healthcare radius magazine april 2013

Embracing modern thinking April 2013 • Vol 1 • Issue 7 • Rs50Published by ITP Publishing India

Total number of pages 48Registered with Registrar of Newspapers under RNI No. MAHENG/2012/46040, Postal Registration No. MH/MR/N/242/MBI/12-14, Published on 27th of every previous month. Posted at Patrika Channel Sorting Office, Mumbai-400001, Posting date: 30th & 31st of every previous month

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CONTROLWIRELESS AND REMOTE PATIENT

MONITORING IS REVOLUTIONISING CRITICAL CARE

>>> IMPORTANT LESSONS IN PATIENT COMMUNICATION

SPOTLIGHTTHE MANY OPTIONS OF MECHANISED FLOOR CLEANING

OPINIONMIXED REACTIONS TO UNION BUDGET 2013

INNOVATION COST-SAVING IDEAS FROM NH, MYSORE

FOCUSSEVEN CHALLENGES TO ACCREDITATION

DR VIKRAM SHAH OF SHALBY HOSPITALS ON BUILDING A STRONG HEALTHCARE EMPIRE

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Healthcare Radius April 20134

09 NEWS This month’s important news updates

13 PROJECT SPOTLIGHTThe upcoming Dr Jayharan Hospital in Nagercoil

14 BUDGET ANALYSISIndustry veterans rate the new Union Budget

17 PREVIEWHealthcare Radius' very own conference

18 STRAIGHT TALKCMD of Shalby Hospitals Dr Vikram Shah talks about the group’s rapid growth

24 TECHNOLOGYWireless remote patient monitoring in critical care

28 INNNOVATIONHow Narayana Hrudayalaya Hospital Mysore reduced cost of project and operations 30 OPINIONA call for donating blood stem cells to the needy

32 BEST PRACTICESThe latest in hygienic floor cleaning practices

36 CUTTING EDGEBenefits of trans-umbilical breast augmentation

Contents18

32

14

38 PATIENT RELATIONSHow hospital staff behaves with patients matters

40 EVENT REPORTHospiArch, Chandigarh

42 QUALITY CONTROLSeven challenges of accreditation

44 CONSUMER CONNECT INITIATIVECarestream’s e-Radiograph

45 MOVERS AND SHAKERSRakesh Singh joins as Manipal COO, Dr Devi Shetty felicitated by IMC and much more

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Editor's Note


To the torchbearers

With the Indian healthcare industry evolving faster than the speed of light, it is difficult to find a single trend that could hold our undivided attention for long. But one facet that continues to enthral us, over the years, is the

inspiring sagas of doctors turned into mega entrepreneurs. From first such icon, the legendary Dr Prathap Reddy, a cardiologist who founded Apollo Hospitals, today, the industry boasts of hundreds of successful medical entrepreneurs, who have created state-of-the-art institutes and pioneered cutting-edge technology, bringing quality healthcare to a larger populace.

Though many of the pathfinders have had fascinating tales to share about their struggle to becoming much-sought after practitioners, their true journey started, or shall I say, that their true character was revealed, only when they decided to don the hat of an entrepreneur. For most, who started in the ’80s and ’90s, the journey was an ordeal by fire, scrambling for funds for a business that is capital intensive and has a long lock-in period. It did not help either that the banks levied an exorbitant rate of interest and that one had to constantly take on the Government for its archaic rules. It was sheer conviction in their dreams and their unswerving grit and determination that helped these individu-als achieve their vision.

Reflecting this die-hard spirit of entrepreneurship is our cover person, the CMD of Shalby Hospitals, Dr Vikram Shah, who belongs to the heartland of India’s entrepreneurship — Gujarat. Read about his exciting journey that started in a small rented apartment in 1990s. From a single orthopaedic set-up, his enterprise has flourished into a multi speciality network of hospitals, spanning Gujarat and Goa.

Despite such Herculean efforts and strides by the private healthcare sector, it’s a pity that the Union Budget has failed to provide any worthy incentive to it. But, incentive or no incentive, the sun in the Indian healthcare industry continues to shine, powered by its many visionaries.

Rita DuttaConsulting [email protected]

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APRIL 2013 • VOL 1 • ISSUE 7

06_HCR_Apr13_Ed letter.indd 6 21-03-2013 12:20:26

Embracing modern thinking

• NEWS • FEATURES • TRENDS • TECHNOLOGY • MANAGEMENT • BUSINESS •

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ADV ISORY BOARD

DR NAROTTAM PURIChairman, NABH and advisor, Fortis Healthcare

DR PRANEET KUMARCEO, BLK Super Speciality Hospital and chairman, NABH appeals and grievance committee

(HONY) BRIGADIER DR ARVIND LALChairman and managing director, Dr Lal PathLabs

DR GIRDHAR J GYANIDirector general, Association of Healthcare Providers

DR ALOK ROYChairman, Medica Synergie

Chairman, KG Hospital & Post Graduate Medical Institute

DR G BAKTHAVATHSALAM

DR RAVINDRA KARANJEKARCEO, Global Hospital and chairman, NABH accreditation committee

DR MK KHANDUJAChairman, BSR Healthcare

SANDEEP SINHADirector, South Asia and Middle East, Healthcare & Life Sciences, Frost & Sullivan

DR NC BORAHChairman, GNRC

BRIGADIER JOE CURIANCEO, SevenHills Hospital

DR GUSTAD B DAVERDirector, professional service, PD Hinduja Hospital

DR DURU SHAHEminent gynaecologist

DR SANJEEV SINGHMedical superintendent, Amrita Institute of Medical Scienceand chairman, research committee, NABH

OUR EDITORIAL BOARD HOLDS UP A MIRROR TO THE HEALTHCARE INDUSTRY, HELPING US UNDERSCORE THE KEY TRENDS AND DEVELOPMENTS OF THE INDUSTRY

MONT HLY M A IL

Good workI have been reading this magazine on a regular basis for sometime now, and I just wanted to appreciate the team for the initiative, inputs and information provided in each issue. The recent one featuring an interview with Dr BS Ajaikumar was impressive. It is indeed true that it takes tremendous grit, courage and drive to build an organisation such as HCG. I complement Dr Ajaikumar for this outstanding achievement and wish him all the success in the years to come.

Healthcare in India needs a big thrust and I hope this decade really stands up to what has been predicted as the ‘decade for healthcare’. We saw tremendous success in IT, and then it was telecom. I am really hoping that healthcare becomes even more successful not just in treating people in major cities but also in treating every other individual, who lives in the remotest corner of our country.

Ashwin Benegal

President, India and SAARC

Merit Medical Systems India Pvt Limited, Mumbai

I really liked reading the March issue of Healthcare Radius.

Dr Aashish Contractor

HOD, Preventive Cardiology

Asian Heart Institute, Mumbai

What a feat!I liked reading the article ‘Small measures, big benefits’ article about BAPS Yogiji Maharaj Hospital in Ahmedabad. It’s encouraging to see their results.

I wish to congratulate the team of the hospital for their feat.

Dr Reshma Ansari

Manager Quality & Patient Safety

Breach Candy Hospital, Mumbai

ImpressiveI am a regular reader of Healthcare Radius and find the magazine impressive. Sudhaker Jadhav

Associate vice-president

Yashoda Hospitals, Hyderabad

Embracing modern thinking Vol 1 • Issue 6 • Rs50An ITP Publishing India publication

Registered with Registrar of Newspapers under RNI No. MAHENG/2012/46040, Postal Registration No. MH/MR/N/242/MBI/12-14, Published on 27th of every previous month. Posted at Patrika Channel Sorting Office, Mumbai-400001, Posting date: 30th & 31st of every previous month

MEDICALL 2013A LOW-DOWN

PPP: SOLUTION TO INDIA’S HEALTHCARE WOES?

HOW BAPS YOGIJI MAHARAJ HOSPITAL INCREASED EFFICIENCY

DEBATE: DOCTORS VERSUS SUPPORT STAFF

March 2013Total number of pages 48

AGAINST ALL ODDSDR BS AJAI KUMAR, CHAIRMAN, HEALTHCARE GLOBAL ENTERPRISE, ON MAKING CANCER CARE PROFITABLE

IN FOCUS

CASE STUDY MAKEOVER OF PARAS HMRI

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NEWS TRACK

Healthcare Radius April 2013 9

LVPEI’S NEW CENTRE AT BELLARY

LV Prasad Eye Institute (LVPEI) inaugurated a secondary care satellite service centre, the Y Mahabaleswarappa Memorial Eye Centre, at Talur Road in Bellary. It is LVPEI’s 11th satellite second-ary care service centre, and the institute’s first in Karnataka. The centre is constructed on a 3.5-acre of land, with 20,000 square feet built up area in phase one of its

There is a dearth of women staff in healthcare. Thus, on the occasion of World Women’s Day, Narayana Hrudayalaya announced being one of the largest employers of women in the healthcare industry.

The Narayana Hrudayalaya, Bengaluru, has around 3,000 women on its staff, including doctors, nurses, paramedics and administrators. In the supporting services staff too, it has employed large number of women employ-

The US Agency for International Development (USAID), the Kiawah Trust of UK, and Dasra, an Indian philanthropy foundation launched a $14 million partnership to address the healthcare needs of adolescent girls, mothers, newborns, and children in India. The alliance will enable greater engagement and committed resources through a multi-stakeholder approach focused on fostering innovation, improving health outcomes, and scaling high impact interventions.

BGS Global Hospitals, Bengaluru, has announced the launch of the innovative Flattening Filter Free Mode (FFF). This is possible through the advanced TrueBeam STx machine installed at the hospi-tal. The FFF not just helps reduce radiation exposure to just a few minutes per session, but also enables treatment of complex and hitherto untreatable cancers with better outcomes.

The technology delivers a high dose radiation to the tar-get tumour, which is generally critically located, precisely and accurately without dam-aging neighbouring tissues/or-gans. The FFF beam has high dose rate 2 to 4 times more than the regular beam, hence treatment time is drastically reduced.

development. It will undertake preventive eye care programmes, provide community-based rehabili-tation services, serve as a site for epidemiological studies and be an eye donation centre.

It will provide high quality eye care services to a population 1.0 million in and around Bellary district, catering to both paying and non-paying patients, wherein

patients who can afford to pay will be charged according to their ability to pay. The three tier fee structure cross subsidises the cost of care for patients, who cannot afford to pay, while ensuring equitable quality of services to all.

From the third year onwards, the centre is expected to cater to over 20,000 out-patients and perform 3,000 surgeries annually.

NH: EMPOWERING WOMEN MATERNAL AND CHILD HEALTH ALLIANCE

BGS GLOBAL INTRODUCES FFF

ees: nine ambulance and buggy drivers, 70 secu-rity and lift operators, 400 house-keeping staff and 20 cafeteria staff.

NEWS TRACK

67,000THE NUMBER OF MOTHERS WHO DIE EACH YEAR FROM COMPLICATIONS DURING PREGNANCY AND CHILDBIRTH

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NEWS TRACK


Fortis La Femme has launched an advanced, level III NICU at Bhagat Chandra Hospital in Dwarka. A level III NICU offers advanced care, including assisted ventilation and CPAP to very sick newborns and pre-term babies. With the launch of level III NICU, Bhagat Chandra Hospital now gets access to the super-specialised care and services of the NICU of Fortis La Femme.

The NICU will be serviced by trained neo-natologist, round-the-clock neonatal resident doctors, NICU trained nurses, paediatric car-diologist — neonatal ECHO, paediatric surgeon and paediatric ophthalmologist for screening of retinopathy of prematurity and treatment and developmental clinic for long-term follow-up of premature babies. Said Dr Raghuram Mallaiah, head of neonatology, Fortis La Femme, “There has been an increas-ing trend towards having premature babies and hence it is important to have a well-equipped NICU to not only save their lives but also to improve the long-term outcome for these very precious babies.”

NICU UNIT AT DWARKA

Piramal Foundation’s Swasthya project and Health Management and Research Institute (HMRI) has signed an Agreement of Service with the Government of Karnataka that aims to provide health infor-mation help line services in the state through 104 BSNL telephone number. This service has been named ‘Arogya Vani’. As a part of the agreement, ‘Arogya Vani’ will assist people living in rural areas of the state, who face difficulty in accessing a qualified doctor. The help line will ensure that these people get basic informa-tion on their health conditions and the available medical facilities through a process, which is easy and accessible, through the year.

On the eve of World Sleep Day 2013, celebrated on March 15, Philips Healthcare India reiterated its commitment to increasing awareness on common sleep disorders that affect an overwhelming 93 per cent Indians.

As part of its awareness drive, Philips Home Healthcare division or-ganised over 150 sleep-focused events in 2012 and intends to increase this to 250 in 2013. Also identifying the need for trained sleep special-ists across the country, Philips has already trained over 200 techni-cians and 500 physicians, and will continue to grow this number over the next few years. In addition to this, Philips will continue to help assist hospitals in setting up more sleep labs across the country.

PIRAMAL FOUNDATION’S NEW PROJECTS

PHILIPS CONTRIBUTES TO SLEEP DISORDERS AWARENESS

JASLOK HOSPITAL PRESENTS BREAKTHROUGH IN DEEP BRAIN STIMULATION

Jaslok Hospital & Research Centre, the pioneer in introducing deep brain stimulation (DBS) therapy in India, demonstrated its experience in corroborat-ing and supporting the breakthrough research on the therapy for early stages of Parkinson’s Disease, published recently in The New England Journal of Medicine.

DBS therapy has been conventionally used after 11 - 13 years of disease, when the quality of life and social status of the patient are considerably damaged, which even a successful DBS surgery cannot fully restore. However, if per-formed in early stages, it gives patients of Parkinson Disease, a new lease of life.

Explained Dr Paresh Doshi, consultant neurosurgeon in-charge, Ja-slok Hospital, “Our experience at Jaslok Hospital has been confirmed by the research, which states that neuro-stimulation was superior to medical therapy alone at a relatively early stage of Parkinson’s disease, before the appearance of severe disabling motor complica-tions. Neuro-stimulation may be a therapeutic option for patients at an earlier stage than current recommendations suggest.”

7 MILLIONIndians live with different types of sleep disorders, with obstructive sleep apnea being the most common

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NEWS TRACK


VASAN EYE IMPLANTS LENSE IN AN INFANT

In first of its kind in south India, the Anna Nagar branch of Chennai’s Vasan Eye Care Hospital has implanted a one-month-old baby with Intraocular Lens (IOL). The baby had cataract in both the eyes. When the baby was brought to Vasan Eye, its eyes were closed and it was not responding to visual stimuli. Before the surgery, other coexistent abnor-malities including glaucoma, small corneas, very small eye balls and presence of active infections were ruled out.

According to Dr Manjula Jayakumar, paediatric ophthal-mologist, Vasan Eye Care Hospital, “In children born with cataract, their immature nervous system will not receive visual stimulation that needs to develop the visual path-ways in the brain. This even leads to permanent vision loss. Therefore, paediatric cataract surgery and visual stimulation needs to be addressed as early as possible to avoid complica-tions such as lazy eye and squint.” Added Dr J Arun Kumar, who is a cataract, cornea and refractive surgeon at the hospital, “Most tertiary referral centres implant IOL only at two years of age. However, we took it as a challenge and performed the surgery on a month-old baby.” The infant's eyesight was restored after the surgery.

Trivitron Healthcare was conferred with the Global HR Excellence Award for Innovative HR Practices by the World HRD Congress. Trivitron

is India’s first medical technology company winning this award in healthcare.

“We are glad to receive this award in a category, which is a challenge in HR practices worldwide. In diverse business segments and industries, especially in healthcare, one of the fastest growing competitive and quality focused industry sectors, this award motivates us to take this initiative a step ahead,” Chandra Ganjoo, general manager, human resources, Trivitron Group of Companies.

The IMS Institute for Healthcare Informatics has announced a new initiative to develop local partnerships with leading universities, research institutions, development agencies and the government to reinforce the

value of information and analytics in decision making across a range of healthcare issues in India. The India Branch of the IMS Institute for Healthcare Informatics, with the support of IMS Health India, will leverage relationships in the public and private sectors to deliver objective, relevant insights and research to advance the country’s health agenda.

The institute will focus on advancing health services research, capacity-building, professional training and analytics-based performance improvement. “The transformation of healthcare systems to better serve the needs of patients worldwide can be energised through a tighter linkage between information and decisions,” said Murray Aitken, head, IMS Institute for Healthcare Informatics.

TRIVITRON HEALTHCARE WINS AWARD

The three-day Afro-Asian Conference of Transitional Re-search in Oncology (ACTRO) brought together oncologists from Asia and Africa to Ben-galuru. It discussed the need for a repository of cancer-based research in the country.

Said Dr BS Ajaikumar, president, ATRO, “India as a country has immense potential to be one of the leaders in oncology research with its burgeoning cancer population and comprehensive cancer care centres. Due to dearth of research in India, we have been depending on the western population data and guidelines, to manage the problem.”

Said Dr Prahlad Ram, medical oncologist, MD Anderson Cancer Center, USA, “One of the emerging challenges in oncology is the utilisation of patient-specific genomic information to develop personalised and targeted therapeutic options based on molecular aberrations in the tumour. A second challenge facing cancer medicine is the identification of pharmacological options to overcome resist-ance and the repurposing of currently approved drugs for cancer therapy.”

Said Dr Samuel JK Abraham, surgical oncologist, Yamanashi University-faculty of Medicine, Japan, “In the human immune surveillance system, a com-bination of adaptive and innate pathways work together to tackle cancer. When functioning optimally, they destroy any aberrant cell, which might evolve into a cancer. The dysfunction of the immune system by itself or a relative dysfunction against an overwhelmingly strong cancer causative factor culminates in cancer development. One of the aims of the therapy is to empower the autologous immune cells to treat an already diagnosed cancer and also to prevent a cancer development as well its recurrence.”

CALL FOR COLLECTIVE CANCER RESEARCH

IMS TO DEVELOP LOCAL PARTNERSHIPS

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News Track


On world kidney day, March 14, Fortis Hospital, Mulund, launched the Fortis Kidney Support Group to enable those suffering from kidney ail-ments to share their treatment and lifestyle experiences, and learn from them. Kidney experts (from Fortis Hospital) will provide guidance to the group, helping them manage their conditions and lead a healthy lifestyle.

On the same occasion, an exhibition of 30 paintings made by kidney patients was held at the hospital premises as part of the ‘Kidney Mela’. The paintings narrated the real-life aspirations of patients currently undergoing kidney-related treatments. The fair had several stalls on kidney-related information.

Fortis launches kidney support group

Alacurity, a provider of organ-ised services in the healthcare seg-ment, has now extended its reach by forming an alliance with Cyg-nus Bensups Hospital in Dwarka, New Delhi. The association aims at providing pre and post hospi-talisation services like nurses, ac-

commodation, translators, medical equipments, transport, etc to the patients of the hospital group. At the same time, it will also promote various services of the Hospital group. Alacurity’s team plans to be present onsite at the hospital to help the patients.

Temasek Holdings, a Singapore-based investment company, has invested in HealthCare Global En-terprises Limited (HCG). Temasek joins existing investors, Premji Invest, and Milestone Religare in a primary equity issuance by HCG. Evolvence India Life Sciences Fund, which has been an investor in HCG since 2007, will be moving

out of the investment in HCG. “Temasek’s global perspective and long-term interest in healthcare makes them a valuable partner. We also welcome Dr Jennifer Lee to our board and look forward to ben-efiting from her vast experiences in health management and policy,” said Dr BS Ajaikumar, chairman, HCG.

Apollo Gleneagles Hospi-tals, Kolkata, became the first hospital in the world to enter the prestigious Guinness Book of World Records for perform-ing 755 free cervical cancer screenings in a single day. The screening programme was a part of the Apollo-YOUWECAN

initiative. Apollo-YOUWECAN has been formed by Apollo Gle-neagles Hospitals in association with YOUWECAN Foundation founded by eminent cricketer Yuvraj Singh for organising mass cancer screening pro-grammes across various loca-tions in the state of West Bengal.

DM Healthcare has announced strengthening its operations in Qatar through its first ASTER Hospital project in the country to be commissioned by 2015. The hospital will provide tertiary care services and will cater to

multi-speciality departments with super-specialty clinics. The focus will be on offering excellence in care delivery with clinical offerings to ensure faster recovery and a minimal length of stay for ultimate patient satisfaction.

AlAcurity Allies with Bensups hospitAl

temAsek holdings invests in hcg

Apollo gleneAgles' world record

dm heAlthcAre signs hospitAl in QAtAr

Hiranandani Hospital inaugurates HBot unit

A Hyperbaric Oxygen Therapy (HBOT) and wound care facility has recently started at Mumbai’s Dr LH Hiranandani Hospital - IHS Centre for Advanced Wound Care and Hyperbaric Oxygen Therapy. The facility has two new and latest hyberbaric chambers. HBOT is effective in non-healing wounds, acute thermal burns, traumatic brain injury, refractory osteomyelitis, radiation damage to tissues, crush injury, compromised skin grafts and flaps, acute sensorineural hearing loss and several other conditions. The treatment is non-invasive and the patient just needs to lie down in the transparent pressurised hyperbaric chamber and breathe. Each session lasts 60 or 90 minutes and the pa-tient can watch television or DVD movie as the sound comes inside the chamber even though the television is outside.

at a glance

Art by kidney patients.

12_HCR_APR13_News.indd 12 21-03-2013 15:52:56

PROJECT SPOTLIGHT

Name: Dr Jayharan HospitalLocation: Nagercoil, KanyakumariType: Tertiary care hospitalProject: GreenfieldBed strength: First phase 230, when fully commissioned, 500 Promoters: Dr Sunil Jayharan, a leading medical practitioner, and his wife Dr Sashya, a leading gynaecologistFocus: Along with cardiac and orthopaedics as super specialities, the hospital would have other specialities as well. The hospital will be well equipped with operation theatres and ICU facilities, private and general ward along with other services. Commissioning by: 2014Status: Planning done, drawing in approval phaseDesign: Hospaccx India Systems Land: 86,865 square feetIn-built area: 1,30,780 square feetProject cost: Over Rs90 crore, inclusive of land, construction and equipmentFunding: Mix of debt and equityCatchment: Nagercoil and its vicinity.Design highlight: Due to the intolerable heat in Nagercoil during summers, the building is designed such that, inside temperature will be colder in summers as compared to outside temperature. Since the hospital makes maximum utilisation of natural light and ventilation, this will not directly cut the operational cost. However, it will certainly offer more comfort to those inside the building and thus aid recovery of patients.

COMPREHENSIVE CARE IN KANYAKUMARI

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Budget analysis


AMEERA SHAH | MANAGING DIRECTOR AND CEO | METROPOLIS HEALTHCARE RATING:

Although the in-crease in allocation for healthcare is a positive move, it is certainly not enough. For the sector to make significant strides, a minimum allocation of 4 to 5 per cent of GDP is

necessary. Although an increase in spending has been promised, a more sound allocation of resources is crucial for India to enjoy its benefits.

A lot of importance is accorded to treat-ment, but the basic question is — can one prescribe a drug without diagnosing the disease? Despite diagnostics being the first step towards effective treatment, none of our vertical programmes have given adequate importance to it. The Union Budget also fell short of this. The diagnostic industry did not get any relief in tax exemptions for life-saving reagents on pathology tests. Such taxes get transferred to patients and this is important for the 1.2 billion Indian healthcare consum-ers who pay for healthcare, particularly for diagnostics, out of their pocket.

However, 24 per cent increase over the

allocation to National Health Mission is certainly a positive note for the sector. There is a lot of hope from the National Urban Health Mission, and one could contemplate that diseases, which were out of focus hith-erto, would garner more attention. Chronic diseases and mental illnesses should gather pace with the National Urban Health Mission. The allocation for geriatric care too is a step towards preparing India to face the burden of healthcare costs of the ageing population.

Allocation of Rs4,727 crore and making six more AIIMS like institutions functional this year should increase the medical capacity, but is too small to affect the doctor : popula-tion ratio significantly. Incentivising doctors and paramedics is the only promising way to ensure an equitable distribution of medical capacity. Apart from direct allocation, health-care would benefit from other sector alloca-tions. Prominent among such allocations is the mid-day meal programme and Integrated Child Development Programme (ICDS). Since these do not fall under the ambit of health-care, measuring their impact on reducing child-malnutrition is difficult. The budget’s focus on women is a strong enabler towards making them financially independent, which improves their access to healthcare services.

DR E SANEESH | RESEARCH ANALYST BUSINESS AND FINANCIAL SERVICES | FROST & SULLIVANRATING: The mention of ‘Health for all as Priority’ by the Finance Minister in the budget speech has clearly implied the Government’s interest to boost public spending on healthcare. As compared to last year, public spending on healthcare has been increased with higher allocation of funds to the Ministry of Health and Family Welfare. Increasing the scope of Rashtriya Swasthya Bima Yojana and proposal for a comprehensive social security package for unorganised sector emphasises the Gov-ernment’s approach towards Universal Health Coverage. The increasing need for healthcare for the elderly has been addressed by the proposal to create regional geriatric centres. This budget has also focused on strengthening the alternative medicines and central medical institutions. Two big industry expectations such as granting ‘infrastructure status’ for healthcare and lowering the duty of medical equipment have not been considered.

Mixed bagIndustry veterans are divided in their opinion on Union budget presented by Finance Minister P Chidambaram

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Budget analysis


DR RR PULGOANKAR | CEO | JALSOK HOSPITAL & RESEARCH CENTRE RATING: I welcome the 22 per cent in-crease in budget allocation for the healthcare sector, up from Rs30,702 crore in the current fiscal to Rs37,330 crore in the next fiscal (2013-14). Out of this, 56 per cent is allocated for primary healthcare.

There is a special focus on completion of six institutions in 2014 that are similar to AIMS and allocation of Rs4,724 crore for medical education. This will help meet the growing manpower demand of doctors, nurses and paramedics. In-creasing expenditure on healthcare and healthcare infrastructure will give a boost to the industry.

DR BS AJAIKUMAR | CHAIRMAN HEALTHCARE GLOBALRATING: The percentage of GDP on healthcare allocated is starting from a low base and is still insufficient, but it is good to see an increase. The government should focus on more PPPs in healthcare, which is the only successful model.

There are many states that are not able to carry forward the healthcare programmes due to insufficient funds; more funds should be allocated to these states. The tax increase on tobacco products is a good move. Health problems from tobacco usage are on the rise in the country, particularly cancer and cardio vascular diseases. The money generated from this tax should be used appropriately on health and not any other purpose.

DR GSK VELU | FOUNDER AND MD TRIVITRON HEALTHCARERATING: Yet another year in which the Govern-ment has ignored the healthcare sector. We wanted a status similar to infrastructure, incentives for local innovation and manufacturing in the medical technology industry and higher tax exemption for annual health checkups to achieve the ‘Health For All’ by 2020 objective. There is just marginal increase in Government spending on healthcare. Overall, a disappoint-ing budget for the sector.

GIRISH MEHTA | CEO | BEAMSRATING: The current budget did not offer anything in specific for health-care, neither in terms of positive measures nor in terms of new road blocks.

DR NC BORAH | CHAIRMAN GNRCRATING: Health is one of the sectors that the union budget of 2013 has fo-cussed on. More than 24 percent increase in fund-ing for the NRHM will benefit large number of people in the rural areas and also poor people in the urban areas.

Of all things, the allocation of more than Rs4,000 crore for human resource development in the healthcare sector is a step in the right direction. This will help address the inadequate numbers of doc-tors, nurses and technicians that impairs the healthcare industry

VISHAL BALI | GROUP CEO | FORTIS HEALTHCARERATING: The budget reflects the urgent need to stimu-late growth in the economy. A single healthcare agenda for the country under the national health mission with an outlay of Rs27,200 crore provides an increase of 27 per cent but is still negligible as a per cent of GDP for a country of 1.2 billion people. The budget disap-points the healthcare sector once again since it does not provide any fundamental impetus to accelerate the growth of the sector. The only positive move is an outlay of Rs4,727 crore for medical education, a good directional change to improve the medical talent pipeline for the country. Lowering of fiscal deficit from 5.2 per cent to 4.8 per cent will be a challenge to meet.

Despite diagnostics being the first step towards effective treatment, none of our vertical programmes have given adequate importance to it"— AMEERA SHAH, MANAGING DIRECTOR

AND CEO, METROPOLIS HEALTHCARE


Budget analysis


DR A VELUMANI | FOUNDER | THYROCARERATING: The Government is thinking in the right di-rection by increas-ing attention to healthcare. Though late and very little, it is still appreci-ated. If adequate attention is given to preventive care, it will help the overall healthcare business and improve quality of life for citizens as well.

RAJEN PADUKONE | MD AND CEO | MANIPAL HEALTH ENTERPRISESRATING: The positives are the increase in focus by the Government to cover a larger portion of the economically weaker segments of our popula-tion and lower income groups with health cover through the RSBY and other schemes. This is an indirect acknowledgement by the Government to move towards taking on the role of a payer than a provider. Also, given that healthcare sector is capital intensive, an investment allowance for capital expenditure of over Rs100 crore is a wel-come move. Additionally, the focus on increasing employable skills and skill building through the

DR RAMAKANTA PANDA | VICE-CHAIRMAN | ASIAN HEART INSTITUTERATING: The deadline of 2014 and an amount of Rs1,650 crore for setting up six insti-tutions modelled on the AIIMS will go a long way in strengthening the country’s medical education infra-structure. The additional Rs4,727 crore al-located for medical education, training and research will help promote innovation. The Indian systems of medicine have age-old acceptance in several communities and, in most places, they form the first line of treat-ment in case of common ailments. Hence, I welcome mainstreaming of AYUSH so that some form of medical treatment is available across rural and semi-urban India as well.

DR SANJEEV CHAUDHRY | MD SRL DIAGNOSTICSRATING: Considering that private sector serves 75 per cent of the health-care diagnostics responsibility for the country, the Union budget has yet again missed the opportunity to recognise the stellar role of the private sector both in terms of providing high quality affordable services and geographic reach. The long-standing industry demands of providing fiscal relief for consumables and tax incentives for accreditation have been left unmet, yet again. Industry really hopes the debate on Finance Bill brings these important issues to the table to enable private sector to pro-vide high quality affordable diagnostics to more and more people.

DR NANDKUMAR JAIRAM | GROUP MEDICAL DIRECTOR AND CHAIRMAN COLUMBIA ASIA HOSPITALS, INDIA RATING: The budget has failed to provide an impetus to health-care finance, which is a vital need as it is the only way to energise the private healthcare delivery sector that accounts for 80 per cent of the healthcare market and will continue to grow. It is unfortunate that the budget has not provided for adequate incen-tives towards mandating or permeating health insurance, the only viable alternative to the ever increasing healthcare costs in our country.

DR GIRDHAR GYANI | CEO ASSOCIATION OF HEALTHCARE PROVIDERS (INDIA)RATING: I welcome the 24 per cent increase in the allocation to NHM, the alloca-tion for six AIIMS-like institutes and the allocation for skill development, education and research. However, the budget is silent on any kind of support to the private sector. The Government should have seriously considered giving concessions like abolition of import duty on medical equip-ment. The Association of Healthcare Provid-ers (India) had submitted to the Finance Ministry a detailed account of how the Government would lose only Rs224 crore if it abolishes the import duty, but the benefit to population will be huge. Similarly, we had submitted a proposal to create a Road Accident Fund, so that victims of road ac-cidents could be provided with timely care in the nearest hospital. But I see none of that mentioned in the budget. Healthcare in this country still has not become an election agenda and therefore does not get the kind of priority, given in countries like the US.

DR AM ARUN | CHAIRMAN VASAN HEALTHCARE GROUPRATING: The finance min-ister has rightly accorded top prior-ity to the health of the citizens with an increase of over 24 per cent to the NHM. He has also realised the need to augment supply of medical professionals and has increased the contribution to the newly started six AIIMS-like institutions as also increased the allocation to medical education and research. I welcome the investment allowance of 15 per cent intended to spur asset creation.

NSDC and alloca-tion of Rs1,000 crore towards this is encouraging.

The disappoint-ments are several. The incremental al-location of expenditure over the previous year is only about Rs7,000 crore of Rs37,330 crore. Government health expenditure is still at one per cent of the GDP out of a total public and private spend of around 5 per cent of GDP.



Preview

Construction of healthcare facili-ties and the renovation of exist-ing ones have created a spurt in the demand for skilled services, be it in hospital planning and

design, engineering and IT requirements, medi-cal equipment, etc.

Healthcare Radius, a publication of the ITP Publishing India, is pleased to announce the ‘Smart Healthcare India Summit’ on May 23 and May 24, 2013 at the ITC Gardenia, Ben-galuru. Spread over two days, the event will be content-driven and invaluable for those in the management and execution of hospitals, where key decision-makers within the healthcare industry will address the strategies and ap-proaches, which help increase efficiencies and drive costs low, leading to improved quality of care for patients.

The platform offers hospital managers the opportunity to learn specific tools and tech-niques to do their jobs better, in an environ-ment of quality learning and networking with peers. Key to this process is the staging of how-to, skills-related sessions, run only by experi-enced professionals and industry experts.

Smart Healthcare India SummitThe two-day event will be a meeting place for the best minds in healthcare

With exclusive C-level roundtable discussions, this is an event that you can’t afford to miss!

SPEAKER PANEL• Rajen Padukone, CEO, Manipal Health

Enterprises Pvt. Ltd., Bengaluru• Dr Umapathy Panyala, CEO, Apollo Hospi-

tals– Karnataka Region, Bengaluru• VP Kamath, COO, Wockhardt Hospitals

Limited, Mumbai• Dr Ravindra Karanjekar, CEO, Global Hos-

pitals, Mumbai• Dr RR Pulgaonkar, CEO, Jaslok Hospital &

Research Center, Mumbai• Dr Sameer Khan, CEO, Rockland Hospitals

Group, New DelhiAnupam Verma, Group CEO, DM Healthcare,

• Mumbai• Dr Mudit Saxena, COO, Healthcare Global

Enterprises, Bengaluru• Brig Joe Curian, CEO, Seven Hills Hospital,

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Synergie Pvt. Ltd., Kolkata• Dr Raja Sekhar Gujju, Medical Director,

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• Government regulations & policies

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We are expecting over 150+ delegates from hospitals, nursing homes and clinics pan India. The conference is also an ideal forum to interact with technology providers who offer turnkey and cost effective solutions that will help in efficient hospital operations.

For registration, contact:Anjali Shetty, sales manager, conferences, ITPEmail: [email protected]: +91 96194 53737Direct: +91 22 6154 6010

17_HCR_APR13_Preview.indd 17 21-03-2013 12:27:06

18 Healthcare Radius April 2013

We put Gujarat on the medical tourism map by performing over 40,000 joint replacements, the largest by a single centre in the world”

18-22_HCR_Apr13_Straight Talk.indd 18 21-03-2013 12:29:04

Straight talk


Shalby Hospitals has managed to resuscitate the recently acquired ailing Krishna Heart Institute in just three months. CMD Dr Vikram Shah reveals the secret behind the turnaround and the group’s rapid growthINTERVIEWED BY RITA DUTTA

Various media reports placed the cost of acquiring majority stake at Krishna Heart at Rs75 to Rs80 crore, but insiders say that it was much less…I will refrain from commenting on the amount we paid as the founders, the Chokshi broth-ers (Dr Atul and Dr Animesh Chokshi), would not like the details to be divulged. It was their dream project and even though we are 86 per cent stakeholders of Yogeswhar Healthcare Limited, which runs Krishna Heart, the broth-ers continue to be associated with the project. Dr Atul, who was the chairman, still takes part in camps, seminars and conducts free angioplas-ties at Krishna Heart, now known as Krishna Shalby Hospital. The former founders’ connect with the hospital will not be severed in the years to come.

How were you associated with Krishna Heart?From 2001 to 2007, I worked there as a con-sultant joint replacement surgeon. During that period, I performed over 3,000 joint replace-ment surgeries.

What made you zero in on the project, which was in the red? It is also remotely located.With our flagship hospital on SG Highway running to full capacity, we have been ramping up our bed strength in Ahmedabad by building two more hospitals. As the other two upcoming hospitals that are greenfield would take time, we acquired Krishna Heart, which was a ready facil-ity with a bed strength of around 100. After the acquisition, we have become the largest private healthcare player in Ahmedabad with 450 beds. As for the location, which is Ghuma, I was not

The healing touch

Dr Vikram Shah did his MBBS and MS, Orthopaedics from BJ Medical College, Ahmedabad. He worked in Ormskirk and Wrightion Hospital, England for two and a half years and later in Shelby Baptist Medical Centre, Burmingham, US, Beth Israel North Hospital, Manhat-tan New York and Darmstadt Hospital, Darmstadt, Germany.

Know Dr Vikram Shah


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In L

acs

SHALBY GROWTH JOURNEY

Revenue EBIDTA Poly. (Revenue)

Straight talk


Dr Shah turned around Krishna Heart Institute in just three months and now plans to scale it up to a 250-bed hospital.

a 250 bed hospital. We are investing around Rs20 crore to install latest CT scans, X –ray machines, cath labs, and creating two ERs and two OTs. After six months, the hospital will start a liver transplant unit.

How has Shalby grown over the years?We invested our savings, took small loans and family’s help to start a medical centre at Vijay Cross Road in 1994. The centre had six beds, one operation theatre and five staff. The centre, housed in a low-rise building with our residence upstairs, offered only joint replacement, while my dental surgeon wife Dr Darshini practiced high-end dentistry with oral implantology. In 2006, our 200-bed flagship hospital, which is a greenfield project, was commissioned. Today, we have a combined bed strength of over 700 beds with multi speciality hospitals across Ahmedabad, Vapi and Goa, and 16 OPD clinics including a patient counselling centre at Nairobi, Kenya.

We have grown 10 times in the last five years and 100 times in the last 10 years. Our turnover last year was around Rs168 crore and EBIDTA was 28 per cent. The EBIDTA fluctuates between 29 to 30 per cent for the flagship hospital. The expected turnover this year is Rs250 crore. Here, on an annual basis, we make Rs1.6 crore per patient per bed or Rs50,000 per bed per day. Our breakeven time for a greenfield project is 18 months, which is faster than the standard two to three years.

concerned about it as we have a steady inflow of patients to be sent to the Krishna Shalby from the main hospital, where we face perennial bed shortage.

Shalby had to carry forward a debt of Rs45 crore from Krishna Heart…That’s true. But that didn’t bother us. In fact, we made the hospital cash positive in less than three months of taking over.

How did you turn it around?By keeping the cost of operations low, sharing clinical resources with the main hospital and allowing doctors to only focus on clinical work. Patient footfall at Krishna Shalby is good as medical tourism patients and patients we cannot accommodate at the main hospital are diverted there.

Do you think that the remote management of the hospital from the US impacted the func-tioning of the hospital, which had state-of-the-art infrastructure at one point of time?That did have a negative impact. Also, the unit lacked good doctors, and the doctors already pre-sent were burdened with mundane administra-tive work, which affected their clinical output. It’s the doctors that patients queue up for, and when the doctors are busy doing other things, clinical work takes a backseat.

What are your plans to strengthen the unit?After three months, the hospital will be trans-formed from a cardiac unit into a 150-bed multi speciality hospital. At a later stage, it will become

TODAY, THE QUALITY OF IMPLANTS REQUIRED IN JOINT REPLACEMENT HAS IMPROVED, ENSURING 20-YEAR SURVIVAL IN 90 PER CENT CASES


Straight talk


The group’s flagship hospital at SG Road in Ahmedabad conducts the largest number of joint replacements by a single centre.

surgery is eight to ten minutes and the patient starts walking a few hours after the surgery.

But there will be more advancements.. I believe that 1995 to 2005 belonged to the era of cardiology, while the 2000 onwards belongs to joint replacement. Today, the quality of implants required in joint replacement has im-proved, ensuring 20-year survival in 90 per cent cases. The design of the implant has changed significantly to achieve high flexion, which is a must for functionality.

Over the last decade, the age of patients undergoing joint replacement has reduced. As against the earlier age group of 60 to 65, today, 50 - 55 year olds are going for joint replacement, which calls for implants with high flexion.

What’s the secret behind the large number of joint replacements at Shalby?In our first year, we could perform only 15 operations. This grew to 600 around 2007 and today, we are able to conduct 5,500 joint replacements annually. This has been pos-sible only due to ‘zero technique’ that, besides significantly reducing the surgery time, has ensured minimal incision and painless surgery. It has also reduced hospital stay, blood loss and medication. It gives good flexion of the knee as it uses superior quality implants. The infection

rate has also improved from 1-2 per cent in 1994 to 0.03-0.04 per cent today. The

‘OS’ needle, which I invented, also helps cut through both bones and soft tissue and saves time during surgery.

So, how do you manage to balance time between surgery and administrative

work?I do zero administrative work. Every day, from 9 am to 7 pm, I am busy only with clinical work. On any day, I do over 30 to 35 knee replace-

ments. There is no better job satisfaction than to see the patients, who were suffering from excruciating pain in the joints, walk back to

pain-free life after the surgery. I have appointed a team to give wings to my

vision. It’s only once or twice a week that I meet the CEO of the hospital and that is also not a structured meeting. I don’t ask for updates like patient turnout or revenue. Usually, it’s held to know regular administrative work.

Do tell us about your upcoming projects.We are coming up with two 250-bed multi speciality hospitals, one in Indore and another

How do you assess the group’s contribution to healthcare in Gujarat?We put Gujarat on the medical tourism map by performing over 40,000 joint replace-ments, the largest by a single centre in the world. Presently, we perform in excess of 500 primary joint replacement and seven to eight re-vision joint replacement surgeries every month. Shalby Hospitals pio-neered Total Knee Replacement (TKR) surgery in Ahmedabad. Using my method, the pioneering zero technique, we can perform a joint replacement surgery in just eight to ten minutes.

Among other things, we were the first Indian hospital with a Class 100 OT that ensures safe and successful knee replace-ment surgeries. Also, our main hospital has initiated cardiac stem cell transplant, ozone therapy for non-invasive and painless uterine fibroid embolism and Kyphoplasty to treat pain-ful, progressive vertebral compression fractures (VCFs) in the Western region. We are also the first hospital in Gujarat to procure fractional laser for high-end cosmetic treatments.

How do you assess the advancements in joint replacement over the years?In the 90s, when we started Shalby Hospitals,

joint replacement was hardly known in India. At that time, TKRs surgery took more than two hours to perform and the patient had to stay in hospital for 15-20 days, post surgery. In 2007, the hospital stay was reduced to five days and surgical time became 30 minutes. Today, thanks to the ‘zero’ technique, the duration of the

SHALBY HOSPITAL, SG ROAD,

AHMEDABAD:

200 BEDS

KRISHNA SHALBY HOSPITAL, GHUMA,

AHMEDABAD:

150 BEDS

SHALBY, VIJAY CROSS ROADS,

AHMEDABAD:

25 BEDS

VRUNDAVAN SHALBY,

GOA:

140 BEDS

USHA SHALBY,

VAPI:

140 BEDS


Straight talk


Do you see Shalby as a pan India player?Definitely. We will be a pan India player in the next two to three years, but we don’t intend to foray into the Delhi-NCR region. We are keen on exploring Punjab, Haryana, western India and even south India. Right now, we are looking for a project in Hyderabad, which would be our first southern project.

How do you foresee the group a few years from now?In the next two and a half years, we will have 1,500 beds and in the next five years, we will have 6,000 beds.

How do you see healthcare in Gujarat chang-ing over the years?Gujarat has always been on the forefront of medical care, be it in technology, clinical work-force or infrastructure of hospitals. Our clinical outcomes and facilities are on par with those in Mumbai or Delhi.

Most of the hospitals in Gujarat are headed by doctors. Do you see this changing in future?No, doctors will continue to remain in the spotlight and even head hospitals. Professional management has already come in hospitals in Gujarat, but I don’t think it will impact the popularity of a good doctor. Let’s face it: It’s doctors that attract patients. Gujaratis and Mar-waris can travel any distance in the pursuit of two objectives: pilgrimage and a good doctor.

one in Surat. Both are greenfield hospitals that would be commissioned after two years. Another multi speciality hospital of around 200 beds is coming up in Jaipur.

In Ahmedabad, we have two more projects coming up at Naroda (200 beds) and Bopal (400 beds). In Goa, where we already have three units that add up to 140 beds, we are planning to add another 150 bed multi speciality hospital in Panjim. Our investment per bed is Rs50 lakh for new hospitals. This is lower than the market rate of Rs80 lakh to Rs one crore per bed.

And existing units?Our 120-bed project in Vapi would be scaled up to 250 beds. In both Goa and Vapi units, we are adding high-end cath lab, CT Scan and MRI.

Why are most of your hospitals 250 beds?I believe that a hospital with 200 to 250 beds has the highest efficiency and gives the highest profitability. Any institute above it, is too large to manage and anything below that is too small.

What’s the secret behind the high profitabil-ity of the group?We keep our cost of operations low right from

the inception of the projects, and emphasise on proper planning before executing the projects. To save electricity, we use fire bricks, dual reflective vacuum spaced glasses, lot of natural light and cool compressed air. Such small mea-sures lead to high profitability.

Shalby is perceived as a doctor-driven organisation…No, we are not doctor-driven. We are pro-cess driven. People may have perceived us as doctor-focused as doctors here are satisfied with their work. The proof of my statement lies in the fact that we have zero attrition rate among doctors.

Otherwise, we have clear demarcation between administrative and clinical work. Doctors are not allowed to interfere in the day-to-day administrative matters of the hospital and have limited say in it.

While the head of our administrative wing is the CEO, the clinical wing is represented by the medical superintendent and the medical director. Both the administrative and clinical wings report directly to me. Each wing has no say in the other and thus there is no conflict between the two. The administrative work in the clinical wing is headed by the medical superintendent, who is not allowed to practice medicine. This is because we don’t to mix power with clinical work. Mixing the two can prove to be a dangerous combination for patients.

So, what’s trick to having happy doctors?In any hospital, as long as doctors are allowed to do clinical work, they feel happy and the hospital does well. On the other hand, if the clinicians are bogged down by administrative work, it spells doom for the institute. Also, doctors should be allowed to take part in conference, training, research projects and camps. If you manage to keep a happy force of doctors, you need not worry about patient footfalls and revenue.

Shalby’s training programme

Shalby provides fellowship training to orthopaedic surgeons from across the globe in joint replacement as well as spine surgery. Many surgeons from India, China, Vietnam, Bangladesh, Kenya, UK, North America have visited Shalby, ranging for training spanning over one week to one year.

It’s the only accredited hospital for DNB programme in orthopaedic surgery in Gujarat which is recognised by the Diplomate of National Board for providing post graduate training to four students every year.

It is also affiliated with many paramedi-cal training collages for clinical training and internship programmes for their students. It is also associated with IIM-Ahmedabad for conducting healthcare-related projects for their management students.

Shalby’s upcoming hospital at SP Ring Road in Bopal area of Ahmedabad.

GUJARATIS AND MARWARIS CAN TRAVEL ANY DISTANCE IN THE PURSUIT OF TWO OBJECTIVES: PILGRIMAGE AND A GOOD DOCTOR


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Dr Praneet Kumar on reviving the ailing BLK Super Speciality Hospital

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Technology


Remote possibilitiesRemote and wireless patient monitoring has enhanced critical care by reducing hospitalisation and ALOS, improving medication compliance and quality of life BY RITA DUTTA

Even a year ago, the family of a critically-ill patient in a place like Dehradun had to brave poten-tially harmful hospital transfers to rush the patient to Delhi, more

than 250 kilometres away, to avail of world class medical treatment. Today, patients in Dehradun and even Raipur, which is 4,000 kilometres away from Delhi, can receive real-time monitor-ing from intensivists at Fortis Escorts Hospital, Delhi. This has been possible through Critinext, an eICU, whereby timely treatment and monitor-ing of patients is provided in collaboration with local physicians over audio/video. Critinext has been launched by GE Healthcare in collaboration with Fortis Healthcare.

The project kick started in September 2011 at the Raipur unit of Fortis which has 18 ICU beds

but lacks 24X7 critical care specialists. For the pilot, four ICU beds at the unit were supported with Critinext, with the command centre at Escorts. After a three-month pilot study, and a pre- and post-stat analysis to prove evidence-based outcomes, the Raipur unit went live with Critinext from April 2012 onwards.

Through remote monitoring, continuous and live data (from monitors, ventilators and other patient-bedside equipment from the satellite centre) is transmitted to the intensivist who is remotely situated at the command centre and can access this data 24 X 7. Smart alerts built into centricity can flag trends in patient’s condi-tion like picking up a spike in a white blood cell count, the start of a low grade fever, and a drop in urine output.

When the intensivists at the command centre

put all those together, they are able to conclude if a serious infection is setting in. With the help of state-of-the-art rules-based engine, clinical parameters are tracked and used to generate clinical notifications, which can be overseen in a paper-based workflow. Thus, the intensivist at the hub offers proactive and reactive solutions to provide the right care at the right time.

As per data available till June 2012, eICU at Escorts has enabled 40 per cent reduction in severity-adjusted mortality across seven academic intensive care units, 58 per cent re-duction in severity-adjusted mortality over 2.5 years, 63 per cent reduction of ICU mortality comparing pre- and post-data over a three-year period and 32 per cent reduction in severity-adjusted ICU mortality and hospital mortality by 18.9 per cent.

Dr N Ramakrishnan, sitting at an eICU command centre located in Chennai, monitoring an ICU setup in a remote location.

Cour

tesy

: Phi

lips

24-26_HCR_Apr13_Technology.indd 24 21-03-2013 12:33:55

Technology


Remote patient monitoring (RPM) has witnessed

huge advancements in recent times, since the

days when RPM and disease management

guideline programmes heavily depended on

daily paper logs of vital signs like weight, BP,

pulse rate and glucose readings entered by the

patient or care provider at home. Explains Navin

Govind, CEO, Aventyn, which offers three core

products in the RPM segment, “In earlier times,

the paper logs were reviewed by the clinician

after 30 day or 45 days during a personal visit

to assess the patient’s response to guidelines.

However, the paper method was quite obviously

inefficient and expensive. It did not engage the

patient regularly, and considered information in

silos and was non interoperable.” Subsequently,

the Interactive Voice Response (IVR) systems

and web-based approaches complemented

the paper-based RPM programmes with better

success in automating patient – clinician

responses.

In the last few years, mobile and cloud

technology has played a significant role

in engaging patients to respond to care

guidelines with the smart phone and tablet

replacing paper/IVR/Web apps. “Also,

wirelessly enabled, wearable vital sign

monitoring devices have improved vital sign

measurement of patients non-intrusively

un-tethered to bedside console. Monitoring

clinicians are also now un-tethered to consoles

at hospitals by successfully using tablets

and ultrabooks to monitor patients remotely

anytime and anyplace securely,” says Govind.

THE DIRE NEEDWhile well-equipped ICUs, qualified intensivists and their 24/7 availability are considered the key determinants of successful critical care out-comes, India has only 6,000 intensivists/anaes-thetists and only 70,000 well-equipped ICU beds as against an estimated demand of 4,00,000 ICU beds to provide critical care for about five million ICU cases per year. eICU addresses this shortage. Says Dr Amit Varma, executive direc-tor, Critinext, Fortis Group of Hospitals, “eICU is a solution to bridge this huge gap of ICU beds by providing specialist care at the point, where it is needed in a cost-effective way.” As many as 1,000 ICU beds can be manned by only 20 intensiv-ists through eICU. It also provides successful evidence-based out-comes, helping stand-ardise critical care for patients irrespective of where they live.

According to Varma, eICU has helped stand-ardise critical care SOPs across Fortis Group, enabled data capture and retrieval, allowed more critical patients to be treated at periph-eral units, ensured quality similar to the hub and facili- Vitalbeat app from Aventyn

GE Healthcare CEO John Dineen at the Escorts Raipur Hospital during the inauguration of Critinext at Fortis Escorts Hospital, Delhi.

tated brand building in tier-II and tier-III cities. Explains Dr N Ramakrishnan, managing

director, Chennai Critical Care Consultants, who provides eICU service to ICUs located in the US and India, “With the increase in the average lifespan of a person on one hand and the disease burden growing on the other, the need for criti-cal care is rising by the day.

Besides most elderly people requiring ICU hospitalisation, today we have a lot of young people admitted to ICU because of trauma and adverse effects of lifestyle diseases like diabetes and hypertension. In the years to come, the num-ber of young and elderly patient we treat in the ICU will only multiply. We do not have enough

manpower to manage the situation and have to look at innovative solutions.”

According to him, remote monitoring offers a good

solution to the many challenges we are facing at a global level as well as

in India. He has selected InTeleICU

services, powered by Philips Technology, to

reach out to critically ill patients anywhere, anytime.

“We already have several hospitals in remote locations which are availing of this

facility with good results,” says Dr Ramakrishnan.

THE EVOLUTION

Techno-logical ad-vancement

has allowed doctors to be in touch with the patients 24X7 even when they are travelling” — JV BALAKRISHNAN,SENIOR VP, SCHILLER INDIA


Technology


THE BENEFITSeICU helps in providing pro-active care to save the patient’s life. The eICU solution also reportedly reduces the length of hospital stay for patients as they receive the highest level of man-aged critical care. While the ICU care at a local hospital allows patients get better support from family as well as help reduce costs by shortening the stay in ICU, the eICU helps to addresses the shortage of critical care staff in remote areas and enables physicians in remote units to manage ICUs more efficiently. Remote ICU monitoring technology combined with expert set of eyes can help reduce medical errors and infection within ICUs leading to reduction in patient mortality by up to 60 per cent.

The unique advancements in mobile medical technology have improved patient engagement and medication compliance. They have reduced hospitalisations and re-admissions, reducing the cost of care with efficient care delivery and improving the quality of life of patients. “Now, the market has several aspects of wearable physiological vital sign sensors and mobile medi-cal devices continue to evolve with Bluetooth low energy, NFC and cloud based monitoring services for specific monitoring of disease condi-tions,” says Navin Govind, CEO, Aventyn.

Today, Remote patient monitoring (RPM) technologies are not only capable of monitoring patients but of sorting data and automatically up-dating patient records. “It allows the health staff to provide care more efficiently and also monitor patients in off-site locations. Technological advancement allows doctors to be in touch with the patients 24X7 even when they are travelling or outside the hospital,” says V Balakrishnan, Sr

A nurse is using InTeleICU services from Philips to take instructions from a doctor sitting miles away from the patient.

Vice President, Schiller India. For instance, the IntelliVue Charting solutions

from Philips Healthcare ensure that there are no errors in reporting of patient vital signs and the nurses or technicians follow the doctors instruc-tions completely and on-time. In this segment, Philips Healthcare has a few key solutions like IntelliVue, IntelleICU, Philips Information Cen-tres and IntelliVue charting systems.

There has also been a significant growth in the usage of wireless networks in patient monitor-ing, enabling hospitals to carry around patient monitors anywhere in the hospital and allowing patients to stay connected to be able to go to various departments or have a walk. Hospitals are installing wireless networks as they are much easier to install and require no infrastructural changes in the hospital building for installation.

REVOLUTIONISING CARE Indeed, remote and wireless monitoring is revo-lutionalising critical care. Says Jitesh Mathur, Sr Director, Patient Care and Clinical Informatics, Philips Healthcare, “Remote monitoring has completely transformed the level of patient care. Today, a physician can take virtual ICU rounds of his ICU, while being anywhere in the world using a standard tablet PC or any handheld devices.”

“RPM has opened a huge window of oppor-tunity for advancements in quality of medical care. Current technologies allow providers to monitor a patient’s health status by remotely and continuously measuring various vital signs. The ability to accurately detect abnormalities in vital signs allows intervention and prevention of problems before clinical signs are even present. The challenge of early detection of the onset of

We do expect more players

in this segment, especially given the high need for improving healthcare accessibility” — JITESH MATHUR SR DIRECTOR, PATIENT CARE

AND CLINICAL INFORMATICS PHILIPS HEALTHCARE

Wirelessly enabled, wearable

vital sign monitoring devices have improved vital sign measurement of patients non-intrusively untethered to bedside console” — NAVIN GOVIND CEO, AVENTYN

these abnormalities is in doing so efficiently and accurately,” says Balakrishnan.

DRIVING FORCEExperts point out that nearly 10 per cent of total patient monitoring market in India is wireless and remote and the rate of growth of this market is more than 10 per cent. What’s driving this market is rising prevalence of


Technology


Some of the popular remote and wireless applications include:• Remote ICU monitoring: One needs to have a central nursing station (CNS), which allows getting vital parameters of all the patients in the ICU on one console. When the doctor is travelling, he can access this information. • Ambulance Monitoring: When a patient is being transported from a distant location to the hospital, the basic treatment can start in the ambulance and doctor at the hospital has a facility to visualise the patient’s vital parameters and proactively decide on the treatment to be administered — an ICU on wheels of sorts.• Connect with the rural hospitals: The doctor practicing in a rural hospital can take the vital parameters of the patient and send it to the urban hospital where a super specialist can look at it and send a report back to him.• Tele monitoring: The paramedical can take the vital parameters of the patient and send it through an email to doctors sitting in other town. The doctor can looks at the vital parameters and send the report back via mail. This way the doctor saves time and can look at cases from 10 different hospitals.

We do not have enough

manpower to manage the rising demand for ICU care and have to look at innovative solutions” — DR N RAMAKRISHNAN MANAGING DIRECTOR

CHENNAI CRITICAL CARE CONSULTANTS

chronic diseases like diabetes, the growing elderly population and advances in wireless and sensor technologies.

“Focus of care providers on better patient care has resulted in creating demand. On the technology front, standardisation in wireless networks and adoption of wireless networks by hospitals has enabled this advancement. Wireless networks are today much more reliable, ensuring no critical alarms are lost, especially in mission critical applications,” says Mathur.

Wireless communication and data transmis-sion are playing an increasing role in critical care. Asked about the challenges in using these systems, Mathur says there are external chal-lenges such as telecom infrastructure, slightly incremental cost and technical know-how.

A GROWING MARKETAccording to Govind, “The RPM market is growing globally. As per ABI Research, by 2017, the market would be growing at an aver-age rate of 41 per cent per year, leading to 169.5 million devices being shipped in 2017. By 2017, according to ABI, 23 per cent will be home monitoring technology for seniors. Seven percent will be devices for remote patient

monitoring, with another 7 per cent for point of care healthcare use.”

In the coming years, Rural health centres (RHCs) or other remote heath locations such as ships navigating in wide seas, ambulances (both air and road) carrying patients to the hospitals would become common examples of possible emergency sites with RPM, where the patient’s data can be sent to the base. This can help the doctors decide and direct the course of treat-ment to be started.

Are more players expected in this segment? “Wireless is a critical high-end technology. While Philips is a leader in this, other companies are working to come out with reliable technolo-gies. We do expect more players in this segment, especially given the high need for improving healthcare accessibility,” says Mathur.

Fortis in collaboration with GE Healthcare has already chalked out plans to target 500 ICU beds in 20 small towns by 2014 with its Critinext. For Aventyn, whose products are being used in Bengaluru’s BMS Hospital Trust, VIVUS Heart Centre and Narayana Hruduy-alaya, the growing markets are in remote home care, community care and acute-bedside care adopting their patient monitoring and chronic disease management products.

eICU addresses the acute shortage of intensivists and well-equipped ICUs.

APPLICATIONS IN USE


Innovation


Low cost, high efficiencyThe recently commissioned Narayana Hrudayalaya Hospital in Mysore has taken several initiatives to reduce cost of project and operations BY TEAM HR

The Narayana Hrudayalaya (NH) Group has recently com-missioned a 200-bed multi speciality hospital in Mysore. Spread over nine acres of lush greenery, the facility is built for patients from Mysore and its surrounding districts in the 100 – 150 km radius. Since the hospital is built to

cater to lower and middle income group, government schemes, corporate and PSU employees, the group has taken several measures, right from the construction stage to reduce the costs of the project and operations. DURING CONSTRUCTION Hospital construction in India has been dictated by tall vertical structures due to constraints of space and location. The vertically developed struc-ture has inherent cost disadvantages such as reliance on power intensive elevators, air-conditioned spaces to keep out the noise and dust associated with crowded spaces. The tall structures also present safety issues such as evacuation of patients in times of an exigency.NH’s low cost hospital is primarily built as a pre-fabricated structure with minimal RCC construction except in the OT, catheterization lab, radiology

The hospital has taken several measures to reduce the costs of the project and operations.

and diagnostic services and ICU areas. The hospital is a ground and first floor construction, thereby reducing construction costs significantly. "The construction is designed to maximise the utilisation of natural daylight and cross ventilation to minimise electrical consumption. Traditional hospitals take over two years to build, while a low cost hospital takes less than 10 months to build. This ensures early return on investment. Moving further, we believe that will be able to reduce this time span even more and bring it to as low as six to seven months," says Karthik Ramakrishnan, vice-president, general management, Narayana Hrudayalaya Hospital.

AIR CONDITIONINGContrary to popular opinion, NH believes that air conditioning in hos-pitals presents a grave risk to patients and increases convalescence time. An improperly designed and / or improperly maintained air conditioning system could lead to the spread of infection. Moisture and humidity, along with mixing of air from different areas, provide the right platform for in-fection to develop and spread. In this low cost facility, the use of air-con-ditioning has been restricted to essential areas such as operating rooms,

28-29_HCR_APR13_Innovation.indd 28 21-03-2013 12:36:03

Innovation


• It’s a 200-bed hospital, which would later be scaled up to 500 beds.

• The inbuilt area of the hospital is one lakh square feet.

• The focus areas of the hospital are cardiology, cardiac surgery, neurology,

neurosurgery, medical and surgical gastroenterology, orthopaedics, urology,

nephrology, laparoscopic surgery, obstetrics and gynaecology.

• This is a greenfield project, for which the land has been taken on a long-

term lease. The model is built as a pre-fabricated structure with minimal

RCC construction.

• The cost of the project, inclusive of construction and equipment, is Rs48

crore.

• At a stable phase, when all the 200 beds will be operational, the number of

employees will be 450.

• The hospital boasts of a 22-bed dialysis unit, six OTs with laminar airflow

and the unique design of ICU wards. The state-of-the-art hospital has a

comprehensive radiology department with 64 slice CT and 1.5 Tesla MRI.

FAST FACTS

The use of air-conditioning has been restricted to essential areas such as operating rooms, ICUs, radiology and diagnostic rooms.

Though a low-cost project, the hospital has six OTs with laminar airflow.

Since the hospital is built to cater to lower and middle income group, the hospital has only general wards in the first phase.

ICUs, radiology and diagnostic rooms. "These areas require air condition-ing for functional requirements. All other areas have been designed for maximum ventilation and natural light, which we believe, will accelerate patient’s recuperation," says Ramakrishnan.

OPTIMAL SPACE UTILISATIONAs a common practice, patient and patient attendant waiting areas are provided inside the hospital, he informed. At Mysore, NH’s designers have optimised space utilisation by clustering waiting areas and providing them outside the clinical zones. "The saving in area, thus achieved, helps reduce the initial capital expenditure on the building," says he.

COMPANION CARE MODULEContinuity of care is an important factor to ensure holistic patient recov-ery. It is often observed that patient attendants are ill-equipped to ensure proper care, which includes basic hygiene, wound care and medicine administration. Recognising the need for this, NH has worked along with a student team from Stanford to identify gaps in attendants’ knowledge of various post-operative care requirements and equip them with the right understanding. "The patient attendants at our hospital in Mysore wouldbe trained by skilled nurses and would be encouraged to actively involve themselves in taking care of the relative (of the patient) in the hospital under expert supervision. The objective is to ensure that expert care is not only available to the patient in the hospital but is carried forward post-discharge, at home," informs Ramakrishnan.

OUTSOURCING MODELThis hospital will use the facilities of the main NH hospitals, such as the one in Bengaluru to outsource some of the back-end / non-critical activi-ties and activities, which involve special skill sets. Tele-radiology is one such area where all radiology scans taken at Mysore will be interpreted by the well-equipped and specialist team at NH Bengaluru. "This will not only help prevent duplication of resources but also ensure optimal utilisation of specialists like radiologists, something which is at the core of NH’s operational philosophy," says Ramakrishnan. Similarly, activities such as claim processing and discharge summary preparation will also be outsourced to the larger NH facilities.

As a common practice, patient and patient attendant waiting areas are

provided inside the hospital” — KARTHIK RAMAKRISHNAN, VP, GENERAL MANAGEMENT, NH

28-29_HCR_APR13_Innovation.indd 29 21-03-2013 12:36:07

Opinion


Steven Carlyle was only 18 when he gave hope of life to six-year-old Samantha, unknown to him till then. As a blood stem cell donor, Steven extended Samantha’s life

span, besides sparing her from undergoing painful chemo treatments for leukaemia. And for Steven, life has been as usual—university, basket ball practice and music lessons, except for a couple of days of rest for recuperation. This is just one among thousands of instances in the US of unrelated blood stem cell donation. In India, ironically, such examples are few and far between.

I say ‘ironically’, because, considering the population of our country, ideally we should have had thousands of volunteers willing to donate their blood stem cells. Especially, since the incidence of leukaemia and other blood-related critical illnesses are on the rise in the country as per research. A recent report indicated that over 55,000 children are af-flicted with some form of malignancy, the most common being leukaemia.

DEARTH OF DONORSOne has heard of private umbilical and men-strual cord blood banks meant only for indi-viduals to use for themselves, when necessary. But few are aware that a concept of ‘unrelated blood stem cell donor’ even exists.

There are more than 20.5 million registered donors in the world. But in India donors are not coming forward in hordes because of low awareness levels among them about the blood stem cell procedure. Few people know that blood stem cell donation is as simple as blood donation. Among those who are aware, there is a fear that they will become weak or fall ill

Call for a causeIndia needs thousands of volunteers for blood stem cell donation to unrelated patients, who need a new lease of lifeBY RAGHU RAJAGOPAL

after a blood stem donation procedure. Most blood stem cell donations happen

among close blood relatives, provided their HLA typing matches. There are few ‘unrelated blood stem cell donor registries’ that are work-ing towards making blood stem cell donation an accepted concept among general public.

REGISTRY BENEFITSAlthough families in India come forward to donate blood stem cells, most times, patients with life threatening blood disorders don’t find a match among their siblings. In fact, the prob-ability of finding a sibling match is only about 25 per cent. Hence, patients have to look out-side the family for a donor, called the unrelated blood stem cell donor.

This is where registry of unrelated stem cell donor helps. Developed countries now boast of hundreds of such registries. There are 65 regis-tries in the world that are recognised as mem-bers of the World Marrow Donor Association (WMDA). Datri is one of them, which improve the chance of finding a matching donor for a critically-ill patient.

This is precisely an area where our country, despite its huge populace, lags behind. As the blood stem cell matching is closely related to ethnicity, there is a dire need to quickly start building such a database, as also build awareness of the concept. A registry is only a database of a donor’s HLA type; it does not physically store blood or stem cells.

At Datri, we get requests for a match from the registry of the country where the patients are getting treated or from the transplant phy-sician from the transplant centre. If the HLA typing matches with that of any of Datri’s list of donors, then the stem cell collection is done

through ‘apheresis.’ This process is to a platelet collection process and is as simple. In it, only stem cells are extracted from the blood and the remaining blood is infused back into the donor’s body. The stem cells are then delivered to the transplant centre, where the recipient is waiting.

URGENT NEED FOR AWARENESSAwareness of the need for this type of registry has to be created, so that we see a more willing public coming forward to register themselves as donors. Worldwide, several not-for-profit organisations have been working in the area and have the experience and expertise needed to handle such a registry.

However, the greater challenge would be in educating the public to come forward to donate healthy blood stem cells for a cause. Firstly, not many people know that they could be the only hope for a patient’s survival and second, even fewer people know that the pro-cedure is simple and harmless and can be over in a few hours.

There are myths surrounding this medical practice and it would help if healthcare institutions get together to increase awareness of this practice through drives and education programmes aimed at enrolling young people for this noble purpose.

Raghu Rajagopal is co-founder and CEO, DATRI Blood Stem Cell Donors Registry, India’s sole public blood donor registry affili-ated to the World Marrow Donor Association.

30_HCR_APR13_Opinion.indd 30 21-03-2013 12:37:09

EVENT CALENDAR


HospiArchOrganised by: Amen Business SolutionsWhen: 27 April Where: Lucknow

10th Healthcare Executive Management Development ProgrammeWhen: 28 April – 4 May 2013Where: Srinagar

HospiArchOrganised by: Amen Business SolutionsWhen: May 2013 Where: Jaipur

XVth National Seminar on Hospital / Healthcare Management, Medico-Legal Systems and Clinical ResearchOrganised by: Symbiosis Centre for HealthcareWhen: 3 – 4 May 2013Where: Pune

III Internationl congress on patient safetyWhen: 6 – 7 September 2013Where: Hyderabad InternationalConvention Centre, Hyderabad

Smart Healthcare India Summit 201323 - 24 May, 2013, ITC Gardenia, BengaluruContact: Mushrif, general manager, conferences on +91 98201 53334 or [email protected] For speaking opportunities, contact Alysha Lobo, project manager on +91 9769 616685. For registrations get in touch with Anjali Shetty, sales manager, conferences on +91 22 6154 6010

Bangalore Palace, Bengaluru

31_HCR_April13_Event Calendar.indd 31 21-03-2013 12:38:28

Best practices


It’s all about hygieneIn healthcare institutions, cleanliness is indeed next to godliness. We track the latest hygienic floor cleaning practices BY TEAM HR

While we may judge the cleanliness of a place by the smells and the sights, neither a vis-ibly cleaned floor nor

the smell of a disinfectant is any indication of whether the hospital floor is really clean. It is the duty of a healthcare institution to make the patient feel that the environment is clean as a hygienically cleaned floor gives patients a sense of safety.

According to Debapratim Dinda, advanced engineer, building & commercial services divi-sion, 3M, in healthcare settings, cleanliness has

to be maintained round the clock. “A hygienic atmosphere is a must for centres that deal with diseases and patients,” says Dinda.

FOR PSYCHOSOMATIC HEALINGThe cleaning practices a hospital follows are crucial. Says Lalit Sharma, sector head, healthcare and commercial laundry, India and SAARC Countries, Diversey, (a part of Sealed Air), “A hospital does not have to look or smell like a hospital and that’s where effective floor cleaning practices come into the picture.” He adds that cleanliness does serve as a motivator for staff and provides psychosomatic healing

for patients. Thus, cleaning takes a step ahead when it comes to cleaning in hospitals. In com-parison with cleaning process in other build-ings, hospital cleaning demands more scrutiny and monitoring. Hygiene becomes the primary requirement here as it concerns the health of the patients and that of the people visiting and working there.

Says Raja Mukherjee, national head, train-ing and technical services/marketing, Forbes Pro-Clean Technology Solutions, Eureka Forbes Limited, “In India, with the advent of multi specialty hospitals and private run hospitals, aesthetics have also been added to the requirements of hygiene and cleanliness.”

Mechanised cleaning is being adopted in Indian hospitals too.

Mechanised meansScrubber dryers: Used for effectively wash-ing and scrubbing the floor using rotating brushes, these dryers then dry the floors using a system of squeegees and sometimes vacuums. Single disc floor scrubbers: Most useful in narrow areas or passages, these scrubbers are also light weight and compact. Automatic floor scrubbers: Used to scrub a floor clean of light dust, oil, grease or floor marks, these can be used to scrub the floor and thereafter vacuum it with an auto scrubber squeegee.Ride-on scrubber dryers: These require the operator to ride and control the cleaning operation at the same time. They reduce the operator time and enhance the efficiency and reduce floor cleaning expenses considerably.Steam cleaners: These employ steam for cleaning purposes.High pressure cleaners: Available in cold and hot varieties, these cleaners are heavy duty. The cold water high-pressure cleaners remove stubborn dirt and are ideal for large areas. Hot water high pressure cleaners clean even better with using the same amount of pressure.

Cour

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32_35_HCR_APR13_Best practices.indd 32 21-03-2013 12:40:38

Best practices


He adds that while the cleanliness standards, some years back, was considered dismal for the Government-run hospitals, today public hospitals like AIIMS, GB Pant hospital and PGI Chandigarh too have gone for outsourcing their cleaning process to facility management companies that take the lead to keep the prem-ises spic and span.

CLEAN CHANGESThe following are the key changing factors in hospital floor cleanliness. MECHANISED CLEANING While the West has adopted mechanised cleaning at an early stage, making it as an SOP

in their cleaning systems, Indian hospitals have only recently taken to replacing manual cleaning with it. Mechanised cleaning has brought in various machines like scrubber dryer, vacuum cleaners, single disk floor scrub-bers and polishing machines, automatic floor scrubbers (walk behind and ride on), sweep-ers, ride on scrubber dryers, carpet shampoo-ing machines, high pressure cleaners (both cold and hot and cold) and steam cleaners into their cleaning processes.

Mechanised cleaning has helped enhance standards, productivity and longevity of opera-tions. “The ‘no touch’ system of mechanised cleaning has gone down well with the janitors, who have retained their interest to deliver the same diligence day in and day out. The system-atic procedures have brought an accountability factor into the systems, providing monitoring options for the users,” says Mukherjee.

MICROFIBRE MOPPINGFrom the use of conventional loop mops for wet mopping, today hospitals are switching over to a new mopping technique that involves microfibre materials to clean floors. Experts point out that to reduce the risk of cross-con-tamination, conventional mopping techniques demand frequently changing the cleaning solution. However with microfibre mop, the

mop head is changed after mopping every room, thus eliminating the need of wring-ing a conventional mop and also doing away with the need of frequent solution changes. In microfibre mopping, the split structure of the fibre makes all the difference: “The microfibre collects the parts of the dirt and leaves the sur-face clean and dry. On the other hand, normal fibres only push the dirt ahead, leaving the sur-

Staff supportHealthcare support workers should be acutely conscious of the critical nature of their work and should not see their work as simply a physical task unrelated to healthcare delivery. Patient care relies as much on the work of ancillary support workers as it does on doctors, nurses and technicians. “Hospital housekeeping staff must have specialised knowledge specific to a healthcare site and unit where they work. They should be required to follow complex and exacting cleaning protocols. They should be conscious of the risks involved in their work and of the grave consequences of errors on their part. Cleaning in hospitals is more demanding and complicated as patients are often present and require additional support and assistance. It is also crucial to recognise the distinct and differ-ent needs that are met in a hospital,” says Lalit Sharma of Diversey.

When it comes to closing the infection control loop in a healthcare facility, the staff members of the environmental services or housekeeping department play a critical role: they can either undermine clinicians’ efforts or support the institution-wide goal of prevent-ing the transmission of pathogens. In an acute care setting, housekeeping is second only to hand hygiene in importance in the infection control loop. “There is no surgical technique, no wound-care strategy and no antibiotic prescription regime that can offset the impact of a dirty hospital,” says Sharma.

Mechanised cleaning brings in various machines that help do a good job with minimum effort.

There is no antibiotic prescription regime that can offset the impact of a dirty hospital"— LALIT SHARMA, SECTOR HEAD, HEALTHCARE

AND COMMERCIAL LAUNDRY, INDIA AND SAARC

COUNTRIES, SEALED AIR


Best practices


using huge amounts of dry and wet mops and cleaning them properly. As the mops are often used in areas far from the laundry room, establishing an efficient mop use and mop laundry is an advanced logistical chal-lenge. Also, hospitals have different flooring surfaces, different types of contaminants and different cleaning and sanitation require-ments — all of which make the cleaning exercise more challenging.

tion with pathogens increases significantly. The critical hygiene requirement is to identify all risk areas and set up a well-controlled and integrated cleaning and disinfection programme. “With over 80 per cent of all hospital infections taking place in the OTs and the ICUs, the Hospital Infection Control committee, at times, can be too obsessed with implementing stringent and wholesome infection control programmes and probably undermine the importance of cleaning and hygiene in the not- so-critical areas,” says he.

A washroom can as much be a potential source of acquiring infections as the OT. Or, the food that is being prepared in the kitchen can as much be a potential source of cross-contamination as would be an inappropriate hand hygiene. Only by adopting a holistic and integrated approach can such infections be reduced. So, not only using the right products but also managing all aspects of cleaning and hygiene into a workable and consistent pro-gramme is important.

MAJOR CHALLENGESAccording to Dinda, the challenges related to hospital floor cleanliness are related to

Establishing an efficient mop use and mop laundry is an advanced logistical challenge.

A ride on auto scrubber drier being used in the OPD section of the AIIMS hospital in New Delhi.

The ‘no touch’ system of mechanised cleaning has gone down well with the janitors, who have retained their interest to deliver the same diligence day in and day out"— RAJA MUKHERJEE, NATIONAL HEAD, TRAINING

AND TECHNICAL SERVICES/MARKETING

FORBES PRO-CLEAN TECHNOLOGY SOLUTIONS,

EUREKA FORBES LIMITED

face dirty,” says Sharma. Microfibre mopping is easier and less tiring, and thus preferred by workers. It also reduces the amount of water and chemicals used.

USING GREEN PRODUCTS When it comes to floor cleaning, a majority of hospitals in the country are still stuck with old fashioned cleaning chemicals. However, the trend is slowly changing to using chemi-cals that are green, thus reducing environ-mental and health impacts. “In hospitals, emphasis on green chemicals has increased through the implementation of NAHP certifi-cation apart from the HACCP requirements. The biodegradability of product and equip-ment has become an important factor for their selection,” says Mukherjee.

India is also waking up to a new technol-ogy in surface cleaning: Accelerated Hydro-gen Peroxide technology or AHP. The AHP Technology is one of the newest disinfectant technologies to be brought to the market in the US. “The AHP technology, which is a disinfectant technology based on hydro-gen peroxide, offers advantages like broad efficacy, realistic contact times, excellent surface safety, excellent worker safety, better cleaning and sustainability,” says Sharma. Many cleaners that contain AHP are ‘Green Seal’ certified.

AREAS TO BE COVEREDAccording to Sharma, without good hygiene the chance of cross-contamination and infec-

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Best practices


Mechanised cleaning has helped enhance standards, productivity and longevity of operations.

Frequency matters

The frequency of cleaning hospital floor depends on area to be cleaned. It’s impor-tant to use the highest level of cleaning and disinfection for the floor cleaning of ICUs and OTs. “The OPD, which is an area with the larg-est footfall in the premises, demands cleaning at regular intervals with a mix of damp and dry moping. The administrative block and the outside areas can be cleaned once or twice a day. The wards, washrooms and the special rooms should have more frequent cleaning schedules. The OTs require cleaning after every use to prevent cross contamination,” says Raja Mukherjee of Forbes Pro- Clean Technology Solutions, Eureka Forbes Limited.

THE ROAD AHEADIn the coming years, experts point out that besides more hospitals going for mechanised cleaning, there would be emergence of top-down microfibre system. A top-down micro-fibre is a complete system, which consists of microfibre cloth, bucket with ermetic cover and trolley among other things.

“The advantages of a top-down microfibre system are it avoids the change of cloth outside the laundry or preparation room, has no risks of pollution and have higher cleaning effect due to the high capacity to pick up dust. Ad-ditionally, it comes with higher life durance of

the cloths, reduction of effective duration of work and is also easy to use,” says Sharma. Be-sides popularity of AHP Technology and green solutions, hospitals would be seen taking into consideration the areas outside the hospital building for cleanliness.

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TECH CZAR

PHILIPPE CHARRAUDEAU OF ITC GRAND CHOLA ON WHATIT TAKES TO RUN INDIA’S MOST HIGH-TECH PROPERTY

ROUND-UP OF THE LATEST IN KITCHEN EQUIPMENT

FOCUS ON TECHNOLOGY & INNOVATIONS

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LOAD-REDUCING INNOVATIONS IN HVAC

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Embracing modern thinking Vol 1 • Issue 6 • Rs50An ITP Publishing India publication

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MEDICALL 2013A LOW-DOWN

PPP: SOLUTION TO INDIA’S HEALTHCARE WOES?

HOW BAPS YOGIJI MAHARAJ HOSPITAL INCREASED EFFICIENCY

DEBATE: DOCTORS VERSUS SUPPORT STAFF


AGAINST ALL ODDSDR BS AJAI KUMAR, CHAIRMAN, HEALTHCARE GLOBAL ENTERPRISE, ON MAKING CANCER CARE PROFITABLE

IN FOCUS

CASE STUDY MAKEOVER OF PARAS HMRI

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march 2013 | Volume 2 | Issue 3 |`50rIght from the heart of the Industry

an ItP Publishing India publication

Retail Todaytotal number of pages 66

on the Upswing

Legal Metrology Act 2009 analysed

pLus Green thumb

Interview

IRE 2013

Brick to click

Online potential

s Ravichandran onsmart franchising

Hop on to the sustainability bandwagon

hypercity ceo MArk AshMAn is All set to jUggle strAtegies to reinvent the brAnd

e-tAiL focus

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Total number of pages 56Volume 1 | Issue 2 | March 2013 | `50

ETElEctricals todayMore power to the industry

powerlessDESPITE THE HYPE, P CHIDAMBARAM’S BuDgET FAILED TO OFFER THE

Is It tIme for a rethInk on PPa condItIons?

focus

SECTOR ANY LIgHT AT THE END OF THE LONg, DARk TuNNEL

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ENTREPRENEURS LIKE ABHISHECK LODHA ARE INSPIRING PLAYERS

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WWW.CONSTRUCTIONWEEKONLINE.IN

COMMENTREVOLUTIONISING HOUSING FINANCE

PEB SPECIAL WHAT’S DRIVING THE SECTOR IN INDIA?

BIG INTERVIEW SUDHIR KRISHNA, SECRETARY, MINISTRY OF URBAN DEVELOPMENT

EXPERTS BRAINSTORM ON CRITICAL ISSUES AILING URBAN TRANSPORTATION

METRO RAIL SUMMIT

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Manufacturingyour Decisive Tool

for ManufacTuring excellence

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March 2013 | `50

AnAlysis

Auto components

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Is the stage all set for the next boom?

masterIng the tool selectIon process

How SMEs canleverage technology

top visionariestop visionariesmagnates like siemens india’s managing director armin Bruck

are taking the manufacturing industry to the next level

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IN A NEW LIGHTNOTED DOP RAVI K CHANDRAN

DEBUTS AS FILM DIRECTOR

SPOTLIGHT

REVEALED

PREVIEWFICCI M&E SUMMIT

KIMBERLY WALSH’S TRUE COLOURS

CABSAT DUBAI


Vol. 5 | Issue 3 | March 2013 | ̀ 50

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Ideas, inspiration and insight for architects and interior designers Volume 4 | Issue 12 | March 2013 | `50

iGen architects like Kohelika Kohli are designing the new India

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Gen

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Cutting edge


Keeping abreastThe many benefits of trans-umbilical breast augmentationBY DR ABRAHAM ZACHARIAH

O ver the years, breast aug-mentation techniques have undergone a wide change. The very first method of breast augmentation was

developed in the 1950s by two surgeons from Texas. In this method, implants made out of liquid silicone were inserted through cuts made on the skin under the breast folds, in the so-called infra-mammary method. Though this is a simple method, the downside is that the ‘smile‘ scars are obviously visible and there is a slightly higher chance for the implants to erode the relatively thin tissues in the skin fold below the breasts. Also, there is discomfort from the support brassiere pressing on the skin cuts during the healing phase.

TOWARDS SCAR-LESS SURGERYThe old adage, “necessity is the mother of invention” has turned out to be true for breast augmentation techniques. In their quest to hide the surgical scars, cosmetic surgeons then developed the “peri-areolar” technique in which the cut is made on the periphery of the areola, the pigmented circle around the nipples. The motive of the technique is to have scars that are harder to notice. However, with this technique, which takes longer, even though the chances are remote, there is a possibility of losing nipple sensation. It may also pose difficulties in breast feeding.

Surgeons then developed the “trans-axillary” method. Here, the surgical scars are hidden in the natural skin crease in the arm pit, which gives this method an advantage. The downside is that it is physically more

demanding on the surgeon, when the implants are placed in its space deep in to the pectoral muscles. Before the advent of surgical cameras and endoscopes in the field of breast cosmetic surgery, reduced visibility was a detriment in this type of technique. But today, this is a moot issue. Another disadvantage of this type of operation is the very remote possibility of injury to the sensory nerve of the nipple that traverses the tissues of the armpit on its way to the nipple. Because of the moisture from the sweat glands in the arm pit, some patients experience minor infections, which even though not serious, can produce ugly scars, which beats the very purpose of this technique.

SINGLE INCISION TECHNIQUEThen came the trans-umbilical breast

augmentation, the latest in the evolution of breast augmentation surgery. In the trans-umbilical method, the small skin cut is made in the umbilicus, which is the Latin word for navel. This method requires only a single cut, a very small one that is almost invisibly situated in the pit of the navel. The healing of the cut happens typically in about two weeks. The technique takes the least amount of time to perform. Most women, who choose this technique, are able to resume their full level of usual activities within a couple of weeks, or even earlier when the implants are placed right underneath the breast tissue. Because the skin cut is only a few millimetres long, only saline implants are used for this procedure.

Many surgeons and patients feel more secure about saline implants as compared

36-37_HCR_Apr13_Cutting edge.indd 36 21-03-2013 12:42:21

Cutting edge


• There are two different types of breast

implants. One is filled with silicone gel and

other variety is filled with sterile salt water

(called saline solution in medical terminology),

which is the same solution that is administered

intravenously when an individual is in need

of fluid for hydration. Among many surgeons,

especially in North America and Canada,

there are some real concerns regarding the

long-term safety of silicone used to fill the

silicone implants, even though the industry

standards have improved over the years. They

feel that saline solution used in the saline

implants is physiologically safe for the body.

The manufacturers seem to promote silicone

implants, which costs more.

• In most western countries and in South

America, surgeons prefer to place the breast

implants underneath the pectoral muscles

as they believe that it gives a more natural

and pleasing appearance. According to them,

if the implants are placed right under the

breast tissues, they have a fake appearance

as they are more likely to be noticed because

the silhouette of the edges of the implants

protruding under the skin.

• However, many other surgeons prefer to place

the implants directly under the breast tissue

because it is a much easier method to perform

and also, patients tend to complain less about

post-operative discomfort.

SOME KEY POINTSDoctors/counsellors should help patients have realistic expectations from the procedure. A preliminary consultation can help the patient determine whether breast augmentation is right for her. There are not many long-term side effects to breast augmentation surgery. Most women who have breast implants believe that they feel better about themselves and more sensuous. The one single negative thing about breast implants is that some women tend to develop firmness of the breasts, over time. This condition is called “capsular contracture”. In this condition, there is increased internal scar tissue build-up around the implants. This condition is treatable. So far, the TUBA method seems to have the least problems with capsular contracture.

Also, when the implant is placed sub muscularly under the pectoral muscle, there is a lower chance of capsular contracture (contraction of the tissue capsule surrounding the implant), and mammography is more reliable.

to silicone implants. Some criticism had been raised that saline implants have a less natural feel in very skinny women, but that issue is negated with the implants placed under the pectoral muscles, which give them nice padding and hence a natural feel and appearance. Furthermore, the chance of infection of the surgical incision with this method is rare.

THE TUBA METHODTUBA, the acronym for Trans-Umbilical Breast Augmentation, is the most advanced method of enlarging the size of a woman’s breasts using implants. TUBA derives its name from the Latin word umbilicus, which in English, means the navel.

Cosmetic surgeons have a choice of two locations underneath the breasts where the implants can be positioned: directly deep into the breast tissue (sub-glandular location), or deep into the pectoral muscles (sub-muscular location) that are situated under the breast tissues.

There is hardly any blood loss with the TUBA method. Nipple sensation is preserved and ability to breast-feed is retained. TUBA is an improvement over the earlier methods of breast augmentation and is a safe procedure that has produced pleasing and satisfying results.

However, not many surgeons have been able to master this technique and the ones who have not, tend to raise unfounded criticism. TUBA procedure was invented and first described by the American cosmetic surgeon, Dr Gerald Johnson of Houston, Texas, who personally trained a handful of surgeons, in this procedure. I was fortunate to be among the group.

Dr Abraham Zachariah is a cosmetic surgeon with SevenHills Hospital, Mumbai.

TYPES AND PLACING OF BREAST IMPLANTS

Sub-cutaneous “tunnels” to introduce the implants, via the umbilicus, and the location of implant “pockets” are marked pre-operatively.

Subcutaneous 'tunnels' created by special endoscopic instruments.

Temporary tissue expander balloon is inserted and hyper-inflated to stretch open the 'pocket' for placing implant (Here, the depiction shows the pocket being cre-ated above the pectoralis major muscle. The pocket can also be created under the pectoralis major muscle).

The permanent implant is deployed into the 'pocket' and filled to the desired size, with saline solution. (The implant can also be positioned in a sub-pectoral pocket, under the pectoralis major muscle).

36-37_HCR_Apr13_Cutting edge.indd 37 21-03-2013 12:42:22


Patient relations

Mr Raj comes to the reception desk of a hospital to register a consultation with Dr Krishnan. He finds the

receptionist busy talking on her mobile phone on what is obviously a personal call. A few minutes later, she looks momentarily at Mr Raj, to say that the doctor will be available after two hours, and then starts reading something on her desk. When Mr Raj asks for directions to the consultation chamber, she tells him to look at a board nearby, without lifting her head.

Mr Raj arrives at Dr Krishnan’s consultation chamber and awaits his turn. The two hours get over, and then another half hour, but Dr Krishnan is nowhere to be seen. Mr Raj asks the attending nurse about his appointment, and she loudly replies: “Wait outside! I’ll call you when doctor arrives.”

Mr Raj goes back to his seat. Dr Krishnan ar-rives some time later. There is no apology from him for being late. When Mr Raj gets his turn, the doctor shoots off a few questions about Mr

Is your staff well behaved?A hospital’s reputation depends not just on patient outcomes, but also on how its staff behaves with patientsBY DR BADARI DATTA

Raj’s problem and then bluntly tells him that it’s because of his lifestyle. Mr Raj feels guilty and embarrassed.

He leaves the consultation chamber and is asking the nurse for directions to the pharma-cy, when he overhears Dr Krishnan mention-ing his name to the next patient. The doctor is quoting Mr Raj as an example: “If you don’t change your lifestyle now, you will also become like that fat man who went out as you entered my chamber.” After his initial shock and disbe-lief, Mr Raj feels humiliated. He returns home depressed.

How would you have felt if you were Mr Raj? If you had thought, this kind of behaviour is certainly not expected of a hospital and its staff, you would be absolutely right.

EXPECTATIONS FROM HEALTHCARE PROFESSIONALSThe management of a healthcare facility as well as its patients and visitors expect a certain standard of behaviour from its healthcare pro-fessionals. These expectations can be classified into three groups:

Aspirational expectations: These expecta-tions are what people aspire for. But they are more utopian than reality. The expecta-tions are high and concern such behaviours of people that may not be exhibited at all or exhibited by very few – those of the highest character and integrity.

These expectations are in accordance with the vision statement of a healthcare facility. For instance, a hospital’s vision statement might state that its staff will treat all patients with the love and compassion of Mother Te-resa; notwithstanding the fact that very rarely indeed will a worker reach Mother Teresa’s standards. (As a rule, however, institutions set ambitious goals in the hope that the ideals they represent will have the needed motivational value.) If one achieves aspirational levels of behaviour, conflicts rarely arise and, when they do, a solution is reached without ego clashes. The fulfilment of aspirational expectations leads to the growth of love and trust. When you meet a person who displays such behav-iour, you wish there were more people like them around.

38-39_HCR_APR13_Patient relations.indd 38 21-03-2013 12:43:45

Patient relations


Minimum expectations: The minimum standards of behaviour that a patient and the administration of a healthcare facility expects from healthcare professionals. Most patients take this kind of behaviour for granted. It is routine and makes them neither happy nor angry. Human dignity and patient confidential-ity are maintained. Conflicts arise frequently and are resolved with difficulty. However, basic patient rights are not violated.

Dr Badari Datta is associate professor and consultant, ENT department and head of quality department at Bangalore Baptist Hospital.

Reasonable expectations: Behaviour that meets reasonable expectations, although not the best, is nevertheless what most humans manifest under normal circumstances. Al-though conflicts do arise when such behaviour is demonstrated, they are resolved with some stress and strain. Healthcare institutions that display reasonable behaviour assure the provi-sion of adequate levels of treatment and care and are not guilty of violating patient rights.

WHAT CONSTITUTES UNACCEPTABLE BEHAVIOUR

Unacceptable behaviour refers to behaviour that is

even below the level of minimum expectations. It

is vital for a healthcare worker to know the kinds

of behaviour that are unacceptable to patients,

colleagues and the administration in a hospital

so that the worker may carry on with his work

successfully.

The responsibility of defining what unacceptable

behaviour is and providing guidelines for employees

to avoid such behaviour lies with the administration

of a healthcare facility.

The following is a sample list of unacceptable

behaviour:

• Any behaviour of the caregiver that violates a

patient’s rights.

• Any behaviour that causes or increases the risk of

patient or employee safety.

• Any behaviour exhibited by a caregiver that does

not uphold the dignity and confidentiality of a

patient.

• Any aggressive behaviour displayed towards

visitors or colleagues.

• Any behaviour violating the law and medical

ethics of the land.

• Any behaviour leading to such levels of patient

dissatisfaction that result in the patient or their

relative not returning to the same doctor or

hospital.

However, as there is often a very thin line between

minimum-expectations behaviour and unacceptable

behaviour, we shall use a scenario-based approach

from real-life experience to draw the line precisely.

Scenario 1A 70-year-old lady, Mrs Nair, is sitting in Dr Bhaskar’s

chamber with her anxious family. The whole family

is depressed, disturbed and tense. Dr Bhaskar has

just told them that Mrs Nair has stage 4 cancer of

the uterus. He explains the treatment options. But

the family gets the feeling that he is not very hopeful

about the success of the treatment. So, they have

already lost hope for Mrs Nair. At that point, the

doctor’s friend, a Dr Chandran, enters the room with

his daughter’s wedding invitation cards in hand.

Dr Chandran has not realised the seriousness

of the atmosphere in Dr Bhaskar’s chamber and,

although initially, Dr Bhaskar tries to put him off, he

soon gets sucked into the conversation. They talk

about Dr Chandran’s future plans, the bride and the

wedding. After a few minutes, Dr Chandran leaves.

Dr Bhaskar puts on a grave face and continues the

conversation with Mrs Nair and her family about her

future treatment.

Learning point: If we do not empathise with

patients and their families, there is a real possibility

that, knowingly or unknowingly, we may hurt their

feelings. Sometimes, the damage is irrevocable.

Points to ponder:

• How do we make sure that we aren’t

interrupted during a serious conversation with

a patient or their family, such as when we are

breaking a bad news?

• How should Dr Bhaskar have cut short his

conversation with Dr Chandran at the outset?

• Do you think Dr Bhaskar’s apology to Mrs Nair

and her family, towards the end helped?

Scenario 2Twenty five -year-old Eswaran has undergone

circumcision surgery. He comes to the minor

operation theatre for the first post-operative dressing.

Dr Ganesh, the surgeon, is very friendly and nice.

He asks the young man to undress and lie down on

the examination table, and removes the dressing.

But, just then, he gets a phone call and, apologising

for the interruption, goes out to take the call. He

then gets busy with some other work, completely

forgetting that Eswaran is still waiting.

Meanwhile, some nurses and doctors enter the

minor OT and see Eswaran lying there. Eswaran is

acutely embarrassed. Dr Ganesh returns after 15

minutes and, realising that he has forgotten all about

Eswaran, is most ashamed. But he picks up from

where he left off, as if it’s nothing, and says, “It’s OK,

all humans have similar organ parts, after all. You

mustn’t mind this.” But it doesn’t help Eswaran in

the least.

Learning point: Patient dignity should be respected

at all costs, and no excuses. In areas like wards,

clinics and OTs, we must be sensitive to the patient’s

need for privacy and dignity, which can easily be

compromised. Knowing the limits will help us be

conscious of when we are in danger of overstepping

our bounds. This awareness is key to ethical conduct

as a healthcare-provider and is developed by

continual introspection.

Points to ponder:

• Although Dr Ganesh made Eswaran wait in

an exposed position for 15 minutes on the

examination table, would Eswaran have perceived

it as just 15 minutes?

• Can you think of situations where patient privacy

and dignity can be compromised in a hospital?

Excerpted with permission from the book Communicate. Care. Cure ... A Bangalore Baptist Hospital Initiative for the Nation, which earned Bangalore Baptist Hospital the prestigious QCI-DL Shah National Quality Award 2013 for Healthcare Communication.

38-39_HCR_APR13_Patient relations.indd 39 21-03-2013 12:43:48

Event report


HospiArch, the premiere conference on hospital planning, design and architecture held in Chen-nai, Hyderabad, Mumbai,

Bengaluru, Kochi, Delhi, and Vijayawada, was successfully conducted in Chandigarh. The event, for which, Healthcare Radius was one of the media partners, was a learning platform for hospital promoters, administrators as well as project directors. Here’s what a few key speak-ers spoke on.

Dr Preethi Pradhan, Dean, Chitkara School of Health Sciences Topic: Hospital planning, design and architectureGist: The nine strategic essentials in hospital planning, design and architecture are design

for flexibility and ex-pandability, anticipat-ing change in demand functions, building healthcare hotels, em-phasising on patient-focused hospitals, focusing on energy conservation, creating a healing architec-ture, focusing on aesthetics, planning for green hospitals

Building better hospitalsHospiArch, held in Chandigarh, had an eclectic mix of topics about designing truly patient-friendly hospitals

and visualising the hospital of the future. Healing architecture: Patients deserve to receive treatment in a salubrious environment even if they give the highest priority to obtain-ing the best treatment. Aesthetics, which is the quality of the total experience of our surround-ings as perceived by our senses and intellect, should be planned for all its dimensions.Green hospitals: Some of the parameters to be added for green hospitals are using passive solar energy, utilising renewable sources of energy such as solar, wind and biogas, proper waste disposal, going organic, using non-toxic and non-allergic materials in hospital building and using natural light and ventilators.

The challenge is to reach a point where green architecture is indistinguishable from good architecture.

The hospital of the future will successfully be reformed into organ-based centres that have a building of their own. The patients would only be moved around in the hospital in excep-tional cases, when there is a need for highly specialised diagnostic equipment or treatment.

Anuj Jindal, Senior consultant, HOSPACCX India SystemsTopic: Budgeting and financial planning of a new hospitalGist: Building a hospital entails several key as-pects. First, it involves market research, which includes demographics, current providers, gap

analysis, availability of talent, defining target market and busi-ness model. Second, it involves financial feasibility, which includes making a revenue estimate, capex opex estimates, profitability analysis and project report. The requirements to build a hospital are

land, building, interiors and furniture, medical equipment, engineering services and utilities and office equipment.

The various options to fund a hospital include promoters contribution (equity or unsecured loans), debt/external funding (from banks/financial institutions generator). The project cost estimation are land (15 per cent to 18 per cent of project cost), building (25 per cent to 28 per cent), interiors & furniture (5 per cent to 7 per cent), medical equipment (30 per cent to 35 per cent), utilities and office equipment (5 per cent to 7 per cent), work-ing capital margin (2 per cent) and pre-op expenses (3 per cent).

In a 200-bed hospital, say built over two acres, the cost of the building should be Rs16 lakh, that of building Rs25 lakh, medical equip-ment at Rs32 lakh and rest for treatment plant,

40-41_HCR_APR13_Event report.indd 40 21-03-2013 12:45:06

Event report


medical equipment inventory for purchase cost, purchase date, equipment type and department name.

Medical equipment planning and layout design are one of the trickiest parts within the hospital design process and should thus have a multi-discipline approach. The advi-sory group should have representation from clinical super speciality, medical/clinical staff — physician, doctors — finance and account-ing team, purchase team, management / administration team, biomedical engineering team, building, plant and facilities team, IT and nursing ward staff.

Gp Capt (Dr) Sanjeev Sood, hospital and health systems administrator Topic: Quality standards applicable to hospi-tal planning

In evidence-based design (EBD), the link-age of the physical environment with safety and quality outcomes for patients is estab-lished. EBD is the process of basing decisions about the built environment on credible re-search to achieve the best possible outcomes. This design process leads to demonstrated improvements in the organisation’s clinical outcomes, economic performance, productiv-ity, and clientele satisfaction.

Measurable de-livery outcomes aim at creating environ-ments that are

therapeutic and healing, supportive of family involvement, efficient for staff per-formance and restora-tive for workers and sustainable design.

Building better healthcare build-

ings should come with Building information modelling (BIM) and Computational Fluid Dynamics (CFD). BIM is an intelligent model-based process that helps service providers achieve business results by enabling more accurate, accessible, and actionable insight through a project lifecycle. CFD simulation using CFD tools can help building design teams model designs, such as operating rooms, to visualise and analyse room air flow and temperature distribution to minimise the risk from aerosol-transmitted infections.

Planning a hospital for better infection control includes the following: functional

office equipment and working capital, among others, resulting in project cost of Rs90 lakh with a capex of Rs45 lakh per bed.

Dr Pranav Sharma, non-vascular interventional radiologist and co-founder, The TopBrass Topic: Equipment selection and optimisation

Gist: Indian corpo-rate hospitals spend about 35 per cent of their total invest-ment to get the best equipment. The investment per bed would be about Rs50 lakh to Rs1 crore and about 30 - 40 per cent of this is often spent on equipment (including OT). The

departments requiring large equipment are diagnosis area, emergency unit, radiation/imaging unit, physiotherapy units, autopsy, central labs, central pharmacy, surgery, cathlab, cardiology, ICU/ICCU, inpatient area and OTs.

The development of equipment plan involves a detailed room-by-room list of required equipment, distinguishing between new and existing equipment. The plan involves meetings with clients to develop new equipment needs, develop preliminary budget, develop alternate specifications to obtain competitive bidding on equipment, make recommendation for new equipment specifications and obtain utility requirements for all existing and new equipment.

The common requirement in the develop-ment of an equipment plan is to evaluate the current equipment. Equipment audits need to be carried out to evaluate what should be kept in service (and for how long) as against what should be replaced. Existing equip-ment assessment services should include the following: identifying master list of existing equipment, on-site evaluation of each equip-ment item, evaluating condition/functionality of equipment, making recommendation for maintaining or replacing existing equipment.

The medical equipment planning cycle should include planning, assessment, acqui-sition and disposition. Equipment plan-ning should have a systematic approach to determine the hospital’s equipment needs. It needs a complete, accurate and up-to-date

segregation of OPD, inpatients, diagnostic services and supportive services so that mix-ing of patient flow is avoided.

Separation of critical areas like OTs, ICU from general traffic, avoidance of air move-ment from areas like labs and infectious disease wards towards critical areas, support concept of zoning and ventilation standards in acute care areas. The clean corridor and dirty corridor should not be adjacent and facilitate traffic flow of clean and dirty items separately.

Dr Col BP Singh, Global Healthcare Integrated Business Solutions, ChandigarhTopic: Hospital planning: An overview

Gist: The guiding principles in hospital planning are patient care of high quality, effective community orientation, economic viability, orderly planning, sound architectural plan and state-of-the-art medi-cal technology.

The key planning and design aspects

include hospital planning team, demographic profile, health statistics, local regulations, local cultures / practices and macro/micro plan-ning. It also involves flexibility, convertibility and expandability – modular approach. In addition assessment of beds, wards, depart-ments, resources/funds, landscaping and electric load, HVAC, hospital equipment inter-departmental relationships, control of hospital infections, circulation routes, utilisation of natural light /resources and eco friendly ma-terials also need to be taken into account. The master plan includes overall site plan, section plan, department boundaries, major entry and exit points, vertical transportation – stairs, lifts, main corridors between departments and areas for future changes/expansion.

The best practices in medical architecture are designing to follow function, taking a multi-dis-ciplinary approach: scientific planning, optimum utilisation of space and making the space pa-tient, staff and visitor friendly. The focus should be on architecture that allows seamless integra-tion of clinical requirements with building plan-ning, flexibility and expandability and aesthetics, functionality and easy maintainability. One must note that contemporary hospital architecture is an amalgamation of science and art.

40-41_HCR_APR13_Event report.indd 41 21-03-2013 12:45:10

Quality control


1 2

For a hospital, getting accred-ited means getting recognised for its performance standards, by a national accreditation body (NABH) or international

accreditation organisation (JCI). It means that the hospital has managed to meet the stringent standards at various levels set by the body, which is an independent external peer. Accreditation is a testimony to a healthcare or-ganisation’s commitment to improve the safety and quality of patient care, ensure a safe care environment, and continually work towards reducing risks to patients and staff.Over the years, hospitals have realised the benefits of accreditations and now have begun to see the opportunity they provide to bench-mark against the best in the industry. Usually, the quality team of a hospital floats the idea of accreditation to the management, which needs to approve of it and commit to it—an important factor in getting through the accreditation.The first important decision that the hospital

Pull out these stopsConsidering applying for accreditation? Then, first ensure that you tackle the seven challenges that can impede your success

has to take is to either rely on in-house exper-tise or look for an external consultant to facili-tate the journey. The core team should have representation of clinicians, nursing team, quality, HR and training, and engineering. As an accreditation coordinator in one of the new multi speciality hospitals in northern India, I had the first-hand knowledge of all the processes involved. We had no external consultant and the detailed gap analysis across various departments with respect to the objec-tive elements of accreditation standards was carried out by the core team, in tandem with functional heads.We came across the following challenges, which we managed to successfully overcome, as a team, in less than one year.

INCONSISTENT PROCESSESBefore embarking on the journey to accredita-tion, most departments had no written and practiced SOPs and each department func-tioned based on the directions of respective

functional departmental heads. The core accreditation team had a major chal-lenge to break the inertia and ensure that the SOPs were prepared in time by each depart-ment. Cross functional team for audits of each department were formed to check the compli-ance with the SOPs. Implementation of the SOPs at the ground level was a key to success and intra-departmental training was strength-ened to ensure that it happened.The audit observations and its closure were linked to the key result areas of a department. The good performers in each department were recognised and rewarded. Towards the end of the accreditation journey, conducting audit had become a habit and each departmental staff ensured that there was minimum non-compliance.

UNSAFE ENVIRONMENTWe had to work on improving the hospital infrastructure to ensure safe environment for patients and staff.

BY DEEPAK AGARKHED

42_43_HCR_MAR13_Quality control.indd 42 21-03-2013 12:47:51

Clinical documentation is an important step towards accreditation.

Deepak Agarkhed is GM-clinical engineering, facilities & quality, Takshasila Healthcare and Research Services Private Limited, Bengaluru. He has done Masters in six sigma black belt.

Quality control


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We found that the adherence to national building codes on fire norms was not up to the mark. The fire sensors in some areas were partially functional, the sprinkler lines in a few areas were not charged as there was leakage of water from pipes. The fire exit passages were used as storage places and were closed. The fire exit signages were reworked in some places. There weren’t enough fire extinguishers and whatever was there weren’t even regularly serviced. The fire hydrants in some area were hardly tested and the locks to open hydrant were missing. We fixed all of that.

The air changes in OT were reworked, HEPA filtration replacement standard operating procedure established, the direct access of OT to external corridor was reworked.

The air-conditioning design for negative pressure in isolation room was reworked.

Patient safety devices like nurse call units were tested on their functionality and hand grabs were installed in every toilet.

Appropriate measures like ramps and visual signages were provided to navigate sharp bends in the building.

The signages in hospital were converted into bilingual and service directory, patient rights and responsibilities were prominently displayed.

IMPROPER DOCUMENTATIONThere were several lapses in documentation, like unsigned treatment orders, incomplete discharge sheets and medication orders. The top management understood the sensitiv-ity of the problem and addressed the issue. The resident medical officers played critical role to reduce these defects. The checklist was created to check patient files and a team of medical officers facilitated the activity both at ward and medical records office. Also, the weekly CMEs for clinicians laid emphasis on documentation and capturing of adverse events, near miss, and sentinel events.

UNTRAINED STAFF FOR EMERGENCY PREPAREDNESS The training department had identified both, hospital-wide and department-wide train-ing needs. The trainers for each activity were identified and were mapped in the training cal-endar. Classroom training and hands-on train-ing for emergencies like fire related training were conducted and feedback of the same were critically evaluated and presented to the core

team. The biggest hurdle was to get employees to attend training sessions during duty hours. The challenge became intense when occupancy increased in the hospital. The constant motiva-tion from departmental heads and the HR team helped us overcome the challenge.

The mock drills on fire, community disaster, code blue and spillage of biomedical waste involved team effort. The cohesiveness in team was achieved after repeated mock tests.

INADEQUATE INVENTORY CONTROL MEASURESConsidering the large number of stores across the hospital and drugs and consumables kept in each sub stores and patient areas, it was a major challenge to identify expired and near expiry drugs. The joint audit from central store and user department on regular basis helped reduce the error to some extent. Physical count and Hospital Information Management (HIS) count were tallied on regular basis.

LACK OF ACCEPTANCE OF DATA-DRIVEN APPROACHAccreditation pushes a hospital towards a data-driven approach as quality indicators/metrics like surgical site infection and patient satisfaction index are captured and analysed by committees. The challenge is to capture correct information regularly, undiluted by human interference. The robust HIS comes handy in most of cases. As in many cases, the accept-ance of data and arrangement to work towards betterment of metrics by functional heads was a challenge.

The top management initiative in quality improvement activities like six sigma helped the hospital to move towards the journey of continuous improvement.

PARTIAL IMPLEMENTATION OF LAWS AND REGULATIONS The list of regulatory compliances involves ob-taining and renewing pharmacy, lift and blood bank licenses before accreditation. However, before the accreditation, the hospital lacked centralised tracking of these.

The legal department took the initiative to put systems in place to track every regulatory compliance. The departmental heads started sharing all documents with the legal depart-ment and management review of regulatory compliances became a priority.

Overcoming these seven major challenges besides others like maintenance of facility/equipment, medication management, and nursing care, had helped the hospital secure accreditation within a year. This was also pos-sible because of the commitment of all stake holders—the management, the team members and the out-sourced employees.

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The objective behind launching e-Radiograph is to establish a knowledge-sharing platform, which is easily accessible for all radiologists

Consumer Connect Initiative


The right platformCarestream’s e-Radiograph offers a platform for radiologists to share best practices in medical imaging

Carestream Health India launched e-Radio-graph, a scientific bi-yearly journal in e-book format at IRIA 2013 in Indore as part of its Radiology Education Services (CRES). The main objective of this one-of-a-kind journal is to provide the radiology community with the latest news on innovations and best practices in radiology. Prabir Chatterjee, managing director, Carestream Health India, elaborates on the purpose and strategy behind this knowledge sharing initiative.

Can you briefly describe e-Radiograph to our readers?e-Radiograph is a scientific journal dedicated to radiology. It delivers in-depth technical insights and expert views in a concise, easy-to-read style. It comes in an e-book format designed to offer an informative and enjoyable read, while serving as a reference tool for practising radiologists.

What is the objective behind launching e-Radiograph?The objective behind launching e-Radiograph is to establish a knowledge-sharing platform, which is easily accessible for all radiologists. It is a perfect fit with our strategy, which is to always provide the radiology community with leading-edge knowledge and information that will help them in their practice.

Please elaborate on how you select topics and create content for e-Radiograph?We select the topics based on feedback from practising radiologists. In every issue, we intend to cover a different topic of interest in radiology. To bring out different views and perspectives, we intend to work with eminent radiologists as guest editors for each issue.

For the launch issue, Dr Anirudh Kohli, head of radiology, Breach Candy Hospital, Mumbai,

was the guest editor. In this issue, he covered the interesting topic of bowel imaging in great detail, and we are grateful for his contribution.

Where can people access e-Radiograph?e-Radiograph is available online on our website. One can simply log on to www.carestream.in/eradiograph to subscribe to the current and subsequent issues, without any charge. The online format allows busy medical professionals

to access this comprehensive educational tool from anywhere, even while commuting.

What future do you see for e-Radiograph?e-Radiograph has opened to a very positive response. Since we focus on interesting topics, collaborate with respected medical radiolo-gists, and tap into our readers’ needs, we are confident that e-Radiograph will continue to be well-received by radiologists.

The e-Radiograph is a first of its kind initiative Prabir Chatterjee, MD, Carestream Health India

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A monthly round-up of high-profile appointments and accolades in healthcare

Shakers&Movers

RAKESH SINGH APPOINTED MANIPAL COORakesh Singh has assumed charge as Chief Operating Officer (COO) for Manipal Health Enterprises, the corporate healthcare entity of Manipal Education and Medical Group (MEMG). Singh will be responsible for the entire operations and P&L of all corporate hospitals of MHE. He will also oversee MHE’s purchase, IT, sales and marketing functions. “I look forward to creating profitable business growth for the organisation with aggressive expansion of services in existing and new markets, innovative solutions and by positioning MHE’s various centres of clinical excellenc-es strongly in different markets. I would be focused on customer-centric solutions and on ensuring that Manipal brand becomes healthcare service provider of choice across all markets that Manipal operates in,” Singh said.

Singh brings with him over 24 years of business management experi-ence from some of the best Indian and MNC organisations such as Godrej, GE Appliances, Whirlpool India, Tata Teleservices and Reliance Communications. He has holds a B Tech degree in mechanical engineer-ing from IIT, Delhi, and PGDBM in marketing and finance from XLRI, Jamshedpur.

LALIT MISTRY JOINS KPMG Former COO of Ahmedabad-based BAPS Yogiji Maharaj Hospital, Lalit Mistry, has recently joined as associate director, strategy service group of KPMG India at Mumbai. “KPMG in India has a strong and focused healthcare team with a rich experience in the sector to pro-vide healthcare solutions. I will build greater depth in KPMG health-care offerings,” said Mistry. “It’s increasingly important in the recent scenario for the healthcare industry to adopt new business models and look for tools beyond healthcare industry and choose and pick the best practices and process from other industries to materialise business objectives,” he added.

Mistry holds a post graduate diploma in hospital administration from KC College of Management Studies. He has also done an Internal Counsellor Programme on NABH Standards from Quality Council of India. He has worked on more than 20 healthcare projects across In-dia, Dubai and Kenya. His areas of specialisation include: BPR, PPPs, supply chain management, process design and operating effectiveness assessment studies for streamlining systems and process.

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Movers & Shakers


DR KAMINI RAO RECEIVES SWASTH BHARAT SAMMANLeading gynaecologist and infertility specialist Dr Kamini Rao has been awarded the Swasth Bharat Samman in the gynaecology category by minister of health and family welfare Ghulam Nabi Azad. The award was given on the occasion of international Women’s Day on March 8 at a gathering of distinguished people from different walks of life.

On receiving the award, Dr Rao, who is also medical director of BACC Healthcare said, “If my work has somehow made people’s lives a little better, then I feel like it has been a huge success. I have lived my passion, which has been giving the gift of a child to those unfortunate enough not to be able to have one on their own.” She added that the inability to bear a child is regarded as a curse in India, where women still bear the brunt of social ostracism for something that often is no fault of theirs. “The joy that my team and I have brought to such couples is something that I can-not express in words,” she beamed.

The Swasth Bharath Samman Award is a national award constituted to recognise and felicitate towering personalities, who have made immense contribution to healthcare sector in the country.

DR DEVI SHETTY FELICITATED BY IMC Dr Devi Shetty, chairman, Narayana Hrudayalaya Group of Hospitals, has been awarded the 2012 IMC Juran Quality Medal by IMC’s Ram-krishna Bajaj National Quality Award Trust. The award was given by the chief guest for the ceremony, Honorable Dr Justice C S Dharmadhikari on March 13 at YB Chavan Centre, Mumbai. Viren Prasad Shetty, senior president, Narayana Hrudayalaya Group of Hospitals, accepted the award on behalf of his father Dr Devi Shetty. “Technology gives the rich what they already have and the poor something, which they could never get. We have to invest a lot in technology and this award will make us achieve our goals faster,” read Dr Shetty’s message.

Dr Shetty has been the recipient of several such awards. In 2001, Dr Shetty founded Narayana Hrudayalaya, a 250-bed multi-specialty hospital on the outskirts of Bengaluru. Today, the group has hospitals across Mysore, Dharwad, Hyderabad, Jaipur, Ahmedabad, Dharwad, Raipur, Kolar and Kolkata.

Dr Shetty has many firsts to his credit. He is the first heart surgeon in India to venture into neo-natal open-heart surgery and the first to conduct an open-heart surgery in the world. He also performed Asia's first dynamic cardio-myoplasty and the first to introduce the concept of assembly line heart surgery, which aims at reducing the cost of surgery and achieving zero mortality.

45-46_HCR_APR13_Movers & Shakers.indd 46 21-03-2013 12:50:35

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