CX Conversations

CX Conversations Episode #1 – The State of Customer Experience in Healthcare with Rajarshi Sen, Manager, Operations & Strategic Initiatives at Kamineni Hospital

We, at Customer Guru, reckon that customer experience (CX) has become the key differentiator in the success and growth of any business. Hence, we are determined to help organizations recognize the potential that CX holds for their business.

Introducing our new podcast series – CX Conversations – where we talk to industry insiders and other CX leaders, who share their stories and experiences, with the intent of guiding organizations in building a customer-centric culture and, thus, growing sustainably.

In this episode of CX Conversations, our guest – Rajarshi Sen (Raj), Manager, Operations & Strategic Initiatives at Kamineni Hospitals – joins our host – Vivek Jaiswal – to discuss the state of customer experience in Healthcare. Raj and Vivek talk about the importance of customer experience in healthcare and how it is changing the healthcare industry. Listen in for some great tips on how to utilize patient feedback to improve the experience of patients.

We invite all our listeners to ask questions on any challenges they might be facing in their organizations with respect to customer experience. We’d be more than happy to help!

Transcript

Vivek: Hello everyone, this is Vivek, your host on CX Conversations, a talk where we talk about everything around customer experience and today we’ve got Rajarshi Sen, Raj as I like to call him. He is the manager who heads Operations and strategic initiatives at Kamineni Hospitals in Hyderabad and I had a very interesting meeting last week with him while I was in Hyderabad for sales meetings around the city. It was amongst the very few meetings where I spent a lot more time talking about everything under the sun but selling Omoto. It was a great discussion, Raj, and I received some very honest feedback about Omoto from you. So, thank you for that. To give you a very brief background about Raj, Raj has a deep passion for market research, which he was doing in his early days after graduating from BITS Pilani. Later, he did an MBA from IIM Trichy. Post-MBA, he made his way into healthcare after a short stint at Cognizant. Now I’ll let Raj add to this. Raj could you please tell us a little bit about your journey from market research to healthcare?

Rajarshi: Hello everyone. Hi Vivek. I do agree that we had a really good conversation when we met here in Hyderabad. We did talk about all and sundry except actually the intent of the meeting, probably. Well, I graduated from BITS Pilani and I completed my MBA from IIM Trichy. Well, I’ve always been into healthcare and I’ve been fortunate enough to make my decisions very consciously. What I mean by that is that I was able to choose what I like doing and I was able to pursue it as well. So, initially I was into market research just post my under-graduation and I would say personally, when I look at it in retrospect, I probably learned the maximum out of market research that I did at that point of time, which included a lot of primary research. It’s a world of learning. So, back then also while I used to work in market research, I would work with pharmaceutical clients and medical equipment companies. It just kept rolling on from there. My ultimate goal always was to get into hands-on healthcare and here I am today.

Vivek: Wow, very few people can say that Raj, to be honest, that they knew where they wanted to go and they have pursued it – they have reached where they wanted to. So, you are amazing in that aspect, I guess, and I remember, when we were talking in Hyderabad last week, you were telling me that market research, actually also taught you how to communicate while conducting the primary research.

Rajarshi: Oh, yes.

Vivek: Could you tell me more of that and specifically share some examples of how those interactions in your market research days, helped you develop the necessary communication skills that you are using till date, even at Kamineni Hospital.

Rajarshi: Like, I had told you, market research is not for everybody, to be honest; it’s not for everybody because it is a tough job. Especially in primary research, where your motive is to get information from somebody who is probably not willing to give the information for whatever reasons – short on time, busy schedule or maybe something else. Actually, to be able to field a conversation which you have interest and knowledge in, as well as you are able to convey the message to the person you are speaking with that there is something to gain out of having a conversation with you is a bit of a skill. It takes time to acquire this skill and the process is very difficult – it is pretty long because you have to go through a lot of rigmaroles in it, a lot of rejections, a lot of here and there. This is why I would like to maintain that it is not for everybody. But, it gives you a world of skills, ideas and understanding which you wouldn’t have been able to gain through secondary research, by reading or even by just interacting with people, because this is a specific motivated discussion. I’ll give you a simple example. We were working on a particular piece of medical equipment and the company was trying to launch in Brazil at that point in time. They had everything – the product portfolio, competitive prices, a good distribution chain. But, nevertheless, they weren’t able to really break into the market and it was a pretty big mystery at that point in time. We were trying to get through it but we weren’t able to. On a particular day, I was again in my primary research and I was talking to this person from Brazil who knew how to speak English. We were trying to understand why there is a lack of preference for this device. I realized that the lack of preference is because the device is a little small and sort of portable. Hence, it is easy to probably steal it or not exactly possible to keep it safe in a particular set up. Yeah, you wouldn’t except this kind of a problem while making your product, right? You wouldn’t expect that it is too handy, or it is too useful, for lack of a better word. So, this is something that you can gain only out of the primary research, straight from the horse’s mouth, straight from the user who said, “I like the device, the pricing and everything, but I fear that it can easily be pilfered or stolen and that is a problem for me.” I remember this particular example. So, I learned to talk to people to have these kinds of uncanny or offbeat understandings about a product or drugs, about everything in the world.

Vivek: Now, that’s the kind of information that you would never get by doing secondary research, I believe – only when you speak with people on the ground, people who are using, living that culture, living that land, would they be able to give you that kind of information. That’s incredible, Raj. Thanks for sharing that. What I believe is that if employees of any organization could learn to collect data in such a friendly manner, they could personalize their interactions with every patient or every customer. In your role at Kamineni, have you trained or coached your team on using such methods to develop a personal connection with the patients, so that the patients also start feeling a little bit more comfortable talking to these people? And in that direction, could you also share some tips on how this can be done and what changes have you observed in staff behaviour after such coaching?

Rajarshi: Yeah, Vivek. So, just like I pointed out that the kind of information that you can get while doing a primary research is very offbeat. That is something that left a pretty deep mark on me. While doing any kind of research even in the healthcare domain right now, all hospitals and all the players are trying to improve on their NPS ratings. Everybody feels that the NPS is an important thing and they should try and improve the score as much as possible. That NPS might be there on social media, or on any kind of ratings, or some kind of a feedback mechanism that you have at your hospital, which tells you that you are doing a good job. So, I remembered that this kind of offbeat information is something that you can gain and it really adds a lot of value to it. So, I always believed that, other than the quantitative research which contributes directly to NPS ratings, we should also have a different method of collecting feedback. So, I developed this, or rather, I conceptualized this entire patient experience idea where I would just go, sit and talk to the patients for almost 30 to 40 minutes, as long as the patient or their attendant is ready to speak with me, as per their convenience. While speaking with them, I would just simply forget about any kind of feedback or anything. I would just sit and talk to them and listen to them about what they have to say. I would ask them about their family members, who works where, whether they are retired, whether they miss their children, what they like and dislike about the hospital. It’s like a proper simple conversation that you would have with another person in a very casual manner. In the process, initially, we kept it very open-ended. Then, we had an agenda and a motive. Additionally, we formulated a form which we internally would look at and keep in mind that these are the data points which we need to ask the consumer or the patient about and, accordingly, we would be able to act on certain things. But this entire process is not an interview process – it is simply going and talking. The manner in which we recorded this information was also completely verbatim. We never really paraphrased or did anything to give any kind of shape to that data. We wanted it to be the way it was. From there, we would derive our insights and correlate them with our quantitative feedback scores. You won’t believe this Vivek when I tell you that more than 60 or 70% of the feedbacks don’t match. Quantitatively, you will notice that the patient has probably marked you as 4 on 5 at several of the parameters, but when you speak with them, they might tell you something like, “we liked the treatment,” or “we liked the food but I wish that somebody came and cleaned my room a little bit more often.” Somebody might say, “we loved everything but the food was a little bit spicy but everything else was okay.” Now, you see, this is not good customer experience or patient experience – this is customer adjustment or patient adjustment when technically something is missing and the customer is somehow adjusting it.

Vivek: And they are not disclosing that in their ratings…

Rajarshi: Correct. So, the ratings belie this feedback; you don’t get to see this kind of feedback on the NPS ratings because it is not mentioned over there or sometimes, patients are reluctant to mention it as well. But, when you actually have a warm conversation with them, they are more open to the idea of confessing it to you, more like sharing it with you. This is something that I used to do personally and then I brought my staff and other people on board and I trained them on how to go about it. On a daily basis, we have a very strong sample size. We try to talk to each and every patient in varying durations and sort out their problems. We are able to seize out feedback and correlate it with our quantitative scores, with which we are actually able to see very meaningful insights which we would be able to take action on.

Vivek: That’s incredible! So, tell us more – what do you think about the customer experience in healthcare? How do you think it is impacting the healthcare industry right now and where do you see it is going in the coming years from the customer care perspective in the healthcare?

Rajarshi: I think patient experience is going to be the ultimate differentiator. If you look at things right now, things are moving in this direction already. A lot of major hospitality chains have actually ventured into healthcare, are expanding into health care or at least have announced plans to come into healthcare. Given that, we can definitely expect that patient experience is going to be the ultimate differentiator. So, you see that this entire thing has become your confluence of multiple industries. Right now, healthcare delivery as a service is part-hospitality, part-retail, and part-healthcare. Now, in that, a lot of investment access to healthcare in India is becoming increasingly proliferated, and a lot of funding and investment has come through the private equity players. I believe that when it comes to the top 6 – 7 chains who got excellent equipment, funding, expertise, and are delivering excellent outcomes, the entire differentiation is going to be a little difficult to perceive for the patient over the next few years. It is because all of them are going to deliver similar outcomes. I wouldn’t say that one would be starkly better and the other would be starkly worse, but they would all be able to deliver outcomes which are in the same ballpark. What could truly differentiate is what kind of experience I am delivering to the patient. I can do everything right and the outcome might be the best outcome on the planet, but on the day of discharge, when the patient is eager to go home, I take 6 to 7 hours to discharge the patient, instead of 2 hours, and all my good work goes down the drain. The same patient might probably not prefer your hospital later on because of that kind of an experience. Which is why, I think, patient experience is going to become a much stronger differentiator in the future; it is already a strong differentiator. Which is why collecting, quantifying, understanding patient feedback and thereby using those as actionable insights to improve patient experience will become very crucial.

Vivek: So, in this case, how do you think, Raj, hospitals can create a memorable and differentiated patient experience? I think you have already mentioned about collecting feedback, what else do you think hospitals can do?

Rajarshi: Well, I told you about collecting the feedback, I would probably elaborate upon what actionable insights you can derive from the feedback and how you can derive them actually. That’s primarily where your point of action lies. What we do is, as I told you, we correlate the two feedbacks to understand whether it matches or not, and what we can do out of it. Another thing that we do, pretty much in-house, is to understand what good feedback, bad feedback, and neutral feedback are. I’ll elaborate a little bit upon this. Vivek, you have been in the industry for quite some time actually, so, if you have noticed, in any feedback form, you will pretty much find that if there are ten parameters, eight, or even, ten out of the ten are marked as four on five, or even five on five. Now, I would have serious doubts about the quality of this feedback because it doesn’t really look like something that I would be able to trust unless I’ve specifically spoken to the patient and understood what he was trying to do over there. So, when I noticed this, I realized that generating an NPS rating by taking all feedback forms into account is not the best practice, or rather, it is not reflective of the true happening. Which is why, after a lot of observation and statistical slicing and dicing, we came up with this in-house algorithm. It is a simple line step algorithm which we use to understand what good feedback is and what feedback we can probably place in the second-tier. Accordingly, we are able to slice and dice the data, following which we do a lot of analytic work to understand where the particular feedback can be positioned and how much it aligns with the rest of the feedback. Because of this, for instance, out of 150 feedback forms and 80 to 90 interviews, we are able to sieve out 4 solid actionable insights. These could be as simple as probably providing with two or more room fresheners in each room, or arranging to drop the patients off at their homes on the day of discharge, and the like. It can be very simple and easy to do things like these, but the outcome – the patient delight, the brand perception and the way it changes, is really immense.

Vivek: Yeah, such valuable insights. Its always in the simple things that you can create delight. That is something that I always tell my customers as well. As a company, we are also constantly looking at making the patient feedback process more valuable for our clients and for other hospitals too. In that direction, Raj, can you share some pitfalls and shortcomings that you have seen in the feedback management process in general?

Rajarshi: Oh, definitely! I wouldn’t want to be critical over here but I must say, the feedback process that we currently have in the industry does provide a lot of insights if you do take actions and insights out of it. But, I think we should pay a lot more attention to the feedback in terms of the way we are collecting, analyzing and finally giving the result to it basically. I find that it is taken a little casually, or maybe I find that people really don’t think much about the feedback. It would occur to anybody when they see a feedback form which has a pattern in the responses, that this particular feedback is probably not of high quality or it probably doesn’t have a direction. But still, if you include it in the NPS rating, your score would become skewed for the better or for the worse. Then there is no point to it, right? You don’t really get what the crux of the matter is. So, this is something that I see that is you probably just need to put a little bit of thought into it, and it is very easy to do. So, I think that part is a little missing for the time being. There are people who are doing it and that it will get better as well.
The second pitfall that I notice is the way in which you involve the other stakeholders in the analysis of the feedback. Sometimes, the feedback might be about the billing department, the physicians or the nurses. You, as somebody who is facilitating the feedback, may not be directly involved or be able to involve yourself in the working and processes of the other departments; you are pretty much facilitator per se. So, you should be able to sensitize other people that this feedback is something that will help them and that one should have a proper form of mechanism to it so that something actually is done and sustained. This is something that needs to be collaborated upon, rather than it becoming a confrontational issue, in which case you can not move from it.

Vivek: Yeah. Which is where most organizations get stuck because when they start collecting feedback, employees start getting defensive or might get confrontational also, which is the most wrong direction to take. And I love what you’ve just said that it’s important to sensitize your team as well about the reason why you are collecting feedback and how it is going to be valuable in improving the organization’s performance and also help the employees grow in the organization.
Now, what I’ve seen is that one of the biggest challenges with patient feedback is to make it actionable and I know that you’ve shared some tips about how to do the analysis – by creating some correlation of the unstructured data, that you collect through your conversations with the patients, with the structured rating data that you collect. In that direction, could you simplify that? I’m sure not every hospital might have a “Raj” in their team and they might not be able to set up a process that allows them to have such deep conversations with their patients. In that case, what processes, measurements, and controls must a hospital establish to make patient feedback actionable, so that, ultimately, it adds to the improvement of the patient experience?

Rajarshi: Definitely! The first thing that they need to do is to improve the collection of the feedback. It has to be collected seriously and defined very well. After gaining some experience on the field, you should develop an understanding of what heads or areas the feedback might come in and what data points are essential to understand how these particular areas are performing. Typically, when it comes to hospitals, you’ll get a lot of feedbacks about house-keeping, food and beverage, and certain maintenance aspects probably. To understand how the health of these departments is, or how they are performing, you need to have certain objectives in mind. This means that when you are collecting feedback, be it quantitative or qualitative, your end objective should be very clear to you and it should be clear department-wise. So, firstly, you need to define the feedback well. Secondly, when it comes to the analysis, you actually need a person good with numbers to do this – somebody who actually knows how to slice and dice numbers – to understand how the entire process should be looked at. Numbers will never lie but we, as human beings, can try to make the numbers lie. That is something where a person who is deep into analytics will become pretty effective, where he can actually look at the data and create simple models out of it to understand where the feedback is going. Finally, the implementation part, just as I told you before, involves the collaboration of all stakeholders involved. So, that would take a lot of collaboration, sensitization and, more importantly, documentation to understand how we went about this, so that, in the future, if somebody needs to refer to some of these processes, they can understand what to refer to. Thus, the knowledge management aspect of this is also very important.

Vivek: That’s incredible! I’ve never thought about this, to be honest with you Raj. The amount of knowledge that is generated in the action that is taken on resolving those patient feedbacks is so valuable and it is so much contextualized to that hospital but it is being lost, I believe. Then, you have so rightly said that it needs to be documented because that document is for your organization and might not apply to any other organizations.

Rajarshi: Correct. You see, today I have a very trained team altogether. Tomorrow, there might be several circumstances in which I probably do not have the team. So, when my new staff member on-boards, or when I have a new team per se, they shouldn’t waste any time; they should hit the ground running or should be equipped with the tools which will help them to hit the ground running. Those tools are things which will come through the proper knowledge management of how things were solved before. Additionally, it really motivates the employees. Honestly, it is a bit of a rush to actually go to a patient, become their family member, talk to them for 30 minutes and get meaningful feedback out of the person. I’ve given my staff some amount of training and statistics as well that they have taken very receptively and have enjoyed it. That is a bit of a gain for them, something that they can take back along with them throughout their careers, from a long-term perspective. Similarly, this entire knowledge management idea it is like creating a new generation of customers experience executives, who, in their own right will probably create more people in this particular idea, and maybe even improve it. That’s how I think we will get there when it comes to customer experience.

Vivek: Wow, wonderful! That’s amazing. Raj, what would be your advice to healthcare organizations who are just starting to collect patient feedback to improve the patient experience? To date, be it healthcare or any other industry, not every organization is collecting customer feedback. What would be your two or three points of advice that you would like to give to these kinds of organizations, who are just getting started with it?

Rajarshi: The first advice I would give them is to have a customer experience team. A lot of hospitals do not have a customer experience team; they rely on their in-patient executives or their quality team to provide the right kind of experience. While I’m sure that they are able to do justice to it, but why settle for justice when you can do much better? My first advice would be to have the right kind of team who will be able to understand it and take things forward. The second advice would be to help or equip these teams with the right tools so that their job becomes a lot easier and they are able to focus on what really needs to be focused upon, for instance, taking action out of those insights. The process that we have here at Kamenini Hospital is a pretty long-drawn process and it is pretty exhausting to finally get to the insights because there are multiple documents involved, which include verbatim files, Excel Sheets, macro-based Excel Sheets and the like. There is a very long conveyer belt of information and documents which keep circulating amongst all of us at all points in time and it can be very tiring. So, we need the right kind of tools so that we spend more time focusing on what we should be doing or what gives us more action, rather than spending unnecessary effort in what we have been currently following. And the third thing that I would say is to keep things sustainable. You start with the customer experience team and then when things are running fine, you, probably, start focusing less on it. That is disastrous because, believe it or not, even though this is the healthcare industry and even though it is not exactly like a product-based industry as such, yet the customer preferences and patient preferences change. So, you have to be vigilant all the time. These are three pieces of advice that I would like to give to any executive or any person for customer experience.

Vivek: I think you have made a brilliant point actually. The last point you have just said that to make it sustainable that relates so well with the first point where hospitals should think of having a separate customer experience team. Now, only in my last newsletter for the last week, I wrote about how important it is to have a separate team or to upgrade your team so that they can do bigger things because if you are loading the same people with more responsibilities they are going to be seeing those things are overloaded and that’s not sustainable.

Rajarshi: That’s right.

Vivek: So, your first point itself ensures that the system becomes sustainable. Brilliant Raj. Finally, this is a question that I ask everyone. Can you name a few books that had the most impact in your life and that you recommend to our listeners?

Rajarshi: Sure. One book I recommend everybody to read is,“Surely You’re Joking” by Mr. Feynman.

Vivek: Okay, that’s interesting.

Rajarshi: This is an immensely lovable book. The book is about what great men do when they take a lot of complex examples and they make it feel really simple. So, it is really complex physics going on in that particular book, like the cosmos is being explained to you but in such a simple fashion. At the end of the book, you will feel why did we all study physics. One should go through it. The second book which I would recommend, Vivek, is this book called “Jane Eyre”. It is written by an English writer called Charlotte Bronte. It is a beautiful book about making choices, about following them. That entire book is something that helps you understand that even though taking a chosen path might not always be the easiest path, but it is always the most fulfilling one. It is really a life-altering, or maybe, focus-altering book. I think everyone should read that. And the third book that I would recommend is a book called “The Art of War” by Sun Tzu. It is pretty often read and quoted by everybody nowadays. The man who wrote it at that point in time is an absolute genius and there is definitely a lot to learn about strategy conduct, on how you conduct your business or yourself. It is a beautiful book. I think these are the three books that people should definitely read and it does leave an impact on your life.

Vivek: Great, well Raj thank you so much for all the time. It’s been a pleasure talking to you like the previous time. And as always, you’ve shared the depth of your knowledge, I believe our listeners are going to enjoy this conversation. This is your host signing off on another episode of CX Conversation. Thank you so much for listening.

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