Revision as of 15:28, 23 August 2015

Most caring hospitals in India

From the archives of India Today , June 10, 2009

Damayanti Datta

India's most caring hospitals

How many of our hospitals would fulfil that very human need to feel cared for when we are at our most vulnerable? Check out the writing on the wall. And that, too, from those who are usually at the receiving end—patients. A survey commissioned by the Ministry of Consumer Affairs, Government of India brought out what patients value the most when living under neon lights and in the shadow of disease.

Conducted by the consumer body, VOICE (Voluntary Organisation in the Interest of Consumer Education) on 4,000 patients in six metros, it is reportedly one of the first-ever surveys to tally patient satisfaction with quality of hospital service in India—a country not known for bestowing power to the patient.

“The view of the patient as a consumer is the need of the hour,” says Bijon Mishra of VOICE, who mentored the project. “Although the healthcare market is booming— from Rs 927 billion in 2001 it’s slated to touch Rs 2,088 billion by 2012—the number of complaints against hospitals has zoomed up.” The world of hospital caring is changing fast for the consumer. A maddening tooth-ache on a Sunday morning had forced Sandhya Negi of Patparganj in Delhi to step into the snazzy neighbourhood hospital. She wasn’t destined to burn a hole in her pocket. The doctor couldn’t be traced. The hospital apologised, but it was the phone call later in the day that took her breath away. “I’m doctor X,” crooned a voice, “Sorry for not being there. Hope you won’t hold it against us.”

A far cry from her trip to a wellknown government hospital some years back. She still remembers the agonisingly long wait and patients swarming around a harassed doctor. Would she go back to that hospital now that she has more choice? That line of patient-thinking is reflected in the survey in hand: the top reason for choosing a superspeciality or tertiary hospital is good reputation and image, followed by referral from a doctor and recommendation by close friends and family. “The new-age consumer—more sensitive about matters concerning health, more willing to spend on the best possible service and more keen to get value for money, is asserting his choice,” says Dr Naresh Trehan, the man who had set up the Escorts Heart Institute & Research Centre in Delhi on his return to India from the US two decades back. Not surprisingly, “referred by doctor” is the top reason in districts, among the less educated and economically weaker. “There is persuasive evidence that quality of care influences hospital demand,” write two US economists, Dana Goldman and John Radley, in their December 2008 study, ‘Hospitals as hotels: the role of patient amenities in hospital demand’. While a one-standard-deviation increase in amenities (“such as good food, attentive staff, and pleasant surroundings”) raised a hospital’s demand by 38.4 per cent on average, the demand was substantially less responsive to clinical quality. In the survey in hand, too, hospitals that topped in “overall satisfaction” were those that offered more amenities. From cleanliness to parking, clear signage to wheelchairs— Apollo, Chennai, and Wockhardt, Bangalore, met most of the standards. At Manipal Hospital, Bangalore, a greater proportion of respondents had used the emergency; Wockhardt, Bangalore won top ratings for easy accessibility, round the clock service, equipment, and helpful nurses. Escorts Hospital, Delhi, and Apollo, Chennai, scored on registration—counter and form, efficient staff, sitting arrangement to time taken. Manipal, Apollo, Chennai, and Care Banjara, Hyderabad, fared best in nursing staff—courtesy, flexibility and attitude. Going by the same logic, the All India Institute of Medical Sciences, Delhi (AIIMS), despite its reputation, did not fare well. Staggering under patient overload, the average time taken to get registered here works out to 74 minutes, while the average in superspeciality and tertiary hospitals is 22.4 minutes. Ask Dr K.S. Reddy, who has been with AIIMS since 1974, first as a student and finally as the head of cardiology. The experience of people “queuing up from 6 a.m. for an OPD at 2 p.m.” has been routine for him. “The idea of ‘medical care’ is benchmarked partly by peers in the profession and partly by the patient,” he says. “Treatment quality forms a key component. At AIIMS, you may have to wait long to access a doctor, but you end up getting the best possible treatment.” But the human interface with a hospital in India often lacks sensitivity and compassion, he adds. “A study like this sends out a crucial signal that a hospital must not only be care-giving, but a caring facility which is hospitable.” The lounge in front of Trehan’s chamber fills up with patients recovering from surgery at a certain point during the day. And it’s always a poignant moment. As the doctor moves about, asking a question here and checking a dressing there, the fragile men and women on wheel chairs reach out—touching, stroking, kissing his hands—looking wonderingly up at his face. In medicine, the patient’s trust in a doctor’s “superior power” is an important part of the therapeutic effectiveness. And more than pristine degrees, the doctor’s attention span and willingness to listen to patients matter. In the VOICE study, patients expressed satisfaction with doctors not so much in clinical terms but more for their “courtesy” and for “listening, explaining and visiting when required”. Surprisingly, the same doctors that patients approved of scored lowest when “communicating the expected charges” to patients (for instance, Apollo, Chennai and Manipal, Bangalore). Wockhardt Superspeciality on Cunningham Road in Bangalore, surpassed on several counts: it’s most referred by other doctors, top in overall trust in diagnostics, second in “trust on doctors”, one of the top five in overall patient satisfaction, to name a few. What’s their secret of success?

Methodology

The survey was conducted at 45 primary and secondary hospitals, 17 tertiary and superspecialities, covering 4,000 consumers from six metros and nine districts over 2007-08 and submitted to the Government in November 2008.

Quality of health has different meaning for providers and recipients of healthcare. For the former, it’s clinical (affiliation, technology, mortality, discharge, treatment, surgical procedures etc). For patients, it’s more subjective. This study was done purely from their perspective.

A Key Performance Indicators model was adopted. A Situation Appraisal Analysis was then conducted to identify factors that impact quality of service. Secondary studies and interaction with stake-holders suggested 110 factors and an Importance-Influence Matrix was drawn up to identify those—safety, security, services, food, cleanliness, availability of medicine, quietness, staff behaviour, communication, speed of service, waiting facilities, location, signage, fees, etc. The choice of hospitals was based on a tele-pilot survey of VOICE subscribers about facilities they frequented most in the last six months. Field workers had faced problems of accessibility in some (e.g. Jaslok, Asian Heart and Hinduja hospitals in Mumbai).

Honour roll: Top 5

Overall satisfaction

1. Escorts Heart Institute & Research Centre, Delhi

2. Care Banjara, Hyderabad

3. Apollo Hospital, Chennai

4. Manipal Hospital, Bangalore

5. Wockhardt Superspeciality, Cunningham Road, Bangalore

Word of mouth leaders

1. Manipal Hospital, Bangalore

2. Indraprastha Apollo, Delhi

3. Escorts Heart Institute , Delhi

4. All India Institute of Medical Sciences, Delhi

5. Peerless Hospital and BK Roy Research Centre, Kolkata

Most chosen for good image

1. Escorts Heart Institute, Delhi

2. Batra Hospital, Delhi

3. Sir Gangaram Hospital, Delhi

4. Max Superspeciality, Delhi

5. Indraprastha Apollo, Delhi

—Report on Study of Client Satisfaction with Quality of Hospital Services, 2008