Dr. Sharma has been one of the most respected orthopaedic surgeons in Chandigarh for twenty years. His clinic in Sector 22 has never lacked for patients. Tricity GPs know his name. His outcomes on complex joint replacements are well-documented, and his waiting list runs three to four weeks in the good months.
For much of that time, he had been working toward something larger. The clinic in Sector 22 was good, but it had limits. Complex cases needed a proper OT, post-operative beds, physiotherapy under the same roof. He had been drawing up plans — and setting aside money — for a dedicated orthopaedic hospital in Mohali for nearly a decade. Last year, it opened.
Rs. 50 crore of capital, much of it loaned from a bank and from investors, 60 beds, a facility he had designed procedure by procedure. It was exactly what he had imagined.
Seven months in, it was running at 6 percent of the patient volumes his financial model had assumed.
When his friend and floor mate from his MBBS days — the Lucknow cardiologist who had spent the past year working through TAM, SAM, SOM, and STP for his cath lab — called to ask how the Mohali project was going, Dr. Sharma’s answer was honest: footfall was running at about 6 percent of model. The hospital had been operational for seven months. And it was stressing him out.
“We have the facility,” he said. “We have the team. We have the clinical capability. I don’t understand why people are not coming.”
His Lucknow friend asked: “What do you think is actually standing between you and your next patient?”
Dr. Sharma did not have a specific answer. He knew there were patients in the Tricity who needed joint replacement surgery. He knew his hospital offered the procedure. He had done some advertising. He had participated in a health camp. He was not sure what else to do.
The question his friend was asking is more specific than “how do we get more patients?” It is a diagnostic question: what, exactly, is preventing the right patients from choosing this hospital? The answer to that question determines what intervention to make.
This is what this JTBD (”jobs to be done”) diagnostic framework is for.
The marketing diagnostic before the spend
Before a hospital can make good decisions about how to attract patients, it needs to know why patients are not arriving. From a marketing standpoint, there are five distinct jobs you should be doing to ensure patients who could benefit from your care choose you. Each reason has a different solution. Treating the wrong reason with the wrong solution is not just ineffective, it is expensive.
The five reasons are:
- The patient does not need what you offer. The demand is not there in your catchment, or the clinical presentation has not reached the stage where intervention is indicated.
- The patient does not know you exist. There is demand, but the patient — or the referring doctor — has no awareness that your hospital offers the service.
- The patient does not believe you can deliver what you claim. They know you exist, but something prevents them from trusting the quality of your care: absence of a track record, lack of visible outcomes, no social proof in their social (or referral) network, or simply a lack of advertising from your end.
- The patient does not want the experience you are offering. The clinical service may be acceptable, but the experience — billing, access, waiting, staff behaviour — creates friction that makes another option more attractive.
- The patient cannot reach you. There is demand, awareness, trust, and willingness — but an operational barrier prevents the transaction: the wrong empanelments, prohibitive pricing, geographic inaccessibility, or a broken referral pathway.
These five gaps operate independently. A hospital can be unknown and also have a reach barrier. It can be trusted but difficult to access. Running the diagnostic means identifying which gaps are actually present, and in what proportion.
Running the diagnostic: Dr. Sharma’s Mohali hospital
Does the need exist?
Dr. Sharma should start with the simplest question. Is there demand for orthopaedic care — specifically joint replacement and complex MSK procedures — in the Tricity area?
In MBA terms, this particular problem is known as “product-market fit” — whether the product (or service) you have invested in maps to genuine, unmet demand in the market you serve.
To be honest, for Dr. Sharma, being in the business for more than two decades and literally having built a specialty hospital — it is likely, in fact, guaranteed that he would have known about the business case. If the need weren’t there, he would not have built the hospital.
The diagnostic: pull the NABH-registered hospitals within 25 km and check which ones have orthopaedic departments with surgical capability. If there are three or more with active surgical programmes, the need exists. If those hospitals have waiting lists, the unmet need is visible. PGIMER’s orthopaedic department runs at capacity. The private hospitals in Sector 34 have two-week waits for elective procedures. The primary problem is not absence of need.
Does the right audience know this hospital exists?
This is where the diagnostic gets interesting. Dr. Sharma is well known in Chandigarh. But Mohali is not Chandigarh. The GPs in Sector 70, 71, and 80 — the residential areas that sit closest to the hospital — do not have established referral relationships with him. They have referral patterns built over years of working with the established orthopaedic departments across the Madhya Marg. The new hospital, operationally seven months old, has not yet entered their consideration set.
For Dr. Sharma, the awareness gap in Sector 70 and 71 is significant. These GPs are sending joint replacement referrals across the Madhya Marg out of habit — not because they have evaluated the Mohali hospital and found it wanting, but because they have never been given a reason to change their pattern.
The diagnostic: call five GPs in the relevant catchment. Ask where they currently send complex ortho cases. Ask if they have heard of your hospital and, if so, what they know about it. The answer will tell you whether the awareness gap is absolute (they have not heard of you) or partial (they have heard of you but do not know what you offer). For a read on patient-level awareness, the method is equally simple. Identify ten people in the catchment who are plausible future patients — a regular customer at the medical store on the main road in Sector 70, a resident in the housing societies nearby, someone attending a physiotherapy clinic in the area, an older adult at a neighbourhood park. Ask them, unprompted, where they would go if they needed a joint replacement or a complex orthopaedic procedure in Mohali. Then ask whether they have heard of the hospital by name, and if so, what they associate with it. Two or three conversations are not enough. Ten gives you a pattern. If most cannot name the hospital unprompted, or if the ones who have heard of it cannot say what it is known for, the awareness gap extends beyond the referral network into the patient population itself — and the two problems require different responses.
Does the audience believe the hospital can deliver?
Awareness and belief are different problems. A referring doctor may know your hospital exists but have no basis for trusting its clinical capability. This is especially true for surgical specialties where outcomes are difficult to observe from the outside. The default, in the absence of visible evidence, is to stick with what is known.
For Dr. Sharma, the hospital has completed twelve joint replacements in seven months of operation. The outcomes are good. But not one of those twelve discharge summaries was followed up with a structured communication to the referring GP. The track record exists. It is not being used as social proof.
The diagnostic: count the number of verified outcomes you can point to — procedures performed, discharge summaries sent, follow-up contact maintained with referring GPs, any published case data. If the number is low, or if the outcomes are not being actively communicated to the referral network, the belief gap is present.
To test patient-level trust, the diagnostic is a search and an ask. First, search the hospital’s name from a fresh browser — as a stranger with no prior knowledge would. Note what a first-time visitor finds: a Google Maps listing with how many reviews and what they say, a website with or without clinical content, a presence or absence on health platforms like Practo or JustDial. If the listing is sparse, the reviews are few, and there is nothing that signals a clinical record, the trust gap is visible to any patient doing basic due diligence — regardless of how good the actual outcomes have been inside the building.
Second, return to the patient dipstick group from the awareness check. Ask them: if someone you trusted recommended this hospital for a family member needing joint replacement surgery, what would you look for before agreeing to go there? The answers tend to converge on the same few things: whether anyone in their network has been treated there; whether the surgeon performing the procedure has a visible profile; and whether they can find independent patient accounts online. Cross-check each of those against what actually exists. The gap between what patients look for and what they can actually find is the trust gap.
Does the patient want the experience being offered?
This gap is less common in early-stage hospitals than the awareness and belief gaps, but it appears when the operational experience creates friction. Billing confusion, long waits, or a patient journey that feels chaotic can turn an aware and willing patient toward another option.
For Dr. Sharma, the patient experience is not the primary problem. The hospital is new, which means the processes are not yet frictionless, but no consistent complaint pattern has emerged in seven months of operation.
The diagnostic: walk the patient journey yourself. Call the hospital’s number as a new patient seeking a consultation. Follow the booking process. Note what is unclear or inconvenient. Read the Google reviews for specific complaints about the non-clinical experience.
Can the patient reach you?
This is the operational gap — the barriers that prevent a willing patient from actually completing the transaction. The most common barriers in a new Indian private hospital are empanelment gaps, pricing that excludes patients with insurance coverage, and referral pathway failure.
For Dr. Sharma, the reach gap is specific: the hospital is not yet on the CGHS empanelled list. Chandigarh’s government-employee population — a meaningful share of the joint replacement patient profile — cannot route their procedure through this hospital without paying out of pocket. This is a real barrier, suppressing volume for a specific and identifiable patient type.
The diagnostic: map your empanelment status against the payer mix in your catchment. For Mohali, this means checking which TPAs covering the nearby tech parks and industrial estates you are empanelled with; whether you are on the CGHS panel, given the significant government presence in Chandigarh; and whether your PM-JAY status is clear and documented.
What the diagnostic reveals
Dr. Sharma’s seven-month audit reveals three distinct gaps.
- A awareness gap among Sector 70 and 71 GPs who are unaware of the hospital, or have not been given a specific reason to change their referral pattern.
- A belief gap among GPs who are aware but have not received any structured communication about the hospital’s outcomes — twelve joint replacements completed, no discharge summary followed up with a clinical communication to the referring doctor.
- A reach gap for the CGHS patient segment, where the empanelment application has not yet been filed.
These three gaps require three different interventions.
- The know gap is a referral outreach problem. It is solved by a deliberate programme of GP introductions in the relevant catchment — carried by a medical liaison who shows up regularly, not by advertising or health camps. Advertising reaches patients. GPs refer them.
- The believe gap is a communication problem. It is solved by a structured process of sending discharge summaries and follow-up notes to referring GPs after every procedure — not a marketing email, but a clinical communication that proves the outcome happened and was handled well.
- The reach gap is an empanelment problem. It is solved by filing the CGHS empanelment application — a process with a defined procedure and a defined timeline — and by mapping which TPAs covering the Mohali corridor still need to be added.
None of these interventions require additional capital expenditure. None require a new marketing campaign. They require identifying the actual problem first.
The discipline of looking first
Most hospitals in Dr. Sharma’s situation will reach first for visibility: more advertising, a health camp, a social media presence. These are not wrong responses but they might be premature ones when the primary gaps are in referral awareness and GP trust, not in patient demand or willingness.
The value of the diagnostic framework is not the framework itself. It is the discipline of stopping before the spend and asking: which of these five barriers is actually present? The answer is almost always available through 20 minutes of honest observation. What it requires is the willingness to look.
“A hospital that has not run this marketing jobs-to-be-done diagnostic is spending to solve a problem it has not yet identified.”
Aviral Prakash
If you want to run this diagnostic on your own hospital, I have put together a printable checklist that covers all five barriers — the specific questions to ask and the top fix for each. Download the Five-Barrier Diagnostic Checklist (PDF)
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