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What Does Patient Want Now: Are Their Preference And Requirement Changing?

Author: Dr. Sunil Dadhich

DM, Gastroenterologist Kala Endoscopy and liver clinic, Jodhpur.

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The novel Coronavirus Disease 2019 (COVID-19) has affected the healthcare systems badly and put a massive challenge across the globe. The traditional healthcare system did not imagine the severity and intensity of the COVID-19 pandemic, which dented the economy, personal health, and human lives. The healthcare systems require the massive updates in terms of functionality and management of the pandemic. At the one side, they need to restructure the operations and on the other hand, they are required to win the trust of the patients again while fighting the pandemic simultaneously. The patient preference has changed due to pandemic and they are seeking the ways to interact with their healthcare providers in a safe environment and are avoiding the physical visits. Patients in very urgent situations only prefer the physical visits. The technology-driven and forward-looking digital healthcare system in compliance with government regulations are the need of the hour. The proper and smooth virtual customer interactions, development of the digital platforms for patients, deeper patient‑doctor communication through audio-video interaction, machine learning, use of artificial intelligence to drive research, and secure database systems to preserve medical data are the key steps which could lay foundation of the new and improved healthcare system. The requirement is necessary for physical as well as for mental healthcare management. Not only the changes in healthcare systems, the need also implies enhancing the regulatory framework as well as more healthcare services may shifts from hospitals to out-of-hospital care and homecare settings. This improvement will pave the way for rapid crisis management capabilities of the healthcare system.

Key Words: COVID-19, Healthcare System, Patient Preference, Artificial Intelligence in Healthcare System, Telemedicine



The first case of novel Coronavirus Disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was reported in Wuhan, China, in December 2019. Till then, a total of 120 million cases were recorded globally, with 2.65 million death so far [1,2,3]. The actual number of deaths due to COVID-19 may be likely to be higher than the number of confirmed deaths, which could be due to limited testing and problems associated with the attribution of the cause of death.3 The entire world faced the lockdown and disconnected from each other, with merely virtually connected. The common public and the healthcare professional, including doctors, nursing, and paramedical staff, lost their lives, saving the patient’s life and fighting against the pandemic. India was no behind the rest of the world [4].

The virus and virus attack spared no country keeps spreading with new changing strains challenging the healthcare workers worldwide. Healthcare professionals face the unprecedented situation of making difficult decisions and working under extreme pressures to fight against the pandemic. In the beginning, many healthcare systems, unaware of the pandemic and limited information about the intensity of COVID-19, had confusion in efforts to fight against the pandemic that led to controversial decisions about the resources, testing, and treatment [5]. It revealed the deep underlying healthcare problems in systems worldwide and point out the lack of preparedness of healthcare systems in pandemics.

However, the situation is improving somewhat, but it had already made a big dent in terms of the economy, health, and humanity. The COVID-19 pandemic will end eventually, with the availability of vaccines now, but the reason for the end, its timing is not precise yet. It gives rise to the discussion of managing the healthcare services post-pandemic. The present article focuses on the patients' expectations and preferences along with the requirements of healthcare systems after pandemics and how the healthcare system can evolve to match those expectations of the patients.


Attacks on Healthcare System

As per the WHO report, there were different types of attacks on healthcare related to COVID-19 with varied contexts that ranged from heavy weapons targeting health facilities to the stigmatization of health care workers [6]. This has a negative impact on the healthcare industries and the challenges were increased. Either in the form of cyber-attack or as the physical assault, they imposter risks to the patients who need care urgently and challenges to healthcare providers, thus undermining the healthcare system as described in the below infographic (figure 1):


Figure 1: Attacks on health care in the context of COVID-19 [Source: WHO]


Patients’ Expectations from Healthcare Providers

There is a level of trust deficit among patients, which has changed their behavior. They do not trust the media and other information, which they hear from different sources. They want accurate information about the things they want to know from their healthcare providers. The patients expect the environment to feel safe with maintaining social distancing and get the right information for their queries. Mental health, along with physical health, becomes utmost importance to patients. COVID-19 has affected mental health as well due to job losses and emotional strains, and the patients with chronic diseases have been affected badly. Social distancing, virtual visits, and teleconsultations are new normal for the patients. Most of the patients are avoiding visiting hospitals and would like to do that only in emergencies only. Physical appointments and follow-up visits have decreased, and patients prefer virtual visits. Suppose it is necessary to visit the hospital. In that case, they expect social distancing in the waiting room, seeing healthcare providers wearing masks and gloves, keeping COVID-19 patients in a completely separate area from non-COVID-19 patients, waiting in the car or outside until it's time for the appointment, avoid touching to humans and things in hospitals and to come out from hospital as soon as possible. The patient expects a redesign of their care management and wants a calm and proactive approach from their healthcare providers.

As per one study from Accenture, the majority of patients have shifted to virtual care. Virtual tools are acting as an essential lifeline for continuing care. The patients had a highly positive experience using the video calls, monitoring devices and virtual platforms and wanted to continue that after the pandemic [7]. As per Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the key important themes for the patient’s included [8]:

  • Hospital environment, cleanliness, hospital policies, procedures, and its impact on patients’ perceived autonomy
  • Complete patient care
  • Communication with and between healthcare teams and use of terms in layman language that patients can understand easily
  • Responsiveness and attentiveness to needs

The patient expectations and satisfaction was studied in 4 Australian hospitals and concluded that besides the above mentioned factors, a proper and clear communication at arrival and discharge from hospital, environmental factors such as room sharing with other patients, and enhanced follow-up at homecare were most important for patients [9].

Virtual care seems to stay for a long time as an adaptation in patient behavior and can be an integral part of the patient experience. Many virtual platforms have evolved and developed interfaces to provide healthcare services to the patients seeing these patients' altered behavior. Many healthcare prominent names have also started digital outpatient departments to provide care to the patients, which does not require physical presence or visits to the hospitals. The evolving trends can be a game-changer for the healthcare industry in the long run.


Post-COVID Changes in Healthcare Delivery System

Due to the pandemic, the entire healthcare system stretched, and the pandemic's rapid spread globally brings hospitals/healthcare facilities to exhaustion. The healthcare professionals continue to risking their lives and fighting against the pandemic to deliver critical services. Plato said the "necessity is the mother of invention," but the "disruption" is the accelerator of change in the current scenario. Though it is challenging, we need to find some of the positive elements from the severe pandemic and its impact on improving healthcare systems. Due to lockdown, we, the people, adopted new habits of doing social distancing, work from home, tele/video conferencing. The changes were also adopted to how the patients interacted with the healthcare systems and their caregivers.

The healthcare professional working in COVID-19 dedicated wards, even those who belong to other specialties like dentistry, dermatology, ophthalmology, neurology, orthrology, neurology, etc. also facing major challenges to run their private practices. This has already affected the healthcare systems, and the healthcare sector may observe many changes, which could include:

  • Less physical visits/no-long queues
  • High-rise in insurance
  • Importance to the timing of consultation/appointment
  • New infrastructure and technology implementation in clinics
  • Increase in online visibility
  • Change in a doctor-patient relationship
  • Change in the healthcare process
  • Window-shopping

To enhance the preparedness for crisis management in healthcare systems, integrating technology and process will play a significant role. The approach to "think different" is the key. Virtual health offerings are the way to create competitive advantages in healthcare systems.

As per the report from Mckinsey [10] and an article from the JAMA network [11], the key shifts across the healthcare systems may involve the following approach which patient will like and the need of the hour to face the challenges:

  • New paradigms for infrastructure, the geographic distribution of providers, and care settings of flexible design, enabling the construction of Greenfield facilities, and customized approach for faster re-purposing of beds
  • Separating the specialty-wise treatment and delivery of elective care in dedicated specialty facilities to relieve the already strained ICUs
  • Acceleration of the online-offline integration (enhanced use of telehealth system) so that non-critical cases could be tackle without a visit to health facilities
  • Separation of ancillary functions, such as imaging and lab tests, from core hospital operations to minimize the associated risks
  • Accelerated transition to ambulatory care and day surgery to avoid the long stay in hospitals and healthcare facilities
  • Operational excellence, which will be critical in the next normal
  • Prolonged revenue growth challenges may remain due to the slow economic recovery
  • The new set of costs challenging the margins due to the increased labor costs among the healthcare workers, especially for trained resources and critical care segments
  • Emergence of new growth opportunities and diversification
  • New growth opportunities such as telehealth consultations, home healthcare services, primary care that do not require an emergency visit, and proactive health screening
  • Innovative arrangements between the private and the public sectors to manage the healthcare needs and crisis management
  • Consolidation of smaller providers, which the big players could acquire to cope with the expected financial stress

Apart from the above-mentioned pragmatic shifts, certain parameters should be adjusted until the situation becomes normal. These enablers include "technological advancements" (artificial‑intelligence [AI]-based diagnosis, could-based medical records and database storage, digital platforms to enhance remote communication, use of home-based monitoring devices), "flexibility in insurance and reimbursement" (regulations for insurance to involve telehealth and home healthcare services), "patient awareness" (more awareness to patients who expect a seamless technology-driven experience, virtual platforms, medications, homecare, healthcare deliveries at home-setting), and "regulatory changes" (government regulations for healthcare systems, resources, licensing, broader set of skills, specialty versus multi-purpose beds etc.).

Technology is the significant parameter to integrate all the enablers mentioned above and enhance the healthcare systems. The digital development of platforms will provide new kinds of interaction and behavioral changes among the patients, ultimately altering the relationship between patients and doctors. Telemedicine will provide a new way for healthcare systems, and the market is estimated to grow by 2024. The use of AI, remote monitoring, and the development and use of homecare monitoring devices will play a significant role in the new robust systems, which will pave the way for a technology-driven healthcare system.

Along with technology, proper resourcing of the healthcare professionals is a major concern due to exhaustion and long working hours in a high-pressure work environment due to COVID-19, and they are the frontline warriors risking their lives. Apart from the physical health, mental health has also emerged as an important factor, which needs to be taken care of. Due to emotional strains, job losses, low confidence, increased cases of depressions; patients are also seeking mental healthcare providers. The healthcare systems are also adopting the tele psychologist's approach to counsel the patients that need mental support, and tele counseling enables a great virtual platform for the patients. However, the need of the hour is also the appropriately trained staff, especially from mental healthcare management perspectives, as there is a lack of well-trained psychologists.



We have the opportunity to reform the healthcare system and adopt the new advancements. There is a lot of pressure and stress on the present healthcare system, healthcare workers, and facilities since the last few months, taking a toll on the workers' physical and mental health. It is necessary to look beyond the traditional healthcare system to adopt a technology-driven and forward-looking digital healthcare system in compliance with government regulations. The enhanced customer interactions and improved efficiency through bots, digital platforms for patients, deeper patient-doctor communication through audio-video interaction, machine learning, use of artificial intelligence to drive research, and secure database systems to preserve medical data are the key steps which could lay foundation of the new improved healthcare system this need to be implemented for physical as well as for mental healthcare management. Along with the changes in healthcare systems, the need also implies enhancing the regulatory framework as more healthcare services may shifts from hospitals to out-of-hospital and homecare settings. This improvement will pave the way for rapid crisis management capabilities to face challenges related to COVID 19 and show the path to preparedness for crises.



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