Dr Avnesh Ratnanesan believes disruption in healthcare and an improvement in patient experience will not come from the healthcare industry itself, but from other industries.
At a glance
- Dr Avnesh Ratnanesan is CEO of digital healthcare company Energesse, which helps healthcare organisations improve patient experience.
- Ratnanesan is passionate about how analytics technology can provide insights into user experience and make a positive difference in hospitals, medical centres and health insurance.
- Ratnanesan believes gathering a broader range of patient metrics will help the healthcare system improve its value proposition.
It seems almost incredible that, in our age of advanced social media and data analytics, many organisations charged with caring for a population’s health have very little real knowledge of their customers.
We are not talking about medical issues here – this lack of knowledge relates to patient experiences, feedback and the relationship the patient has with the healthcare provider – the kind of information that companies of every stripe are now gathering to improve their business practices.
Dr Avnesh “Avi” Ratnanesan, the CEO of digital healthcare company Energesse, worked out years ago that there was an information gap between medical care providers and their patients.
When was the last time you were asked to rate your experience of your local general practitioner’s (GP) clinic?
Most of us have undergone a medical procedure at one time or another, but have you ever been offered the opportunity to communicate your experience to the medical staff who treated you or their employer? What was the quality of care you received? Were you fully informed of what was happening along the way? What were waiting times like? Was it easy to get a parking spot, and were your friends and family allowed easy access?
The realisation of this disconnect did not come to Ratnanesan while he was working as a doctor, but only once he gained some perspective after leaving the profession to do an MBA and work in the worlds of big pharma, technology start-ups and the film industry.
“I came to realise that technology companies know so much more about human behaviour than most healthcare organisations,” Ratnanesan says.
“There’s something paradoxical about that. I realised that the big technology companies – the Googles and Apples of this world – can identify human behaviour by which buttons they press and, in turn, influence behaviour.”
Ratnanesan’s ambition of becoming a doctor and desire to help humanity started at an early age.
His father was one of Malaysia’s most highly feted dental surgeons, and rose to become the president of the World Dental Federation.
As a young man, Ratnanesan won a general scholarship to study at Raffles Junior College in Singapore, going on to study medicine at the University of Sheffield in the UK.
He came to Australia to practice for a short stint, which turned into several years.
Before he turned 30, Ratnanesan had a medical degree, several years of medical practice in two countries and an MBA from the University of Queensland.
Then, on a whim, Ratnanesan took a sharp career pivot into the world of business.
He got involved with Pfizer as a medical director, became innovations manager and rose to chief of staff. “The experience helped me understand the ins and outs of industry. I mean, how did medicine even get to a doctor’s prescription sheet? All I’d ever done before was literally sign off prescriptions. I never had any idea how they got there in the first place.”
Three million people a day use Pfizer medications, and Ratnanesan now had a full view of the industry apparatus. “I began to understand what was required within an organisation – from sales, marketing, research and operations – to enable that impact to occur. I was seeing behind the scenes.”
After his stint with big pharma, Ratnanesan became involved in technology start-ups and filmmaking. The reason for his seemingly unusual career choices, Ratnanesan says, is that he followed his interests – and trusted his instincts.
“It’s like what Steve Jobs said – that you can connect the dots backwards, but you can never connect them forwards.”
The founder of Apple was always interested in calligraphy and, while this had nothing to do with computers, it had everything to do with design.
Similarly, while Ratnanesan was working “outside the box”, he never forgot where he came from.
He was eventually drawn back to the world of medicine in 2012. “I realised that my heart was still in health, and it was where I found the greatest meaning and purpose. I didn’t get that in tech. Yes, I was doing cool stuff and trying to make money, but I wasn’t doing anything to ease suffering.”
The big idea behind Energesse, the company Ratnanesan now runs, was to bring in analytics technology to the world of hospitals, care centres and health insurers.
It was the result of his many and varied experiences, but understanding the user experience was also becoming the way of the world. Patients were getting savvier, and the expectations of what they could receive from medical organisations – as well as how they should be treated – were growing.
“The private hospital sector has to really demonstrate a much clearer value proposition. If it doesn’t, the people go back to public hospitals because they simply don’t see the value-add.”
Healthcare, Ratnanesan says, is now a A$185 billion business. “Dr Google”, as he puts it, has raised the bar. “People started to have a lot more access to information about health, diseases, medical conditions, treatment options and medical care, and they were and still are comparing health services with other kinds of experiences – retail experiences such as banking.”
From inception, Energesse set about developing new forms of patient metrics, which would include measurements of activities hospitals mostly never thought about – the communication skills of staff, the infrastructure relating to the building, or the quality of information being provided by the hospital on discharge.
You only have to look at the current aged care crisis unfolding in Australia – already the subject of a Royal Commission and taken to a whole new level by the pandemic – to see that something is not right in the world of patient care.
Medical facilities and aged care providers have been widely accused of putting process and profit ahead of health and welfare outcomes, a situation in need of urgent correction.
Consumers have choice, and will vote with their wallets.
“The private hospital sector has to really demonstrate a much clearer value proposition. If it doesn’t, the people go back to public hospitals, because they simply don’t see the value-add,” Ratnanesan says.
Private health insurance premiums have been rising by 4 per cent to 6 per cent annually and have only recently been capped.
“A lot of consumers just can’t afford it anymore, so they’re just not taking it up at all.”
When Ratnanesan first put the idea of customer experience assessment technology to hospitals, they showed little interest. Only one hospital, in Baton Rouge in the US, expressed interest in putting some of Energesse’s ideas into practice.
Gradually, the concept of harnessing analytics technology took hold in Australia as well, and Energesse began to pick up work from health insurers, including Bupa and NIB, followed by several hospitals, mainly in the central and western Sydney area.
The company has now developed its own intellectual property based on its “6E methodology”, which includes Experience (capture and measure patient experience), Emotions (analyse stories and comments for pain points and delights) and Engagement (engage frontline staff, clinicians and management in the process).
This has culminated in a software product, PXME, which is an abbreviation for “patient experience maturity evaluation”. The software was developed to become scalable and affordable both to hospitals and much smaller health practices.
In the last six months of 2019, the PXME software was trialled in hospitals across five Australian states.
“It has turned out very well. The last testimonial had it as 9/10. That’s rare for a health product score,” Ratnanesan says.
To get the project off the ground, Ratnanesan had developed a clear financial strategy, capital raising with financial investors including angel investors, high-net worth individuals, venture capitalists, hospital groups and private equity firms.
Ratnanesan says he hopes that Energesse will be a “clear business” in three to five years; even better, that it will be a catalyst for industry-wide change.
He also hopes that the software will be used throughout Asia, Europe, the UK and the US.
“That’s one part of the vision. We also want to apply to age and disability care – these industries have also been coming into this. Had these industries been responding to patient care effectively, there would have been no need for a Royal Commission.”
As Ratnanesan puts it, the key message is that organisations applying customer-centric ideas have found that his software works. It is time, he says, for healthcare organisations to think beyond short-term financial goals and focus on strategic investment in the same way as other smart businesses do already.
“Studies of hospitals in the US found that those at the top tier of patient experiences will always win the long-term race. They are, incidentally, also the most profitable.”