HDT4007: Digital Strategies for Disrupting Healthcare Systems
Case 01: KG Hospital part A: Digital Ecosystems in HC
The case is set in early 2021 and follows the journey of Avanthika Raghu, a technology analyst in
New York, who returns to India to assume the role of the Chief Experience and Technology Officer
at her grandfather’s hospital in Coimbator. The 45-year old hospital, which has state-of-the-art
facilities, has been performing well, with excellent revenues and operating profits. Her grandfather,
Bakthavathsalam, has envisioned elevating the hospital to the next level in the
industry, with a robust technology backbone. He sets an ambitious capacity expansion target for
the hospital by 2025 (Vision 2025), a vision Raghu is entrusted with fulfilling.
Vision 2025 = making KG Hospital a 500-bed facility, dedicated to patient satisfaction, with a keen
focus on preventive health.
The vision of building a digitally enabled, scalable, and reliable integrated technology system at KG
Hospital.
2 tasks for Raghu:
- Deliver an improved patient experience
- While planning and executing a massive scale-up of the hospital facility
India’s HC industry:
Undergoing a major transformation, driven by economic, technological, and epidemiological shifts.
With 74% of total HC expenditures coming from private HC services, hospitals are increasingly
pressured to adapt and innovate to stay competitive.
At the same time, while there are plenty of private hospitals, community hospitals are in increasing
demand given their affordable and quality HC (also attractive for internationals!).
India is transitioning to a patient-centred care pathway.
A rapid rise in income levels has led to an epidemiological transition, shifting the disease burden
from infectious diseases to non-communicable diseases (NCDs, e.g. diabetes, heart disease, and
hypertension). Result: HC providers are moving away from curative treatments and shifting toward
preventive care models to better manage long-term patient health.
India also boasts a huge digital footprint, making technology a key enabler of this transformation.
More and more people are connected to the internet, however, its application remains low in areas
related to hospital information management systems (India heeft groot aantal mensen, 2de land na
China van digitaal gebruik, alleen lacked dat dus blijkbaar in hospital information management
systems).
One of the biggest changes is the concept of "Flipped Care"—where the focus of HC is shifting
from providers to pts, fueled by digital innovations. Pt engagement has become a key differentiator
among hospitals, as rising costs and increased competition put pressure on HC providers to find
new ways to sustain profitability.
For smaller hospitals, falling margins have made it clear that sticking to traditional models is no
longer a good option. Instead, many are transitioning to digital health models, where pts have more
control over their health, and care delivery is more personalized and efficient.
This evolving landscape sets the stage for hospitals like KG Hospital, which must navigate these
industry shifts while planning for scalable, technology-driven growth.
Value-based HC: collaborate more and better.
1
,The ecosystem refers to the network of interconnected stakeholders, technologies, and healthcare
services that work together to achieve Vision 2025—the hospital’s expansion and digital
transformation.
Patients see HC as a service rather than as an infrastructure.
Value-based HC (VHBC) = pt-centric HC model focusing on delivering better health outcomes at
lower costs rather than just increasing the volume of treatments.
- Instead of being paid based on the number of procedures performed (fee-for-service
model), they are rewarded based on pt outcomes and care quality.
- Value in HC is about improving pt outcomes relative to cost, not just reducing
expenses. Value-based care focuses on measurable health improvements rather than
process compliance, pt satisfaction, or cost-cutting alone.
- It aligns stakeholders by emphasizing common ground among outcomes → co-design.
- VBHC aligns with the “triple aim”; 1) improving pt experience of care, 2) improving health of
population, and 3) reducing the per capita cost of HC, as well as (4) improving clinician
experience).
- VBHC model improves efficiency, pt satisfaction, and long-term cost-effectiveness, making
it a major driver of digital transformation in hospitals like KG Hospital.
Raghu found that pt satisfaction itself was lacking in the current setup.
How would you identify metrics for improving patient experience while planning the
hospital expansion? How will you justify each of these metrics from both the patient and
provider perspective?
→ Patient Satisfaction Score (e.g., HCAHPS or Net Promoter Score)
Metric Type: Holistic Satisfaction Proxy
How to Quantify: Use a standardized survey (e.g., HCAHPS), or Net Promoter Score (NPS: “Would
you recommend this hospital?”). Combine with sentiment analysis from Google Reviews and
feedback forms.
- Patient: Reflects how patients feel about their care, communication, and comfort.
- Provider: Helps pinpoint areas (e.g., bedside manner, clarity of instructions) needing
improvement.
High satisfaction scores often correlate with better health outcomes and loyalty; for providers, it's a
reputational and reimbursement-linked metric. No single score tells the full story—but surveys and
reviews give a rich composite. Helps set performance goals like “Improve NPS by 10 points in 6
months.”
→ Turnaround Time for Insurance Claims (Exhibit 2)
Metric Type: Operational Efficiency + Financial Ease
How to Quantify: Average time (in days) from treatment completion to claim approval.
- Patient View: Faster processing = reduced financial stress, smoother care journey.
- Provider View: Better cash flow, fewer billing-related complaints, stronger ties with insurers.
Especially in expanding systems, faster claims build trust and accessibility. Can set goals like “80%
of claims cleared in under 10 days.”
→ Average Length of Stay (ALOS) (Exhibit 4)
Metric Type: Efficiency + Outcome Proxy
2
,How to Quantify: Mean number of inpatient days per admission (adjusted for case mix).
- Patient View: Shorter stays often mean efficient care and lower burden.
- Provider View: Enables better bed turnover, cost control, and resource planning.
ALOS is a key metric in hospital planning. A decrease (without compromising quality) indicates
smoother care delivery.
→ Average Wait Time (in ER, OPD, diagnostics, pharmacy)
- Patient: Shorter wait times = less stress and a smoother experience.
- Provider: Efficient operations improve throughput and resource allocation. No longer
working hours (in the case nurses worked long hours after their shifts ended.
Long waits frustrate patients and indicate process inefficiencies; reducing them shows respect for
patient time and enhances service flow.
→ Time to Treatment / Care Transition Efficiency
- Patient: Faster diagnosis and treatment builds trust and improves health outcomes.
- Provider: Reduces backlogs, boosts clinical efficiency, and optimizes capacity.
Especially in expansions, reducing treatment delays shows the hospital is scaling quality along with
quantity.
→ Readmission Rates
- Patient: Lower readmissions mean better care and less disruption.
- Provider: Indicates care quality and effective discharge planning.
A high readmission rate can signal inadequate initial care or follow-up systems—key areas to fix
while expanding.
→ Infection and Complication Rates (e.g., Hospital-Acquired Infections - HAIs)
- Patient: Patients expect a safe, hygienic environment.
- Provider: Impacts clinical outcomes, liability, and reputation.
Safety metrics are non-negotiable; expansion must ensure infection control scales up, too.
→ Staff-to-Patient Ratio / Staff Satisfaction
- Patient: Adequate staffing leads to attentive, timely care.
- Provider: Happy, well-staffed teams perform better and burn out less.
You can’t improve patient experience without a motivated team—this is the foundation of quality
care.
→ Ease of Access to Care (appointments, telehealth, parking, navigation)
- Patient: Convenience impacts overall satisfaction.
- Provider: Fewer missed appointments and better flow.
During expansion, physical infrastructure must prioritize patient access—from parking to signage to
digital interfaces.
Follow-up and Continuity of Care
- Patient: Patients want to feel supported after discharge.
- Provider: Reduces complications, improves chronic care outcomes.
Continuity drives loyalty and health results—must be considered in IT, staffing, and process design.
Patient Feedback and Complaint Resolution Time
- Patient: Shows the hospital values and acts on input.
- Provider: Source of insight for continuous improvement.
Fast, empathetic responses to concerns signal a patient-first culture.
3
, The list above are well-defined metrics for improving patient experience while planning the
hospital expansion, what to measure and why; but actionable metrics are about: “Can we act on
this? Can we measure it consistently, tie it to a goal, and use it to guide decisions?”
Each of the metrics listed becomes actionable when:
- It has a clear data source (survey, EMR, billing system)
- It’s quantifiable (e.g., average time, % change)
- It links to a concrete goal (e.g., reduce wait times by 20%)
- It triggers a process
Actionable metrics = quantifiable indicators that directly inform decisions, trigger improvement
actions, and help track progress toward specific goals (>< “vanity metrics,” which might look good
on paper but don’t lead to real change).
- Tied to goal
- Specific and clear
- Changeable by your team
- Leads to improvement
- Consistently measurable
E.g. Average pt wait time > signals bottleneck > action it can trigger: redesign scheduling, add staff, optimize
check-in
Always ask: “If this number changes, do I know what to do next?” If yes → it’s an actionable metric.
Q: How Do These Become Actionable Metrics?
A: Metrics are only useful if they can be measured, interpreted, and tied to goals.
Expansion strategy:
“No single metric gives the full picture. We need proxies—like satisfaction surveys, claim
processing times, and length of stay—to translate patient experience into measurable data. For
each, we’ll set clear goals (e.g., reduce claim turnaround by 20%) and track progress. Reviews,
surveys, and internal data turn experiences into insight.”
⇒ By choosing metrics that intersect operational efficiency, clinical quality, and emotional
experience, Raghu can ensure the expansion truly enhances care delivery from both ends of the
stethoscope.
How would you prioritize the identified metrics as determinants for process improvement?
The guiding-principle to prioritize the previously identified metrics as determinants for process
improvement is that value is co-created.
In HC, value is not just “delivered” to pts. It is co-created with them, alongside staff, payers, and
technology partners. To prioritize the metrics for process improvement (so, by which metric should we
start to achieve the two goals of Ragu → increase pt satisfaction + upscale hospital), we must apply co-design,
supported by the experience-based co-design framework (ECBD).
ECBD = framework that combines user-centric orientation (“experience-based”) and
collaborative change processes (“co-design”) to identify and co-design improvements
service design for patients. Making pts active participants in service improvement.
→ Value within the ecosystem is co-created with customers through relational exchanges in
interaction experiences (not linear!).
To decide which metrics matter most for improving the hospital, Raghu should analyse the
following areas:
4
Case 01: KG Hospital part A: Digital Ecosystems in HC
The case is set in early 2021 and follows the journey of Avanthika Raghu, a technology analyst in
New York, who returns to India to assume the role of the Chief Experience and Technology Officer
at her grandfather’s hospital in Coimbator. The 45-year old hospital, which has state-of-the-art
facilities, has been performing well, with excellent revenues and operating profits. Her grandfather,
Bakthavathsalam, has envisioned elevating the hospital to the next level in the
industry, with a robust technology backbone. He sets an ambitious capacity expansion target for
the hospital by 2025 (Vision 2025), a vision Raghu is entrusted with fulfilling.
Vision 2025 = making KG Hospital a 500-bed facility, dedicated to patient satisfaction, with a keen
focus on preventive health.
The vision of building a digitally enabled, scalable, and reliable integrated technology system at KG
Hospital.
2 tasks for Raghu:
- Deliver an improved patient experience
- While planning and executing a massive scale-up of the hospital facility
India’s HC industry:
Undergoing a major transformation, driven by economic, technological, and epidemiological shifts.
With 74% of total HC expenditures coming from private HC services, hospitals are increasingly
pressured to adapt and innovate to stay competitive.
At the same time, while there are plenty of private hospitals, community hospitals are in increasing
demand given their affordable and quality HC (also attractive for internationals!).
India is transitioning to a patient-centred care pathway.
A rapid rise in income levels has led to an epidemiological transition, shifting the disease burden
from infectious diseases to non-communicable diseases (NCDs, e.g. diabetes, heart disease, and
hypertension). Result: HC providers are moving away from curative treatments and shifting toward
preventive care models to better manage long-term patient health.
India also boasts a huge digital footprint, making technology a key enabler of this transformation.
More and more people are connected to the internet, however, its application remains low in areas
related to hospital information management systems (India heeft groot aantal mensen, 2de land na
China van digitaal gebruik, alleen lacked dat dus blijkbaar in hospital information management
systems).
One of the biggest changes is the concept of "Flipped Care"—where the focus of HC is shifting
from providers to pts, fueled by digital innovations. Pt engagement has become a key differentiator
among hospitals, as rising costs and increased competition put pressure on HC providers to find
new ways to sustain profitability.
For smaller hospitals, falling margins have made it clear that sticking to traditional models is no
longer a good option. Instead, many are transitioning to digital health models, where pts have more
control over their health, and care delivery is more personalized and efficient.
This evolving landscape sets the stage for hospitals like KG Hospital, which must navigate these
industry shifts while planning for scalable, technology-driven growth.
Value-based HC: collaborate more and better.
1
,The ecosystem refers to the network of interconnected stakeholders, technologies, and healthcare
services that work together to achieve Vision 2025—the hospital’s expansion and digital
transformation.
Patients see HC as a service rather than as an infrastructure.
Value-based HC (VHBC) = pt-centric HC model focusing on delivering better health outcomes at
lower costs rather than just increasing the volume of treatments.
- Instead of being paid based on the number of procedures performed (fee-for-service
model), they are rewarded based on pt outcomes and care quality.
- Value in HC is about improving pt outcomes relative to cost, not just reducing
expenses. Value-based care focuses on measurable health improvements rather than
process compliance, pt satisfaction, or cost-cutting alone.
- It aligns stakeholders by emphasizing common ground among outcomes → co-design.
- VBHC aligns with the “triple aim”; 1) improving pt experience of care, 2) improving health of
population, and 3) reducing the per capita cost of HC, as well as (4) improving clinician
experience).
- VBHC model improves efficiency, pt satisfaction, and long-term cost-effectiveness, making
it a major driver of digital transformation in hospitals like KG Hospital.
Raghu found that pt satisfaction itself was lacking in the current setup.
How would you identify metrics for improving patient experience while planning the
hospital expansion? How will you justify each of these metrics from both the patient and
provider perspective?
→ Patient Satisfaction Score (e.g., HCAHPS or Net Promoter Score)
Metric Type: Holistic Satisfaction Proxy
How to Quantify: Use a standardized survey (e.g., HCAHPS), or Net Promoter Score (NPS: “Would
you recommend this hospital?”). Combine with sentiment analysis from Google Reviews and
feedback forms.
- Patient: Reflects how patients feel about their care, communication, and comfort.
- Provider: Helps pinpoint areas (e.g., bedside manner, clarity of instructions) needing
improvement.
High satisfaction scores often correlate with better health outcomes and loyalty; for providers, it's a
reputational and reimbursement-linked metric. No single score tells the full story—but surveys and
reviews give a rich composite. Helps set performance goals like “Improve NPS by 10 points in 6
months.”
→ Turnaround Time for Insurance Claims (Exhibit 2)
Metric Type: Operational Efficiency + Financial Ease
How to Quantify: Average time (in days) from treatment completion to claim approval.
- Patient View: Faster processing = reduced financial stress, smoother care journey.
- Provider View: Better cash flow, fewer billing-related complaints, stronger ties with insurers.
Especially in expanding systems, faster claims build trust and accessibility. Can set goals like “80%
of claims cleared in under 10 days.”
→ Average Length of Stay (ALOS) (Exhibit 4)
Metric Type: Efficiency + Outcome Proxy
2
,How to Quantify: Mean number of inpatient days per admission (adjusted for case mix).
- Patient View: Shorter stays often mean efficient care and lower burden.
- Provider View: Enables better bed turnover, cost control, and resource planning.
ALOS is a key metric in hospital planning. A decrease (without compromising quality) indicates
smoother care delivery.
→ Average Wait Time (in ER, OPD, diagnostics, pharmacy)
- Patient: Shorter wait times = less stress and a smoother experience.
- Provider: Efficient operations improve throughput and resource allocation. No longer
working hours (in the case nurses worked long hours after their shifts ended.
Long waits frustrate patients and indicate process inefficiencies; reducing them shows respect for
patient time and enhances service flow.
→ Time to Treatment / Care Transition Efficiency
- Patient: Faster diagnosis and treatment builds trust and improves health outcomes.
- Provider: Reduces backlogs, boosts clinical efficiency, and optimizes capacity.
Especially in expansions, reducing treatment delays shows the hospital is scaling quality along with
quantity.
→ Readmission Rates
- Patient: Lower readmissions mean better care and less disruption.
- Provider: Indicates care quality and effective discharge planning.
A high readmission rate can signal inadequate initial care or follow-up systems—key areas to fix
while expanding.
→ Infection and Complication Rates (e.g., Hospital-Acquired Infections - HAIs)
- Patient: Patients expect a safe, hygienic environment.
- Provider: Impacts clinical outcomes, liability, and reputation.
Safety metrics are non-negotiable; expansion must ensure infection control scales up, too.
→ Staff-to-Patient Ratio / Staff Satisfaction
- Patient: Adequate staffing leads to attentive, timely care.
- Provider: Happy, well-staffed teams perform better and burn out less.
You can’t improve patient experience without a motivated team—this is the foundation of quality
care.
→ Ease of Access to Care (appointments, telehealth, parking, navigation)
- Patient: Convenience impacts overall satisfaction.
- Provider: Fewer missed appointments and better flow.
During expansion, physical infrastructure must prioritize patient access—from parking to signage to
digital interfaces.
Follow-up and Continuity of Care
- Patient: Patients want to feel supported after discharge.
- Provider: Reduces complications, improves chronic care outcomes.
Continuity drives loyalty and health results—must be considered in IT, staffing, and process design.
Patient Feedback and Complaint Resolution Time
- Patient: Shows the hospital values and acts on input.
- Provider: Source of insight for continuous improvement.
Fast, empathetic responses to concerns signal a patient-first culture.
3
, The list above are well-defined metrics for improving patient experience while planning the
hospital expansion, what to measure and why; but actionable metrics are about: “Can we act on
this? Can we measure it consistently, tie it to a goal, and use it to guide decisions?”
Each of the metrics listed becomes actionable when:
- It has a clear data source (survey, EMR, billing system)
- It’s quantifiable (e.g., average time, % change)
- It links to a concrete goal (e.g., reduce wait times by 20%)
- It triggers a process
Actionable metrics = quantifiable indicators that directly inform decisions, trigger improvement
actions, and help track progress toward specific goals (>< “vanity metrics,” which might look good
on paper but don’t lead to real change).
- Tied to goal
- Specific and clear
- Changeable by your team
- Leads to improvement
- Consistently measurable
E.g. Average pt wait time > signals bottleneck > action it can trigger: redesign scheduling, add staff, optimize
check-in
Always ask: “If this number changes, do I know what to do next?” If yes → it’s an actionable metric.
Q: How Do These Become Actionable Metrics?
A: Metrics are only useful if they can be measured, interpreted, and tied to goals.
Expansion strategy:
“No single metric gives the full picture. We need proxies—like satisfaction surveys, claim
processing times, and length of stay—to translate patient experience into measurable data. For
each, we’ll set clear goals (e.g., reduce claim turnaround by 20%) and track progress. Reviews,
surveys, and internal data turn experiences into insight.”
⇒ By choosing metrics that intersect operational efficiency, clinical quality, and emotional
experience, Raghu can ensure the expansion truly enhances care delivery from both ends of the
stethoscope.
How would you prioritize the identified metrics as determinants for process improvement?
The guiding-principle to prioritize the previously identified metrics as determinants for process
improvement is that value is co-created.
In HC, value is not just “delivered” to pts. It is co-created with them, alongside staff, payers, and
technology partners. To prioritize the metrics for process improvement (so, by which metric should we
start to achieve the two goals of Ragu → increase pt satisfaction + upscale hospital), we must apply co-design,
supported by the experience-based co-design framework (ECBD).
ECBD = framework that combines user-centric orientation (“experience-based”) and
collaborative change processes (“co-design”) to identify and co-design improvements
service design for patients. Making pts active participants in service improvement.
→ Value within the ecosystem is co-created with customers through relational exchanges in
interaction experiences (not linear!).
To decide which metrics matter most for improving the hospital, Raghu should analyse the
following areas:
4
