changes in the patient’s communication status 3. Involve patients and families in the care process 4. Tailor the informed consent process to meet patient needs 5. Provide patient education that meets patient needs 6. Address patient mobility needs during treatment 7. Accommodate patient cultural, religious, or spiritual beliefs and practices 8. Monitor changes in dietary needs or restrictions that may impact the patient’s care 9. Ask the patient to choose a support person if one is not already identified 10. Communicate information about unique patient needs to the care team 11. Provide discharge instruction that meets patient needs 12. Identify follow-up providers that can meet unique patient needs

COMMUNICATION OF STRATEGY TO THE PEOPLE

BOMBAY HOSPITAL, INDORE | 3 4 Social Media Promotions

Introduction Online advertising maybe defined as a form of marketing communication on the Internet intended to persuade an Internet user (viewers, readers or listeners) to purchase or take an action based on content displayed on a website (or webpage). This communication may be in relation to products, ideals or services. Advertising viewed or consumed on mobile phones and tablets is increasingly an inherent component of online advertising today. It is therefore necessary to encompass these formsof advertising together under a category which is called Digital Advertising. In other words, Digital Advertising is simply an extension of online advertising, including advertisements on mobile phones and tablets.

Components of Digital Advertising

Digital Advertising can be classified into the following main components:

Display Ads - Ads that are placed at various points on a web page that typically contain logos, photographs, other images or even text. Banner ads are priced slightly higher than Search Ads and are known to have higher effectiveness.

Search Ads- Advertisements made up of text (displayed largely as sponsored links on search engines) constitute this category. These are backed by hyperlinks that when clicked on, take the potential customer to the advertiser's website. Search Ads are usually lower in cost than banners, as they are simple and a lot of websites accept them.

Mobile Ads- The number of active mobile Internet users has touched about 35 million users (Source - ICube 2011) by March 2011. This is estimated to reach 48 million by March 2012. As a result, advertisements placed on mobile phones and tablets are increasingly becoming commonplace. Additionally, Internet accessibility is another reason why Mobile Ads are increasingly gaining prominence. Moreover, advertisers have realized that end users of such devices predominantly belong to higher socio economic classifications (SECs) i.e. usually SEC A and SEC B. Therefore placement of advertisements to a desired target group can be effective.

Display Ads Online Display advertising has matured quite an extent today. Various technologies are being used to develop such ads. Display Ads usually are in the form of web banners that contain images, flash objects

BOMBAY HOSPITAL, INDORE | 3 5 or interactive media using audio or video. The images can be static or dynamic. In terms of Technology Formats, Display Ads are categorized as follows – - Image (GIF/JPEG) - Simple Flash - Rich media with video - Rich media without video Display Ads are further classified into sub categories based on Size of the Advertisement. They are broadly classified into the following types, with an illustration below – - Banners & Leader boards - Buttons - Rectangles & Boxes - Skyscrapers

Ad Placement on Webpage Banners and Leader boards are almost always placed on the top of the webpage. On the other hand, rectangle and boxes can be placed either on the left or right sides of a webpage. However, as per various research studies, these ad types are usually placed on the right side of the web page. Skyscrapers are another popular display ad type. These tend to be also placed on the right side of the webpage.

Search Ads Search advertisements type forms an important component of digital advertising. Companies belonging to various verticals continue to invest in such advertisements for their cost effectiveness. A few illustrations of Search Ads are given below –

BOMBAY HOSPITAL, INDORE | 3 6 Google, which is the industry leader as far as Search is considered, dominates the Search advertising revenue. It is widely expected to garner in excess of 75% of Search ad type revenue.

Mobile Ads Globally, the Mobile Ads ecosystem has developed with the arrival of smart phones in 2007, when Apple formally launched the iPhone. Other companies like Samsung, Nokia, Google, Microsoft etc. are playing catch up, but are increasingly playing a major role in the war of mobile phones and tablets. Mobile applications or ‘Apps’ as they are popularly known as, have played a major role as far as popularity of the digital medium is concerned. In India of course, with the arrival of tablet devices in 2010, the digital ecosystem has evolved. The iPad, Galaxy Tab have been the front runners as far as tablets devices are concerned.

Mobile Ad Types As per IMRB International’s primary survey findings, the main types of mobile advertisements include – • WAP / Browser Based Ads • In-App Advertisements • Short Messaging Services (SMS)

ADVANTAGES OF DIGITAL ADVERTISING

Digital Advertising is increasingly an inherent budgetary component of many organizations today. Organizations of all sizes use the medium to promote their products and services. So well, why do so many organizations use the medium? Simply put, it is due to the numerous advantages that online advertising offers. These are discussed in the paragraphs ahead. Reach - The ability of the online medium to target a certain demographic of users is one of the greatest advantages of digital advertising. In addition, the geographical reach of the online medium is far greater than that of traditional media. It’s not only cost effective to achieve a wider geographic area but the ads can also be targeted to the desired audience. For example, if an advertiser is keen on selling his or her products targeted to a certain demographic of people, it is quite possible through online advertising. Digital advertising has matured to the extent that web publishers, media agencies and advertisers themselves know the optimal ways and websites for a certain category of products or services.

Measurement - With various tools becoming available, tracking effectiveness of ad campaigns is becoming possible today. In other words, measuring Return of Investment (ROI) is increasingly possible today. Organizations that were previously reluctant to spend online, now realize that the online medium does offer means to alleviate any such fears. Moreover, when properly designed online marketing campaigns generate the desired results, advertisers are further encouraged to continue advertising online.

Interactiveness and Engagement - The Internet is arguably the most interactive and engaging medium among various others. Interactive campaigns have become a norm with the power of the online medium.

Creativity - Creativity that advertisers can have in the online medium is additionally worth mentioning. There are numerous multimedia tools that make online ads powerful, engaging and above all, effective.

BOMBAY HOSPITAL, INDORE | 3 7 Time - Through the Internet, an advertiser can reach a desired target group or demographic in a much shorter time frame. For example, if an advertiser needs to plan some sort of ambush marketing, the online medium can be an effective means of achieving it. Even otherwise i.e. for regular marketing campaigns, the total time necessary to complete an online advertising campaign is less than that of traditional advertising methods.

Cost - When compared to traditional forms of advertising, digital advertising is cheaper. Various payment models are available between the advertisers and publishers. Many a time, advertisers are charged only when visitors click on their ads.

BOMBAY HOSPITAL Having a first look at the Facebook pages comparison of Bombay Hospitals with Apollo Hospitals, another big Medical Center in India on similar lines of operations, gives a revealing picture on how Bombay Hospital needs to engage on the social media network.

BOMBAY HOSPITAL, INDORE | 3 8 Likes

The numbers of pages that appear on a regular Facebook search are the same for both the hospitals. However, the emphasis laid on which pages to promote made a ‘big difference’ between both the major hospitals. A total of 690,000 people Like the main page of Apollo Hospitals where as Bombay Hospitals, despite their quality of service and care being in comparison, if not better than Apollo Hospitals, has less than 500 Likes shown by

Pages

Of all the prime pages being promoted by both the hospitals, the importance laid down upon which pages to prioritize over the others has differed a lot. For example, Apollo Hospitals promotes their main page for the whole enterprise – similar to Bombay Hospitals. However, the priority given to the next few important pages by Apollo Hospitals is based on their importance to promote their other emerging market locations (here, Dhaka) rather than already well- established locations such as Bangalore. Bombay Hospitals on the other hand is trying to promote Bombay Hospital Institute of Medical Sciences, having only 400 likes so far, which it could improve by promoting heavily among the student community.

Also, duplication of the same pages, rather than trying to push more important pages is another area to concentrate upon. See the above picture having the shape of

Logo

The logo of Bombay Hospitals depicts the picture of an expensive Medical care center – a perception the management strongly believes to remove from the minds of the marginal/ average middle class Indian, who has respect for his/her own personal health that he/she could afford. This is shown with the shape of

Even a simple Google search of Bombay Hospitals shows tall buildings like:

This by its very nature depicts a wrong image of an expensive medical center that a middle class Indian could not afford. The perception could be changed by repositioning itself as a hospital for the common people. Instead of giving an impression of tall buildings that seems like a burning a hole in the pocket to avail medical facilities here, the hospital needs to emphasize the affordability in their billing system, their facilities, specializations etc.,

BOMBAY HOSPITAL, INDORE | 3 9 Activity

The Bombay Hospital Facebook pages are highly inactive over the past several months as against any of the Apollo Hospital Facebook pages – which are actively followed by thousands of followers due to the constant updating of information regarding their facilities, medical camps, health tips, new advances in the equipment technology being used in their hospitals. Bombay Hospitals’ pages seem to lack these features that could constantly hook the medical enthusiasts and customers to look up to it and no other hospital for their health concerns. Conducting some contests for reaching milestones in terms of number of fans, followers etc., are the strategies used by Apollo Hospitals to keep their fans/ followers to themselves. These measures followed by Apollo Hospitals are shown as:

CONCLUSION

Bombay Hospitals needs to increase the activity on their Facebook pages (quantity-wise) and improve on the content on which it could boast of on those pages (quality-wise) to attract new customers and become a prospective hospital for the common man. Besides, it could promote its pages through capitalizing on the student community it possesses and also try to push it forward among the medical enthusiasts and practitioners to increase referrals. In addition, the hospitals emphasis on the quality of service, patient satisfaction, facilities available, the unbeatable source of competitive advantage – their doctors etc., need to be showcased on these pages if they were to produce any satisfactory results. Leaving their pages inactive is as worse as having no page at all, and this needs to be given importance in their promotions strategy.

BOMBAY HOSPITAL, INDORE | 4 0 RECOMMENDATIONS When considering employment opportunities and loyalty, the top two priorities for the doctors are:

 Fair Compensation  Flexibility  Fringe Benefits

Fair Compensation

Bombay Hospital, being the leading hospital in Indore, has the privilege of benchmarking the pay structure across the industry in Indore. The organizational structure is Hierarchical, however, the doctors need to be innovative and handle the patients with extreme care, caution and patience.

Hence, we suggest the hospital to follow a compensation based on performance, with a fixed salary component. The variable performance based component can be evaluated on the following parameters:

 No. of patients served  Kind of patient catered to-Old/New  Duration of service( in hours)  Amount of Revenue generated  Feedback from patients (based on treatment and satisfaction)

The list is exhaustive and can incorporate parameters to include effective treatment of patients

Flexibility

The profession demands a good state of mind, especially, when it comes to taking patients in severe condition. Doctors need to be extremely patient and cautious, stress-free, pacify the patients and build relationship.

This calls for a stimulating environment where doctors can work according to their will. They should rather not work for a day, than work under stress conditions. Doctors should be given the flexibility in terms of working hours per day. However, to ensure the availability of services to the patients, a cap. On the minimum numbers of hours per day can be placed, with a compulsory attendance on a minimum no. of days per week. The doctor would be required to achieve the target of minimum no. of hours per week.

The pay would be based on the no. of hours served and the level of patient satisfaction and effectiveness of the treatment.

Fringe Benefits

The doctors can be motivated to offer their best services, with long hours of services by offering them basic perks like insurance cover, family cover, health benefits and access to resources to the entire family, a sponsored one week holiday package for the family, transportation reimbursements etc.

BOMBAY HOSPITAL, INDORE |