Friday, June 9, 2017

Winds of change - 24

(This is the twenty fourth part of a short story which is entirely a work of fiction.)

Manav worked hard on the plan. This plan would be much bigger and riskier to implement because it would not be restricted to the nephrology department. Vasudha felt that this had to be done across all departments for it to be effective. Manav wore down the high level points that Dr. Som had proposed:

1. High fixed salary for doctors
2. No incentives for investigations and prescriptions
3. No monthly targets for investigations
4. No referral fees to refer to other consultations
5. OP and IP investigations and drugs to be charged at the same rates
6. Medical Representatives to send all new product details to a common email id which would be screened by a Vigilance Committee
7. Outcomes of the patients being treated to be tracked electronically and monitored closely
8. Patients to take a satisfaction survey at the end of their visit

He thought over each of these items and came up with the problems they had encountered in each of them. He wrote down the set of problems and possible solutions for each problem. He worked without taking a single break except for meals and sleep. After three gruelling days, he emailed the document to Vasudha.

Vasudha took a day to review the document, making notes and adding comments. She called Manav and discussed each of the points. They had several discussions over the next few days and about a week after Vasudha addressed the team in the conference hall, she emailed them the plan. She asked them to review in detail and said that they would meet in three days for a detailed discussion.

The email read:

“Dear team,

I appreciate your co-operation in running Narayana Hospital for all these years. As we discussed the other day, we would like to change the way we operate in this hospital. We would like to make sure that every department here practices in the most ethical way possible. At the same time, we obviously need to ensure the financial sustainability of the hospital and also ensure that any of the stakeholders, especially you are not financially affected. Keeping all this in mind, Manav Sharma and I have come up with a draft of the plan. I am putting down the high level details here for your perusal. Please review this and keep your questions and comments ready which we will review on Monday morning at 9 am in the Conference Hall.

1. Fixed salary for all doctors: computed as average monthly income from hospital for last 3 months plus 10%
2. No incentives would be paid for prescribing investigations, pharmacy products and procedures
3. No additional fees will be paid for monthly targets for investigations; no monthly targets would be set
4. All referral fees for other consultants would be scrapped
5. IP investigations and drugs would be charged at OP rates
6. A Vigilance Team would be created whose job would be to ensure and monitor adherence to the new plan
7. A committee would be formed for each department which would consist of the head of the department, one member from the Admin team and one member from the Vigilance Team
8. Medical Representatives would need to send details of all new products to this committee which would then pass on the information to the doctors based on the merits
9. The Vigilance Team would be authorised to conduct checks on patient prescriptions and medical records
10. Each Head of Department would come up with the list of outcomes to be tracked for various conditions and these outcomes would be tracked on a regular basis. Doctors would get an outcome based incentive
11. A Patient Satisfaction Survey would be administered to most patients from time to time using a mix of paper based and telephonic surveys. Doctors would get incentivised based on the results of these surveys

All these points are open for discussion. Please come up with questions and comments and we will discuss on Monday.

Vasudha Som”

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