LEAN SIX SIGMA | CASE ANALYSIS | APOLLO HOSPITALS 1

Table of Contents
Introduction to Apollo Hospitals: .............................................................................................. 3
Difference between Hospital and Hospitality: ....................................................................... 3
Differentiation through Hospitality: ...................................................................................... 4
Apollo Hospitals - The Trendsetter: ...................................................................................... 4
Case Questions: .......................................................................................................................... 5
1) What strategy should be used to reduce the numbers of complaints and sustain the culture
of excellence at Apollo hospitals, Bangalore under the leadership of Dr Panyala? .............. 5
An integrated system.......................................................................................................... 5
Feedback Loop: .................................................................................................................. 6
Better use of Technology ................................................................................................... 6
Use of Analytics:................................................................................................................ 6
Availability of Doctors and Nurses 24/7: .......................................................................... 6
Policies: .............................................................................................................................. 6
Promotion........................................................................................................................... 6
Staff training and support................................................................................................... 7
Tracking ............................................................................................................................. 7
Data collection ................................................................................................................... 7
2) Given the manual intensive process involved in addressing the hospitality issue, what is
good sigma level? Could Apollo set a target for sigma level in hospitality? ........................ 8
How to achieve? ................................................................................................................. 8
Quantitative improvement ................................................................................................. 8

LEAN SIX SIGMA | CASE ANALYSIS | APOLLO HOSPITALS 2

Introduction to Apollo Hospitals:
"The Indian hospital industry accounting for 80% of the total healthcare market is expected to
touch US$ 132 billion by 2023" -Ministry of Commerce and Industry Government of India.

"At present Apollo Hospitals have more than 10,000 beds across 73 hospitals, more than 4500
pharmacies, more than 300 clinics, 1100 diagnostic centres and 200 Telemedicine units across
17 countries" -Apollo Hospitals website.

"The company's segments include healthcare, pharmacy, and others. The healthcare segment
consists of hospitals, hospital-based pharmacies, and projects and consultancy services. Its
tertiary care hospitals provide care in over 50 specialties, including cardiac sciences, oncology,
neurosciences, critical care, orthopaedics, radiology, gastroenterology, and transplant. The
company also provides project consultancy services, health insurance services, education and
training programs, and research services. It also operates birthing centers, day surgery centers
and dental clinics" -Ministry of Commerce and Industry Government of India.

Difference between Hospital and Hospitality:

Hospital:

• "An institution where the sick or injured are given medical or surgical care" -Merriam-
Webster
• Patients seek treatment.
• Sentiment of people could be frustration, irritation, depression, insecurity etc.

Hospitality:

• "The activity or business of providing services to guests in hotels, restaurants, bars,

etc." -Merriam-Webster
• Healthy and normal people.
• Purpose could be leisure, vacation, business etc.

Apollo Hospitals Enterprise Limited aims to provide hospitality of premium hotels in their
hospitals. The best doctors, the best treatment and the best hospitality all at one place.

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Differentiation through Hospitality:

The best-in-class service relies on constant innovation and demands continuous and sensitive
focus on all issues that may affect the patient's stay in a hospital.
Believed that the services provided to the patients would
differentiate Apollo Hospitals from others. Other competitors
may replicate infrastructure within short span of time, but not the
service culture. To ensure the that the hospital provides the best
services, he had set up a quality department in Apollo Hospitals
Dr. Umapathy Panyala,
Bangalore. He wanted to develop the benchmarks and Sigma
CEO, Apollo Hospitals
metrics and replicate the system in all Apollo Hospitals in the
country.

Dr. Ananth N Rao was appointed as the Head-Quality Cell & Sr. Consultant Biochemistry &
Metabolic Diseases & Member Secretary Ethics Committee from
March 2009 to March 2017. Lean Six-Sigma black belt of the
Indian Statistical Institute, Chennai. He believed that the
hospitality aspect would differentiate Apollo Hospitals from its
competitors so he wanted to integrate healthcare and hospitality.
Hospitality aspects included each and every touch points where
patients used to interact with. Patient cure and care at each
Dr. Ananth N Rao
department would play important role in hospitals. He wanted to
implement Six Sigma concept to eliminate complaints and hence dissatisfaction.

Apollo Hospitals - The Trendsetter:

In 1971, the country had 3862 Hospitals, 12180 Dispensaries with a ratio of 6.36 beds per
10000 people. In 1972, Dr. Prathap C. Reddy, Founder of Apollo Enterprise Hospitals Ltd. -
completed his medical career and later, used to send patients from India to abroad for specific
treatments. In 1979, one of his patients succumbed to death as he could not arrange for him to
send him to US for treatment. Thus, Dr. Reddy decided to provide the best treatments that he
saw in West, here in India with emotional touch - 'High Tech with High Touch'. In this venture,
he involved 10K Indian Doctors and 4700 US-based doctors and had 60 doctors invest in the
venture from UK. It gave the patients best care and services and itself becoming a world-class

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pioneered healthcare system in India. Apollo focused on technological excellence and was the
first in many areas in the country. Launched Oncological Robotic Surgery, first in South Asia
and many more. Dr. Preetha Reddy, MD of AEHL and Pioneer Tender Loving Care (TLC)
Mantra was applied to every patient at Apollo. This mantra integrated service delivery with
clinical outcomes which resulted in exceptional patient experiences.

Case Questions:

1) What strategy should be used to reduce the numbers of complaints and

sustain the culture of excellence at Apollo hospitals, Bangalore under the
leadership of Dr Panyala?

An integrated system
The complaints system should be integrated into the work of the whole organization. This
means that:

• Complaints are used to identify gaps in the quality of the service,

• Investigation of complaints is collaborative, and

• Information is shared among management teams (including clinicians and quality

improvement teams), administrators and consumers.

In a fully integrated system, complaints can highlight adverse events that may otherwise have
been overlooked. Furthermore, complaints data can be aggregated with incidents data to
provide more complete information.

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Feedback Loop:
Creating a system where feedback is encouraged allows for consumers to make positive
comments as well as complaints.

Better use of Technology

Use of technology at its fullest not only for the treatment purpose (generating report quickly
etc.), but also for hospitality can help hospitals to win customer’s loyalty.

Use of Analytics:
Collected feedback from customers on a regular basis can be stored and Analytics can be used
on top of that data to predict the system to make it efficient which will help the hospital to give
better experience to their patients in terms of treatment as well as hospitality.

Availability of Doctors and Nurses 24/7:

Ultimate aim of a hospital is to provide good treatment and for that, Doctors and nurses should
be available to handle any emergency situation.

Policies:
The hospital needs to have policies on how complaints will be handled and on how adverse
events will be treated. These policies need to be clear to all staff.

Promotion
The organization demonstrates that it actively seeks feedback from consumers and their
families through the way it promotes the complaint process. The complaint process should be
advertised widely and it should be clear to patients and their families how they can make
comments about the service or express their concerns. The overriding message from the
organization needs to be that all feedback is welcome, whether positive or negative.

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Staff training and support
An organization that is committed to better complaint handling will ensure that its staff is
properly trained.

Tracking
Once the complaint is recorded, there must be a system for tracking complaints. A
computerized system will enable ‘flags’ to be sent to relevant staff for them to take action. The
complaints manager is responsible for coordinating complaints. Monitoring of complaints
progress, particularly more serious complaints, should be a regular agenda item at quality and
risk management meetings.

Data collection
To ensure that systemic problems can be identified and dealt with, it is most important that
organizations have adequate data collection tools. This will enable data to be aggregated and
analyzed to identify trends. This will also ensure wider transparency and public accountability,
which are key aspects of a high quality health care system.

Good data collection means the organization can:

• learn from mistakes,

• identify systemic issues,

• reduce risk in the future.

Reporting

This is an essential element of an integrated system. There must be systems set up to report on
the outcome of complaints, as well as a system for analyzing and reporting on trends identified
by complaints.

Reporting has three main components:

• Reporting to the consumer, family or friend who made the complaint (this is discussed further
in the section on ‘Complaint handling processes).

• Reporting to the quality systems of the organization and to senior management – to enable
decisions to be made regarding organizational change, policies and resourcing.

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• Reporting to staff – both to staff involved in a complaint and, if there are broader issues
involved, staff to inform them of changed procedures/policies and to facilitate learning and
change. Complaints can be used as a concrete example of why change might be needed

2) Given the manual intensive process involved in addressing the hospitality

issue, what is good sigma level? Could Apollo set a target for sigma level in
hospitality?

Presently period from march 2011 to December 2012 1434 complaint were received from
among the 138600 in patients treated during the period which makes approximately 1.03%
complaints.

The company objective should be reach sigma level of 6 which can only be achieved by
working upon certain key aspects

A good sigma level in hospitality industry will be to work upon these aspects

• Smooth admission procedure

• Friendly medical and non-medical staff
• Comfortable furniture
• Varied choices of food menu
• Attractive surroundings
• Recreational facilities
• Privacy
• Clear signposting
• Adequate Provision for the visitors

Apollo Can definitely set a target sigma level if it works upon two important challenges

1. Patient’s sentiment towards the hospitality provided

2. Design a process improvement plan that is affordable

How to achieve?
Customer feedback-treating each complaint as a defect. All services that did not require core
clinical expertise were classified as hospitality service, including service such as billing,
dietician service, food and beverages, facility housekeeping, nursing, facility an overall
operations. All the metrics defined and mapped can be helpful as a sigma metrics.

Quantitative improvement
Working on each problem as defect would not only help in reducing the number of complaints
but also improve the service levels

Word Frequency count-word frequency count will help in improving the problem areas which
will help in benchmarking.

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