caneta wee teat AraR "we INDIAN INSTITUTE OF MANAGEMENT eermemn | BANGALORE IMB 425, SUHRUTA KULKARNI, KRIPA MAKHIJA AND U DINESH KUMAR APOLLO HOSPITALS: DIFFERENTIATION THROUGH HOSPITALITY ‘The ““wow"” factor in service relies on constant innovation and demands continuous and sensitive focus on al issues that may affect the patients stayin a hospital. Every touch point ofthe hospital needs to be “alive'” and the client must be able to feel the warmth oflered. The culture of service is imperative in today's scenario, where the differentiators could just be the manner in which services are offered. All the major players could replicate infrastructure within a short span of time, but not the service culture. Dr. Umapatiy Panyala, Chief Executive Officer, Apollo Hospitals, Bangalore (March 2013) Dr. Panyala, CEO, Apollo Hospitals, Bangalore believed that in the future, the hospitality aspect of hospitals—the service provided to patients—would differentiate Apollo Hospitals from a large number of equally competent competitors in the growing Indian healthcare industry. He had set up a quality department at the Apollo Hospital in Bangalore, headed by Dr. Ananth Rao. Apart from being an expert on Metabolic Diseases and Biochemistry, Dr. Rao was also a Lean Six-Signna black bel om the Indian Statistical lastiute, Chena, You can’t manage what you don’t measure—although this may sound clichéd; I am still a firm believer of this philosophy and want to apply this, especially in the hospitality part of hospitals, Clinical benchmarking is a compulsory requirement and is taken care of; however, patients have so many other touch points in their stay at hospitals—the hospitality part. Some of the world-class hotels (such as the Ritz-Carlton) have performed benchmarking to standardise their hospitality offerings; at the same time, its employees are allowed to use their judgment to provide whatever delights the customer in every visit.! We want ta interalse this in our culture as well, Dr. Ananth Rao, Head-Quality Department, Apollo Hospital, Bangalore (March 2013) Dr Rao also believed thatthe hospitality aspect would differentiate Apollo Hospitals from its competitors. Patient cae and care played very important roles in hospitals. Many patios were generally anxious when in a hospital and the sense of disservice increased their anxiety level very easily. Integrating healthcare and hospitality was essential {or cresting patint-focused care. Hospitality aspects included a smooth admission procedure, iendly medical and non-medical staff, comfortable fumiture, varied choices on the food menu, attractive suroundings recreational facilities, privacy, clear signposting, adequate provisions for vistors, and so on.* Impertant aspects of hospitality were managed by the nursing saff and other non-medical staff, whick meant inherent variability of service owingto hhuman interventions. Dr, Panyala and Dr. Rao wanted to measure the hospitality aspects at Apollo Hospitals and improve hospitality to create 2 world-class hospital. Dr. Rao and his team collecied feedback every day from the patients and received a ‘number of complaints, ranging from not having a TV remote to lang response time on the part of nursing staff in attending to requests from patients. For Apollo Hospitals, it was important that the patients’ experience in the hospital was not compromised, since it could have a significant financial impact. Managing the hospitality cements of the hospital was as important as managing the clinical aspects. Apollo Hospitals had a stringent process in place to take care of clinical aspects. Dr. Rao wanted to improve the hospitality at Apollo Hospitals by reducing the “Hepple J_Kipps, M-and Thomson, J, The concapt of hospitality and an evaluation ofits applicability to the experience of hospital patients, Intemational of Hosp Management, 9D, 90)35 316 Sulruta Kulkami, Kspa Mathie and U Disesh Kumar Proissor of Quantitative Nethods and lnfornaton Systoms, prepared thi case for Pwinary data, orto show efectve or infin handing of decision er business process, Copyright © 2013 by the Indian nstine of Management Bangalore. No part of he pullaton may be rprodaced a ansmited in ay form or trey means ~electranie mechanical photcopping, recording. ov atherise Cncadlg internet) witoat he person of Indian te oF Management Bangalre This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiation through Hospitality Page 2 of 20 ‘number of complaints from patients; he also wanted to achieve significant improvement in sigma levels measured through the Six Sigms performance scale, According to Dr. Ananth Reo: The immediate challenge is to understand the patients" sentiment towards the hospitality provided and to design a process improvement plan that is affordable. Apollo takes feedback from patients every day and the quality department staff interviews many patients every week to understand their needs Dr. Rao was aware that improving hospitality at Apollo Hospitals was going to be a continuous exercise in improvement; collecting feedback was one way of approaching the process of continuous improvement. He treated every complaint as a “defect” and planned to use lean Six Sigma concepts to eliminate defects. Implementing Six Sigina in all departments was likely to be a challange since departments such as housekeeping faced high attrition rates. His immediate objective was to introduce a system where future complaints related to hospitality could be reduced.Also, how much importance should be given to hespitality by Apollo Hospital was one of the dilemmas faced by Dr Rao and he wanted to set a realistic target far Sigma level in hospitality t Apollo, APOLLO HOSPITAL! HE TRENDSETTER De. Prathap C. Reddy, founder of Apollo Hospital Enterprises Lud. (AHEL) had accomplished a successful medical cateor in the United States. He rotumed to India in 1972 10 contribute to the healthcare system in India. Health infastructue in India was very poorly developed in the 1970s. In 1971, there were 3,862 hospitals and 12,180 dispensaries with a total of 348,655' beds for a population of $48,159,652'—a ato of 6.36 beds per 10,000 pecple as against the ratio of 9 beds per 10,000 people in 2011. India’s first National Health Policy was declared in 1983," almost 36 years after independence, which was an indication of the neglect faced by the heath sector inthe country since independence. Dr, Reddy had set up a good medical practice in India and used to send patients outside the country for specific treatmeats. However, in 1979, a young patient died as he could not arrange the money for treatment in the United States. Dr. Reddy thea decided to provide the best of medical treatment ffom the West 'o patients in India with an ‘emotional touch, calling it “High Tech with High Touch.” Apollo was a doctor promoted enterprise 10,000 Indian dostors, 4,700 US.-based doctors, and 60 doctors from the United Kingdom invested approximately USD 5,000 to start the venture. Dr. Reddy selected the best of the talent available to ensure the best possible service and care. He also easured that a clear distinction was maintained between business management and clinical ‘management.’ Apollo pioneered world-class healthcare in India, which was later emulated by several other hospitals. Apollo focused on technological excellence and gamered many firsts to its credit in the country. Apollo was the frst ‘not only in India but ako in South Asia to launch Oncological Robotic Surgery, G4 Cyberkaife Robotic Radiosurgery System. 320-slice computed tomography scanner. 64-slice positron emission iomozraphy-computed scan system, full-field digital mammography with tomosynthesis, and many such technologies.’ According to Dr. Rao, Apollo intended to carry forward technological excellence in hospitality to provide patients with the best care and care services, Dr Prestha Reddy, Managing Director, Apollo Hospitals Enterprises Limited has been the pioneer and chief architect of the tender loving care ~TLC “mantra”, a pillar of the Apollo way, which is affectionately applied to ‘every patient at Apollo Hospitals. “The patients and staff comprehend this languoge better,” she points out. The concept of TLC integrates service delivery with clinical outcomes resulting in exceptional patient experiences" °ackgroand Papers: Financing and Daivery of Heakhexe Services in Ina, Naonal Commission on Nacrossononics aud Health, Ministry of Health al Family Weare Governmen of Indi. 208. 47. + Stace: tp eyberjumals org incenuscenpop hin, aeceed o Mach, 2013, son Macht 201, ‘Mira, M, The Apllo Mision, Carporae Dossier wih The Economic Ties Je “Apolo laverar resnatien, www pellabompialcom,acesed in January 301, °N Amarsath, nd D Ghosh The Toye to Bscllence: The Ascent of21 Women Leaders of Ida ne, Pastak Mahal pp. 80-95, “hepsi apolobospitak comapoll pide pect reddy mansging rece par This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiation through Hospitality Page 3 of 20 CLINICAL BENCHMARKING Apollo Hospitals had been using a clinical score card called ACE@25 (Apollo Clinical Excellence), which ‘measured and monitored clinical excellence among the group's hospitals. ACE@25 measured 25 clinical parameters (Exhibit 1) every month, which were benchmarked against global standards ACE@25 was launched on Septemberl8, 2008 and used across 32 hospitals of the group. Clinical benchmarks were published by various Institutions and bodies such as Cleveland Clnic, Mayo Clinic, and Naticnal Healthcare Safety Network (NHSN), among others. Hospitals were grouped according to their bed strengths, locations, services offered, and so on. Group ‘A hospitals had to report 25 parameters—23 were common parameters, while two were location-specific. Group B and Group C hospitals had to report 15 and 10 parameters, respectively, out of which two were location-specific. ACE@25 was an intemally developed clinical scorecard, created by drawing upon the wealth of expertise available within Apollo. An audit committee at the corporate level was Se up tO validate the data, methodology, and detinitions followed at each location. According to Sangita Reddy, Executive Director. Apollo Hospitals Group: We necded a yardstick like ACE@25 that would pit us against international institutes like Cleveland Clinic, Mayo Clinic, and ethers, and position us on the global healthcare firmament for excellence in clinical quality. This also enables us to assess where we stand and where we need to be, while pursuing excellence in clinical quality.!! Apart fom this intemal benchmarking exercise, seven of Apollo's hospitals were accredited by the Joint Commission Intemational (JCI); and it was the largest group in South Asia to be accredited by the ICL The JCI was a USz-based accreditation body dedicated to improving healthcare quality and safety around the weeld and recognized as the gold standard for hospitals. Apollo was also accorded the Superbrand status by the Indian Consumer Superbrands Council, which recognised that the best practices were used in the brand, Apollo was the only hospital that was accorded the Superbrand status in Inda.'” There were other accreditations that several Apollo hospitals had achieved (Exhibit 2). According to Dr. Panyala, Living the brand should be our focus in every initiative or activity we perform. Apollo Hospitals has been one of the consistent names among the Superbrands. The perceived value of a brand like Apollo Hospitals is set very high in the backdrop of the decades of service and excellence it has offered. Clicats nocd to see and experience that value, and the gap between perceived value and obtained value must be zero at best or at a bare minimum. PATIENTS’ FEEDBACK AND REAL-TIME ACTION (On average, a patient spends 80% of the ime in hospital for the care part rather than the cure, and wwe need to focus on care to ensure speedy recovery and maximum satisfaction. Hospitality is critical in healthcare as the patient and hisher attendants are already distraught and highly anxious. Hospitality is driven mainly by human interventions —in nursing, housekeeping, as welll as food and beverages. It is very difficult to ensure consistency of quality and hence, we want to Denchinark these to ensure we provide the best quality of hospitality all the time. Dr. Ananth Rao, Head-Quality Department, Apllo Hospisl, Bangalore (December 2012) Dr, Rao believed that although clinical services formed the core of Apollo's services and brand image, hospitality ‘Would support the brand, and in the long run, both would merge to form the Apollo brand (as shown in EXMIDIt 3) AA services that did not require core clinical expertise were classified as hospitality services, including services such asbilling, dietician service, food & beverages, facility, housekeeping, nursing, facility, and overall operations. Each service was execited through a variety of processes. All the processes included in each service were identified and defined with regard to the procedure, timelines, required output, and so on. All the processes were mapped and the quality measures defined; these would be used as Sigma metic. "Express Heatheate, 2010), hp /heatheainanialexpess con/20100) sate sy01 shunt Souree Intp Kosta apallobspitlscom/ewsreom/71l-palo-hspital-only-healhcar-superbrandinoda al This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiation through Hospitality Page 4 of 20 ‘The Quality Department, established under the leadership of Dr. Rao, comprised two dedicated stsff~Sourai Dutta and Nisha Maria—who locked aftera variety of quality-related issues. Soumi and Nisha collected feedback from the patients between March 2011 and December 2012using the form presented in Exhibit 4, Patients were asked to rate teach department on a scale of | to 10. Additionally, open-ended feedback such as patients’ comments, opinions, or suggestions was also collected, A schedule was developed for collecting feedback, which ensured that Soumi and Nishs collected feedback from cross-section of patients; this also ensured that no biases crept into the feedback. The feedback collection ‘methodology is shown in Exhibit 5. Soumi and Nisha were trained to collect fiank, free-flowing feedback ffom the patients. If they received complaints while collecting feedback, they would immediately inform the department concerned and get the errors rectified, whenever possible; or ensure that the complaints were addressed to the patient's satisfaction ia real ime. Oue of them recdllected the following anecdote A patient had complained that the door was not getting locked properly. | got in touch with the facility personnel and they worked on the door and the lack and fixed the problem —all in a matter of 25 minutes from the momentit was brought to my attention. The patient was satisfied with the immediate solution, However, we did not step there. We teamed up with the facility tam and checked every door of the hospital and repaired them if required. We wanted to ensure that such complaints were not repeated, ‘The feedback collection process served multiple objectives such as collecting open-ended feedback from patients, resolving the issucs in realtime, and further auditing the actions of the service departments. The real-time escalation flowchart is shown in Exhibit 6 The feedback was saved on an MS Excel spread sheet, and stored on a monthly basis for easy retrieval. The data was then analyzed using various parameters and trends were plotted for each service. At Apollo, each service was related to. department; hence, it was easier to deal with the complaints and determine monthly improvements. FEEDBACK ANALYSIS From March 2011 to December 2012, 1,434 complaints were received from among the 1,38,600 in-patients treated during that period (approximately 1.03%). A Pareto chart was plotted for these complaints (as shown in Exhibit 7) The housekeeping department received the maximum number of complaints, while the dietary service had the least ‘number of complaints. The department-wise spread of complaints is shown in Exhibit 7. Some of the complaints were genuine concerns while some were related to minor discomfort. A few of the complaints were very specific, while some were gencric. All ofthese were analyzed, which would enable the hospital to work towards reducing the overall aumber of complaints. Some of the sample complain's from each department are provided in Exhibit 8. According to Dr. Rao, Every complaint is an opportunity toimprove. We keep looking forthe smallest of the complaints, which will help us in improving our quality by several levels. Sometimes itis difficult to interpret the complaints and itis even more complex to develop strategies that will enable a better patient experience. The complete data set was analyzed to determine the word frequency count in the complaints section. The significant words with thei frequencies are shown in Exhibit 9. This analysis Was used to focus on specific tasks to ensure reduction in the number of complaints. For example, the most significant word was “time” and it was associated with delays in response time for the various services. The twenty-fourth most frequent word was “lat,” Which is again related to response time. Thus, the word frequency technique helped in focusing on problem areas Based on the results of the analysis, benchmarks were set in consultation with the respective department for the response time of each service as shown in Exhibit 10 Apart from this quantitative analysis, ancther approach was used to analyze the feedback and obtain deeper insights for quality improvements Dr. Rao used the term “defect-defective” from the Six Sigma methodology one “defective” product/service could be caused by one or several “defects”. According to Dr. Rac, This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiation through Hospitality Page $ of 20 Any complaint from a patient is considered as a “defective”. For example, consider the ‘complaint: “Food is not served on time”. This complaint may arise duc to several reasons such as food not being prepared in time, food not being delivered on time, patient changing his/her order, etc. It isessential to identify these defects in order to eliminate the defective On receiving a complaint from the patient, which was teamed as “defective,” defects that led to the defective (complaint) were identified. Reot-cause analysis was perfoumed on all the processes of the identified defects. The processes were re-engineered to eliminate all the defects anda pilot study was conducted using the “Define Measure Aalyse Improve Control” (DMAIC) cycle. Once the process was found acceptable, it was then deployed across locations. This was followed by routine and surprise audits to ensure that the process was being fallowed as defined to ensure customer satisfaction. The flowchart is shown in Exhibit 11a and b. All feedback related to medical seavices was escalated o the Medical Directors fice. In addition to this, the Quality Department at Apollo Bangalore developed a methodology called the Daily Point Average” or DPA®. The ratings provided by patients for different departments were used to calculate the DPA®. The departments had to improve these ratings over a period of time. The DPA® effectively captured the “mind of the customers” since the feedback was colleced during the patents’ stay and not at the time of discharge. BENCHMARKING OF HOSPITALITY Hespitality required high human involvement and was very specific not only to local cultures but also to exch Individual. Since a patient had to stay in a hospital to get cured, hospitality automatically came into the picture. Hespitality in various hospitals was very different owing to the surroundings and differences in customer (patient) requirements. Patients did not walk into a hospital out of volition—they came in only because there was some problem. Under such conditions, the patient would be very agitated and any small thing that was out of place would become a big issue. Any kind of delay would be extremely intolerable and all the services had to be perfect all the tine. Even in the hotel industry, hospitality was not standardized and benchmarks were not avaible. The Ritz-Carkon hotels, which are considered the gold standard in the hspitalityindusry, had wed Six Sigma and benchmarking for their hospitality business." Although benchmarks for clinical services were well-established, those for hospitality in hospitals were yet to ke established Apollo Bangalore developed benchmarks for several common complaints with three levels of services (as shown in Exhibit 10) by adopting the Kano model, which was developed by Neriaki Kano (Exhibit 12) This model was used across service industries and it helped in understanding customer expectations from any product or service. The threshold or the tasic quality was the minimum requirement of the customer, which would be taken for granted even if it were present: however. if it were not there, the customer would complain about its absence. Normal or performance quality was something that the customer would expect because these were stated cither by the productservice provider or by the customer as a requirement. This quality was observed by the customer and its absence would cause discomfort and disappointment. Exciting quality of the service or product was something that ‘would not cisappoint the customer; the presence of this would delight the customer, since the customer did not expect this quality. With time, the exciting quality would become performance quality and the performance quality ‘would become a basic quality. Hence, the manufacturer or the service provider should always strive to provide new exciting qualities. Accordingly, several metrics were defined for benchmarking. For example, patients were informed that routine hhospital-provided meals would be served within 10 to 20 minutes of every mealtime. This became a performance attibute. The threshold requirement of the patient would be that meals should be served within 20 minutes after plecing the order. If the meal was served within 10 minutes, the paticat would be delighted. Howover, if thi customer (patient) were to come to the hospital again, shefhe would expect the meal to be delivered within 10 ‘minutes; this then would become a performance quality for her/him. Source: ipwwr. afi arg/acnsletrssin, sigma. gf hate aplication html This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiation through Hospitality Page 6 of 20 FINANCIAL IMPLICATIONS The Quality Department required funding for data collection, analysis. and other related activities. These expenses affected the bottom line of the hospital. However, fram March 2011 to December 2012, the number of revisits increased, which implied that customer loyalty had increased. There was a 15% increase in the number of in= patients. Eater, high discounts had been offered to dissatisfied patients owing to ertors in service or poor quality of service. Gradually, there was & reduction in the discounts provided, which was a direct result of bester satisiied patients, Additionally, owing to better processes, cost of quality (in terms of re-work and consumable wastage) had reduced, which helped in improving the bottom line. Further, ewing to better service and higher levels of satisfaction, the patients acted as brand ambassadors for Apollo and provided word-of-mouth publicity, which improved the top line. Another example of decreased turnaround time and a resultant increase in profitability was seen in the Biochemistry Lab at the Apollo Bangalore Hospital. Dr. Rao headed this lab and he understood the paticnts’ requirement of receiving diagnostics reports in two hours instead of three. Dr. Rao and his team redesigned the process using SS and lean concepts and managed to reach a tumaround time of two hours. Profits from the Biochemistry Lab neatly doubled after the decrease in tumaround time; while the cost of consumables increased by only 119%. Even though the Apollo team was trying to improve customer sttisfiction, it stil faced the question of how much satisfuction could be sctually provided to the customer considering the room tariffs that were charged. As seen from Exhibit 13, the charges atthe Apollo Bangalore Hospital ranged irom USD 25 for a basic room to USD 120 for the Platinum Suite. A Ritz-Carlton basic room would cost USD 799 at Washington, U.S.A. and USD 165 st Kuala Lumpur, Malaysia (per person, per nigh’). The Apollo team might be able to provide high quality hospitality to patients in the Platinum Suites. However, the aspiration to provide the same service to patients in cther rooms might no! be financially feasible. The team was trying to build high levels of service for the Platinum Suites. However, the volumes in the ether rooms were too high to be ignored, especially in the Indian context. Additonally, customer loyalty was extremely important to Apollo; in Dr. Panyala's words, Customer loyalty and not mere retention is what we need to focus on. It is important to think ahead of the customer to identify issues that may compromise the experience. QUANTIFYING HOSPITALITY ACROSS APOLLO According to Dr. Rao, Once, we develop the benchmarks and the Sigma metrics, we want to replicate the system across all Apollo hospitals in the country. Each hospital will have ta devise its own benchmark and Sigma metrics. However, we want to provide a framework for developing these and then ‘measuriag the outcomes. All the hospitals would then be compared by equalisation of scores and ‘would benefit from one ancther’s leaming”. Afier collecting the fedback and attempting to set benchmarks, Dr. Rao knew that he needed to go deeper and analyze each service through the complaints, set up relevant benchmarks, and target certain Sigma levels for exch benchmark. He wondered whether they could collect and analyze data in a better manner. He wanted to arrive atthe basis forthe cost-benefit analysis of tis activity. Looking atthe complaints and the analysis, Dr. Rao had two major questions on his mind: 1. What strategy should be used to reduce the number of complaints and sustain the culture of excellence at Apollo Hospital, Bangalore under the leadership of Dr. Panyala? 2. Given the manual intensive processes involved in addressing the hospitality issues, what is a good Sigma level? Could Apollo set a target for Sigma level in hospitality? Source: wwwcitzeaionsom, ecesstd on Api 18,2013, This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Diflerentiaticn through Hospitality Page 7 of 20 Exhibit 1 ACE@25 parameters Ss & Parameter 1 [Coronary artery bypass grating (CABG) mortality rate 7 [Complication rate post coronary intervention{percitansous transluminal coronary angioplasty; PTCA) 3 [Average length of stay (ALOS) pos: angioplasty [Average length of stay (ALOS) pos total hip replacement (THR) [Average length of stay (ALOS) pos total knee replacement (TKR) © |Complication rate for total knee replacement (TKR) [Average length of stay (ALOS) post renal transplant 7 [Average tumaround par dalysis chair per day ‘9 [Average length of stay (ALOS) post wansurethral resecion of the prostate( TURP) 10 [Complication rate transurethral resection of the prostate(TURP) TT [Endoscopy complication rate T2 [Patient satisfaction with pain management TS [Door t thrombalysis ime in ischemic Soke in emergency Foom (ER) Ta Percentage conversion of coronary angiographies to Goronaly ariery bypass grafting (CABG) TS [Gathetarrdated blood stream infection (CREST) To \Ventilator ssoclated pneumonia (VAP) T7 [Catheter rated urinary tract infection (CR-UTT) TW [Average length of say (ALOS) in hospital TD [Average lengih of say (ALOS) in intensive care unit (CU) By [Door to CT time in Sroke cases in emergency room (ER) 2 [Surgical site infection (SSI— Clean wound) [Medication eos 25 [Average length of stay (ALOS) post molified radical mastectomy (MRM) 2 [Average length of stay (ALOS) post microdisectomy [Average urea reduction ratio®™ [Percentage of patienls achieving/maintaining haemoglobin level of I gram or higher after 3 months of dialysis 26 jn end stage renal disease (ESRD) *otional This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiation through Hospitality Page 8 of 20 Exhibit 2 Accreditation of Apollo Hospitals ‘Accreditation ‘Apollo Hospital Location Toint Commission International CT) Delhi, Chennai, Hyderabad, Ludhiana, Bangalore, Kolkata, Dhaka Nationa’ Acsraitaton Board for Hospitals & | Maduni, Chaanar Healthcare Providers (NABH) National Acsredfation Board for Laboratories (NABL) | Chennai TS0 9002 ‘Chennai Source: ApollolavesorPresctaton(etievel ftom www apolahosptals com in Sanuury 2013) Exhibit 3 Apollo Brand-Clinical and Hospitality Services OIG MoBPrTats Core Clinical RT Ta lacy kT icl ia Source: Inerview wit Dr Ananth Rao This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiaticn through Hospitality Page 9 of 20 Exhibit 4 Feedback Form w Apollo Hospitals YOUR FEEDBACK Thank you for choosing Apollo Hospitals for your healthcare needs. As a quality Tamm improvement initiative, we are looking for improvements in parameters towards “Service Excellence” of our hospital Please provide afew minutes of your valuable time for a personal interaction. How satisfied are you with your experience and the services provided by our hespital on a scale of 1 to 10? 1. MEDICALSERVICES TSE OT OT > 7 Poor Good Excellent 2. NURSING SERVICES tp? Psp* ~s be >? Le 3 10) ——— Poor God Excelent a eee SHON 7 2 a a 5 € 7 = 3 70) eo = Poor Good Excellent a.rooveneveraces a3 a > rT ht ts Poor God Eicon S.HOUSEKEEPING SERVICES TL2 pb! Ls Le LL?) 3 70 as <= Poor Good Excellent «FACILITY & MAINTENANCE EO 2 30 a = Poor Good Excellent COMMENTS (OVERALL): Patient Name (Optional) UnDD: Date of Admission: Room No: Signature: Date This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiation through Hospitality Page 10 of 20 Exhibit 5 Feedback collection methodology A Typical Process Map: DPA Daily Data Collection Method ee is Peery ere eee Sone a Sonne Survey conducted Eye Serene prea rennet Pere eer Poe De to CEO. & DMS Peed rr Pree rer Py This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiaticn through Hospitality Page 11 of 20 Exhibit 6 Flow for real-time complaint escalation Sete Real-time escalation of issues within 15 minutes to ad eon eo eae es stakeholders Closure audits conducted at the end of TAT Patient surveyed Res Pee eae et ne Peet Pee fees This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiation through Hospitality Page 12 of 20 Exhibit 7 Department-wise complaints mE Complaints ‘Cumulative Department No. of Complaints HK 373 FRE a8 Facility 36 ‘Operations 189 Nusing 173 Medical R Billing Mf Dieary 1 This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Diflerentiaticn through Hospitality Page 13 of 20 Exhibit 8 ‘Sample complaints from each department in Apollo Hospitals Housekeeping: Sample Complaints Housekeeping service needed to be improved. “The dustbin was broken. The patient's rdative went to the housekeeping desk and got a new one, but housekeeping staff came and took the new dustbin away and replaced it with broken dustbin Tinga was not Ghanged in 24 hours. Today moming, when we requested for fresh Tinen, they said it would be provided in $ minutes; it was not changed till 3:13 pm. ‘The TV remote was not provided in the room. We asked fort 3 fo 4 tines, but there was no FSpomse “The toilet was staking, Vestorday evening, the floor was din: Drinking water was not provided whan we asad for fsa Finally we had to gat from home Hlcusekeeping came to clean only once a day. The inpatient guide book said that they would come twice day. “The clock battery had to be rephoed Yesterday, [did not get a lanka the entire day Triook 20 minutes to get a Blanket Food & Beverages: Sample Complaints The foed served was not hot, Tasked for Kichidi but got only rice. Around 3:50 pon ast aight, the patient aiked Tor mill, We ware told Wt would be served Wt by 9 pm, but the patient did not get mille Today, we asked for mill again. “The focd served was too spicy and dry. The food served was not what we fad ordered The focd served was not tasty, so we brought food fromhone. “The quantity of food served was not sufficient The quality of roti was bad it was diy and hard Coffee and milk were always served cold, even afler complaints Food quality was nat good Triook 1-5-2 hours for the plates taken away. ‘The cafoeria menu card was spoiled. They should get anew one. Despite the patient informing the Saif that She did nat eat food with gailie or onions, the food served contained gailic and onions. After endoscopy was done, it took 1 hour forthe food to be served despite repeated reminders. “There was foo much pepper in the child's Food: Facil ‘Sample Complaints “The nursing call bell did not work properly. The nursing call bell wire was short and did not reach the patient's bed. “The roam was too congested and stufly. The temperature in the room should be checked regularly Tn the semi-private room, the light fom the next room was too bright; the glass partition should be covered with curtains. “The TV remote was ken away since theTV disturbed the other pater. This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiaticn through Hospitality Page 14 of 20 Exhibit 8 (Contd.) ‘The staf members in the parking area were not cooperative. They were very arrogant. Last time, the patient was admitted to the ER at 11:30pm, but we were not allowed to park even fora few minutes. ‘The Balcony was not clean. When we fet suffocated in the a.c. room, we opened the window. There was stagnant water outside, which led toa Lot of mosquitoes coming in let water was net available in the bathroom: Extra curtains should be provided. There were hooks Tor exira curiains. Thad asked for ourlins, But they were not provided. This hampered my privacy. The doce made too much noise, which disturbed my sleep, The Tush was not working properly “The attendaat's cot sie Should be a Ie Bigg. ‘Operations: Sample Complaints The doctor advised the patent undergo Bronchoscopy, and the patent was asked not to eat anything fom §:30 am that day. At 12:30 pm, when the pate that the procedure was postpored to the next day. No communication was provided tothe patient regarding this 'sattender enquired with the bronchoscopy department, theattender was told information was given only when the attender specifically asked for it. The patient's attender was told that the pa i WOUTd be shiffed to the ward fom the OT recovery only after T hour, so the patients atender went for unch. However, the patient was shifted in 20minutes ‘The insurance Saif Teh at 00pm on Sunday and there was nobody toassint us wih the formalities We came to the Emergency Room at 10am, We ware told we would get a room around pm. Theroom was Finally allotted at 9pm. (A Telugu translator was required TA “ilence please” board should be put in cach room ‘The transport boy's shoes were stinking. The hygiene of shoes should be improved. All the siaffshould close the door while Teaving the room. We ado wait forthe discharge summary as i was not updated on time: ‘The patient or the attendars should be made aware of what to Bring to the hospital. When we asked the doctor what all we should bring, the doctor told us to get some clothes for the baby. Nobody informed us about the other things that would be required and were not included in the package. Informatica and orientation should be given beforehand and not at the time of an emergency. Three days ago, while making an appotuunent over the phone, the receplionist made mae walt for 3-4 malnates the first time, When I called again, the same person made me wait for 7-8 minutes. The appointment was finally given only when Icalled the third time. This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Diflerentiaticn through Hospitality Page 1S of 20 Exhibit 8 (Contd.) Medical: Sample Complaints The patient was in severe pain We expected the doctor to visi the patient in the morning. He had not come oa rounds ill 3 pm. We were waiting for the treatment plan and discharge. Many sialf members were seen walking info the canteen wearing OT gowns and shoe covers. ‘The operation theatre was available earlier, bul was not allotied due to coordination issue (ihe surgery was scheduled at 12pm,but the patient was not shifted even at 3 pm). ‘The patient was suffering Fom pain in the stomach. ‘Backup treatment should be available Tor oncology patienis ia the ERC and even ia the ward ‘Narsing: Sample Complaints “The nurses should attend to patients more frequently, especially on Sundays and other holidays. TIDU: there was a sight delay inservice. Some of the nursing staif members were not prompt. ‘Blood sample had already been taken inthe morning, but the stall came and took the sample again; hey said thatthe previous blood sample could not be used as the blood had clotted. The sample collection process was extremely painfil ‘Yesterday night, around 1.30pm, the nurse on duiy pulled out the IV Tinein a rough manner, which caused lot of pain, even though the patient kept asking the nurse to do it slowly. “The response lime OF muse was bad. Tr (ook tem at least half an hour to come aller being Caled 2-SUimes Te would be nice to have a specific set of nurses to ake care of me regularly “The nursing staff seemed to be overworked. ‘K checkliatpationt edacation material forthe plan of care should be available for patents convenience, ‘The staif should try to find out the patients needs. The response time was very high. There should be additional staff, asthe staf’ seemed to be overburdened, Talay morning, he nurse iied thrice but could not find a vein, She then called another nurse, who completed the procedure. My hand hurt fora long time after this. Billing: Sample Complaints Billing took a long time. Itshould be monitored and abnormal delays chould be avoided. During admission, the credit cel department Saif Fohaved very rudely ‘The discharge process took more than 2 hours What all were included in the package was not very clear tows, ‘The cont of surgery should be informed beforchand, rather than calling us at short notice and telling us to pay immediately. If we had been informed eatlier, it would have been easier for us to arange the finance and settle it We ad to wait for 40 minutes for the finalization of the bil: This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Diflerentiaticn through Hospitality Page 16 of 20 Exhibit 8 (Contd.) Dietary: Sample Complaints Food should be less spicy and should be according tothe child's taste ‘The dicician didnot visit the patient uni 10pm. The patient war admitted ov 0/6; the nargery (ance replacement) ‘was performed on 10/6, The patient would be discharged the next day, and we needed to meet the dietician. The doctor suggested normal diet but yesterday moming, the dietician changed To sot diet. Inthe evening, the doctor changed it to normal dit. However, soft diet was continued unil lunch today. After we complained, the F&B, boy changed it to normal dit, but I had already finished my lunch by then, The dostor told us not fo give chutney and sambar to the patient Afler having the food suggested by the dietician, the pationt had stomach pain, The diiician has not come to my room yet Exhibit 9 Text analytics—word frequency count Cou word | Cow 2T Good oF 2 2 20_| Response a 3 2 | Proper 3 7 206 2 [said 7 3 rer) 23_| Hot water En 6 9 24 [Tate ® 7 ToT 25] Bedsheet F © improve 105 | Qualiy % o | wait oF 27 _| Floor sy 10 [Sar 5 28 | Seve sy TT Bad oT | Tanck cn 12 | Morning or 30_| Response ime a 13 | Night ca 14 | Aivend 7B 1S | Work 7B 16 | Hat 7 17 [AK @ Te | Minute & This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Diflerentiaticn through Hospitality Page 17 of 20 Exhibit 10 Benchmarks for hospitality developed by Apollo Hospitals, Bangalore Kei DEP MEASUREMENT FREQUENCY >20MINS ROUTINE MEAL DELAY TO-2ONINS | FORTNIGHTLY <10MNS [ [ T waerwetnonoensonay fT 20MIN S20MINS “SMS [ [oT naerweenoroerspaay fT >30MINS BEVERAGES 1S30NINS SISMINS WRONG DET NA 0 POST ADMISSION DIETICAN S0MNs CONSULTATION DELAY 60-120 MINS] <6OMINS REPARTINE >30 MINS MINOR 1530 MINS, <15 MINS REPAR TINE 260 MINS 3060 NING, 20 MINS RESPONSE TIME. ‘LEIS INS. 610 MINS OS MINS RESPONSE TIME >3MINS 15-3MINS O7-15MIN This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiation through Hospitality Page 18 of 20 Exhibit La Defective/Defects analysis and process re-engineering flowchart Adentity defect(s) ‘complaint/feedbs leading to fe ack defective Analysis If solution If solution acceptable Deploy at all locations This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiation through Hospitality Page 19 of 20 Exhibit 11b Defective/Defects analysis and process re-engineering flowchart Den as Cause pee This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024Apollo Hospitals: Differentiation through Hospitality Page 20 of 20 Exhibit 12 Kano Model Exhibit 13 Room tariffs at Apollo Bangalore (as of January 2013) Bel Type Charges USD Shared Bed Category-1 75 Shared Bed Category2 36 Trin Sharing Bal w Tigh Dependency Unt GHDU) w Tivate Bal 77 Tassie 3 Planum Sate 730 Tassie Care Unit (CU) rtd Care Unit (CCU) 3 This documents auttrized for use ony in Prof Arhnder Kau’ Serices Operatons Managemen at indan Intute of Tecnology - Madras tom Aug 2025 to Feb 2024