This year has been a dawn of new hope for healthcare. As you know we have started a new series called Evolving Leadership in Healthcare. In the earlier piece, we spoke to med-tech leader Ravi Ramaswamy. The link to that article is here.
Today We are in conversation with Nitin Nag, Regional Director Cloud Nine Group of Hospitals. Nitin has spent a lot of time in IT and Healthcare before joining Cloud Nine he was leading critical initiatives at Manipal Hospital.
Dr Vikram Venkateswaran: Thank you Nitin for taking time off from your busy schedule. I want to start with the most important question first, in your opinion and your experience, what are the changes you feel are required to make healthcare more accessible to people and women in particular?
Nitin Nag: Thank you for having me here.
Healthcare in India has been evolving constantly. Even prior to COVID 19 there was this wave in Indian healthcare which was kind of building up but very slowly in terms of trying to get into remote health digital health, get more digitization of data, get more tools enable the doctor to aid them in their consultation diagnosis.
Unfortunately, there was very little uptake for these initiatives. A lot of traditional thinking, and perception issues about the health care being more about touch and feel prevented large scale uptake. There was a belief that physical presence is mandatory for the patient-doctor interaction and a few other dogmas which prevailed, prevented many of these initiatives being widely adopted.
But COVID has transformed things, or at least pushed the consumer and the healthcare service provider towards embracing many of these changes.
Since March last year when lockdown was announced, service providers realised that for the foreseeable amount of time the entire traditional outpatient services is not going to happen as patients will not be able to commute. If nobody is going to be able to commute, entire outpatient services would vanish. That gave the impetus for healthcare service providers to put telemedecine platforms in place. This happened almost overnight.
All of us had some version of a digital platform basis which we started doing remote consultations. Then we started figuring out other solutions like home lab services for collection and home delivery of lab services. Similarly, home delivery of drugs too. So the significant part of healthcare value chain shifted online.
Thankfully, this change, or this push towards digitalization and embracing these new tools, has not lost its theme or interest. Even after things came back to normalcy around November- December timeframe, many of us have continued to stay invested in these new platforms.
Dr Vikram Venkateswaran: Do you think things will change once normalcy returns?
Nitin Nag: In fact, we are only enhancing and then trying to get more and more stuff done on the digital side. So quite a lot of excitement continues to still stay with many of these things existed before COVID.
Now, women in particular, are going to be big beneficiaries of this. None of these solutions are specific to them. But this push towards digital health is going to bring in a lot more tools, which will solve specific problems around women. Those will start getting more accepted.
One of the areas where we are working on is foetal monitoring.
Is there a B2C version of foetal monitoring? Now that would be really interesting.
The parameters can be relayed to a digital engine, so the doctors can see. I would say the little reluctance that existed within the fraternity, and industry at large in terms of embracing some of these new tools, doesn’t exist anymore. Lot of changes in perspective are coming, which I think is good. This will set the tone for a slew of such products coming into the space.
Dr. Vikram Venkateswaran: Makes a lot of sense. So the follow-up would be that, you know, for the last year now almost we’ve been doing remote consultations, and a lot of them are with women. So what have we learned in the last year as insights when this has become almost like the mainstay that we can apply to the future, have given any unique lessons learned here?
Nitin Nag: First big learning is public perception towards consuming remote healthcare services is optimistic. They are keen on taking up these new solutions.
Customer is not an impediment that we had initially thought. That’s number one.
Secondly tools aimed at convenience and are clinically relevant would have faster adoption cycles. Now, what do I mean the convenience aspect of it, like, just the video consultation itself. If it prevents or it outweighs the need for any anyone to go to a hospital, then it will gain traction. The amount of time that is spent in waiting for a doctor, consulting & driving back and forth from a hospital is considerable. Digital solutions take away this entire time factor, and make the entire experience so convenient that entire consultation can be done in about 30 minutes. These video consultation solutions also assist in documentation of consultation notes, medication details, patient history etc., So digital solutions which are clinically relevant and aim centred around convenience of the consumer.
The third learning is hospitals are looking at optimisation of experience and space. Reducing time of customer at hospital and leveraging large waiting lounges to commission other clinical services helps hospitals get more from already existing spaces.
Dr Vikram Venkateswaran: that is interesting, especially this transformation from patient to consumer, I think that’s a very big. So, the next thing was, it’ll be since the 90’s and early 2000’s We’ve been seeing a lot of activism, especially from people who are learning more about their health through online resources, generally getting educated. I think COVID was also a big way in which people woke up to a lot of things right from comorbidity and vitamin D levels. So do you think that once the pandemic is over when we kind of get back to some kind of semblance of normal life, you would see a lot more people getting very actively involved in managing their health, or do you think we will slip back to the old ways, where this was a one off and now we are back to how we were
Nitin Nag: I think health awareness is rising and will continue to do so. So, over the last, I would say almost 15 to 20 years now I have been hearing a lot of people talk about fitness along the way. Obviously the conversations have increased in the last few years, as compared to what I had amongst my friends, almost 15-20 years ago. Gym memberships have increased.
People are constantly talking about how many steps they have taken in a day. So there are fragments of data scattered all around the ecosystem. What COVID has done is, I think somewhere it’s made a lot of people internalise, their health requirements. This is a common theme in most groups that I have interacted with. It’s not just a move towards health in general, but I think it’s more of constant lifestyle change. It’s also maintaining some kind of a balance in life between pursuing your dreams versus living your life today, which is here right now.
Another aspect that will a lot of time and attention in India specifically is around mental health. That was something that didn’t get the requisite attention over the last few years in this country. We only had a few celebrities endorsing the relevance of it and it became a great dinner conversation, or a media byte. Beyond that, there weren’t any structural solutions put in place. People haven’t been able to even step out of their houses for months. They’ve been locked in rooms.
People will start realising the onset of many of these things, and their response would vary. That’s when stress on mental health is going to gain more significance. So this might not become a closed or conversation anymore. Hopefully there will be more structural solutions to looking at mental health holistically will come up.
In 2011 When I moved to healthcare industry, fertility was a close door discussion. It took almost four or five years before it became a mainstream service in Indian healthcare. I think mental health will kind of witness, the same kind of change over the next few years.
Dr Vikram Venkateswaran: My last question is what kind of thinking, change or systemic change do we need thinking in healthcare itself. Because today, I think a lot of leaders in healthcare, both on the clinical side as well as on the management side are still wedded to a very old model of providing care, and clearly that model has been shaken. Soon, do we need new thinking and if yes, what kind of thinking, do we need
Nitin Nag: Quite a lot of new thinking is required for sure. That almost transcends the entire service delivery model. There is a need for anyone and everyone to look at how much of the portfolio is digitised. How much of the portfolio of services can be delivered on a digital platform, remotely? There is some massive rethinking happening on the portfolio side due to the stress on digital.
You see, number one healthcare brand in the country is doing a TV commercial, which says number of tele consultations they did in the last, few weeks, days and months. So I think there is a tremendous amount of rethink about having digital as a centrepiece of the portfolio of services. So that’s one big change that’s already underway. Some people are a little ahead of the journey. Some people are behind but more or less, everyone is in the cube.
Second is how much of the doctors, time is can be centred around caregiving and how much of it is, can be taken away from doing routine activities? That will take up some amount of change. There will be collaboration with the doctors and we will see an evolution of tools, in the space of diagnostics and clinical decision making.
The final piece is around, people. In the March, April, May timeframe, many of us realised how important it is to be able to draw upon the strength of people we have in the system. Had we not had these people around us, committed, passionate, and against all odds still coming in to provide care, while putting their lives at risk, I wonder what we would have done. I don’t think any of us had a clue about the impact of this pandemic on us as individuals or, or the care providers in general. Many of them put their lives at risk and then still turned up for work. That showed the kind of resilience and passion they had.
We need to find ways to take care of them, continue training them and invest in their growth. A lot of evolution in thinking has to come in the way in which we care for our people.
Dr Vikram Venkateswaran: Thank you Nitin for talking to us and enriching us with your insights
Nitin Nag: It was a pleasure
