The Science of Healthcare Delivery

Construct and its impact on service delivery

Gurrit K Sethi, Strategic Advisor, Global Health Initiatives

The science of service delivery is a skill that can only be mastered by understanding the requirements and the needs of the service consumer: patients and their attendants / family in our context. While the medical talent provides for the requirements, the need is fulfilled by the overall experience through the patient journey. Since we deal with people and lives, the personal touch is critical, alongside expectation setting for medical conditions, outcomes as well as patient movement, all along reflecting empathy and care.

There are many aspects to healthcare delivery: the spread, aided by market factors, government policy and regulations, the enablers like IT, digitisation, connected health etc., the support ecosystem like pharma and device etc., and, the delivery construct at the organisational level. All of these aspects come together at the delivery Segment, aiding the very construct of the services offered.

In my last article I touched upon the spread; in this, let us talk about the delivery construct. Also, because I have had the pleasure of working on this area with hospitals, IT as well as medical devices, segment over the last few years. A very recent incident of hospitalisation of a close family member also exposed me to experience the work flows from the other side of the table—as a patient’s attendant, and have interesting insights to share.

So let me start with my experience as a service consumer. My kin was wheeled into a hospital emergency. As I finished the registration, I looked on in anticipation to get some insight on the patients’ condition. Blood samples were taken, different doctors came in and went out and I kept waiting. As I went to complete the admission procedure I felt as lost as any other patient attendant, forgotten were my years of experience of working in hospitals. It was a great experience though from a professional perspective. While there was no lack of courtesy as I badgered everyone with my questions, which were politely answered, I still felt lost not only from an emotional perspective, but also from a procedural / information / whatdo-I-do next perspective. And this, when I had no financial worries because of the insurance privilege that offered total financial security.

Ever since, I have wondered about the missing link.

Being handed some papers and told to go to the admission desk, I couldn’t find the way–—the sign boards were either too small or confusing or tucked away in a corner so I had to look hard and my brain refused to remember the path instructions given. Of course I finally found another attendant who walked me across. When I walked back, I was as confused—whom do I hand over the document, who will explain what next? I walked up to the doctor who said it’s a cardiac emergency, the respective team is looking into it. I chided myself to be patient as my kin was put into hospital clothing. And then I realised they were shifting him elsewhere, I quickly ran to ask where and was told to walk along.

Well the senior physician under whom the patient was admitted, didn’t come along as he was not in the hospital. Of course the treatment went fine through his team and they answered my questions to the point. But this stood out in my mind that the admitting doctor hasn’t come, hasn’t contacted. I raised my concern to one of the doctors on duty who seemed to be senior amongst those present. I first requested for his name and then asked him next steps. He told me another name (again not the admitting doctor) as the person who will do the angiogram and any further procedure. I politely asked him to introduce me to him on arrival. The nursing staff and a junior doctor got a consent form signed. When I saw a seemingly important person walk by I ran behind to be told that he is the guy I was looking for as he would do the procedure. The meeting was brief—information about the procedure and then told to wait outside the cathlab. The procedure went fine. I asked the nurse and duty doctor on what I needed to do next—wait? If so, where? Did they need me around? What are the visiting hours? Etc.,

Next day the patient was posted for discharge. Having being told in the morning that he would be going home by noon, there was much elation in his eyes. Well, noon came by and went by. I went up and down—the nurses said they had sent all the documents to billing, billing said they hadn’t received it. Then someone told me to go to the OT to see if they had done their bit of clearance and posting of implants used. And then the billing system stopped working. The staff was inpatient now with all the questions from the many waiting people.

Slowly I was able to regain my composure, and know how from experience started kicking in. I calmly called in the supervisor, told him how and where to get the information he needed regarding the amount I needed to pay so that I could go home while his ‘system’ was down. I promised to return the next day to sign the documents and get a copy of the bill. Two days later, I went to ask for the bill—it wasn’t ready. They didn’t remember! And once I reminded them, they are finally following me around to get my signatures on it as only then can they submit the bill to the payor for payment—an interesting role reversal!

While the Treatment was Good and Very Satisfactory, what was the Missing Link?

The big C&I all the way—Communication and Information, flow of communication, method of communication, the how of communication, the missing pro-activeness of communication, the level of detailing expected in the communication, who needs to communicate what and when, how does the communication flow, when and where does it flow, what and where are the interconnects with the patient’s family and attendants. And what information flows with this communication. It is these processes that finally define how the service consumers come out of that experience. And irrespective of the medical outcomes (there will always be terminal cases), if we get it right we will have the patient and family walk out our doors with a good and satisfactory experience. And when they do, they will come back again as well.

The delivery at the organisational level revolves around the design and construct of the organisation itself, the way it is wired, what tools are used; which in turn defines the information flow and who does what. Those who have mastered the art, also take care to define the how and when. The current that flows through this wiring is our big C&I—communication and information—that enables good service delivery. This current is also the culture, the capability and the motivation of the people and the team and carry this delivery to the last mile.

There is a growing focus on culture building within organisations these days. It is people who deliver the services. It is the front end staff that finally manage the moments of truth on our floors and not the senior management. However, it is the senior management that drives the environment in which the team members operate. It is finally the environment and the EQ that motivates these front end teams to do what they need to do and how. Therefore, the last mile delivery is so badly dependent and correspondent with the culture / environment of the organisation.

It’s also a common misnomer to read the organisation structure as a hierarchy archetype. By my experience, the organisation structure lays out the basis of the operations—who is required to do what, definition of the what, and the details of the how, the required skill sets and the capability build that forms the basis of the culture. This in turn defines the plugins of the various to dos across the department structures and layers. Information flows through this construct and is relayed by way of communication—across the patient journey and through this system.

I have also come across various organisations that simply ape the structures of other organisations as they come up. It is important to understand the model first before an organisation structure gets defined. Because it is this model that will give shape to the end delivery and how this is to be done. It is advisable to use the requirements of this model to build an org structure that works rather than a copy paste.

As I look through the various service delivery organisations in healthcare—we have miles to go before we sleep, but maybe we need to put this through a sleep study to be able to drive it more scientifically!!

--Issue 44--

Author Bio

Gurrit Sethi

Gurrit K Sethi, Hospital Chief Operating Officer, Care Hospitals; Strategic Advisor for Global Health Services, Global Strategic Analysis, contributes to healthcare by helping providers build and better business efficiencies and concept development, also strives to contribute socially through the Swiss Foundation, Global Challenges Forum as Strategic Advisor, through conception of sustainable health initiatives. She started her career from the shop floor working her way up to lead and set up different healthcare businesses. In her words, her significant achievements have been in bringing to life different SMEs and SBUs signifying a change in the Indian healthcare scenarios, as the opportunity paved the way along the healthcare growth curve in the country. With over 18 years in healthcare under her belt, across different healthcare verticals, she has carried transformational changes in the projects she has led, four of those being early stage start-ups. Gurrit is an avid traveller and voracious reader of varied genres, attributes which she says, provide her with incisive insights about people and systems and what drives them.