Helping or Hurting?

Exit interviews were usually handled by junior managers on the HR team, but Amrita felt that given the high rate of attrition among doctors at Krisna Hospital over the past year, it was her responsibility as head of HR to talk to Dr. Vishnu Patel, a respected cardiologist who’d just given his notice. “Everyone is always very polite in these interviews, but I need your honesty,” Amrita told him. Dr. Patel shifted in his chair. “There are a host of reasons for my departure, many of which you can’t do anything about. My family obligations, for example, and the demands in my own practice.” Most of the physicians at Krisna saw patients in their private practices, but they also partnered with and referred patients to the hospital for procedures that weren’t possible in an office setting. As the largest multispecialty hospital in Noida, in the National Capital Region of India, Krisna provided secondary and tertiary services in cardiology, orthopedics, neuroscience, oncology, renal care, and gastroenterology. “Is there anything that would’ve made you stay? Anything in particular that made you decide to leave now?” Amrita prodded. “There was that argument I had with a PCE,” Dr. Patel said after a pause. He was referring to a relatively new position in the hospital: the patient care executive. Three years ago, in response to patient complaints about not understanding doctors’ explanations about their diagnoses and treatments, Krisna had introduced this liaison role. It was meant to be a win-win: Patients and their families would get a better, more personalized hospital experience, and doctors could spend less time managing patients and more time practicing medicine.  
The program fit well into the hospital’s brand as an expensive but high-quality care center with the best talent, technologies, and services. Unfortunately, Amrita had heard grumbling from physicians from the moment she’d hired the first PCE. Dr. Patel explained how the PCE assigned to one of his more complicated cases—a patient who had bypass surgery and needed a pacemaker—had caused the patient’s family to lose trust in him. “I don’t know what he said to them during the operation, but from then on, they wanted to talk only with him and acted like I was an enemy. It was definitely the PCE and the family against me.” “To make matters worse,” he continued, “he gave them misinformation about the pacemaker, and when I tried to explain that he’d been wrong, they didn’t believe me.” It was true that Krisna’s PCEs didn’t have medical training. Most had MBAs but only a few years of experience in health care. And Dr. Patel wasn’t the first to complain about PCE interference in the doctor-patient relationship. But thanks to higher customer-satisfaction scores, senior leaders were happy with the PCEs. “Is the PCE program the reason you’re leaving us?” Amrita asked. Dr. Patel reluctantly admitted that it was. “To be honest, it just makes the job that much harder. I already have to answer to the patient, the patient’s family, and the administration. Now I also have to answer to the PCE. It’s too many people to please. Why wouldn’t I prefer to work in a hospital that doesn’t interfere in the same way?” Amrita didn’t have a good response, and she was pretty sure Dr. Patel wasn’t expecting one. “Could we convince you to change your mind?” she asked instead. “Fire that PCE. Actually, fire them all. And let us doctors do our jobs. Then maybe I’ll stay.” LEAVING IN DROVES Later that day, Amrita sat down at a table in the hospital’s cafeteria with Meera Kumar, Krisna’s chief medical officer. The two executives had worked together for nearly 20 years, and despite their hectic schedules, they tried to meet for lunch each month.
Amrita was still thinking about her conversation with Dr. Patel and broached the issue of PCEs with Meera. “I wish I could tell you that he is an anomaly,” Meera said, “but he’s not. Many of our doctors are unhappy about the PCEs.” “Why didn’t you tell me this earlier?” Amrita asked. “I did. You said, ‘Give it time.’” Amrita smiled sheepishly. Meera continued, “I know I’m biased because of my position, but I agree with my physicians that the PCEs are unnecessary and, in a lot of cases, do more harm than good. From the stories I hear, they seem inexperienced and intrusive. They understand the lingo, but they don’t really understand medicines and treatments.” “That’s not fair,” Amrita said. “It’s not as if they’re making medical decisions for patients. The doctors are still in complete control. The PCEs are just helping patients better comprehend their options.” “That’s not what I hear,” Meera said. “A doctor told me that a PCE talked one of his patients out of an important diagnostic test because she was having panic attacks about the procedure. The doctor tried to explain that they could treat the anxiety and that the test was critical, but the PCE wouldn’t budge.” Amrita took a breath, about to speak. “I know what you’ll say,” Meera cut in. “‘That’s one bad apple.’ But I hear more stories like that every day. This is why our doctors are leaving in droves.” The hospital’s attrition rate had been between 20% and 25% for the past 18 months. It was true that because of the current doctor shortage across India, many hospitals were fighting talent wars, but Krisna ranked among the worst on this metric. And it was the only medical center to have the patient care executive role. Amrita was beginning to wonder if they were ahead of the pack or venturing in the wrong direction. GOOD OR BAD ATTRITION? A week later, Ghiridhar Iyer, Krisna’s CEO, called Amrita and Jai Srinivasan, the head of patient services, to his office to discuss doctor turnover.  
He explained that the issue had come up at the last board meeting. “Have we identified any patterns or root causes?” he asked. Amrita glanced at Jai, and then answered, “There are the usual reasons, of course, but I’m starting to wonder about the PCE position.” She could see Jai tense up next to her. The PCE program had been his baby, and his body language suggested he would not take criticism well. Still, she pressed on, summarizing her conversations with Dr. Patel and Meera. “We wouldn’t need PCEs if the doctors had a better bedside manner,” Jai interrupted. “I’m sick of trying to keep them happy at all costs. We are a ‘patient-focused care center,’” he said, citing Krisna’s mission statement. “Yes,” said Ghiridhar, “but we can’t deliver patient care if we don’t have doctors.” Krisna’s compound annual growth rate was 82%, and it had been struggling to keep positions filled. “There is no doubt that the PCE program has been great for the hospital,” Amrita said, hoping to defuse Jai’s agitation. “Revenue is up, as are patient retention rates and referrals—” “That’s right,” Jai said. “When we treat patients with dignity and care, they come back to our hospital for all their health concerns and tell their friends and families to come here as well. And the customer satisfaction scores say it all: They love the PCEs.” “We aren’t debating that,” Ghiridhar said. “Who wouldn’t love a person whose primary job is to hold your hand through a difficult time? The question is: What are we losing as a result?” Jai jumped back in. “I don’t believe that the PCEs are driving the doctors out. I think the doctors are tired of splitting their revenue with us. And they’re not happy that the patients would rather come to see the PCEs than go to the doctor’s private practice. They’re also jealous that the PCEs get paid no matter who comes through the door.” At Krisna, and most Indian hospitals, physicians’ salaries reflected the number of patients they treated. “We could consider more training,” Amrita suggested. “We did sessions when we launched the role, but maybe it’s time to bring the doctors and PCEs together again to share best practices.”
“We had enough trouble getting the doctors to show up the first time,” Jai said. “What we need to do is find doctors who believe in the hospital’s mission and want to collaborate— not put their own interest first.” “According to Meera, those are exactly the doctors we’re losing,” Amrita said. “We all know that there is good attrition and bad attrition, and Meera assures me that we’re now dealing with the bad kind.” “This is a top priority for me,” the CEO said. “I know where you stand, Jai. And I agree that we need to be careful not to alienate patients. But we don’t want this to escalate into a crisis. We need to think about remedies.” AN EMOTIONAL DECISION On the elevator ride down from the CEO’s office, Amrita replayed the meeting in her mind. She took issue with Jai’s characterization of the doctors as money-hungry and selfinvolved. She knew that most of them could live comfortably on the revenue from their private practices, but they chose to take on challenging cases and bring them into the hospital, splitting the revenues, because they wanted to help people. If PCEs were making the doctors’ jobs more difficult, she had to do something about it. The elevator stopped, and the doors opened. A woman stepped in, crying into her cell phone. “They don’t seem to care if he lives. They do test after test, but no one decides what to do. The only person I trust is Karthik.” Amrita recognized the name. He was a recently hired PCE, and when the doors opened again on the first floor, the man she remembered was waiting there. He caught Amrita’s eye but then focused his attention on the woman, who fell into his arms sobbing. They spoke quietly, then hugged again. As Amrita watched them, she couldn’t help but think that the PCEs were indeed filling a critical role. She doubted any of Krisna’s competitors were providing this level of service. Amrita now felt weepy herself. This was business, yes, but emotions invariably played a huge role. She needed to make sure that both doctors and patients trusted Krisna to do right by them.

Answer the questions
1.Identify (giving justifications) the external environmental factors that predominately played dominant role in influencing the above mentioned situation. (10 marks)
2.According to you what are the strengths and weakness of the organization? (10 marks)
3.Suggest ways by which the situation can be dealt with. (10 marks)
4.Identify and explain any one of the management principles that accordingly to you would be useful in justify the your suggestion (s) as par question no. 3 (10 marks)

N.B. Each answer is expected to be written within the word limit of 150 words