drawing board

Line of treatment: How a dose of ‘graphic medicine’ helped doctors at AIIMS

At a workshop last month, AIIMS doctors learnt to draw comics to improve doctor-patient communication,

As part of Grassroots Comics, a social venture that uses comics as a means of communication, Sharad Sharma had conducted many workshops. But never one with doctors. He feared there might not be many takers because, as he acknowledged, it was an idea that many might consider “crazy”.

“I was going to offer comics as graphic medicine,” said Sharma. “The idea was to introduce this medium to doctors and therapists as a way to communicate better with patients or to simplify medical jargon. But I wasn’t sure whether this would be accepted as a serious idea or worth their time.”

However, as he reached the the All India Institute of Medical Sciences in Delhi last month, Sharma was told that almost 30 people had registered for the workshop, even though there were only 25 seats. There were surgeons, physiotherapists and lab technicians in attendance, all eager to learn.

Armed with paper, pencil and erasers, Sharma first got them comfortable with drawing. “Many are intimidated by the idea of drawing and give up even before they begin, thinking it’s too hard,” said Sharma, who believes in “ABCD” – anybody can draw. “It is not about the art. It’s about the story. The focus should be on communicating. If it successfully tells a story, then it is well drawn, no matter what the quality of the image is.”

Those attending the workshop were encouraged to practice drawing patterns in the air before putting pencil to paper and sketching basic figures. Next they were told to break the narrative into four panels and to tell a story in short, clear sentences. Incidents from their lives, red tape in a government hospital, ideal patient care were some of the chosen story subjects.

The resultant illustrations were simple, but each had an important message, even if told dramatically. “I was surprised at the self-critical nature of some of the stories,” said Sharma. “They were not shying away from addressing some of their flaws.”

While laboratory technologists Vidushi Uniyal and R Lakshay based their comics on the dangerous carelessness of some of their peers, doctors reflected on how they were sometimes remiss in tending to patients. Senior resident Ashutosh Kumar injected humour into his comic by noting that all the doctors were off celebrating Doctor’s Day – which fell on the workshop’s first day – and that there was nobody to see patients.

Title: Doctor's day for patients  Panel 1 – Patient: Why is there not a single doctor to be seen around the hospital? General staff member: They are all out celebrating Doctor's Day. Panel 2 – Patient: So who will help us? Staff member: Who do you think looks after the ones who have no one? Panel 3 – Patient: God? Staff member: Exactly! Panel 4 – Patient: (Panics) But who will treat us? Staff member: God.
Title: Doctor's day for patients Panel 1 – Patient: Why is there not a single doctor to be seen around the hospital? General staff member: They are all out celebrating Doctor's Day. Panel 2 – Patient: So who will help us? Staff member: Who do you think looks after the ones who have no one? Panel 3 – Patient: God? Staff member: Exactly! Panel 4 – Patient: (Panics) But who will treat us? Staff member: God.
Panel 1 – Laxmi Prasad: Can someone please guide me towards the right department? Various departments: Not here. Go to the other one. Panel 2 – Laxmi Prasad: There is such a long queue. I hope my turn comes quickly. Panel 3 – Nurse: The doctor's visiting schedule has changed. Come back later. Laxmi Prasad: Please help me! Nurse: Fine, let me check. Panel 4 – Sir, there is someone from another unit who has come for a check up. He just needs to be
Panel 1 – Laxmi Prasad: Can someone please guide me towards the right department? Various departments: Not here. Go to the other one. Panel 2 – Laxmi Prasad: There is such a long queue. I hope my turn comes quickly. Panel 3 – Nurse: The doctor's visiting schedule has changed. Come back later. Laxmi Prasad: Please help me! Nurse: Fine, let me check. Panel 4 – Sir, there is someone from another unit who has come for a check up. He just needs to be "entertained". Doctor: Sure. I have been doing that with many others today anyway.

Issues like the thankless nature of their job and patients’ apathy too came up at the workshop. While some threw light on the need to donate blood regularly, others tried to lift the stigma associated with mental illnesses. Dr Maunita Kanjilal from the Department of Rheumatology raised the problem of faith healing. In her comic she lamented that so many people place their hopes in babas and yogis, delaying proper medical attention in the process.

Title: Right treatment at the right time. Panel 1 – Parents: Our son Ramesh has been experiencing back and knee pains. Let's take him to the local masseuse for treatment. Masseuse: Don't worry, I'll cure him. There's no need to take him to a doctor. Panel 2 – Family friend: You're an educated man. Why are you putting your faith in this healer instead of taking him to the hospital? Ramesh: Father, it has been three years and I'm still experiencing pain. Panel 3 – Doctor: He is suffering from juvenile idiopathic arthritis, which is curable but you've delayed his treatment too much. Ramesh: Will I be able to walk again? Panel 4 – Parents: If I had brought him to the doctor in time then Ramesh would not have been disabled.
Title: Right treatment at the right time. Panel 1 – Parents: Our son Ramesh has been experiencing back and knee pains. Let's take him to the local masseuse for treatment. Masseuse: Don't worry, I'll cure him. There's no need to take him to a doctor. Panel 2 – Family friend: You're an educated man. Why are you putting your faith in this healer instead of taking him to the hospital? Ramesh: Father, it has been three years and I'm still experiencing pain. Panel 3 – Doctor: He is suffering from juvenile idiopathic arthritis, which is curable but you've delayed his treatment too much. Ramesh: Will I be able to walk again? Panel 4 – Parents: If I had brought him to the doctor in time then Ramesh would not have been disabled.
Title: If everyone stands by the patient. Panel 1 – Patient's relatives: She has gone mad. She constantly mumbles to herself, doesn't do anything and stays shut in her room. Panel 2 – Doctor: This illness is like any other and is curable with the right treatment and care. Panel 3 – You would have to take your medicines regularly and come for regular counseling sessions. Panel 4 – Family members: We will support her and make sure she does as you advise and see the treatment to its completion.
Title: If everyone stands by the patient. Panel 1 – Patient's relatives: She has gone mad. She constantly mumbles to herself, doesn't do anything and stays shut in her room. Panel 2 – Doctor: This illness is like any other and is curable with the right treatment and care. Panel 3 – You would have to take your medicines regularly and come for regular counseling sessions. Panel 4 – Family members: We will support her and make sure she does as you advise and see the treatment to its completion.

According to Yogesh Kumar, educational media generalist at AIIMS, the doctors have requested for more such workshops. “Those who could attend the workshop were extremely pleased,” said Kumar. “They were being able to express themselves and in such a creative way too. The posters created by them have already been displayed in places where the patients can see them. They want to learn more of this form of expression, so that they can begin using this medium in their everyday operations.”

Medical social service officer Vivek Kumar Singh, who drew a comic on the Rashtriya Arogya Nidhi, a government scheme providing financial assistance to patients, has started distributing copies of his work to create awareness about the provision.

Title: Don't lose faith. Panel 1 – Ramdhani, I'm sorry to tell you that you have blood cancer. It can be treated, but it will cost around Rs 8 lakh. Ramdhani: Oh god! What am I supposed to do now? Panel 2 – Ramdhani (to the medical social service officer): I'm a rickshaw puller. How can I afford this treatment? MSSO: Do not worry. Just get your ration card and a letter from the doctor and we will help you. Panel 3 – Ramdhani: Really? Treatment is possible if I just bring these documents? MSSO: Why not? Last year we provided around Rs 25 crore for more than 650 patients who fall below the poverty line. Panel 4 – Ramdhani: I had lost all hope, but you have given me a new ray of hope. MSSO: We are going to help in any way we can. Please don't lose faith.
Title: Don't lose faith. Panel 1 – Ramdhani, I'm sorry to tell you that you have blood cancer. It can be treated, but it will cost around Rs 8 lakh. Ramdhani: Oh god! What am I supposed to do now? Panel 2 – Ramdhani (to the medical social service officer): I'm a rickshaw puller. How can I afford this treatment? MSSO: Do not worry. Just get your ration card and a letter from the doctor and we will help you. Panel 3 – Ramdhani: Really? Treatment is possible if I just bring these documents? MSSO: Why not? Last year we provided around Rs 25 crore for more than 650 patients who fall below the poverty line. Panel 4 – Ramdhani: I had lost all hope, but you have given me a new ray of hope. MSSO: We are going to help in any way we can. Please don't lose faith.
We welcome your comments at letters@scroll.in.
Sponsored Content BY 

Putting the patient first - insights for hospitals to meet customer service expectations

These emerging solutions are a fine balance between technology and the human touch.

As customers become more vocal and assertive of their needs, their expectations are changing across industries. Consequently, customer service has gone from being a hygiene factor to actively influencing the customer’s choice of product or service. This trend is also being seen in the healthcare segment. Today good healthcare service is no longer defined by just qualified doctors and the quality of medical treatment offered. The overall ambience, convenience, hospitality and the warmth and friendliness of staff is becoming a crucial way for hospitals to differentiate themselves.

A study by the Deloitte Centre for Health Solutions in fact indicates that good patient experience is also excellent from a profitability point of view. The study, conducted in the US, analyzed the impact of hospital ratings by patients on overall margins and return on assets. It revealed that hospitals with high patient-reported experience scores have higher profitability. For instance, hospitals with ‘excellent’ consumer assessment scores between 2008 and 2014 had a net margin of 4.7 percent, on average, as compared to just 1.8 percent for hospitals with ‘low’ scores.

This clearly indicates that good customer service in hospitals boosts loyalty and goodwill as well as financial performance. Many healthcare service providers are thus putting their efforts behind: understanding constantly evolving customer expectations, solving long-standing problems in hospital management (such as long check-out times) and proactively offering a better experience by leveraging technology and human interface.

The evolving patient

Healthcare service customers, who comprise both the patient and his or her family and friends, are more exposed today to high standards of service across industries. As a result, hospitals are putting patient care right on top of their priorities. An example of this in action can be seen in the Sir Ganga Ram Hospital. In July 2015, the hospital launched a ‘Smart OPD’ system — an integrated mobile health system under which the entire medical ecosystem of the hospital was brought together on a digital app. Patients could use the app to book/reschedule doctor’s appointments and doctors could use it to access a patient’s medical history, write prescriptions and schedule appointments. To further aid the process, IT assistants were provided to help those uncomfortable with technology.

The need for such initiatives and the evolving nature of patient care were among the central themes of the recently concluded Abbott Hospital Leadership Summit. The speakers included pundits from marketing and customer relations along with leaders in the healthcare space.

Among them was the illustrious speaker Larry Hochman, a globally recognised name in customer service. According to Mr. Hochman, who has worked with British Airways and Air Miles, patients are rapidly evolving from passive recipients of treatment to active consumers who are evaluating their overall experience with a hospital on social media and creating a ‘word-of-mouth’ economy. He talks about this in the video below.

Play

As the video says, with social media and other public platforms being available today to share experiences, hospitals need to ensure that every customer walks away with a good experience.

The promise gap

In his address, Mr. Hochman also spoke at length about the ‘promise gap’ — the difference between what a company promises to deliver and what it actually delivers. In the video given below, he explains the concept in detail. As the gap grows wider, the potential for customer dissatisfaction increases.

Play

So how do hospitals differentiate themselves with this evolved set of customers? How do they ensure that the promise gap remains small? “You can create a unique value only through relationships, because that is something that is not manufactured. It is about people, it’s a human thing,” says Mr. Hochman in the video below.

Play

As Mr. Hochman and others in the discussion panel point out, the key to delivering a good customer experience is to instil a culture of empathy and hospitality across the organisation. Whether it is small things like smiling at patients, educating them at every step about their illness or listening to them to understand their fears, every action needs to be geared towards making the customer feel that they made the correct decision by getting treated at that hospital. This is also why, Dr. Nandkumar Jairam, Chairman and Group Medical Director, Columbia Asia, talked about the need for hospitals to train and hire people with soft skills and qualities such as empathy and the ability to listen.

Striking the balance

Bridging the promise gap also involves a balance between technology and the human touch. Dr. Robert Pearl, Executive Director and CEO of The Permanente Medical Group, who also spoke at the event, wrote about the example of Dr. Devi Shetty’s Narayana Health Hospitals. He writes that their team of surgeons typically performs about 900 procedures a month which is equivalent to what most U.S. university hospitals do in a year. The hospitals employ cutting edge technology and other simple innovations to improve efficiency and patient care.

The insights gained from Narayana’s model show that while technology increases efficiency of processes, what really makes a difference to customers are the human touch-points. As Mr. Hochman says, “Human touch points matter more because there are less and less of them today and are therefore crucial to the whole customer experience.”

Play

By putting customers at the core of their thinking, many hospitals have been able to apply innovative solutions to solve age old problems. For example, Max Healthcare, introduced paramedics on motorcycles to circumvent heavy traffic and respond faster to critical emergencies. While ambulances reach 30 minutes after a call, the motorcycles reach in just 17 minutes. In the first three months, two lives were saved because of this customer-centric innovation.

Hospitals are also looking at data and consumer research to identify consumer pain points. Rajit Mehta, the MD and CEO of Max Healthcare Institute, who was a panelist at the summit, spoke of the importance of data to understand patient needs. His organisation used consumer research to identify three critical areas that needed work - discharge and admission processes for IPD patients and wait-time for OPD patients. To improve wait-time, they incentivised people to book appointments online. They also installed digital kiosks where customers could punch in their details to get an appointment quickly.

These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.