My Experience of Top 5 Ways to Acquire Clients

Looking to Build a career and a fortune in Sales, follow these 5 simple tricks

  
A business thrives on sales and customer acquisition.  Any doubts? Getting regular business is the key to an organisation’s sustainability.  It is not an easy function and requires a lot of effort, energy and planning.  It is a known fact that some strategies may not work on the ground and one has to continuously keep customising it to make an impact.

It is also important to understand if the product or the service you are offering is required by the prospect or not.  Nobody buys a product or service unless it meets some specific requirement unless it is a new product designed after tremendous amount of research and to meet the specific needs of the market.  Also your product has to have unique features and it can only sell if it has some very important unique selling propositions that is different from those already available in the market. 

Follow these tips to become a "rock star business developer" and garner sales to become a top ranking performer which your boss you would.

1.    Getting through the "gate keepers"

When you first visit the prospect, you encounter the staff at the security desk or the reception, who in common parlance are referred to as “Gatekeepers”.  These gatekeepers safeguard the employees inside the premises from “outsiders” and “intruders”.  This is a normal approach because a lot many “Jhola” type (“bag carrying” salesmen) call upon organisations on an everyday basis and offer products and services, some of which are local and unbranded, are commonly available, make them available at dirt cheap cheap rates, offer guarantees (wonder who will provide back-up guarantee and where do you catch hold of them?) and add no utility value to the user.   These are such cheap products that you wonder how they make any profit at all.  Well, that’s besides the point.  The point here is that because of such gate crashers, genuine persons get blocked and bombarded with questions like – why you want to meet, the person is busy or in a meeting, he will be or is available only at some very odd hours, just to keep you away.

So they key here is to do the following:

Make sure that you have a prior appointment.  If you don’t have one, make sure that your opening statements to the front desk is convincing enough for them to let them through to the person you are looking to meet.  Tell them why it is important for their manager to meet you.  Provide effective answers to their counter questions which you must anticipate and be prepared for them.

You must also be dressed to impress.  The reality of life is that people don’t value a person o his product or knowledge and the purpose but people do get impressed with one’s attire or how you carry your personality.  Not intending to demean anyone, but the reality is that people holding lower positions are far likely to get impressed with a person wearing a formal jacket or attractive sunglasses or carrying an impressive bag.  Yes, in the 21st century that still holds, at least in India.  If you have people accompanying you and if they address you as “Sir” or “Madam” that helps make a still bigger impression.  If they approach you on her/his behalf while s/he waits, also adds to the “impression communication”.  But in some cases, even this does not work.

I do not advise this but display of a bit of attitude and a slightly stern but not using curt language helps cast an impression.

I know of a real life instance where a short sized person arrived in a swanky car with security personnel in a car ahead of his and one behind.  The security personnel would cordon off people so that he could walk towards a store.  This created a kind of image of a very important person and people started wonder who he really was even though he may not be any celebrity or a rich corporate executive.  It just zapped people’s thinking and he had attained a superiority position over other lesser mortals.  He became the “upper crust” very easily.


2.    Building a good rapport with the prospect

Be thankful that you are finally got into the inner “sanctum sanctorium” where the “lord” sits and is an achievement in itself.  Now let’s get on to the most important part which is where we need to focus on our remaining energies on impressing the prospect.  A lot has been written and spoken about your opening lines, the firm handshake and so on so we will skip that part.

Now it is important to recall what you have observed and made mental notes, while you were waiting in the reception because that will help you raise discussion points and get into the prospects mindset. 

It is important that after initiating the discussion, you allow the prospect to talk or share as much as possible.   You do not want to put him off or tell you that you hardly know what s/he has been trying to convey or hardly understood the needs or requirements.  Once he has exhausted, you start giving him your replies point to point to ensure that you have covered every detail aspect of his “stated” requirements.  Don’t oversell your product or service but explain the key salient and uncommon features.  Make sure that you make constant eye contact, watch his facial expressions change with every statement. Facial expressions are a big giveaway and you would know that you have a strong or a poor chance of striking a deal.  Remember that some people have trained themselves not to reveal their mindsets through expressions or to have a straight face all through.  I have encountered such people who will smile all throughout the meeting and concur with you and yet mislead you into believing that you have “sealed the deal”.

How you resolve their queries is very important and explaining that the product or service has already taken care of their problem or pain points is crucial.  It might be important that highlighting such key features in the initial discussion itself will save her/him from embarrassment.
   
I have used praise and appreciation for something which I have found unique or special while I was waiting and convey my admiration and that it has impressed me.  I make it a point to convey my genuine appreciation or happiness at some client sites  and this has helped me build a good rapport with the prospect and also converted many of them as clients.


3.    Picking up cues about his pain points without the prospect even mentioning about it.

If you are smart enough and of course you should be, allow the Lord to speak as much as he can.  Ask her/him relevant questions that will do two things (a) he will understand that you are actually asking the right questions; (b) and that you can solve his problems and therefore he will open up by freely sharing information.  At this point, s/he will start blurting out her/his problems and that gives you an opportunity to get deeply into her/his mindset.  S/He will have almost fallen in your trap.  You have to be mentally alert to understand and recap whatever has been said so that s/he get the message that you have understood his pain points.


4.    Telling them how you’d be able to resolve this

Now this is like going for the kill.  Telling them that you have understood the problem, you can propose a couple of options of how it will be resolved, without giving much away.  Withhold some solutions and make sure that they ask you.  The moment they ask you about process, formalities, timelines or more details which you do not expect them to understand about your service, it is better to assume that the prospect is interested.  As soon as he starts asking technical questions, it is to be realised that the prospect has already been approached earlier and he is coming from there.  The question that is uppermost in their minds right from the initiation of the discussions is “how much will it cost me?” is the last but firmly asked.  Now there are two things to do: (a) tell him an estimate of the proposal if it is a product whose price is known; or (b) if it is too technical or involves both supply of products and technical service, then you can say that you will have to go back to your team, work out the various details and only then you will be able to give a final proposal.  Don’t forget to take an email id.  Give them a time-frame by which they should be able to receive your proposal.  Ask them if they have any other details to share or to ask which will be critical to the discussion.  If not, express your thanks and re-commit about the deadline for sending the proposal.


5.    Giving him a proposition s/he cannot refuse

Once you have understood that s/he already has a proposal, consider the costing and make it competitive but don’t undercut drastically.  This ends up spoiling the entire business opportunity, not only for yourself but for others too.  It is a buyer’s market and there are multiple competitors, then you might have to adjust your pricing accordingly.  But if your product is unique or exclusive, then you have the opportunity to demand a reasonable amount and even premium too.  

Follow-up your proposal by telephone calls to confirm if they have indeed received the proposal.  I have seen that prospects have not even checked to find out if they have received your correspondence.  At other times, they will simply tell you honestly that they have received but not have had the opportunity to go through it in detail and will ask for more time.  Such behaviour delays decision making for everybody.  You can follow-up but up to a point.  Telephonic calls may not be sufficient after a while and then you will have to make a personal visit for a face-to-face interaction to understand their body language and other non-verbal cues.

The personal visit may be an opportune time for the prospect to bargain and negotiate which is where you should open up.  It must be understood that s/he was waiting for this opportunity but was shying away.  Give him a final offer, get her/his verbal confirmation, offer to send a final proposal, if required or get his signature on the struck deal, send the contract papers later and get working!

Best Wishes!



Sarfaraz Lakhani
22nd January, 2020
#calibrecreators

Interview of Mr. Saurabh Kulkarni, a Bio-Medical Engineer turned Entrepreneur

Mr. Sarfaraz Lakhani of Calibre Creators had the opportunity to interview Mr. Saurabh Kulkarni of Thane, Mumbai who has tasted Entrepreneurship and seems to be basking in its glory.

Saurabh Kulkarni SK), the ever smiling and charming person, is a young eligible Bachelor, a Bio-Medical Engineer turned a healthcare professional.  He has done his Bio-Medical Engineering from a very reputed college in Mumbai and later pursued an MBA in Health & Hospital.  He worked with the Asian Heart Institute (AHI), Mumbai, AAA HealthCare Consultancy Services Pvt. Ltd., Mumbai and later with Hospro Consultancy, Thane, handling their sales and marketing function.  At AHI, he was responsible for its branding activities (internal & external) whereas at AAA HealthCare & Hospro Consultancy his role was to meet the hospital owners to promote consultancy services for various products and services.


At a very young age, he along with his friends-turned-partners, plunged into entrepreneurship, establishing two companies - starting a garment manufacturing company and also taking up the franchisee of an Indian fast food chain.


CC.1    Saurabh we worked together earlier and now its sheer pleasure to be interviewing you.  How does it feel?
SK:   Sir, its my honour that you considered me for an interview since my experience is not that much to be eligible for one.  I’m and always want to be a learner. I have learned many things from you e.g. time management, people management, idea generation, etc. and it has been a great learning experience which I will cherish for a long time to come.  These will be my guiding posts in my future life and career journey.


CC.2    Saurabh, tell us why you chose to be a Bio-Medical Engineer and what was your vision then?
SK:    I always wanted to be an engineer from childhood. I was good in Science, especially Biology, maths and engineering and had some interest in it too, so it was logical to get into Bio-Medical Engineering.  As for the vision part, I have for long dreamt of starting something of my own and do something creative.


CC.3    You then pursued a Masters degree in Hospital Administration.   What took you to that route?
SK:    In third year of Engineering, I realised that I needed to choose between working in the IT sector as a programmer or working in hospital as an Engineer.  However, I chose neither of these two and opted to pursue higher studies, clearly looking at the low compensation levels being offered and limited career options, in my opinion.  I wanted to pursue a Master’s Degree in later part of professional career but then I realised that rather than delaying the decision later, why not do it now  Also, we had been introduced to the subject of Hospital Management as part of our curriculum and it got me thinking and hence the decision.


CC.4    Why did you opt for Sales as against pursuing a career as a Bio-Medical Engineer or a Hospital Administrator, either with a Hospital or a Medical Equipment manufacturing company?
SK:   After getting into Hospital Management (MBA), I always got internships in Marketing & Sales function and I liked the part of meeting newer people and getting wider exposure about the functioning of the healthcare sector.  It was then that I decided to pursue this as a career choice since by this time, I had somewhat lost touch with the technical aspects of Bio-Medical Engineering.  I was now exposed to the larger aspects of healthcare and hospitals.  I could look at a much bigger opportunity rather than restricting it to just being a bio-medical engineer and it really helped.


CC.5    You seem to have suddenly caught the “entrepreneur” bug.  What was that turning point in your life when you decided to be an entrepreneur and was it a sudden event?
SK:      I wouldn’t say that it was a sudden event.  After my stint at AHI, me and my friend who are now my partners thought of starting something of our own.  During every outing, we would touch upon this and kept the discussion alive.  After a bit of market research, we narrowed down on the clothing segment.  We initially started on a small scale and at a very slow pace so that we learn the nuances of the business and not end up making major mistakes.  Till the point, I was in AAA HealthCare, my two partners were handling the pre-requisites and after exited from there, I got actively engaged in the venture.


CC.6    What challenges did you encounter and how did you strategise to overcome them?
SK:      The sector was completely new for the 3 of us.  We initially spent 6-8 months meeting people, knowing new things, exploring the market, understanding the market potential, specific requirements, etc.  Since we were completely new to the sector, we had little or no understanding of the supply side of clothes, manufacturing and sales.  People were not willing to entertain us but there were some people who valued the quality of our work and gave us the opportunity to do business with them.  People negotiated on rates, terms and duration of payments and they were important because we did not have much working capital to play around with.


CC.7    What is good and the flipside about being an Entrepreneur?
SK:      The good part of being an Entrepreneur is that you get to learn all the things that are required to run a company starting from market research, managing funds, your product, marketing promotion, sales, client relationship management, etc. The flipside is that your family should be supportive enough to understand the pressures.


CC.8    Most entrepreneurs would have started with one line of business and given it say 3 to 5 years but you seem to taken up two divergent industries and unchartered territories.  How do you manage this?
SK:    It is not tough if you ask me.  Every person is good at multitasking and it must be given a try.  We also faced many hiccups during this process but we persisted. An entrepreneur should be a leader who passes his strengths to his team, in turn, creating many more. Once you have learned to do that you can manage 2 or more businesses. It also depends on the scale of the business.  Also, we saw that these were opportunities that we could easily take up.  We shared the responsibility but were collectively involved.  The understanding between the partners was well laid down and all issues and problems are resolved through a healthy discussion.


CC.9    You are a Bio-Medical Engineer at core.  Any plans to venture in this sector too?
SK:      Definitely yes, I’m a Bio-Medical Engineer at core which is one thing that makes me restless and motivates me to do more and to do something in that field.


CC.10    Most young people believe it is easy being an entrepreneur.  Please comment.
SK:        Not at all!  It is a gross misconception.  There is nothing easy in life.  As they always say “the grass is always green on the other side” which is not the case.  It is way tougher than you think because your entire future is at stake.   There are times, when the anxiety levels are very high and can be an unnerving experience.  However, If it succeeds, nothing like it but if it does not meet the expectation, then it affects one very badly, not that one should take it personally.  There is always a 50% chance of success right from day one and therefore it requires perseverance, commitment, energy, enthusiasm to put all that behind and look ahead.  If one has the courage, then anyone can

What we learnt and realise is failure is not bad as it is made out to be.  It leaves us with lots of learning’s and there are so many things to imbibe before one rests, before age catches up and when you have to then go slow.  We are all roaring to go!


CC.11    What Risks and Benefits did you weigh before becoming an entrepreneur?
SK:        The major risks are that till the time your business isn’t set, you will have to be dependent on your family for sustenance and I have been fortunate on that count. You will not be having any stable income coming in every month and which pushes you harder. Benefits are that you will become an all rounder who knows everything from every department and that stays with you for life.


CC.13    Please list your learning’s and challenges and what did you learn from them?
SK:        My learning’s are:
1.   Always spend wisely. Think 10 times before spending as you might need that resource in future when needed the most. 
2.  You become self sufficient to encounter any problem.
3.  You get a whole new approach to look at life.

become an entrepreneur.
As far as challenges go, I can say that
1.    Be sure before quitting your job to become an entrepreneur. 
2.    In today’s age, always start a business in partnership.  Have partners that are always with you in your toughest times. 
3.    Most importantly, convince your family and take them into confidence if you want to be an entrepreneur, because if you have the support of your family then on emotional front your mind is stable. You can concentrate on your business.


CC.14    What are some of the key differences in being a professional corporate employee v/s being an entrepreneur?
SK:    A professional corporate employee is like wearing “horse blinkers” who always looks at only his assigned core responsibility while an entrepreneur is an all-rounder who has to know everything about his business from all departments.  The vision gets wider, the exposure to is unlimited, success gives your courage to still move forward to move higher and higher.  It gives him energy and the push to succeed and expand his business.


CC.15    Young entrepreneurs rise early and have a long stretched day.  What are your first thoughts in the morning about the day and what is your daily routine?
SK:    True. They rise early and have a long-stretched day and thinking about 1st thoughts in the morning is to plan your day, prioritise according to the need, attend to business demands and can be very hectic at most times.


Saurabh, Calibre Creators wishes you a successful entrepreneurial journey and that you may achieve your goals and aspirations to become an industry leader of the immediate future.

Health Care Quality : An in-depth interview with Dr. Manisha Dogra.

“There can be no excellence in patient care without monitoring quality of healthcare services”


Mr. Sarfaraz Lakhani of Calibre Creators (CC) had the opportunity to interview Dr. Manisha Dogra.  The discussion brings out some very key facets of Hospital Quality and its importance to patient outcomes.  Here she shares her thoughts about her journey, the challenges and future of quality and makes interesting reading.


Dr. Dogra is a dynamic healthcare professional with 13 years of extensive experience in Hospital Administration and healthcare quality.  She is currently associated with a premium healthcare organization in Mumbai.  Adding to her qualification of BAMS, she has furthered here academic credentials with a Master’s Degree in Hospital Administration (MHA) as well as achieved certification as an NABH Assessor (Entry Level).  She has also had the privilege of working with 2 to 3 renowned multi-specialty hospitals in Mumbai.

She has endeavoured to achieve Clinical excellence, Operational excellence, implemented Quality initiatives and accreditation (NABH & JCI), is excellent at clinical engagements and resolving issues/ patient grievances to improve efficiency and satisfaction in patient care. With core strength in planning, administration, and monitoring consistent readiness of all quality management, regulatory requirements, and quality-improvement processes, she is also good at people management to achieve/ align employee satisfaction with organizational goals. 

With the following quote, “the quality of a man’s life is in direct proportion to his commitment to excellence”, she carries a vision of achieving clinical excellence & quality in patient care.

Dr. Dogra’s achievements in the arena of Quality for the last 5 to 6 years for tertiary care set ups….
•    Successful NABH Surveillance Assessment
•    Successful NABH Ethics Committee
•    Successful NABH Re-Accreditation
•    Successful JCI Accreditation
•    16 Quality Improvement Projects (In sync with other departments)
•    Improvement in Net promoter Score by 30% (Patient satisfaction)
•    Certification - NABH Assessor (Entry Level)   


CC.1.    Please tell us about your current role?

Dr.MD: I am currently attached to a reputed multi-specialty tertiary care centre in Mumbai of a capacity of more than 300 beds.  My broad core responsibilities are:
•    Planning, administration, and monitoring consistent readiness of all quality management processes, compliance with regulatory requirements and quality-improvement processes.
•    Manage the Continuous Quality Improvement Programs.
•    Monitor clinical quality
•    Responsible for Accreditation's


CC.2.    How has the Quality journey been and what were the challenges?

Dr.MD: It has been an interesting & challenging journey of Quality for me.  I am fortunate to get this opportunity, as it gave me a good platform to channelize my 13 years of rich experience in Hospital Administration.

With a good mix of Helping, Persuading & Organizing skills, it has been a very interesting and challenging journey for me in healthcare quality.

The “Helping” interest area in me indicates a focus on assisting, serving, counseling, or teaching other people. With the “Persuading” interest area, I focus on influencing, motivating, and convincing other people to get involved and not leave anyone behind.  My “Organizing” interest area is focused on working with data, information and processes to keep things arranged in orderly systems so that they progress towards the larger goal.

Challenges encountered by me in this process are :
1) Lack of proper integration of Quality Assurance (QA) in system;
2) Weak methods of communication of Accreditation standards;
3) Poor measurement of compliance with clinical care  standards;
4) Constraints on the work of quality improvement teams;
5) Inconsistent Support system;
6) Constricted feedback on performance, benchmarking with peer groups;
7) Staff support (avoiding blame, providing training), Incentivising (Motivating for continuous improvements);
8) Systems development (Configuring & re-engineering towards requirement at user end and meeting patient needs). 
These are some of the challenges that push me harder and harder to achieve the desired outcomes.


CC.3.    On a daily basis, how do you monitor quality is being practised?

Dr.MD: Measuring & monitoring the quality of health care is important because it tells us how the health systemis performing and leads to improved care. Quality measurement in health care is the process of using data to evaluate the performance of health plans and health care providers against recognized quality standards.

I have been successful in monitoring quality by the following means:
•    Being regular in conducting weekly audits of departmental processes
•    Incident analysis to identify the Root Cause
•    Periodic Analysis of Patient feedbacks
•    Conducting Mock drill and analysis
•    Organising Trainings on various trainings
•    Periodic Self-assessment audits of NABH standards
•    Monitoring the effectiveness of various committees
•    Periodic revaluation of gap closure for the above audits

I engage the whole team in the process and that his how we all understand the problems and come out with effective solutions to address them.


CC.4.    How do you align your staff to be motivated about delivery qualitative healthcare?

Dr.MD: I have been a staunch advocate of involving the staff, in discussions of incidents for the Root Cause Analysis (RCA), Corrective Action Preventive Action (CAPA) (which by itself is a continuous learning process). Conducting periodic interactive training sessions for their departmental SOPs and hospital wide policies, as well as NABH standards, followed by organising Quiz programmes, help them to understand the importance of their activities and how it is linked to the overall organisational goal of achieve the desired quality outcomes.As a result of which they are made conscious of doing the right thing in a right manner.
   
It must be recognized that today, medicine is increasingly becoming technology driven. New technologies create new methods for producing errors and therefore, constant vigilance and newer methods to stay in tune with new technology and monitor them is required to track these.

One powerful tool that I used is implementing “anonymous incident reporting” by the Consultant’s, Doctor’s, Nurses and Technicians working in high risk areas without having any fear of repercussions or being negligent and it has so far delivered the desired result. Lapses of discipline, errors or incidents are noted and dropped into a ‘ballot box’. The head of department opens the box at periodic intervals and uses the reports to generate a discussion on how practices can be improved.  It creates an environment where free dialogue is encouraged and no one feels threatened about consequences or job security.All the above measures are included as part of daily practice, thereby installing a culture of ownership for safety & quality by everyone involved.


CC.5.     Documentation is a very important part of the entire process.  Does it ever lead to delays in clinical or other process because one has to comply with them first?

Dr.MD:  Documentation is admissible as evidence and is the core requirement of an Accreditation body to substantiate the claim of having of having followed the due process.  Incomplete documentation in patient clinical records can cause the organization legal problems and lead to payment of settlement fees which can be very high, given the recent rulings by courts in favour of patients, can cause you to lose your license, contribute to inaccurate statistical databases, cause loss of revenue/reimbursement, and result in poor patient care.  The purpose of complete and accurate patient record documentation is to foster quality and continuity of care.

It is important to continuously train staff on the importance of documentation as lapses here could be detrimental to the sustenance of the Accreditation and other problems cited above.

Documents are the only piece of evidence that can be produced to measure quality of performance or services and therefore become the most important activity in the entire spectrum of quality healthcare delivery.

    
CC.6     What would be your suggestions to make the role of various committees more effective in driving the quality initiative?

Dr.MD:  In my opinion, it would be:
•    To revisit frequency of the committee meetings.  If the gap between any two meetings is too long, then frequent meetings will be required and it will also depend on the size of a hospital or range and volume of patients catered to.  If there is an extended delay in measuring performance and if corrective is not taken quickly, the time lag in between will lead to more reported incidents with consequences.
•    Remedial measures, adequate monitoring of CAPA done by the respective committees to be assessed.  Time should be devoted to measure the impact of CAPA and must be continuous until the desired outcome is achieved.
•    Any requirement for involving education sessions that help the committee understand the new developments & how it impacts the quality outcomes.  This must be thoroughly planned and there should be a strong connect between the Quality department facilitating the education and those delivering it.
•    Regular evaluation of Individual committee members to ensure that they are actively engaged in the process
•    It goes without saying that “High risk”areas to be devoted more attention and are looked at with more seriousness.
•    What could we do differently in the meeting to improve the substance of discussion?  How can the Convenor of meeting ensure that discussion is meaningful, is based on analysis of data and everyone is actively engaged and committed to the overall goal.
•    Revisit Terms of Reference (TOR) of each committee for amendments.  This should be done at periodic intervals to stay relevant.


CC. 7    How did you get associated with healthcare quality?

Dr.MD:  In my earlier roles, I was a part of the Quality process (third party evaluations (NABH & JCI Assessments for Accreditation)and had a complete approach and commitment to delivery of quality healthcare.  I developed a keen sense of interest and realised that this is the future and what I want to be doing in the years to come.  I got myself to get fully involved and kept on upgrading myself through workshops, training programmes, etc.


CC.8.    Why do you think quality in healthcare is important?

Dr.MD:  There can be no excellence in patient care without monitoring quality of healthcare services.
   
During the past 2–3 years, improving patients’ experience of health care has become a higher and more visible priority.Quality from a patient’s point of view, relates not only to outcomes but also to a more humane, respectful treatment, convenience, and timely access. Yet, physicians often believe that quality should be based more on what is done to patients than what happened to them and how it happened.


CC.9.    How does quality based systems and processes impact employee and patient satisfaction?

Dr.MD: The quality debate is primarily about “what” processes should be used and what outcomes should be achieved or, in financial terms, how to maximize return on investment. This necessitates the development of a clinical evidence base and adherence of practice to what is known or believed to be appropriate and effective care.

Other attributes of any healthcare system such as overall capacity and technological capability also affect these outcomes. Quality of care efforts must focus at both, the macro (population) and micro (individual) levels. While the ultimate test of healthcare systems may be their impact on health outcomes at the population level, many population level health outcomes are more susceptible to non-medical factors such as sanitation, education and housing than to the influence of healthcare services.

Historically, quality in health care has been an implicit judgment at the level of patient-physician contact. Quality has been largely addressed through professional registration, review of professional appointments,and less through the formal peer review processes. Over the last two decades, this has changed dramatically, with increasing recognition that quality improvement cannot be seen just as a by-product of other processes.

Process based quality management systems are very important for a safe treatment environment in any healthcare organisation.


CC.10.    What are some of the common problems encountered by hospitals in implementing and sustaining quality?

Dr.MD:  Following are the challenges, usually encountered by me in my work experience.

Challenge 1: Convincing people that there is a problem. One fundamental, but often poorly met challenge for improvement efforts is that of convincing healthcare workers that there is a real problem to be addressed. Clinicians and others may argue that the problem being targeted by an improvement intervention is not really a problem; that it is not a problem ‘around here’; or that there are far more important problems to be addressed before this one.  Trying to convince clinical teams who think they are already doing well to change, is likely to be futile unless they can be shown that action is really needed.

Challenge 2:  Convincing people that the solution chosen is the right one. Improvement interventions are often ‘essentially contested’: everyone may agree on the need for good quality but not on what defines good quality or how it should be achieved. Clinicians and others may resist change on grounds that interventions lack sufficient evidence or are incongruent with preferred ways of practising that already appear to deliver good results.

Challenge 3:  Getting data collection & monitoring systems right.   Data collection and feedback are indispensible to improving quality. Data helps in demonstrating the scale of a quality problem and presents evidence of what is happening in response to an intervention. But data collection, monitoring and feedback systems are remarkably hard to get right: they are often poorly understood, poorly designed and poorly implemented.

Challenge 4: Organisational Culture. Trying to secure improvement in situations where organisational capacity is inadequate, and culture is adverse or non-conducive can result in emotional exhaustion and evaporation of support. Differences in morale, leadership and management in organisational settings may lead to variation in outcomes.  Organisational cultures supportive of personal and professional development, and committed to improvement as an organisational priority, are, unsurprisingly, more likely to provide an environment where improvement efforts can flourish.1

Challenge 5: Sustainability. e.g.; Clinicians and managers interest may dwindle when, at a project's end, they are faced with new, competing priorities.


CC.11.    From your vast experience, what are some of the key learning’s that you would like to share? Please share at least 5 if not more.

Dr.MD:   Key Learning’s with Quality:
a.    Continuous improvement.  A very important facet of quality.
b.    Reduction in errors.  If uncontrolled, it can spiral beyond control.
c.    Less variations & disparities in care, i.e. standardisation
d.    Collective learning – Foster’s learning and creates an equitable environment
e.    Systems improvement – the scope is endless.  Learn from errors.

The best part is that all the above 5 are interlinked to each other and by themselves are of no consequence.


CC.12.    If you had to change about 3 things or more in the delivery of healthcare services with regard to quality care, what would they be?

Dr.MD:  In my opinion, specifically in India and other developing and under-developed countries, the following three factors have largely been influential in healthcare quality not being where it should have been
a.    Lack of understanding for Quality improvement Processes
b.    Myths about Quality
c.    Compromise on Quality to save costs and increase profit


CC.13.    One of the perceptions is that delivery quality healthcare leads to increase in costs. Is that true?

Dr.MD:  Strong financial performance is associated with improved patient reported experience of care, the strongest component distinguishing quality and safety. Financially stable hospitals are better able to maintain highly reliable systems and provide on-going resources for quality improvement.

Financial impact of Quality & Safety - When a hospital makes more profit, it has the capacity to finance investment using debt, pay higher wages presumably to attract more skilled nurses / doctors, its quality of care would generally improve. While the pursuit of profit induces hospitals to enhance both quantity and quality of services they offer, the lack of financial strength may result in a lower standard of health care services, implying the importance of monitoring the quality of care among those hospitals with poor financial health.

Performance-based payment incentives may improve care but may also add new financial burdens to facilities that treat the uninsured population. As such, a provider’s payer mix may need to be considered in the design of QI programs if they are to be sustainable.
   
Despite the significant investment in Quality Improvement (QI) efforts and encouraging data regarding their effectiveness, less is known about how these programs have affected the financial status of Healthcare organizations. Past research has demonstrated that delivering high-quality care in the current healthcare system—and particularly within healthcare organisations, meaning hospitals  — does not always save costs and increase revenue for the provider.

If health care workers are of varying quality so too are the institutions in which they work. Government hospitals are characterized by chronic overcrowding, underfunding, and facilities perpetually stretched to the limit. They are the victims of an economy which spends less than 2% of its GDP on health. They turn out bright young doctors and look after a workload of patients with a spectrum of diseases far broader than found in the private sector; yet are at times the unfair target of criticism during healthcare crises. Their circumstances seldom allow quality and safety to appear on their radar.


CC.14.    What kind of training is required to be imparted to staff to upgrade their skills to keep them attuned to the organisational commitment to delivery of quality healthcare?

Dr.MD:  Definition of quality can be explicitly stated - ‘without excessive use of financial resources’. In the same vein, the quality and safety measures listed below are implementable by any institution, government or private, having the necessary commitment.

a.    Ensure the SAFETY OF patient's identity. At times of blood collection, blood transfusion, laboratory investigation, and surgery, correct identity is crucial. Mistakes are not common but can be devastating when they occur.
b.    Use evidence based medicine to save lives: For e.g. a) acute myocardial infarction; b) central line infections; c) surgical site infections; d) ventilator associated pneumonia.  The challenge here is not intellectual, but one of determination to implement what is already known for the benefit of each and every patient.
 c.    Better communication between healthcare workers: Since a single stay in hospital may involve interaction with ten or more caregivers, errors may occur during changes in nursing shifts and when daytime junior doctors transfer care to emergency doctors at night. Proper documentation of unstable patients’ status in case files including DNR orders can avoid distress and futile resuscitation efforts in the event of a cardiac arrest.
d.    Safer delivery of health care: Multitasking is inbred into the daily life of doctors and nurses with the distraction of mobiles, casualty calls, and emergencies superimposed upon patient work and meetings. Staying focussed can lead to decrease in errors, picking up symptoms quickly and addressing them.Checklists and bundles should be followed for common clinical conditions for delivering daily care to patients especially in ICUs to ensure no component of care has been missed.
e.    Hand hygiene to prevent nosocomial infection: These infections cost lives and increase morbidity and health care costs.
   

CC.15.    Should healthcare quality be linked to Accreditation or can it still be delivered as a value with any Accreditation or external stamp of approval?

Dr.MD:  With the increasing awareness of Quality in healthcare, patients will certainly look forward to an accredited hospital. Quality and safety have always been of prime importance in healthcare. However, in the future, under health care reform and associated initiatives, a shift in the paradigm of medicine will integrate quality and safety measurement with financial incentives and a new emphasis on consumerism.

A system of transparency, consumerism, open outcomes, and financial incentives has clearly moved medical quality and safety into a much more regulated and financially incentivized realm.


CC.16.   What would you recommend to Hospitals who are still not keen on implementing quality in healthcare?

Dr.MD:  As per the individual requirements of patient, QI helps in yielding better results.  Quality improvement in healthcare lessens the time of healthcare initiatives.  Quality improvement helps in consulting the concerned specialist with least time lags.With challenges come opportunities. For providers who continue their ethical practice of keeping the patient as the focus and centre of the delivery system, there will be new and different ways of succeeding in health care. Better quality, safety, patient satisfaction, and competitive advantages that result will inure directly to the benefit of those providers.


CC.17.   Do you have any suggestions for strengthening the Accreditation Standards currently in force to make it easier for hospitals to implement without compromising in any way?

Dr.MD:   Yes. At the moment only two:
1.    Frequency of Programs of Implementation (POI) conducted should be increased by the Accreditation body to encourage more entries for accreditation.
2.     There should be more preliminary inspections by the Accreditation body with the motive of training the staff with the same.


CC.18.    What would be your recommendations for healthcare quality to become a strong movement in India?
   
Dr.MD:   Quality and safety have always been of prime importance in healthcare. However, in the future, under healthcare reform and associated initiatives, a shift in the paradigm of medicine will integrate quality and safety measurement with financial incentives and a new emphasis on consumerism.

A system of transparency, consumerism, open outcomes, and financial incentives has clearly moved medical quality and safety into a much more regulated and financially incentivized realm.


CC.19.    Any advice you would like to share with the readers and hospital administrators related to quality?

Dr.MD:  The challenge in the future is to ensure that the goals of improving quality and safety, as well as high patient satisfaction, continue to be the aim in the context of diminishing reimbursements and higher costs.

What is important is that health care providers understand this new delivery role and embrace it, while maintaining their professional role in collaborating with the patient to achieve the patient’s health care goals. Historically, quality in health care has been an implicit judgment at the level of patient-physician contact. Quality has been largely addressed through professional registration, review of professional appointments, and less formal peer review processes.

Over the last two decades this has changed dramatically, with increasing recognition that quality improvement cannot be seen just as a by-product of other processes.

So as I see it, future of Healthcare Quality, requires that we will need to reinforce both the modalities, i.e. the processes as well as have a humane approach to delivery of healthcare.

Dr. Manisha, I thank you for your time and sharing your views on a wide range of topics related to healthcare quality.  I am sure, readers will find a lot of ideas for strengthening their quality initiatives.


Note:
1.  The views expressed by Dr. Manisha Dogra are her personal and do not represent the view of the organisation she is associated with.
2. Calibre Creators shall not be responsible for the views expressed by her.