Saturday, 17 August 2013

Tricky issues: Standardization of hospital charges

Indian healthcare industry is unique in many sense. We have such a huge burden of patients on the existing facilities, yet penetration of modern medicine is low in the country. We always crib about the need for more medical colleges, yet we are net exporter of medical talent to the world. We are worried about quacks in our system, yet we also have some of the best doctors and healthcare systems in the world. We worry about healthcare being out of the reach of common man in this country, yet our pricing is one of the lowest world over.

In this context, one can imagine the challenge NABH would be facing in adoption of its standards. I felt the need to discuss some of the practices that are commonly prevalent in Indian hospitals and how these become a roadblock in NABH implementation. I might not be able to suggest a sure shot way to handle these practices, however I will make an attempt to create awareness on these issues.

Doctors are a very knowledgeable lot and their skill levels may vary depending on years of training and experience. This has a bearing on the outcome of the treatment they offer to their patients. There can also be perceptions about certain doctors, i.e. patients might feel outcomes of one doctor is superior to others, whereas there may be no factual data for the same. It is therefore natural for doctors to feel that they have a right to charge a fee that is commensurate to their reputation in the market. More often than not, doctors from the same specialty in a hospital charge different levels of fee for same consultation, treatment and surgeries/procedure. For the hospital management, it is all about keeping doctors in good humour and allow them to follow their own personalized pricing policy for their patients as long as they bring business to the hospital.

The practice runs into trouble when the hospital decides to go for accreditation. NABH demands uniform pricing policy for all patients. For example, all patients in cardiology department in a hospital should be charged same consultation fee and same procedure charges, irrespective of which doctor they consulted. But you would know from your experience that this is not the case practically. Specialists charge different set of fee as per their own comfort.

For the hospital management, it can be the source of worst nightmare in ensuring that doctors comply to a standard pricing policy common to all consultant. I have been even asked by managements how they can circumvent this requirement of NABH through some innovative way! My answer to all of them is that there is no running away from standardization if they are committed to implementing NABH. If you compromise in one area, your get into the habit of compromising everywhere. That's against the very ethos of quality. Quality demands adherence to common rules.

I think the management needs to realise that they are making a long term commitment to Quality and NABH standards help them conclusively demonstrate their commitment to quality by complying to standards. Short cuts don't work. They never work!

One way to handle this issue is to first establish a Medical Advisory board which has representation from management and some senior consultants. The advisory board should come to a consensus that they are committed to implementing NABH. Then the board should have rounds of discussions with all their doctors to educate them about NABH requirements and their role in achieving compliance. I think the most complicated problems can be solved through open and transparent dialogue between different parties, and this is going to be the best way to bring a consensus among the management and doctors on the future course of action. It also lies with the management to define and explain to various stakeholders how NABH implementation will benefit them. By taking care of the anxieties and queries of the doctors, the management can win their trust in the times of change and breaking up of established practices.

There can be tough times, discussions can sometimes turn ugly. You could have some really hard headed doctors in your panel. Your visiting consultants may threaten to take their patients away to other competing hospitals. Some might actually start bad mouthing management's intentions. All this is part of the game. Ask anyone in any industry who was implementing quality standards, and they would unanimously tell you it is not easy. Having said that, it is also not impossible. 180 hospitals in this country have displayed their commitment to standards and that places them in a different league from other thousands of hospitals in our country.
Be open, be patient, communicate and listen, be respectful while dealing with disagreement and most importantly, don't lose the focus on the end goal, i.e. achieving long term commitment from everyone in your team to continually improve quality in your hospital.

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