Sunday, August 23, 2015

Effective Employee Engagement in Hospitals: Challenges are Opportunities, Bonded by Nobility!

In India’s quest for becoming a more vibrant and more robust society, healthcare plays a very important role, along with all other aspects of social infrastructure like education, housing, nutrition, water, and sanitation. In the important field of healthcare, hospitals have a great role to play. The General Hospitals and the Railway Hospitals established and run by the Central & State Governments and the Indian Railways respectively, and the dedicated hospitals established and run by certain large industrial townships and leading business houses have served as the backbone of Indian hospital infrastructure. The entry of private sector into medical care in the post-independent India initiated a significant change in the country’s hospital system.  P D Hinduja Hospital established in the early 1950s in Mumbai by late Shri P D Hinduja, the visionary patriarch of the Hinduja Family is a pioneering example of how business entrepreneurship can transform healthcare in India. The transformation in healthcare standards brought in by the private initiative concept has been significant. Subsequent decades have seen the important trend of medical professionals turning entrepreneurs in the healthcare sector through corporatization route in India.

One of the important benefits of corporate hospitals has been the institutionalization of a national hospitals-chain concept. Apollo Hospitals established by the physician-visionary Dr Prathap C Reddy in Chennai is a shining example of what corporate hospitals can achieve. Starting with the first hospital in Chennai in the early 1980s, Apollo has grown rapidly in Chennai as well as across India. Fortis Hospitals, Wockhardt Hospitals and a few other such chain initiatives in more specialized areas like eye care and dental care are clear examples that the corporate imperative of growth drives the creation of a large modern hospital infrastructure that could benefit the society. Governments have also become cognizant of how a combination of scale, scope, modern technology and best medical practices constitute both the drive and result of corporate hospitals. The new NDA Government has, for example, taken up establishment of more All India Institutes of Medical Sciences (AIIMSs) as an important driver for social equity in different states. What has been accomplished, both in public and private sectors, so far is but a fraction of what needs to be done in India.

Medicine and Management

These developments have brought to the fore, the importance of management in the growth of hospital chains. As long as hospitals remained as location-specific ventures run within the State budgets or specific corporate contributions, the challenges and opportunities of management tended to be loaded in favour of medicine rather than management. As commercial and business interests started to fuse with the welfare interests in a corporate setting, management is seen to be as important as medicine in enabling growth of hospitals.  There are no preset limits for growth nor are there any restraints on corporate entry. The four pillars of successful hospitals, namely scale, scope, technology and practices become the four pillars of successful hospital management. The success in each and together, however, rests on people.  

The variety of talent that is required to run a modern hospital is simply amazing. From interns and assistants to specialists and super-specialists, and from nursing and paramedical staff to engineering and technology professionals, the expertise that is required is varied. Today’s hospitals are an embodiment of technology as much as of medical practice. Expertise with equipment has become a dominant need, bringing with it a concomitant need for superior medical and surgical support practices. This has not only resulted in better diagnostics and treatment but also brought out the need for generating adequate returns on investment for viability and reinvestment.  The net consequence is that a modern hospital is a 24X7 operation, evident as a beehive of intense activity during the daytime, and as an institution that never sleeps even in the nighttime.

Personalized Science

A hospital is like no other institutional activity (not even like education which is commonly seen as the most individualized institutional activity) not only because the biology of each individual varies but also because wellness is a combination of the body and mind. Surely, there is a great degree of standardization in terms of disease causative organisms and disease curing pharmaceuticals but each individual (and individual’s) case of disease and its treatment. Unlike in a factory or laboratory setting where each good process produces a good result and a bad process leads to a bad result, in a hospital setting a good process may not always assure a good result while a bad result will surely lead to life-threatening outcomes. This is because the individual cause and response mechanisms vary significantly. A hospital, unlike any other business or industrial setting, converts an intrinsically “bad” (diseased) “product” (patient) into a “good product” (cured patient).

Further complexity arises because a cured patient still needs days and weeks if not months to become a fully recovered individual. This means that even outside the hospital’s confines, the hospital needs to exert a positive influence through motivation for, and engagement with, the patient. In doing so, the hospital needs to be sensitive to the living environment of the patient and be concerned about the caregivers (and stress givers too!). A standardized and holistic treatment paradigm is, therefore, a major challenge. The way the challenge can be met is only through pooling of knowledge on patients, practices and outcomes. To address the complexity of personalized science that true medicine is, a factory-style commercially run hospital would have few solutions except continuous employee engagement. In a 24X7 operational environment where every participant is fully stretched and specializations are tightly defined, the time and space to engage employees is severely limited.

Employee Engagement

Employee engagement has multiple connotations. Many, including experts, define engagement in terms of initiatives and activities such as on-site and off-site learning and development initiatives, group sports, celebration times and recognition initiatives. This is probably in tune with the philosophy that individuals in organizations are well covered on-the-job as to the ‘know how’ and ‘know why’ aspects, and they need to be developed only in terms of personality and interpersonal skills. Employee engagement has, however, a perspective beyond competencies and attributes of members and teams. Employee engagement is both a process and outcome; the process seeks to develop and sustain oneness between the employee(s) and the organization, with oneness being the outcome. Employee engagement would be a cluster of initiatives emphasizing the larger purpose of the organization and its employees. It demonstrates how the work of each and every employee contributes to the larger purpose.

In the case of an automobile firm, each employee is engaged to appreciate how his or her work contributes to making the automobile more efficient, more economical, more elegant and safer for the user. For a pharmaceutical firm, the employee is engaged to appreciate how the medicines developed and manufactured by his or her firm are critical to healthcare and patients. In a design firm, the employee is engaged to appreciate how his or her designs help consumers meet new functionalities with greater lifetime value. For a hospital, employee engagement is all about diagnosis and treatment of disease and making patients healthy. Firms typically resort to multiple staff get-togethers, with adequate time and space, to promote employee engagement. However, unlike such firms, hospitals which work round the clock in confined spaces find it difficult to disengage their staff for even short lengths of time and in any extent of space.

Engagement at Apollo

Ever since its inception in 1983, Apollo Hospitals has set up a scorching pace of growth. According to Apollo Website, in just over 3 decades, Apollo’s presence grew to encompass over 10,000 beds across 64 hospitals, more than 2200 pharmacies, over 100 primary care and diagnostic clinics, 115 telemedicine units across 9 countries, health insurance services, global projects consultancy, 15 academic institutions and a Research Foundation with a focus on global clinical trials, epidemiological studies, stem-cell and genetic research. Each of the facilities is marked by a seemingly endless flow of trusting patients keeping all of its facilities and expert and support staff fully stretched. Chronic hyper-demand and consequent acute under-capacity leaves no time for anyone to be on any special engagement efforts, either in terms of time and space. Yet, Apollo happens to be at the forefront of medical technology and practice, providing world class healthcare at fractional costs.  The model of employee engagement at Apollo, that is effective despite the constraints, is unique. It is a combination of living entrepreneurship, visible leadership, state-of-the-art technology, patient-centric business model and sustainable brand equity.   

Fundamentally, the Founder-Chairman, Dr Prathap C Reddy continues to be a highly visible leader even as the hospital network focuses on the strides made by him under his astute leadership. He has retained, to date, his office in the hospital premises, preferring the bustle of teeming patients to the solitude that an independent office tower may offer. Secondly, the hospital organizes highly visible campaigns within the hospital premises; the recent green tree show recognizing the families of organ donors and raising awareness about the virtues and benefits of organization is one example. Dr Reddy takes part in all such campaigns, reinforcing leadership visibility. Thirdly, Apollo pioneered a system of highly competent and creative surgeons and physicians developing their own teams of medical excellence. The institute for cardio-thoracic surgery under the care and leadership of Dr M R Girinath, Chief Cardiovascular Surgeon at Apollo Hospitals Chennai is a great example. Specialized institutes were progressively set up under the leadership of various physicians and surgeons of repute. Fourthly, Apollo established schools of nursing to train nurses to the requisite standards, and to provide the needed talent pool given the shortage of qualified and trained nurses. Fifthly, Dr Reddy pioneered the integration of the latest technologies as they became available, from PET Scans and fMRIs to Radio Knifes and Robotic Surgeries.

Bonded by Nobility

Employee engagement in hospitals should not merely be a process of managements engaging with employees. Effective employee engagement in hospitals needs to be a highly visible process of employees inspired to engage themselves in patient care. Engagement develops with an appreciation of how complex and challenging, and yet how satisfying, the process of scientific, empathetic and compassionate patient care is. As individual experts treat complex cases, they need to be showcased not merely to build the hospital’s brand equity but more importantly to increase the confidence levels of patients and to inspire its medical experts and technical staff to seek higher accomplishments. Apart from introducing high technology equipment, information technology needs to be employed to automate patient medical records and transactions, facilitating data integrity with faster turnaround. As hospitals fight infections, avoidance of contamination and assurance of sterility becomes paramount; in this, every employee from janitors, ward boys and caterers to nurses, doctors and theatre staff have a critical role. Unlike any other industry, hospitals deal in microbes and viruses as well as biological and medical waste even as they seek to rid patients of these harmful marauders and toxins. Environment, Safety and Health needs to be a high visibility and high impact division in hospitals.

Continuing medical education for all employees at all levels is the core of employee engagement. Periodic public interest campaigns to enhance medical awareness (like the MIOT campaign in the print media on different types of cancers) provide the essential connect between the society and the hospitals. Emergency and Ambulance Services are yet another component where saving the lives stays at the centre and core of all employees. Home health services and telemedicine could provide a cost-effective holistic wellness paradigm based on prevention as well as rehabilitation and recovery. That employee engagement transcends the boundaries of individual hospitals but encompasses a network of different hospitals, law and order departments as well as general public across cities is illustrated by how organ donations and transplants are performed through networked professionals and green corridors. A life saved is a life given to an individual; a patient cured is a gift to a family and the society; and a disease prevented is a contribution to the humanity. Employee engagement founded on these principles is a noble fulfillment that converts the scientific, operational and business challenges of high quality, affordable and compassionate medical care into a noble opportunity of employee self-actualization and socio-economic development.

Posted by Dr CB Rao on August 23, 2015

1 comment:

Narayanan said...

I am curious as to how much of preventive health at one end and end-of-life care/hospice expertise at the other end exists in even corporate hospitals. Admittedly, I am not up on this topic but would like to think that there are stronger 'nudges' being put to use on the preventive end of things given the rapid increase in lifestyle diseases, especially cardiovascular/metabolic syndrome(s).

I can attest to superior care at Apollo overall although my interactions with docs were more of a mixed bag. My dad spent ~2 weeks in the ICU (in coma) after being admitted one November evening in '04. He did not wake up from his mid-afternoon nap and the suspicion was stroke. Folks at the ICU were really helpful; in fact one particular young doc was forthcoming with information on possible options for hospice care. We had to move him to another facility eventually and he passed away a week or so later.

At the other end of the spectrum, already jet lagged with mixed emotions, I sat in the office of another specialist (neuro) who was more passionate about discussing stock tips over the phone to whoever was at the other end of the line than helping me understand the diagnosis and possible next steps based on the many CAT scans/MRIs we were consulting him on. His only 2 second advice - pull the plug! To say he lacked empathy would be an understatement. Perhaps things have improved now and I would hope that all docs and support staff are better trained in interacting with patients/family. Each patient/family has their own story of hope and despair and it is incumbent upon hospital staff to "humanize" their interactions while providing accurate/candid assessment of the situation....for anything short of this is a disservice to all.