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Implementation of CRM in Health Care
CRM system needs a daily accumulation of data from both in-patient and outpatient departments’ terminals through multi-media platform and integration with other ancillary technical systems enable an effective CRM system to be completed after the following work is done well.
• Integration of CRM system with HIS
• Integration of CRM with Hospital Web Platform
• Integration of CRM with Call Centers
• Integration of CRM with short-message gateway
• Establishment of Customer Responding Mechanism and Database (Anshari, 2011, Poku, 2016)

PRM Programs in Hospital Setting
A Customer Relationship Program for patients in a hospital can be broadly classified into two factions i.e. In Patient CRM and Out Patient CRM. In Patient CRM includes all those customer care activities when a person gets treatment in the hospital and avail the facilities rendered by the hospitals. Here the customers can be the patient and the attendants to the patient i.e. who accompanies or visit the admitted patients. Out Patient CRM consists of those customer care activities when the person is discharged from the hospital. It includes maintenance of database of each and every patient and thereafter, maintaining regular interaction with the patient.

Components of a well-organized care management program

Figure 4. Components of a well-organized care management program.
Many healthcare organizations have leveraged information from their Health Catalyst Analytics Platform, including their Late-Binding™ Data Warehouse (EDW) and broad suite of analytics applications, to support the identification of specific patient cohorts to monitor the impact of care management interventions on individual and population health outcomes. The programs featured below focus on different patient populations, but they share major commonalities. The themes of aggregating data to identify and risk stratify potential patients, focusing on care coordination functions, developing processes to improve patient engagement, and importantly, measuring performance, are prevalent throughout the examples. The care managers assess patient risks and needs, including comprehensive functional assessments and potential barriers to care. They closely monitor patients during office appointments; looking for gaps in understanding or the ability to comply with the established medical treatment plans; use phone calls and home visits to monitor patients after visits; and coordinate services such as diagnostic tests, transportation, social services, and specialist services. Care managers also serve as liaisons between the patient and other members of the care team across all settings. Leaders at Partners use data from the EDW to calculate the return on investment (ROI) for the iCMP, and to compare the iCMP patient outcomes to non-iCMP patients (Source: Chaguturu, 2016).

In Patient CRM:  The most important parameter for a person visiting any hospital is the way of treatment he will get there. Winning over patient’s faith is of utmost importance for the employees of the hospital. Presence of a clean environment and suitable hoteling and space in the hospital cannot attract the patient's trust and in fact hospital must show its ability to meet the patient's needs practically in terms of the manner of service delivery and the personnel-patient interaction. Right from the chief doctor to the ward boy, it is the duty of each and every employee to ensure patient satisfaction and proper training can be given in this regard. They should make the patient believe that the hospital is doing their level best to cure him. Clear instructions about the procedures should be given to the patients and their attendants to eliminate unnecessary steps and avoid hassles. If the private hospitals aim to enhance the patients' trust, the quality improvement efforts must focus on the managerial aspects of service delivery, such as scheduling, timely and careful doing of the services, and strengthening the interpersonal relationships as well as the communication skills of the physicians, nurses and other personnel.

Out Patient CRM: Out Patient CRM includes post discharge activities which help in maintaining and strengthening the relationship with the patients. Hospitals should record and maintain computerized database of each and every patient in detail which includes personal details of the patient, medical history, referred physicians, scheduled appointments, frequency of visits etc. This information would in turn help in other CRM activities of the post discharge period. Even after getting discharged from the hospital, the patient needs to come again for further treatment or check up at regular intervals. These activities might include:
• Sending greetings and wishes on birthdays to the patients along with the offer of free health check-up. This would make the patient feel special and make him believe that the hospital still cares for him even after discharge.
• Maintaining a database would enable the hospital to send continuous reminder to the patients about the scheduled appointment and seek their confirmation that they would be coming.
• The hospitals can create “Rehabilitation Centers” for the patients who are suffering from long ailments. Once they are discharged from the hospital, the hospitals can arrange a visit to these centers for them where they can meet the people who are suffering from similar ailment or have already been treated for the same. This would give moral support to the patients and would curb the sense of insecurity and loneliness in them.
• The database helps the hospitals to get the proper understanding about the profile of patients who are visiting the hospital. It helps to list out the kind of disease from which most patients suffer from, their referral sources, the geographical areas from which the patients come from etc. Creating customer delight is crucial for any organization. Similarly, hospitals must also strive hard to achieve customer lifetime value by improving customer loyalty. CRM is not only confined to maintenance of database of every patient but it also about the use of technology to provide value added services to its customers. Apart from patients and attendants, now the hospitals are also driving their attention towards the customers i.e. the ones who are presently healthy and are availing the offers given by hospitals in terms of health packages and insurance schemes etc (Rafique, 2016; Paazine, 2011; Walker, 2013; Posner, 2017; Freytag, 2017; Khoshraftar, 2011; Zarei, 2015)

Improving the effectiveness and efficiency for outpatient services

PRM and Industrial Age Medicine
Patients who are more engaged with their care have better outcomes, and leading healthcare organizations are actively seeking to develop strategic approaches to promote this process. Many profit hunting HCEs are striving to improve patient satisfaction. Focus on patient satisfaction alone can actually be undesirable in terms of achieving cost-effective, high-quality care. For example, physicians have been known to inappropriately prescribe opioid pain drugs and antibiotics in order to protect patient satisfaction scores. To thrive in a value-driven reimbursement environment, providers will need to adopt a sincere orientation towards patients and families in order to achieve significant activation and engagement. This process can result in stronger therapeutic alliances between providers and patients, improved patient decision-making, and better health outcomes. Stronger relationships between providers and patients can increase value, but these relationships cannot be forged by initiatives that focus merely on satisfaction. Just as companies outside the healthcare sector have developed systems, tools, and processes around CRM, healthcare organizations should build the same discipline around the concept of PRM (Poku et., al 2016; Khoshraftar, 2011; Yaghoubi, 2017; Elangchezhian, 2014; Dash, 2011; Asgar, 2015; Lyapustina, 2015; Zgierska, 2012; Business Roundtable, 2014; Primary Care Collaborative, 2010; Zgierska, 2014)

Tools for Providing Excellent

Figure 5. Tools for Providing Excellent Communication in a Healthcare Setting.
The AWARE pneumonic is a great way to improve communication in the healthcare environment. Communication with sending and receiving facilities, dispatch, and even with those on scene calls will only help increase the continuity of care. Patients and carers place high value on face-to-face communication with health-care professionals, who can engage on an emotional level, listening and assessing patients’ information needs and providing information with clarity and sympathy. This is especially relevant when dealing with patients with a cancer diagnosis, who may be facing difficult or complex decisions about treatment options. Specific communication needs at different stages must also be considered—diagnosis, treatment, recurrence, palliative and terminal care. It is suggested that good communication is a pre-requisite for enabling patients and carers to make informed decision about care (Source: Liptrott, 2009)

Prompt Attention and Ensuring Hassle Free Service
There is much that a concerted effort around PRM can address. Most importantly, delayed access to health care is assumed to negatively affect health outcomes due to delays in diagnosis and treatment. Patients still have to wait days together to see their physicians after scheduling an appointment. The actual doctor’s visit consumes an average of 2 h of a given patient’s time, the bulk of which entails travel and waiting, with precious little dedicated to face-time with providers. The Institute of Medicine recommends that at least 90% of patients should meet doctors within 30 minutes of their scheduled appointment times. A waiting time is not only a factor that affects patient satisfaction but also one of indexes to evaluate the quality of services rendered to outpatients. Healthcare providers do not routinely check in on patients after even major changes to treatment regimens to assess efficacy, adherence, and side effects. Moreover, there is still no national mandate for providers to include patients’ caregivers around transitions of care. Patients and families deserve better healthcare delivery systems than they are currently getting, and a focus on PRM is one mechanism for realizing this aim (Poku, 2017; Abou-Malham, 2018; Edward, 2008; Thi-Thao-Nguyen, 2018;

Empirical framework

Figure 6. Empirical framework: barriers and enablers in relation to provide reasonably adjusted health services to patients
The findings reported here have been derived from across data sets. An empirical framework representing the full list of barriers and enablers in relation to providing reasonably adjusted health services for patients with intellectual disabilities is given. The adjustments needed by different patients with intellectual disabilities varied greatly. This lack of homogeneity could make it difficult for healthcare staff to know how to adjust their care for an individual patient. For example, one patient with intellectual disabilities would benefit from an early morning appointment in an outpatient clinic, so that the waiting area was not yet too busy and waiting times were kept to a minimum; for another patient, however, such an early appointment was prohibitively difficult, as it took him several hours to get ready in the morning (Tuffrey-Wijne, 2014).



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