Saturday, June 10, 2017

Winds of change - 25

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

On the following Monday, at 9 am, all the Heads of Departments along with the Admin team assembled at the Conference Hall. Vasudha greeted them and started asking for comments on each of the points identified in the email that outlined the plan.

Dr. Samba Murthy spoke first. “Ma’am, this plan is almost the same as that which Dr. Som had piloted. The only difference is that it is being implemented across all departments rather than one department. I am just concerned that when the pilot failed, how will this project, which is an extended implementation of the same pilot, work?”

Vasudha turned to Manav. “Manav you want to take that?”

“Yes ma’am. Dr. Murthy, alongside these changes, we have planned a massive marketing campaign in the entire state of Andhra Pradesh. The problem we faced in the implementation of the pilot was that we did not see an increase in footfalls in the hospital. We were doing a great job from the patient’s perspective but that was not being communicated to the patients. We will be having a special budget allocated for marketing. We will he working with a very reputed firm from Bangalore for this.”

The Head of the Orthopaedics Department said, “The project is very good ma’am. However, one concern we all have is on the Vigilance Team. What would be the powers of the this team? Who would be the members of this team? Would they be doctors?”

“They will not be doctors. Doctors would not have time for this,” Vasudha responded curtly.

“If they are not doctors, how will they understand medical records? We are worried that they would overstep their mandate. They would become a superpower within the hospital and question everything we do.”

Vasudha softened a little. “Don’t worry about that Doctor. We will ensure that proper guidelines are given to the Vigilance Team. Honestly, we have not decided who will form this team. We just realise that we need someone to check that the new rules are not misused.” She needed to make sure everyone was genuinely on board for this plan to work.

Dr. Sampath from Nephrology then said, “Ma’am, there are two points that talk about additional incentives - one is based on the outcomes and the other is based on patient satisfaction surveys. No details have been given on how those incentives would be calculated.”

Manav responded, “Dr. Sampath, these incentives will be pegged at 5% of each doctor’s fixed salary. So, each doctor can earn a total of 10% over and above the 10% additional over your last three month’s average. Let’s say a doctor receives a patient satisfaction score of 90% during a month, that doctor would be eligible for a 4.5% additional salary.”

“What about the outcomes? How would that be linked to the salary?”

Vasudha interjected, “As you know, each HoD is going to come up with a set of outcomes for their department. The proportion of patients who achieve those outcomes would determine the outcomes based incentive. For example, in dialysis, one of the outcomes, I am told, could be the Hemoglobin. If the Hemoglobin target range is 9 to 11.5, the % of the doctor’s patients that achieve this target value would affect the doctor’s incentive. A weighted average of all the outcomes would be used.”

Suddenly there were a lot of murmurs in the hall. People started talking with one another. Vasudha raised her hand, “One at a time please.”

One by one the doctors started raising their concerns about this incentive.

“These outcomes are not solely in the doctor’s control. If patients cannot pay for the drugs prescribed, how can we be blamed?”

“How will they be measured? If patients don’t do investigations, how will the outcomes be measured?”

“If anything is going to be outcomes based, doctors will refuse to take critical cases! Who will be responsible for this?”

Vasudha raised her hand again and spoke loudly this time. “Please, please remember that this is over and above your base salary. If these things don’t work, you will get your base salary.”

“That is not the point ma’am. The system should be fair. If the hospital has a policy for outcomes based incentive, the rules should be fair for those incentives.”

“Let us scrap the outcomes based incentive,” Vasudha said loudly.

“Ma’am, maybe we can delay the implementation until we figure out a fair way. Outcomes based incentives are a great way to link performance to pay,” Manav said.

“Yes, sure, let’s do that.”

Vasudha asked if there were any other questions.

“Let us start with this ma’am. We can hold a monthly review of this group and discuss.” Dr. Samba Murthy concluded.

“Sure. This plan starts from first of next month.”

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