Registered with Registrar of Newspapers under RNI No. MAHENG/2012/46040, Postal Registration No. MH/MR/N/242/MBI/12-14, Published on 27th Total number of pages 52 of every previous month. Posted at Patrika Channel Sorting Office, Mumbai-400001, Posting date: 30th & 31st of every previous month
Embracing modern thinking
February 2013 • Vol 1 • Issue 5 • Rs50
An ITP Publishing India publication
BRIG. JOE CURIAN ON THE SEVENHILLS CONTROVERSY
CASE STUDY ABMH’S EXCITING JOURNEY TO JCI ACCREDITATION FOCUS BALANCE SCORE CARD IN A HEALTHCARE SETTING ILEAL TRANSPOSITION WITH SLEEVE GASTRECTOMY
REPORT
TROUBLESHOOTERS IN SMALL HOSPITALS
IRIA 2013: CAPTURED ON CAMERA
DR MUKESH HARIAWALA SPEAKS OUT ON HIS PIONEERING TRIPLE HEART THERAPY
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Contents
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February 2013
10 NEWS
22 TECH TREND
This month’s important news updates
Dr Ramen Goel discusses the benefits of the Ileal Transposition with Sleeve Gastrectomy
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17 CASE STUDY Gulshan Vijayshankar recounts the experience of preparing Aditya Birla Memorial Hospital for JCI
24 STRAIGHT TALK Boston-based cardiac surgeon Dr Mukesh Hariawala speaks on triple heart therapy
18 RENDEZVOUS CEO Brig Joe Curian clears the air about the controversies dogging SevenHills Hospital
32 INFRASTRUCTURE Choosing the right flooring for hospitals
29 PROFILE Narayana Hrudayalaya's second multi-speciality hospital in central Karnataka
38 IRIA 2013
30 ANALYSIS
48 PREVIEW
Balanced Score Cards in healthcare settings
Medicall 2013: An event not to be missed
What made IRIA 2013 a roaring success
21 VIEWPOINT Sandip Chaudhuri underscores the need for a troubleshooter in small and medium hospitals
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Editor's Note
FEBRUARY 2013 • VOL 1 • ISSUE 5 ITP PUBLISHING INDIA PVT LTD Notan Plaza, 3rd floor, 898 Turner Road Bandra (West), Mumbai – 400050 T +91 22 6154 6000
Deputy managing director: S Saikumar Publishing director: Bibhor Srivastava
Heart felt
I
distinctly remember being seated at the packed Dr Nitu Mandke Convention Centre at the Kokilaben Dhirubhai Ambani Hospital in January 2011. I was attending the eight birth anniversary of the late Dr Nitu Mandke, one of Mumbai’s finest cardiac surgeons. Commemorating the greatness of one stalwart was another — Dr Mukesh Hariawala — a Boston-based cardiac surgeon, who was the orator at the event. Unlike the clinical talks that most surgeons deliver, Dr Hariawala spoke in a manner comprehensible and enjoyable to all. Over the next two hours, he presented his 12-year-long painstaking research work, adding dollops of humour to the serious topic. Today, his efforts have culminated into the path-breaking triple heart therapy, a combination of angiogenesis, stem cells and bypass surgery. Exactly two years later, as the therapy is being tested, discussed and deliberated around the world and is about to launched in Mumbai’s Jaslok Hospital, we decided to highlight his innovation. The cost-effective triple heart therapy is expected to be a boon for patients, who do not qualify for bypass or angioplasty. We salute the spirit of research scientists like him.
Group editor: Shafquat Ali
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The publishers regret that they cannot accept liability for error or omissions contained in this publication, however caused. The opinions and views contained in this publication are not necessarily those of the publishers. Readers are advised to seek specialist advice before acting on information contained in this publication, which is provided for general use and may not be appropriate for the readers’ particular circumstances. The ownership
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Printed and Published by Sai Kumar Shanmugam, Flat no 903, Building 47, NRI Colony, Phase – 2, Part -1, Sector 54, 56, 58, Nerul, Navi Mumbai 400706, on behalf of ITP Publishing India Private Limited, printed at Repro India Limited, Marathe Udyog Bhavan, 2nd Floor, Appasaheb Marathe Marg, Prabhadevi, Mumbai 400 025, India and published at ITP Publishing India, Notan Plaza, 3rd floor, 898 Turner Road , Bandra (West), Mumbai – 400050 Editor: Rita Dutta
WRITE TO THE EDITOR Please address your letters to: The Editor, Healthcare Radius, Notan Plaza Third Floor, 898 Turner Road, Bandra West, Mumbai - 400050 or email rita.dutta@itp.com. Please provide your full name and address, stating clearly if you do not wish us to print them. The opinions expressed in this section are of particular individuals and are in no way a reflection of the publisher’s views.
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Published by and © 2013 ITP Publishing India Pvt Ltd RNI No: MAHENG/2012/46040
Healthcare Radius February 2013
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A DV I S O R Y B OA R D OUR EDITORIAL BOARD HOLDS UP A MIRROR TO THE HEALTHCARE INDUSTRY, HELPING US UNDERSCORE THE KEY TRENDS AND DEVELOPMENTS OF THE INDUSTRY
DR NAROTTAM PURI PADMASHRI DR DR ALOK ROY chairman, NABH and ARVIND LAL chairman, Medica advisor, Fortis Healthcare chairman and managing Synergie director, Dr Lal PathLabs Pvt Ltd
DR RAVINDRA KARANJEKAR CEO, Global Hospital and chairman, NABH accreditation committee
DR GUSTAD B DAVER director, professional service, PD Hinduja Hospital
(HONY) BRIGADIER JOE CURIAN CEO, SevenHills Hospital
DR DURU SHAH eminent gynaecologist
DR PRANEET KUMAR CEO, BLK Supers Speciality Hospital and chairman, NABH appeals and grievance committee
DR MK KHANDUJA chairman, BSR Healthcare
DR NC BORAH chairman, GNRC
SANDEEP SINHA director, South Asia and Middle East, Healthcare & Life Sciences, Frost & Sullivan
DR SANJEEV SINGH medical superintendent, Amrita Institute of Medical Science and chairman, research committee, NABH
DR GIRDHAR J GYANI director general, Association of Healthcare Providers
DR G BAKTHAVATHSALAM chairman, KG Hospital & Post Graduate Medical Institute
M O N T H LY M A I L
The December issue, specially the Vishal Bali interview, was excellent.
The latest issue was well-crafted and informative. I enjoyed reading it.
Dr Ashish Banerji Chief Executive Officer Umrao Hospitals, Mira Road
Naveen Wadhera Investor with TA Associates
Registered with Registrar of Newspapers under RNI No. MAHENG/2012/46040, Postal Registration No. MH/MR/N/242/MBI/12-14, Published on 27th Total number of pages 52 of every previous month. Posted at Patrika Channel Sorting Office, Mumbai-400001, Posting date: 30th & 31st of every previous month
Embracing modern thinking
January 2013 • Vol 1 • Issue 4 • Rs50
An ITP Publishing India publication
Plus LESSONS IN INNOVATION FROM HARVARD BUSINESS SCHOOL
Healthcare Radius is a nice and informative magazine.
DEBATE
The pros and cons of group medical practice
UPDATE
Advancements in complicated spinal surgery
RNI No. MHENG/ 2012/46040
An ITP Publishing India publication
EXCLUSIVE HOSPITALS ARE EMBRACING HIGH-TECH ENERGY EFFICIENT SOLUTIONS
Embracing modern thinking
December 2012 • Vol 01 • Issue 03 • Rs50/-
PARTNER PERFECT Six steps to finding the right HIS provider
LOCAL FLAVOUR
DR TURNAROUND Dr Praneet Kumar on reviving the ailing BLK Super Speciality Hospital and strengthening NABH’s appeals and grievance committee
Medical product makers go low cost to suit Indian pockets
EXCLUSIVE THE WAY FORWARD FOR SAHYADRI HOSPITAL
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Many likes
The right focus
IRIA 2013: A PREVIEW ON THE MUCHAWAITED EVENT IN INDORE THE SECRET BEHIND PATIENT LOYALTY
FORTIFYING ITS PRESENCE
The January issue of the magazine is splendid. I also liked the coverage on Dr Praneet Kumar immensely.
Liked reading the December issue.
Dr Shugota Chakrabarti AGM, healthcare operations CIHPL- Bengaluru
Dr Prasad Rajhans Chief intensivist Deenanth Mangeshkar Hospital, Pune
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Dr Pankaj Nathavani Centre head Wockhardt Heart Hospital, Surat
Vishal Bali, CEO of Fortis Healthcare, spells out his plans to increase the group’s footprint across the Asia-Pacific region 01_HCR_Dec12_Cover Final.indd 1
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Congratulations on a useful compendium for healthcare in India. I was delighted to read the article on healthcare quality and safety. Request you to continue focusing on accreditations in India. Dr Narottam Puri Chairman, NABH; advisor, Fortis
Healthcare Radius February 2013
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NEWS TRACK MOOLCHAND HEALTHCARE IN AGRA Strengthening its footprint in the NCR and adjoining areas, Moolchand Healthcare has acquired the 200-bed Pankaj Apollo Hospital, the largest private tertiary care hospital in Agra. "The acquisition provides Moolchand an early mover advantage as leading hospital groups are largely
absent in the healthcare market in Agra," said Vibhu Talwar, managing director, Moolchand Healthcare, adding, "We intend to bring the best of healthcare services available in Delhi to Agra and western UP.” Many of the leading clinicians of Moolchand Medcity will now also be available at Moolchand, Agra.
In phase one, over the next 18 months, the new hospital would be expanded to include a comprehensive cancer institute. And in phase two, the capacity would be expanded to 300 beds. The total capital outlay for this project is Rs75 crore. “This acquisition is in line with Moolchand Healthcare’s Rs500-
crore expansion plan, enabling Moolchand to expand its footprint to cover western Uttar Pradesh. We are aggressively seeking additional acquisition opportunities as we intend to assemble a portfolio of 5 – 10 hospitals over the next few years,” said Shravan Talwar, managing director, Moolchand Healthcare.
RARE NEURO SURGERY AT FORTIS MORE HOSPITALS OPT FOR Doctors at Fortis Hospital, Shalimar Bagh have successfully conducted a critical brain surgery on a 26-year-old lady pregnant with twins. She was in her second trimester and had symptoms of severe headache, vomiting and drowsiness. Doctors diagnosed the aneurysm resulting in brain haemorrhage. The diagnosis was a challenge with such a condition as diagnostic tests, like CT scan and X-rays are not recommended during pregnancy. This condition
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has a mortality rate as high as 25 to 30 per cent. Speaking on the challenges involved in the surgery, Dr Anil Kansal, senior consultant and head, neuro & spine surgery said, “We immediately carried out a complex micro-surgery, clipping the aneurysm to stop the internal bleeding and were successful in saving the three lives.” Post-surgery, the patient was kept under observation in the ICU for 14 days before being discharged.
BIO-ABSORBABLE STENTS Kolkata-based BM Birla Heart Research Centre became the first institute in eastern India to use the recently launched ABSORB bioabsorbable stent for interventional cardiology applications. Five such stents were implanted during angioplasty of significant blockages in coronary arteries at BM Birla Heart Research Centre. In western India, Asian Heart Institute started using the
bio-absorbable stent by performing angioplasty on a 49 year-old woman with 100 per cent blockage in her Left Anterior Descending Artery (LADA). ABSORB stents dissolve in about 18 - 24 months, reducing the risk of scarring, restenosis and other issues prevailing with the earlier forms of stents. These stents allow the artery to become as normal as natural in just over a year.
Healthcare Radius February 2013
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NEWS TRACK
TELERAD TECH FORAYS INTO RAJASTHAN
FORTIS ESCORTS HEART AGRA COMMISSIONED Fortis Escorts Hospital Agra (FEHA), a unit of Fortis Escorts Heart Institute, was inaugurated recently. The hospital is equipped with diagnostic service like angiography and treatment options include primary PTCA or angioplasty, artificial pacemaker, coronary artery bypass, valve replacement and periphery bypass surgery. The hospital offers advanced techniques like dissolvable stents in place of me-
Telerad Tech, the service provider for Cisco’s HealthPresence telemedicine platform in India, deployed yet another telemedicine centre with its first site established in Rajasthan. The centre went live at Bhawangarh— a rural village in Kota, Rajasthan. The telemedicine project will impact a population of around 10,000 villagers, who will
now get specialist consultations from ENT and eye specialists, surgeons, senior physicians, gynaecologists and paediatricians. Dr Sunita Maheshwari, a paediatric cardiologist and chief dreamer of Teleradiology Solutions, informed that monthly consultations of the group have crossed 1,000 patients.
LEUKAEMIA TREATMENT WITH UNRELATED STEM CELLS Narayana Hrudayalaya–Mazumdar Shaw Cancer Centre successfully treated infantile leukaemia through unrelated stem cell transplantation on a six-month old girl. This is first such instance in Karnataka. Dr Sharath Damodar, consultant haematologist and head – Bone Marrow Transplant Unit, Narayana Hrudayalaya-Mazumdar Shaw Cancer Centre diagnosed the baby with acute lymphatic leukaemia, when she was evaluated for a low blood count and was started on chemotherapy. This type of leukaemia has an extremely poor prognosis in this
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age group with the survival rate being as low as 10 per cent and hence, stem cell transplantation was the only possibility. After a worldwide search, a matched unrelated donor from USA was identified from the registry of national marrow donor programme and the stem cells reached Narayana Hrudayalaya. Dr Damodar said, “In India, it is very difficult to find a donor for stem cells and there is much dependence on donors from USA and Europe. We need to inspire people to come forward for stem cell donation, because it can save several lives.”
tallic stents and renal denervation therapy. While inaugurating the facility, eminent cardiologist Dr Ashok Seth, chairman, Cardiac Sciences, Fortis Escorts said, “Equipped with cutting-edge technology and a team of superspecialists in cardiology, Fortis Escorts at Agra is a one-stop destination for all heart-related ailments for local patients and of the adjoining areas.”
WESTBANK HOSPITAL PARTNERS WITH NARAYANA HRUDAYALAYA Narayana Hrudayalaya Hospitals has inked a deal with Westbank Hospital to set up a 'comprehensive cardiac care unit' at Westbank's Howrah Hospital. The unit will comprise two cath labs, two operation theatres and 75 ICU beds. RTIICS, one of the flagship hospitals of NH Group in Kolkata, will be playing a key role in setting up the cardiac care unit in the Hospital. The agreement was signed by Dr
Ashutosh Raghuvanshi, managing director, vice chairman and group CEO, Narayana Hrudayalaya Hospitals and Ashish Chakraborty, group executive director, Westbank Hospital. Said Ashish Chakraborty, “Collaborating with Narayana Hrudayalaya to bring in world class cardiac care was an important decision to bring the best in cardiac care and treatment to the doorsteps of the community.”
YUVRAJ SINGH FLAGS OFF MOBILE CANCER SCREENING UNIT Apollo Gleneagles Cancer Hospital, Kolkata, which has partnered with Yuvraj Singh's 'Youwecan' Cancer Screening Initiative, has launched its first mobile cancer screening unit. The mobile unit, which will undertake cancer screening programmes at various locations in West Bengal, was flagged off jointly by cricketer Yuvraj Singh and Dr Rupali Basu, CEO,
Apollo Gleneagles Hospital. The specialised unit is equipped with state-of-the art auto analysers and enzyme analysers for blood tests and an X-Ray machine to carry out on-the-spot chest X-rays. All the tests and clinical examinations would be done by the on-board doctor, lab technician, X-ray technician and nurses. This initiative offers free consultations to all.
Healthcare Radius February 2013
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NEWS TRACK
NEW LAUNCHES LVPEI’S 91ST VISION CENTRE
LV Prasad Eye Institute (LVPEI) recently inaugurated its Vision Centre (VC) at Mandasa in Srikakulam district of Andhra Pradesh. Spread over 500 square feet, the VC is LVPEI’s 91st such centre and is equipped with a refraction set, slitlamp with applanation tonometer, retinoscope and lensometer among other things. The centre is managed by a vision technician. Said V Rajashekar, assistant director, Village Vision Complex, International Centre for Advance-
ment of Rural Eye Care at LVPEI, “While the cost of setting up one VC is around Rs8 lakh, INGO Lavelle Fund supported the cost of medical equipment, a local business man offered rent-free space and Lotus Wireless technologies, offered to support the one year operational expenses of the centre.” A VC's purpose is to increase access to systematic eye screening through this permanent committed facility and enhance awareness about refractive error related to visual impairment and blindness in all those screened at VC. It also aims to improve access to affordable spectacles, identifies people with blinding conditions and refers to the next level for further management and links the activities of VC with school health/primary health/panchayat/NGO activity.
INDIA’S FIRST DIGITAL BROADBAND 1.5T, 16 CHANNEL MRI SYSTEM GE Healthcare has introduced its new 1.5T 16 channel 60cm Digital Broadband MR –system – Optima MR360 Advance in India. It provides high definition image quality and addresses the demand for increased patient comfort, increased productivity, and reduced total cost of ownership under GE’s guiding principle of humanising MR.
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“The system is engineered to offer advanced clinical applications leading to excellent diagnostic confidence that is inviting to patients and user friendly for technologists. The system is also eco-friendly as it uses 34 per cent less power as compared to similar premium 1.5T competitive systems, thus lowering total cost of ownership,” said Dr Karthik Kuppusamy, director, MR, GE Healthcare India.
INDIAN BOOK ON HEALTH COMMUNICATION RELEASED Highlighting the importance of communication in healthcare, Bangalore Baptist Hospital in collaboration with Mudra Institute of Communications, Ahmedabad, released a book: ‘Communicate. Care. Cure. A guide to healthcare communication’. The book is a culmination of workshops organised by the hospital on healthcare communication. Edited by Dr Alexander Thomas and Dr Nagesh Rao and published by Bangalore Baptist Hospital, the book has chapters and illustrations by a committed group of physicians, nurses, pharmacists, administrators and communication experts. “Healthcare organisations lose substantial money annually as a result of ineffective and inefficient communication. Unlike the western countries, doctors and other personnel concerned with the Indian healthcare industry do not receive formal training in healthcare communication. So, this book aims to increase awareness about the significance of communication in healthcare and serve as a guide to effective and efficient communication, keeping in mind the interests of patients,” said Dr Alexander Thomas, CEO, Bangalore Baptist Hospital.
11 MILLION THE NUMBER OF PEOPLE IN INDIA WHO ARE AFFECTED BY GLAUCOMA, WHICH IS THE SECOND MOST COMMON CAUSE OF BLINDNESS
MOBILE MEDICAL VAN IN MUMBAI Wockhardt Foundation launched a mobile medical van under its flagship programme called ‘Mobile 1000’ in association with Rashtriya Chemicals and Fertilizers Ltd. The van will operate in Chembur area of Mumbai and will provide free primary healthcare. Each van is equipped with GPS tracking system, a doctor, driver and a co-ordinator and provides free consultations along with free medicines.
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NEWS TRACK
AUTO CODING AND LIGHTWEIGHT BLOOD GLUCOSE MONITORS Omron Healthcare India, a leading player in innovative medical technologies and products for monitoring and therapy, has launched easy-to-use, no coding required and economical blood glucose monitors for home blood glucose monitoring. The HGM 111 comes with a large LCD screen and provides accurate measurements of glucose level within five seconds. The device stores up to 512 sets of measurement and can provide average data for 714 and 30 days. The HGM 112 weighs a miniscule 25.5 gm including battery. It has a testing time of five seconds and is priced at Rs990.
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SPORTS MEDICINE DEVICE MARKET SET FOR A BOOM The sports medicine device market is expected to grow with a CAGR of 9.5 per cent with knee applications being the largest share holder due to the higher occurrences of ACL (anterior cruciate ligament) injuries, states Transparency Market Research. The market includes devices and products that help in the diagnosis and treatment of injuries mainly caused while pursuing a sport. The US is the largest market for sports medicine devices. The sports medicine device market can be primarily classified based on the product type as body construction and repair, body support and recovery and cardiac monitoring. According to the report, the primary reason for the growth of the sports medicine market is changing demographic trends and the increased awareness and expenditure on healthcare. The increase in the ageing population too has contributed to the development
of the market. The increase in net income has helped consumers focus more on healthcare than before. Also, sports medicine devices are based on the concept of minimal invasive techniques in surgery, which leads to a quicker healing process for sportspersons. With an increased number of people opting for sports as their career, the sports medicine device market is set to expand.
23-01-2013 12:12:09
NEWS TRACK
MEDICAL BIONIC IMPLANTS TO REACH $17.82 B BY 2017
JABALPUR AND CUTTACK GET TWO NEW CARDIAC 128 SLICE CTs
The medical bionic implants market, which is currently pegged at $12.67 billion, is expected to reach $17.82 billion by 2017, according to a report by RnR Market Research. Bionics is mechanical/electronic replacement or enhancement of organs/parts of living organisms. While the global medical bionic implants market has been segmented into vision bionics, ear bionics, orthopaedic bionics, heart bionics, and neural/brain bionics, heart bionics accounts for the largest share in this market, primarily due to a large global population with heart diseases, the report points out. Rising healthcare expenditure and the emergence of new healthcare facilities in emerging economies provide growth opportunities for the medical bionic implants market. The report states that new and improved technologies, increasing organ failure owing to ageing and age-related disorders, increasing accidents and injuries leading to amputations, and a rise in the number of people awaiting organ transplants are the major drivers slated to propel the growth of this market. “However, a few pivotal factors restraining the growth of this market are high cost of devices and uncertain reimbursement scenarios in different regions, limited surgical expertise, and high cost of development,” the report adds.
BSR Healthcare has installed two cardiac 128 Slice CTs in its centres at Jabalpur in Madhya Pradesh and Cuttack in Orissa. These are the first 128 slice CTs in these two areas. Said Dr MK Khanduja, CMD, BSR Healthcare, “Both these places needed this high-end technology as both are upcoming towns on healthcare delivery map of India, having more than two million population.”
DIAGNOSTICS LAB IN BEAS
He added that the imaging tool would help establish a definitive decision for various organs. Also, the radiation dose reduction protocol of these machines to the patients is approximately 1/3rd, which is good for paediatric patients. “It’s excellent for trauma patients, where whole body imaging from head to toe can be finished in 10 seconds,” he informed.
2ND URGENT CARE CENTRE IN DELHI Urgent Care Centre that is in prehospital medical care launched its second centre in the capital, barely one month after coming up with its first centre at Vikas Marg. The second centre, located in Kalkaji/ Nehru Enclave region of Delhi, is spread over 4,000 square feet.
“The centre has four emergency medicine doctors on duty 24x7, besides specialists on-call for OPD in orthopaedics, surgery, cardiology, paediatrics, pulmonologist, internal medicine and gynaecology,” said Dr Pervez Ahmed, chairman and managing director, Urgent Care.
INDUS HEALTH ’S 55TH CENTRE Pune-based preventive healthcare firm Indus Health has entered the southern India market by tying up with Apollo Hospitals to set up its 55th centre in Hyderabad. “We already have a tieup with Apollo Group in Ahmedabad. We now decided SRL Limited (SRL) has launched a state-of-art laboratory at Beas in Punjab. The laboratory is fully equipped to handle more than 4,000 tests, ranging from the routine to the highly advanced. Spread over six acres, the lab facility maintains superior reliability of two-level reporting. The lab also offers the facility to get samples collected from home. Said Sanjeev Vashishta, CEO, SRL Limited, “Being at the apex of three states, Beas—the riverfront town in Amritsar district of Punjab—is best poised to hold a state-of-the-art reference laboratory to cater to the healthcare needs of the people of the large region comprising Punjab, Himachal, Jammu & Kashmir and parts of Haryana.”
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to extend the association to Hyderabad,” said Amol Naikawadi, joint managing director of Indus Health. The firm currently has a tie-up with 15-odd hospitals, providing specially designed healthcare packages through 55 centres.
DM FOUNDATION'S NEW CENTRE DM Foundation, the non-profit charitable arm of DM Healthcare, has launched an early diseases detection and cancer screening centre at Haripad in Kerala. The centre is equipped with X-Ray,
mammograms, lab tests and other diagnostic facilities. The advanced diagnostic services are offered free. DM Foundation had earlier set up a similar early disease detection centre in West Bengal.
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Case study
AMBH’s JCI journey Gulshan Vijayshankar shares the experience of preparing Aditya Birla Memorial Hospital for the coveted JCI accreditation
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All employees across the organisation participated in getting ABMH ready for JCI
n December 2012, multi super speciality hospital Aditya Birla Memorial Hospital (ABMH) became the first hospital in Pune to earn the accreditation from Joint Commission International (JCI). It took year-long planning for the hospital to achieve this feat. In January 2012, ABMH had set an ambitious target of achieving both NABH and JCI certifications within a year. CEO Rekha Dubey had made it clear right from the beginning that the primary objective for the accreditations was not only to create an environment for patient and employee safety, but also to set systems in place for continuous quality improvement across each department. During the JCI journey, significant improvements occurred in areas such as clinical safety, interdepartmental communication, medical records management, infection control, staff training, competency and professional ‘credentialing’ and in implementation of proactive safety measures. To prepare for the rigorous survey various teams were formed. Each employee, right from the housekeeping person to the visiting consultant, participated in this exercise with zest. The teams were divided primarily on the basis of one’s interest and competency rather only on the basis of various chapters. People with similar skills sets were grouped together.
document only what one did and then follow systematically whatever is written down. The documentation team of ABMH did the herculean task of standardisation of the documents and integration between the departments. This effort was appreciated by the JCI auditors, who specifically made special notable mention of it during the survey.
DOCUMENTATION TEAM
POSTERS AND SIGNAGES
Documentation being crucial, employees who were organised in approach were included in the documentation team, which involved the development of policies and protocols across the hospital with the help of respective HODs. The leadership made it clear to the team that there would be no emulation of policies of SoPs from any ideal scenario. The mandate was to
The hospital had to develop posters and signages related to patient rights, safety and employee safety. The marketing team took up this task and came up with some creative designs.
TRAINING Training turned out to be one of the most interesting parts of the entire process. After discussion with the top management, training modules were formed. In-house training videos were developed for all the major departments. It was an interesting exercise as each department scripted a small story and acted on it.
MEDICAL RECORDS COMPLETION Medical records can prove to be a major hurdle when going for JCI. However, with the support from the management and the involvement of senior consultants, we could easily sail through it. We involved users and the outcome was surprising. Medical professionals discussed and themselves came up with innovative solutions to make work easy and yet compliant with JCI. The simplicity and standardisation of medical record played an important role here.
QUALITY IMPROVEMENT PROGRAMME Each department was trained to identify and develop their own quality improvement pro-
gramme and cumulatively, they established the understanding of the quality driven culture of the hospital in the minds of the JCI auditors.
JCI CAMPAIGN PROGRAMME This was the most interesting part of the entire journey. Ten clinical and 10 non-clinical training coordinators were chosen and all employees were assigned to them. The trainer who best trained employees under him won the best trainer award. Similarly, competitions were conducted for best performing departments. A two-day JCI fun and activity programme was conducted which involved different quiz and poster competitions.
THE JCI AUDIT After a year of intense preparation for the audit, a five-day long survey in December 2012 conducted by three JCI expert auditors was what it took for ABMH to finally get the prestigious accreditation. The standards that were measured covered both clinical care and organisational management areas, such as assessment of patients, infection control, facility management and safety, staff qualifications, quality improvement, patient safety, organisational governance, leadership, and management of information and communication. The result of the survey was highly encouraging and it was proved that the quality of care, documentation practice and training methodology at ABMH is on par with international quality standards.
Gulshan Vijayshankar is director, finance and strategy, Zon Healthcare Consulting Pvt Ltd.
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Rendezvous
‘We are keeping our part of the agreement’ In an interview with Rita Dutta, Brigadier Joe Curian, who took over the reins as CEO of SevenHills Hospital last month, clears the air about the many controversies dogging the hospital and spells out his plans for the hospital
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hat made you join Seven Hills, which has been in the news for all the wrong reasons? It’s partly because everyone tried dissuading me against it, saying it was a wrong career move. I am notorious for taking up tasks that everyone thinks are unachievable. It gives me an adrenaline rush to pick up something that everyone says is impossible. As for the negative publicity the hospital is getting, it’s because the public and the media do not have access to facts. So, what’s the tussle all about with the municipal authority, who's the partner in the project? I took over as CEO of this hospital on 9 January, this year, and so far, I have been minutely going over the important documents like tenders, contract papers and lease agreements with the BMC. As everyone knows, this a PPP project, whereby the hospital management has been given 17 acres of land on lease to build a super speciality hospital. The lease agreement clearly states that besides the lease rent, we have to provide 20 per cent beds free to poor patients. We are paying an annual rent of over Rs10 crore and also fulfilling the criterion of free beds to poor patients. But the problem is that now BMC is demanding that we also provide free medicines to the poor. This was never suggested, discussed or agreed upon till now. It is also not in the lease agreement. On the contrary, the lease agreement,
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which is the final document, clearly stipulates that we are free to charge for medicine and all bought out items. When some other hospitals could get Government land for free or at a subsidised rate and have similar conditions, why should we be singled out by our ‘partner’? We pay monthly lease rent and provide free beds, and thus keeping our side of the agreement. What is the reason for such ambiguity with the BMC? There is not any ambiguity if one goes by any of the agreement papers with BMC. What about the allegations by the BMC that the hospital is refusing poor patients and the hospital staff is rude with them? This is utter nonsense. People from the BMC office should visit the hospital before making such wild allegations. Even today, we have about 40 per cent patients from the poor class. We do provide all services, including high-end surgical services, to them without any differentiation. The BMC is making deliberate attempts to malign the hospital and gain public sympathy. What is the status of the court case regarding BMC asking the hospital to vacate the premises? The matter is sub-judice. In a partnership, how can one partner wake up one day and suddenly ask the other partner to leave?
How do you plan to resolve the tussle? The honourable court will take an appropriate decision, and come out with a judgement based on facts and evidence. The judgement should be just and fair. Perhaps, the public and the media are not aware that the BMC had all along kept this fact hidden from us that they were planning to hive off a portion of the land offered to us and for which payments were received as per contract process to a private individual for setting up a hotel. This in itself is illegal because the land was earmarked long ago for a hospital or an educational institution. This is a clear violation of public interest. The BMC should at least compensate the hospital on this account as our project planning was based on the availability of the land as advertised. Secondly, till date, the BMC has taken no action to remove all encroachments, something that was assured to us. One does not know who is drawing benefit out if it when large number of shops still continue to function from this land. The BMC, in all fairness, must either uphold all commitments given to us or compensate us adequately. It is reported that around 60 doctors and even former CEOs left the hospital. Are you taking any initiative to stop more staff from leaving the hospital? It’s not usual for doctors and other functionaries to join and leave a start-up hospital. I have already addressed the whole hospital along with
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the doctors to explain to them the actual situation and to quell the baseless rumours about the hospital. Communication between the top management and the functionaries would be an ongoing process so that they are not carried away by such unfounded rumours. What plans do you have for the hospital? The hospital is a 1,500-bed hospital with 300 operational beds as of now. It has a great potential, backed by cutting-edge technology and quality medical care. I want to position the hospital as a leading healthcare provider for the city and the country and then pitch it as a destination for medical tourism. We are specially geared to cater to the Middle East and African countries. We will definitely build on our strengths in key specialities. We will expand into additional specialities by investing in additional resources. For instance, organ transplant, cosmetology, high-end neuro-surgery and cardiology support-
ed by the latest and unique IVUS technology. Generally speaking, I would bring into practise tools and techniques of management in all departments. These will include decisionmaking techniques, appropriate organisational development intervention and cost control techniques. Marketing will play the lead. Doctors will be in continuous communication with the top management and will participate both in planning and execution. Process improvements will involve personnel across the board. SevenHills Hospital will aim to function as one cohesive team. Finally, I am focusing on making the hospital EBIDTA neutral in the next one year. Considering that the hospital has been commissioned two years ago, what’s taking time for breakeven? The hospital is well on its own growth trajectory that any new hospital has. I do not see any delay. Any hospital of this magnitude takes two
and a half years to three years to breakeven and ours is no different. What strategies will you be adopting to ramp up the bed occupancy level? Our present occupancy level is over 60 per cent. Any hospital can be said to be seating on a tripod. The first leg of the tripod is the group of doctors, which, for us, is already excellent and will be strengthened to improve the quality of medical care. The second leg is technology. We have every perceivable technology that any tertiary hospital can dream of. The third leg is managerial expertise — this is a dimension that we improved in the recent past and will continue to invest in. These three elements are to be brought together to be the key differentiator of our hospital. An improved product and better processes will lead to better patient outcome. This will be made visible to the market through an appropriate marketing strategy. To this end, we have
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The SevenHills Hospital in Mumbai is a PPP project built on land leased from the city's municipality
beefed up the marketing department and put in place a clear roadmap for them. I am sure the bed occupancy would be positively impacted by these initiatives. Is the hospital going for NABH? The evaluation for NABH is already done and after working in so many hospitals, I must say that this far exceeds all NABH standards in quality compliance. However, NABH is held back because of some pending licenses from the BMC. Is the hospital still looking for private equity funding for expansion? We are constantly looking at optimal funding options and the efforts are ongoing. Has the company asked lenders to recast its debt that runs up to Rs800 crore? These figures may not be accurate, but we will be trying to recast the debt structure. In your opinion how has hospital management changed over the last decade? I do see a lot of difference in the way hospitals are managed today as compared to the last decade. Earlier, there was a lack of clarity in the way a hospital has to be run. Most hospitals did not understand the business model of a hospital, and that managing a hospital is significantly different from managing organisations of other industries. There was a lack of clarity about organisational structure, line of control and span of control.
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For instance, there was no clear understanding about the difference of role of a medical director from that of an operational head. The primary reason for this lack of clarity was that people at the senior level of hospitals hailed from different industries—marketing, hospitality or the military. It was difficult to get senior people qualified in hospital management or having experience of managing a hospital. There was also insufficient understating of capital procurement and utilisation of equipment. Long-term planning was missing. It was almost like a day-to-day existence for the hospital. The owners also did not believe in delegation of tasks and empowering managers and this often led to disharmony among the board members and managers. There was a poor dependence of systems and processes duly supported by IT. What is the picture now? Today, we have many young and qualified people with MHA or MBA in hospital management. These people are knowledgeable and confident. The workforce at the senior level is also much younger. Hospitals have evolved to have better structures and governance. Information technology has played a great role in business process re-engineering. Owners and board members are seen to be more forthcoming in delegation of tasks, more open in accepting inputs from professional workforce and more trusting in the
ability of the young managers. There is more clarity and better understanding in the method of achieving business goals of a hospital by both, managers and owners. Today, one’s role is well-defined. And all these have resulted in greater congruence of the organisational goal and individual goal and brought about a more harmonious working environment. This change is specially visible in Mumbai, where hospitals are more professionally run and there is better corporate governance. Are you saying that in corporate governance, Mumbai is ahead of south, which is considered the Mecca of medical care? When it comes to medical care and technology adoption, south is definitely at the forefront. However, when it comes to running hospitals in a professional manner, Mumbai leads. You are almost 70. Don’t you want to settle for a more comfortable job than helm projects that require a lot of hard work? I agree with great actor Arnold Schwarzenegger when he says: “Retirement is for sissies”. It’s a matter of what gives you internal happiness. Many people of my age love to relax and have it easy, by walking the dog in the morning and taking a nap in the afternoon. For me, if I won’t have my plate full of work, I feel stressed. I love this field. And I am extremely passionate about it. However, how can one predict the future? When I stop enjoying my work, I will retire.
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Viewpoint
Why you need to find a fixer Sandip Chaudhuri underscores the need for small and medium hospitals in India to find their own trouble shooters
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roubles are as unpredictable as health, even in well-managed hospitals. And it especially throws small and medium-sized private hospitals off-track. These hospitals are forever in a reactive firefighting mode trying to align to the multitude of regulations and standards. And they are often left to fend for themselves when the systemic rigidity brings them to their knees. The larger hospitals still find their feet, but for the former group, it remains an ongoing survival drama. This is why hospital trouble shooters are worth their weight in gold for such organisations as they help the hospital wriggle out of difficult situations.
CURIOUS CASE OF LOVELY SINGH Let’s look at how Lovely Singh (name changed) emerged as the man for all seasons at a super speciality hospital, giving credence to the role of a hospital trouble-shooter. Lovely was roped in by a middle-aged businessman, when his dream hospital project got mired in legal and administrative issues that paralysed the functioning of the hospital. This businessman, a novice in healthcare, joined hands with a doctor, wanting the cushion of a clinical expert to go along. Within a year, the bad blood between the partners led to a management paralysis, before finally exacerbating into an all out war for accession. With the help of a some doctors, acolytes and political influence, the doctor partner almost established his fiefdom at hospital. Once Lovely Singh arrived, a bloodless coup was launched. The main conspirators were identified, separated and given the ‘prod to disappear’. The political bosses of the doc-
tor partner were made to bow before bigger power blocks, leaving the doctor high and dry. It was done such that the hospital didn’t stop admitting patients for a single day. Lovely had to intervene and remove two ‘suspiciously ineffective’ lawyers and frustrate the designs of a local usurping businessman before the hospital was back on its feet. The three major touch-points where hospital trouble shooters are urgently needed are: 1. Regulatory engagements: This represents the most prominent challenge for a trouble shooter. With its plethora of interlinked licenses and permissions, hospitals are happy hunting grounds for regulatory inspectors. For example, planning oversight at the conceptual stage can come back to haunt a hospital later. While infrastructural reorientation may not always be possible for practical reasons in a functional hospital, this may deny a crucial expansion or a capability enhancement plan. Men in official capacity often follow the rule book in its entire obtuseness, making it difficult for hospitals to cope up with the ‘outstretched demands’ with their stretched resources. Small hospitals desperately need somebody to talk ‘reasonably’ to unreasonable men and persuade them to see the bigger picture. 2. Political engagements: It is almost impossible to keep the ‘political classes’ out of the picture when you are engaged in ‘social welfare’. They may be tempted to look (a little too closely for the hospital’s comfort) at the engagement of the ‘right workers’ and the rights of the workers thereafter. Also,
speculations of the hospital’s profitability might entice them into picking up stakes in the organisation. Of course, somebody in the hospital needs to be well-connected himself to put up a systemic barrier to thwart such political overtures. 3. Customer engagements: Indian hospitals are no strangers to the ‘sob’ sentiment giving way to the ‘mob’ sentiment when a patient succumbs. This is often used as an excuse by disgruntled elements to teach the hospital a lesson for imagined ‘negligence in treatment’. And though we don’t exactly live in a ‘lawsuit-happy society’, hospitals can’t afford to ignore the threat of consumer lawsuits as mere ‘greedy gold-diggers’. The bigger threats are of course the criminal lawsuits especially when stoked by vested interests. Hospitals need someone to work between the lines of activities of lawmen and lawyers. Healthcare institutions might cringe at the thought of officially designating an employee as ‘trouble shooter’, but they should be on the lookout for such a person as part of their disaster contingency plan. To take on the ‘inspector raj’. Regulatory obduracy. Sinister designs. Disruptive activities. And even handle the fallouts of Force Majeure. The top management of hospitals would sleep a lot easier if they can get hold of such an indemnity cover.
Sandip Chaudhuri is a Kolkata-based healthcare professional
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Tech trend
A sweet solution for
diabetes Dr Ramen Goel, who pioneered Ileal Transposition with Sleeve Gastrectomy for lean diabetics in India, enumerates the benefits of this path-breaking surgery
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he American Diabetes Association and International Diabetes Federation have accepted the role played by bariatric surgery in the remission of type-2 diabetes. Consequent to this, clinical research for similar treatment for slim diabetics is gaining steam. This is of vital importance for our country, where a majority of diabetics are not obese. As per conservative estimates, over 60 million Indians suffer from diabetes — a figure likely to surge multi-fold as the government initiative to identify undiagnosed diabetics gets underway. A disease with no known cure, diabetes increases risk for complications such as heart attacks, brain strokes, blindness, renal failure, nerve damage, amputations and early death and requires severe lifestyle restrictions throughout one’s life. A combination surgery involving the intestine and stomach offers hope to lean diabetics,
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who are otherwise not considered for surgical intervention to control the disease. A new procedure, Ileal Transposition with Sleeve Gastrectomy or SGIT, pioneered by Dr Aureo dePaula from Goiania, Brazil, has shown promising results of over 90 per cent diabetes remission. Based on the understanding gained from gastric bypass, this procedure helps early secretion of GLP-1 hormone from interposed terminal ileal segment, besides reduction of the hormone Ghrelin from excised gastric fundus.
A PATH-BREAKING SURGERY SGIT represents a landmark treatment for type-2 diabetics. Performed through key-hole route in normal or just over-weight patients, the first component of the surgery involves mobilisation of a 170-cm segment of small intestine (ileum) along with its blood supply. The divided remaining ends of intestine are then joined together to provide intestinal
continuity. The mobilised ileal segment is then interposed at the beginning of the small intestine (jejunum). The food reaches this interposed segment within 5 – 10 minutes of eating it, compared to its earlier position, where the it took over 60-90 minutes. This interposed segment through K cells in its internal lining produces GLP-1 hormone in response to early food stimulus. The GLP-1 hormone is believed to reduce insulin resistance, increase insulin production and also stimulate production of insulin-generating beta cells in the pancreas. This helps control blood sugar through physiological mechanisms. The second component of this surgery involves partial excision of the fundus and body of stomach. The resection of stomach, compared to sleeve gastrectomy for morbid obesity, is conservative to avoid significant weight loss. This reduces the production of hormone Gastrin, besides restricting calorie intake. Ghrelin is believed to be a diabetogenic hormone, which increases blood sugar. The reduced availability of this hormone results in better glycaemic control.
THE BENEFITS Although it sounds unbelievable, most of the operated patients are able to get off insulin within five to seven days of the surgery and 60
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Step2 Sleeve gastrectomy for reduction of Ghrelin hormone Step2 Sleeve gastrectomy for reduction of Ghrelin hormone Step1 Interposition of a segment of Ileum into jejunum — for early production of GLP-1 hormone Step1 Interposition of a segment of Ileum into jejunum — for early production of GLP-1 hormone
AN INDIAN STUDY • A study at the Bombay Hospital showed that by repositioning a portion of the intestine and at the same time reducing the size of the stomach, the production of diabetes-causing hormones in the body could be regulated successfully. The study, published in the 'International Journal of Diabetes in Developing Countries' (August 2011), underlined how Ileal Transposition with Sleeve Gastrectomy (SGIT) could offer hope to millions, who suffer from type-2 diabetes despite having normal weight. The study results were presented at the Annual Conference of International Federation for Surgery of Obesity at Delhi in October 2012.
• As part of the study, patients in the age group of 44 – 53 years and having a Body Mass Index (BMI) between 23 and 35 had undergone the SGIT procedures. In less than six
- 70 per cent are even able to stop oral medicines within two to three months. An important outcome is that over 90 per cent are able to maintain their Glycosylated haemoglobin (HbA1c) within six months of surgery. It is important to realise that before surgery, despite medicines, these patients were maintaining HbA1c of around 7 – 14. It is expected that in a majority of patients, most complications related to lack of glycaemic control may be avoided or delayed due to diabetes remission or better control of sugar levels. Furthermore, the anti-diabetic medicine related side-effects can be completely avoided. Quality of life improves significantly with freedom from restrictions like sticking to food and medicine timing and frequent blood sugar monitoring. Possibility of hypoglycaemic episodes, usually associated with diabetic drug induced tight blood sugar control, also reduces as post surgical glycaemic control is physiologically related to meal size.
months following the surgery, 60 per cent were completely off insulin, while 40 per cent of
THE DOWNSIDE
them just one basic diabetes medication a day.
Being a new procedure, the long-term impact and maintenance of results will only be known in due course. Publications report excellent five to eight years follow-up maintenance. Since the surgery involves working on different parts of the abdomen, it requires a new set of surgical skills, besides a keen understanding of the disease.
• In all patients, the problem of uncontrollable sugar levels was successfully taken care of as their HbA1c (vital parameter to determine diabetes control) level had dropped below seven. While in a normal non-diabetic, the
as the last resort as, by that time, pancreatic function may be irreversibly damaged. Though glycaemic control improves in all operated patients, possibility of diabetes remission is higher in early diabetics or those with better pancreatic function. Various tests like C-Peptide and insulin antibodies can be done pre-operatively to assess and prognosticate surgical results.
THE COST FACTOR Fortunately, this technique does not require any additional investment in hospital infrastructure. Patients too are able to recover cost of surgery within one to three years from the direct cost of medicines for diabetes. The improvement in
quality of life, productivity, avoidance of complications cost and increased life span are also significant indirect benefits.
INDIA ADVANTAGE Ahead of most western countries, ICMR registered clinical trials after due Institutional Ethical Committee (ICE) approvals started in India in 2008. Unlike pharmaceutical research, these self-funded researches are slow to pick up, but with over four years of follow up, early results have been accepted and published in international journals. Though, over 10 surgical groups worldwide now perform SGIT surgery, well-informed patients prefer Indian surgeons, who are pioneers in this field.
HbA1c is 3.5 - 5.5 per cent, for diabetics about 6.5 per cent is considered good. For all the five
SURGICAL CANDIDATES
patients whose HbA1c levels were between
The surgery is typically offered to medically uncontrolled type-2 diabetics only. For diabetics with insulin resistance, surgery may be offered early after adequate time-bound trial of antidiabetic medicines. It should not be considered
7.6 to 11.7 per cent before the surgery, it had gone down to less than 6.5 per cent after the procedure.
Dr Ramen Goel is head of bariatric surgery at Nova Specialty Surgery, Mumbai.
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The
braveheart Acclaimed Indian-American cardiac surgeon, research scientist and healthcare economist, Dr Mukesh Hariawala is set to introduce triple heart therapy in India. He speaks to Rita Dutta about his research journey, the procedure, and his idols
There is lot of hope and hype surrounding the new ‘triple heart therapy’ that you are going to pioneer in India... Triple Heart Therapy has been presented at the Cardiological Society of India’s annual scientific conference in 2012, World Congress of Cardiology in Dubai 2012, in addition to several global forums. Leaders of the cardiovascular scientific community have received it well with genuine accolades for its potential. Thus there is no hype at all, but certainly there is new hope for patients with heart disease. Triple heart therapy ensures total myocardial revascularisation of the heart. The patients get complete relief of symptoms, obviating the need for future repeat surgery, which is not just expensive but also high risk. The therapy provides the patient with an improved quality of life for many years. In layman’s terms, it remodels the heart to be stronger and makes one live longer and hopefully, symptom free. The benefits,
when viewed on a national level, convert to a large saving of money and resources, which can be better utilised for rural development and other healthcare projects. How did you come to pioneer the triple heart therapy? Angiogenesis work was originally initiated at Mumbai’s KEM hospital by cardiac surgeon Dr PK Sen in the early 1950s. This was called the ‘Snake Operation’ and involved making fine nee-
The entire research experience was like driving a car without wheels in a dark tunnel”
dle punctures on the surface of the heart. The technique was revolutionary, but due to lack of funds, the entire concept went into slumber for several decades. Subsequently, in the late 1980s, cancer surgeon Dr Judah Folkman started isolating endothelial cell specific growth factor Vascular Endothelial Growth Factor (VEGF). I started working on angiogenesis in 1995 in Boston where I am attached with the Harvard and Tufts Medical School Affiliated Hospitals. Our team, under my guidance, pioneered the creation of the first successful animal model which replicates human progressive coronary artery heart disease. This led us to draft a protocol to use VEGF to revascularize the ailing heart muscle. It has taken 15 years to become a clinical reality and the scientific journey is littered with more failures than success. The entire research experience was like driving a car without wheels in a dark tunnel.
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Straight talk
Triple heart therapy is optimally performed in the high-tech hybrid operating room,
Dr Mukesh Hariawala was presented with 'India's Most Admired Surgeon' award by
where cardiologists and cardiac surgeons work synergistically
K Sankaranarayanan, Governor of Maharashtra at a ceremony in Mumbai
Fifteen years is a long time to persevere over one technique. What were the hurdles that you faced during the research stage and what kept you going? A true heart failure model that mimics progressive human coronary artery disease never existed till 1995 and there were no literatures and ready references available. The initial dog experiments failed as they have very high native collaterals, so developing ischemia or heart failure was not possible. It was by chance that one of our technicians suggested to try Yorkshire pigs instead and to the delight of the entire team, the coronary architecture was identical to humans. The team consisted of positive-minded motivated individuals with a focused attitude to come up with an answer to human heart suffering which would impact all mankind. Can you please explain the technique in simple terms? Triple Heart Therapy is a combination of angiogenesis, stem cells and bypass surgery. Angiogenesis is a science of stimulating the activation of collateral blood vessels from preexisting ones in the heart. These dormant vessels were provided by nature as a backup, and exist right from the time of birth. But the threshold of signals for their activation is low, so external intervention becomes necessary. Angiogenesis and stem cells independently are weak therapies and thus a combination is necessary to meet therapeutic levels to treat patients successfully—especially since the heart is a large muscular pulsatile organ responsible for distributing oxygen-rich blood through the body. Triple Heart Therapy entails spontaneous
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development of new blood vessels in the heart by low energy laser stimulation and subsequent injection of patient’s own stem cells. First, stem cells are derived from the patient’s own hip bone marrow to accentuate the clinical impact of this procedure. Then, for the actual surgery that is done on a beating heart put on bypass machine, a combination of an arterial graft is taken from under the surface of the chest wall. This is called ‘Left Internal Mammary Artery or LIMA ’. The next step is angiogenic stimulation of territories, where no graft can be placed by using 10 to 12 laser shots. Subsequently, stem cells are injected in these zones, creating a natural bypass in them. This novel approach could lay the foundation of future treatments for heart disease.
How does the therapy work on patients? The new channels created using lasers are expected to get blocked off in about six months, but the intended goal of laser energy is not to open channels for blood flow. It simply acts as a ‘shock trigger’ to release growth factors like VEGF and FGF (Fibroblast Growth Factor), which reside in the native hibernating heart muscle. This will internally initiate an angiogenic process, leading to early proliferation of micro blood vessels from endothelial cells, which are not visible to the naked eye. This process is done under Trans Esophageal Echocardiography guidance to ensure that the laser beams fully penetrate the full heart muscle and reach the left ventricular
Risk and cost factor What complications can be expected during or after the surgery? Based on initial experience, it is anticipated that less than 1 per cent of patients will get irregular heartbeats during surgery while stem cells are being injected or laser stimulation is being applied. This is due to the irritation of the electrical conducting pathways around the heart and sensitivity of the diseased heart muscle fibres. This can be easily corrected by medication and there are no longterm adverse effects. How safe is it for Indian patients? Safety is paramount for any patient enrolled in a clinical trial, regardless whether it is conducted in the US or in India. The initial safety standards have already been established and the next step is to ascertain efficacy on a large volume of patients. The current morbidity and mortality rate in India for open heart surgery is less than 0.5 per cent, which is comparable to most western countries. What about the cost of the therapy? There are no supplementary costs to the patient undergoing open heart surgery, who receive angiogenesis stimulation or stem cells as they are cellular donations made by the patient’s own body. Thus, the total cost is expected to stay around the same as bypass surgery with minimal increment costs for usage of laser and stem cells filtration devices.
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matrix —the cellular element of the heart’s pumping chamber. Traditionally, when placing stents or performing open heart bypass, cardiovascular specialists leave these small zones of heart attack or low blood flow muscle segments alone. Nuclear Perfusion scans of treated zones and calculated improvement in ejection fraction (or fraction of blood pumped out of ventricles with each heart beat) are used to quantify success of the procedure and sustained long-term results. Who are ideal candidates for the surgery? It will help sick patients with extremely degenerated heart muscle. It is particularly therapeutic for those suffering from diffused non-treatable disease, which is extremely common in
The surgical results and long-term outcomes in India often exceed the US and European standards”
Photos: Bajirao Pawar
Location Courtesy: Jaslok Hospital, Mumbai
Indian diabetic patients for whom routine bypass surgery alone will not help. Unfortunately, those who have had more than two major heart attacks or those who are not fit for anaesthesia will not be able to undergo this surgery. What kind of infrastructure and equipment is required for Triple Heart Therapy? This procedure is optimally performed in a high-tech hybrid operating room, where cardiologists and cardiac surgeons work synergistically, but the procedure can also be done without it. The hospital also needs to install a special laser system and surgeons must undergo formal proctoring and training to perform this procedure. I plan to conduct surgical workshops all over India on it.
How long does the surgery take? The entire procedure is expected to take about two hours, including harvesting with filtration of stem cells, laser induced angiogenesis and single vessel bypass surgery. Is this an alternative to angioplasty or bypass surgery? This is not intended to replace these well established traditional therapies, which have shown excellent results for many years. In fact, the procedure is only intended for those patients, who do not qualify as candidates for these procedures. Is it a day care procedure? Not, at all. This procedure must be treated just like any open heart surgery and patients will have to stay in the hospital for a minimum of five days after the surgery. All patients will have to be carefully monitored for subsequent four weeks with repeat perfusion scan studies to monitor success of the procedure. What is the ideal mix for the team performing this surgery? The team comprises radiologist, interventional cardiologist, adult cardiac surgeon, cardiac anaesthesiologist, echocardiographer, cardiac perfusionist, intensivist, and laser and stem cell filtration technicians. How long has the procedure been tested? Heart angiogenesis clinical trials have been underway in stages, in the US, for the last 10 years with satisfactory results, occasional disappointments but fortunately only few adverse events. The use of stem cells is still new and different centres are experimenting with variable protocols to better understand which one would best benefit patients. ‘Triple Heart Therapy’ protocol has been completed in over 22 patients worldwide, predominantly in Europe. This protocol with few modifications is now going to be extended in India. A multi-centre clinical trial will begin in 2013, where I will be the chief surgeon and principal investigator for India. There will also be participation from other international surgeons as co-investigators. In India, the trial will be initiated at Mumbai's Jaslok Hospital, where I am the honorary cardiac surgeon and director of its international programs. Subsequently, this trial will be expanded to multiple centres across the country in co-ordination with other Indian surgeons.
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Straight talk
How has the Indian medical community reacted to it? It has been well-received by the cardiovascular community inclusive of surgeons, interventional cardiologists, teaching academicians, retired professors and senior hospital administrators. Technically, how difficult is it to conduct this procedure when compared say, with a heart transplant? A heart transplant is a challenging procedure, which can be performed only by specially trained cardiac surgeons. It is reserved for a different group of patients, who have reached a stage of last resort making them non-candidates for any other traditional heart procedure. Transplantation requires a donor heart, long-term immune-suppression and several other ongoing logistics to monitor the heart and other organs of the patient. Triple Heart Therapy comparatively is less demanding surgically, and can be adapted by most surgeons with minimal training. Have you published any papers on angiogenesis and triple heart therapy procedure? I have presented the concept at several inter-
Know the good doctor After his graduation from TN Medical College & Nair hospital, Mumbai, Dr Mukesh Hariawala gained experience in cardiac surgery at Nanavati and Breach Candy hospitals. He proceeded to London, where he acqured training in open heart surgery followed by experience in transplantation. Subsequently, he got invited to the US and was made an American citizen for scientific excellence. He also went on to become a Triple Fellow of the Royal College of Surgeons of England, American College of Surgeons and International College of Surgeons. He was on the surgical team that performed the first bypass surgery on PM Dr Manmohan Singh in 1990. Additionally, he has operated on music maestro RD Burman, industrialists Ramakrishna Bajaj, Goenka, Madhwani and many more celebrities worldwide. He was recently bestowed with the prestigious ‘India's Most Admired Surgeon 2012’ award by K Sankaranarayanan, Governor of Maharashtra.
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national conventions and published scientific papers since 1995 in peer-reviewed journals and text books. This has been done along with senior investigators and coauthors Dr Symes and Dr Sellke from Tufts and Harvard Group of hospitals in Boston, USA.
ratory and grant money in Tufts and Harvard hospitals in Boston, USA. Most of my scientific protocols and publications were directed and edited by them. Dr Michel Klein, senior professor of cardiac surgery from Dusseldorf, Germany, is my co-investigator in the Triple Heart Therapy protocol. Do you have plans of returning to India? I plan to help establish cardiac centres of excellence like Jaslok Hospital all across India. However, I do not plan to relocate to India completely as I can pursue my research goals better in the US.
Angiogenesis is a science of stimulating the activation of collateral blood vessels from pre-existing ones in the heart
Please share some details about VAD implant that you plan to introduce in India. Ventricular Assist Device or VAD is a technology offered to end stage heart failure patients, who are waiting for a donor heart to undergo transplantation. The Heartmate 2 device offered by Thoratec will soon be made available to patients in India as an alternative to transplantation in 2013. Which cardiac surgeons have inspired you over the years? My teachers and senior cardiac surgeons from India have been the late Dr Nitu Mandke and Dr S Bhattacharyya. Both of them inspired me since my days as a registrar at Mumbai’s Breach Candy Hospital. It was Dr Ashwin B Mehta, who did crucial mentoring and arranged for my training in London. My career stays eternally indebted to Dr Mehta. Later, Dr John Wright and Sir Magdi Yacoub helped consolidate my cardiac surgery and transplant training. They encouraged me to pursue original research work in the US. Also, I want to mention Dr Jeffrey Isner, Dr James Symes and Dr Frank Sellke—all of them gave me opportunities like access to their labo-
Why does India lack in medical research? What can be done to give a boost to medical research, so that doctors like you can get to pursue research here? India has tremendous intellectual power within the medical community, but lack of funding deters young doctors to even consider research as a parallel career. Additionally, there is lack of government encouragement and inadequate financial grants to pursue high quality research. A potential solution could be private sector contributions towards research as part of their social responsibility mission. When it comes to techniques and using latest gadgets in cardiac surgeries, where does India fare via-a-vis the US? India is on par with the US and most developed countries in utilisation of the newest technologies in cardiac surgery. How can we help improve clinical outcomes of cardiac surgeries done here? Early diagnosis of heart disease, particularly in rural India, is the key to better outcomes. Also, sharing of surgical expertise and conducting regular training workshops with international collaborations will help deliver augmented positive results. What’s your opinion about Indian cardiac surgeons? Indian cardiac surgeons continue to be my professional idols and I firmly believe they are the best in the world. The surgical results and long-term outcomes in India often exceed the US and European standards. I would be happy to be operated on by any one of them, should I need bypass surgery in the future.
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Profile
A medical mecca for Karnataka
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arayana Hrudayalaya has commissioned its second multi-speciality hospital in Karnataka — the Sahyadri Narayana Hrudayalaya — at New Thirthahalli Road in Shimoga. The hospital was inaugurated by Sri Shivarathri Deshikendra Mahaswamiji of Suttur Mutt, Mysore. Former chief minister of Karnataka BS Yeddyurappa was the chief guest.
PROJECT DETAILS Bed strength: This as a 500-bed hospital, but in the first phase, the hospital has commissioned 200 beds. “In the next three years, we will scale up to 500 beds,” says Dr Llyod Nazareth, COO, Narayana Hrudayalaya. Business model: This green field project is a JV between the Mangalore-based Sahyadri Group, a group with educational institutes in Karnataka, and Narayana Hrudayalaya. While the land and infrastructure of the hospital belongs to Sahyadri Group, Narayana Hrudayalaya has installed equipment and manages the hospital with its own people. Built-up area: Spread over four-acres, the hospital has a built-up area of two lakh square feet. Target patient base: Central Karnataka, which comprises districts of Dharwad, Bellary, Shimoga, Chitradurga, Gadag, Raichur, Haveri, Koppal, and Davangere. People from these places travel all the way to Bengaluru and Udupi seeking quality and advanced medical treatment. “Even if some hospitals exist in central
The hospital makes advanced medical care affordable
Karnataka, the facilities are neither adequate nor affordable. Sahyadri Narayana Hrudayalaya is the first comprehensive multi super speciality hospital of Shimoga that makes medical care both affordable and accessible to the people of Shimoga and its neighbouring districts,” informed Dr Llyod. Employees: For the first phase, the hospital has employed 70 medicos in addition to 150 employees and about 100 ancillary staff — all full-time as is the policy.
USP: “In accordance with the policy of Narayana Hrudayalaya, the hospital will maintain high quality standards in medical service, delivered at the most affordable costs. Our forte is providing quality healthcare at an affordable cost using the best available technology in medical science offered at a price within the reach of the common man,” said Dr Devi Prasad Shetty, chairman, Narayana Hrudayalaya Hospitals, during the inauguration. Facilities: The hospital is partly centrally air conditioned and offers advanced medical technology and world-class facilities across a variety of disciplines. It is equipped with 64 slice CT and 1.5 Tesla MRI. It provides a wide range of surgical and therapeutic treatments in various specialities such as adult and paediatric cardiology, cardiac surgery, gastrointestinal laparoscopic surgery, nephrology, urology, neurology and neurosurgery, orthopaedics, paediatrics, obstetrics and gynaecology apart from other clinical and allied services. “For the first time, advance cardiac surgery would be available to people of central Karnataka,” says Dr Llyod. Looking ahead: In the pipeline, is a chain of three to four outreach centres. To begin with, these would offer affordable dialysis facilities. “For the convenience of dialysis patients in Shimoga, we are taking treatment facilities near their locality and also offering them at an affordable rate,” informs Dr Llyod. In the coming years, besides scaling up the bed strength, the hospital plans to offer comprehensive oncology care.
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Analysis
The Balance Score Card evaluated Dr Aninda Chatterjee discusses how the tool fares in healthcare settings
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alanced Score Card (BSC) is a tool that helps translate an organisation’s mission and strategy into a comprehensive set of performance measures that provides the framework for a strategic measurement and management system. BSC is an approach for driving organisational improvement toward pre-selected goals. It helps keep track of progress through carefully selected measures. BSC is also an integrated management system consisting of three components: a strategic management system, a communication tool, and a measurement system. It results in a carefully selected set of measures derived from and linked to an organisation’s core strategies.
APPLICATIONS Since the early 1990s when Robert Kaplan (a professor at Harvard University) and David Norton (a consultant from Boston) developed the BSC, there have been many different applications of it in all types of industries, both in the US and outside it. Companies are using BSC to: • Clarify and update strategy • Communicate strategy across the company
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• Align unit and individual goals with strategy • Link strategic objectives to long-term targets and annual budgets • Identify and align strategic initiatives • Conduct periodic performance reviews to learn about and improve strategy.
IT’S DIFFERENT Several articles and books have been penned on the BSC methodology and a variety of software products have been developed to assist and expedite implementation of this performance measurement process. Historically, performance improvement systems have focused on measurements and indicators alone. What is unique about the BSC approach, in contrast to other methods, is that it links strategy with performance and goes beyond the traditional financial metrics in determining whether an organisation has been successful. Integral to BSC is the notion that an organisation’s strategies and their execution are among the most important factors in performance improvement.
ITS NEED The shift from an industrialised economy to a knowledge/information economy has neces-
sitated a change in how value is determined. According to management researchers, value is now associated more with intangible assets (employees/knowledge) than with traditional tangible assets (equipment/plant). Instead of focusing solely on historical financial data, new management concepts are needed to more effectively assess how well an organisation is performing. Only 35 per cent of respondents to a performance measurement survey rated their current performance measurement systems as effective or very effective (American Institute of Certified Public Accountants and Lawrence S Maisel, 2001).
BENEFITS OF BSC IMPLEMENTATION The fields of organisational development and human performance technology have blossomed in this decade, all focused on better methods to assess and manage performance in organisations. The BSC now has a documented history of successful implementation in several industries including healthcare. Benefits of implementation have included: • Increased financial returns • Greater employee alignment to overall goals • Improved collaboration • Unrelenting focus on strategy.
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Analysis
BSC IN HEALTHCARE In healthcare, BSC is the current flavour of the day, with consultants advocating it as a ‘miraculous treatment’. However, healthcare organisations have had to meet some unique challenges in adapting BSC. Since 1994, when the first referred article was published on BSC in healthcare settings, numerous articles have appeared in the health services and management literature as BSC appears to have gone into a growth phase. According to Zelman, Pink et al.’s study (2003), BSC has been adopted by a broad range of healthcare organisations, including hospital systems, hospitals, psychiatric centres, and national healthcare organisations. In healthcare, much of the literature relates to how to apply BSC successfully and less common are surveys about applying BSC in healthcare. However, Chan and Ho (2000) conducted a survey of the BSC in Canadian hospitals in 2000 and Inamdar and Kaplan (2002) surveyed executives in nine provider organisations in the USA. There is insufficient information about the overall pattern and success of BSC implementation in healthcare. Various case studies of application of BSC in healthcare also indicate that the health of the patients is not as central as it should be in the development of the BSC — the balance is tilted towards financial rather than health outcomes. BSCs are still in an evolutionary stage in healthcare settings and strategy mapping is not yet common.
BSC IN RURAL SET-UPS Most healthcare BSC implementations, such as those profiled in Kaplan and Norton’s literature, have occurred in urban centres that have larger and more specialised staff, IT capacity, and resources. However, even smaller hospitals in Arkansas, Michigan, Minnesota, Mississippi, and Pennsylvania have also used BSC with promising outcomes. The challenge is to find a meaningful, relevant, and affordable way to implement BSC in small rural hospitals.
THE FOUR PERSPECTIVES The earliest writings of Kaplan and Norton advocate a performance measurement system
that would provide ‘a set of measures that gives top managers a fast but comprehensive view of the business’. Four perspectives — financial, customer, internal business process, and learning and growth — are central to the measurement system. In subsequent development, the perspectives were linked in a causeand-effect manner by ‘if-then’ statements: If we increase capabilities, then lower re-admission rates will occur. If re-admission rates are lower, then patient satisfaction will increase. If patient satisfaction is higher, the hospital will
Xerox did not sell its machines; it leased them and earned revenues on every copy made on the machine. Sales and profit from leasing machines and those of supporting items like paper and toner were large and growing. But customers apart from concern about high copying cost, for which no ready alternative was available, were disgruntled about the high breakdown rates and malfunctions of these expensive machines. Rather than redesigning the machines, Xerox started direct selling of machines thus pushing up revenues. They also introduced after-sales service and the division became a substantial contributor to Xerox’s profit. Xerox enjoyed a monopoly in the US market from 1955 through 1975, but when Japanese and American entrants started offering better copiers at lower prices, Xerox’s sales plummeted. Only in 1980 did they make a remarkable turnaround under a new CEO.
IMPLEMENTATION MATTERS
BSC AS A MANAGEMENT TOOL attract more patients and increase its revenue. Although the four perspectives have been found to be robust across a wide variety of companies, some organistaions are found using fewer than four perspectives, depending on industry circumstances.
RETURN ON CAPITAL V/S BSC However, financial measures alone are inadequate for guiding and evaluating organisation’s trajectories through competitive environments. Let’s take the example of Xerox, which enjoyed a virtual monopoly on plain paper copiers through the mid-1970s.
In 1999, a Fortune magazine story suggested that 70 per cent of CEO failures were a result of not poor strategy, but of poor execution. In addition, it is estimated that nine out of 10 organisations fail to implement their strategies. Over the last 12 years, several methodologies have been developed in various industries to address the need for a more ‘balanced’ way to assess and manage performance (such as Six Sigma, TQM, CQI). BSC helps strike a balance between strategic plan and operational plan of a healthcare organisation. It improves success rate of implementation, operational efficiencies and minimises weaknesses. It acts as a road map that helps healthcare organisations to achieve their long-term vision. And although BSC has been applied successfully many times as a strategic management tool, there is also evidence of many failures. Studies claim a failure rate of 70 per cent. Identifying features of successful implementation is therefore important.
Dr Aninda Chatterjee is CEO and director of Jubilant First Trust Healthcare Ltd.
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Infrastructure
Getting floored
Choosing the right flooring is a complex task with hospitals looking for multiple features like anti-skid, anti-scratch, anti-static, anti-stain, germ-free and fire-resistance in resilient flooring materials, finds out Rita Dutta
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hospital can look as swanky as a hotel, but when it comes to the flooring, it’s more than mere aesthetics. The list of criteria that a hospital needs to look at while choosing its flooring material is quite exhaustive. The flooring in a hospital has to be resilient, easy maintain and have a high degree of resistance to the high footfalls and match requirements of various areas. The flooring has to be anti-skid, antiscratch, anti-static, anti-stain, fire-resistant and germ-free, besides easing the repetitive stresses of walking and standing for medical staff. This miscellaneous list of requirements makes choosing the right flooring for a hospital a daunting and complex task.
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The flooring requirements of different areas of a hospital vary as per the use
CURRENT TREND Flooring materials that accumulate dust are a big no-no in hospitals, so are materials like ceramic, marble and stone as they often develop gaps between the joints, a fertile ground for bacteria. While most hospitals in the west have stopped using hard flooring (ceramic, marble and stone), Indian hospitals continue to use them, but only sparingly. They are used mainly in the lobby, cafeteria and diagnostic areas. Indian hospitals are increasingly using resilient floorings, such as vinyl and linoleum. Says Shrijit Nair, senior executive, marketing, Armstrong, “The general myth of easy maintenance in hard flooring is slowly changing. Hard flooring fails to suffice the slip resistance and antifungal features, which are considered a
major requirement in the healthcare industry. Resilient flooring takes care of the safety standards as well as the decontamination standards.”
DECIDING FACTORS So, how should hospitals go about deciding on their floorings? As Dhruv Sodani, Director, CCIL, puts it, “Flooring for hospitals should be durable, hygienic and easy to maintain.” Others point out that besides good installation quality, ease of maintenance and aesthetics, floorings solutions in healthcare institutions must guarantee infection control, static control in OTs and be seamless to prevent the growth of bacteria. According to Poornima Kuruvilla, architect, Medica Synergie, additional qualities to be
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FEATURES IN DEMAND Hospitals are also going for various features on its resilient floorings. Some of them are: Scratch-free: Many hospitals are going for tiles that are scratch-free; these tiles contain a special coating of granules comprising natural granules. Explains Dinesh Vyas, senior general manager, Johnson Tiles, “This special coating makes the tiles resistant to scratching. The scratch-free tiles offer high degree of abrasion resistance.” Experts say that the minimum requirement for corridors is a class T abrasion product. Germ-free: Many are preferring fungiostatic and bacteriostatic tiles as they offer protection from various disease-spreading bacteria
Medica Synergie has opted for linoleum for its ICU as it’s a natural product made of linseed oil, wood flour and cork
and fungus. Fungiostatic and bacteriostatic properties usually come with a special treatment, using a specially formulated anti-microbial glaze, which inhibits bacterial or fungus growth, thus contributing to a healthier living environment. However, for some companies, the properties come from the chemical composition of the products and hence stay throughout time even if the surface treatment is worn off. Anti-skid: Hospitals are prone to a high degree of accidents due to slips and trips. Hence the flooring has to be anti-skid to cushion the falls and prevent injury. However, “Anti-skid properties come in PVC products called ‘safety floorings’. As the surface of these products is not smooth, it is not recommended to install them in main areas of hospitals,” suggests Thomas.
FMRI has installed flooring that meets all the tough requirements of an intensive care facility
Anti-static: Hospitals have to ensure that the flooring has an anti-static system that ensures that static electricity is easily dispersed. This is particularly important in OTs. Anti-stain: Hospitals prefer anti-stain tiles so that it becomes easy to remove stains from iodine and other materials and damage marks. The anti-stain quality comes with surface treatment, which is often made of PUR (Polyurethane).
desired in hospital flooring are ease of replacement, acoustics, odour, foot comfort and green compliance. She adds that one has to look at combining aesthetics and sustainability with the need of a hospital. The flooring has to cope with heavy traffic from moving equipment like wheelchairs, trolleys and X-ray machines and meet standards for smoke, fire and slip resistance – without
Columbia Asia has installed vinyl flooring in its patient areas as the joints are welded, which minimises chances of infection. Moreover, it is also easy to clean and maintain
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FACTORING IN MAINTENANCE
A hospital's flooring should be non-porous and resistant to chemicals and acids besides being aesthetically pleasing
relinquishing aesthetic qualities. According to Abhishek Saraf, joint managing director, Square Foot, “Flooring is considered the fifth wall of any building. So, flooring for hospitals besides being durable, cost-effective, aesthetically pleasing, should also be non porous and have resistance to chemical and acids.” Adds Surender Kumar Dhiman, general manager, projects, FMRI, Gurgaon, “The design should blend well with overall design in creating an ambience which is soothing and helps in healing. The flooring is also designed keeping functionality of the area in mind.” The success of a type of flooring doesn’t
depend just on its material. Its correct application, pre-installation preparation, the adhesives used, the skill of the installer and adherence to the maintenance protocols, all matter. And that’s why the application process is as important as the material according to Kuruvilla. According to Nair, the area it is to be used in decides the kind of floor application. For instance, anti-fungal and decontamination floor coverings are better in patient rooms, conductive and anti-fungal floor coverings in OTs, conductive and anti stain floor coverings in scan and lab areas, vinyl sheet or tile in lobbies, waiting areas and doctors’ cabins.
According to Thomas Schneider, general manager, Tarkett Western Asia, before deciding on the material, it’s important that the hospital first studies its investment cost and budget on maintenance for flooring. “In Europe, 8 per cent of the total flooring cost is on investment (purchase of flooring) and 92 per cent on the maintenance cost over its life cycle. Even if the maintenance cost is lower in India, it is better to chose a product with good resistance (Class T abrasion) and restorable, which will allow to keep the product for 15 to 20 years,” says he. It will also allow the hospital to avoid using wax and polish, which add to the cost. According to Thomas, the flooring also needs to be hot welded (rolls welded to each other to ensure a good dimensional stability). Hot welding ensures a seamless joint and prevents the growth of bacteria. “A PVC flooring product made with bio plasticizers (Phthalate free) is better from an environmental perspective,” says Thomas.
RESILIENT FLOORING MATERIALS Resilient floorings are designed to be durable and resist stains and water. Unlike hard concrete, they are comfortable to stand and work on, offer static control options and also provide some cushioning for falls. According to Saraf, flooring made from polyvinyl chloride (PVC or vinyl) has proved time and again to be among the most popular choices for hospitals and other healthcare facilities. According to experts, Indian hospitals are
Like Medica Synergie most Indian hospitals continue to use hard tiles in their lobbies
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opting for homogeneous PVC products as they can withstand high traffic and are low on maintenance. On the contrary, offices often look for an acoustic solution (heterogeneous PVC or carpet tiles). “In France, hospitals are mostly designed with acoustic heterogeneous floor coverings with vivid colours, whereas in Sweden, they are designed with homogeneous floor coverings with more sober tone,” informs Thomas. Vinyl and linoleum are also being preferred as there is greater awareness about greener flooring choices — those with renewable resources and low volatile organic compound (VOC) content so that the air quality remains good. Few people know that PVC flooring often obtain the same number of rating points in Leadership in Energy and Environmental Design (LEED) as linoleum. Some hospitals abroad use sheet rubber floors in their operating rooms because of the comfort underfoot for physicians, who spend hours standing and also due to the ease of maintenance. However, “Rubber flooring is much more costly and difficult to maintain. It scratches easily and hence not so present in healthcare institutions,” informs Thomas.
FLOORING IN DEMAND Vinyl: Indian hospitals are replacing hard tiles with vinyl in areas like patient rooms, OTs and
ICUs. Vinyl flooring, available in sheet and tile, is preferred for being attractive, durable, hygienic, resilient, low maintenance (due to advance polyurethane surface treatments) and fungiostatic and bacteriostatic. “While vinyl tiles are a hit among western healthcare facilities as they are easy to maintain and replace, Indian clients like vinyl sheets,” points out Nair. The Hong Kong government has instructed all its hospitals install vinyl flooring to prevent re-emergence of the SARS virus. Vinyl flooring is also preferred as it does not trap dirt or create dust particles, which may lead to static charges in the presence of electronic equipment. Vinyl is available in various shades and designs. Some vinyl flooring is available in designs that give the look of marble or granite flooring but features of vinyl. “The cost of vinyl is almost one fourth the cost of marbles or granite flooring. Apart from price, the installation is easier than marble or granite flooring,” says Saraf. FMRI has installed vinyl flooring in OT, while Columbia Asia has it in patient areas. Says Satyendra Khurana, VP, project, Columbia Asia Hospital, “In vinyl flooring, the joints are welded and hence grooves avoid the chances of infection. Also, the 90 degree corners between skirting and flooring can be avoided by using vinyl since it comes with a cove former for the skirting.” He adds that the material is easy to install and durable and can be replaced easily and quickly, thereby reducing a hospital’s shut down time for maintenance of flooring. FMRI has opted for vinyl, which has anti bacterial properties. Vinyl is also preferred for its ability to withstand knocks and abrasions. A vinyl sheet may include plasticisers, which help make PVC flexible and resilient and stabilisers, which are added to minimise its degradation from heat and light. Many vinyl sheet flooring products are heat-sealed to form a seamless surface that prevents the collection of water, dirt and other contaminants. As these products are based on a polymer that is naturally fire retardant, vinyl flooring products have excellent fire-resistant qualities. Linoleum: This material is being preferred by many institutes like Medica Synergie, Kolkata, which has installed it in its ICU and by FMRI that has it in patient rooms, corridors and nurse station. “Linoleum is a hygienic flooring material, which prevents bacteria from growing on surfaces and are suitable for patient areas,” says Dhiman of FMRI.
HOSPITAL FLOORING MAINTENANCE Proper maintenance of the floor is extremely important to extend the life and also provide a hygienic surface. It is difficult to maintain flooring in hospitals because of the constant movement of trolleys and also due to the spillage of liquids. Points to remember for maintenance of flooring: Many hospitals are going for Polyflor's polyurethene reinforced floors (PUR), which provides a lifetime polish free guarantee, making it extremely easy and inexpensive to maintenance. Each resilient floor has a different maintenance regime, which differs as per the product’s quality. “Usually, the highest end products require a lower maintenance regime,” says Thomas. Usually no special treatment is necessary for germ-free or stain-resistant tiles. They are resistant to most chemicals. Hence, commercially available detergents and cleaning agents can also be used for regular maintenance. Experts recommend use of water to dampen the tiles and joints when using a strong chemical agent. “Depending on usage, fresh micro pores may open up. So, any spills and stains must be removed immediately,” says Vyas. PVC floors should be cubed on to a wall, so that the edges can be cleaned easily.
Being a natural product, linoleum is also being preferred in green designs as it helps a project qualify for points under the LEED rating system. Linoleum tile and sheet flooring, which are tough and durable, can be used in almost any traffic area. Though linoleum provides a seamless floor, many refrain from using it in OR as besides being susceptible to staining by iodine, experts say that harsh chemicals used for cleaning the OR areas can lead to its damage.
IN THE COMING YEARS The Indian floor covering market, pegged at around 500 million square meters and posting a 10 per cent growth rate, mainly consists of ceramics and natural stone. The approximate size of the healthcare market for vinyl flooring is over 2 million square metre and growing in double digits. Experts say that there will be increasing awareness of seamless vinyl flooring among major hospitals and smaller clinics. Analysts foresee vinyl floorings becoming an integral part of hospital design in the coming days. Others point out that pleasant-looking wooden view and stone view resilient heterogeneous sheets would become popular flooring solutions for healthcare facilities.
Ease of cleaning is one of the prime
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factors to consider when choosing the kind of flooring in a hospital
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EVENT CALENDAR
EyeStrat CHENNAI Organised by: Amen & Pranav Healthcare When: 23 February 2013 Where: The Raintree Hotel, Anna Salai, Chennai
CRITICARE 2013 Organised by: Indian Society of Critical Care Medicine When: 1 – 6 March 2013 Where: Science City, Kolkata Website: emsindia.in
Medicall 2013 Organised by: Medexpert Business Consultants When: 8 – 10 February 2013 Where: Ahmedabad, Gujarat
Marketing of healthcare services Organised by: Aum Meditech When: 7 March 2013 Where: Delhi
SASH 2013 Organised by: Academy of Hospital Administration When: 9 February 2013 Where: Delhi
ISVIR Annual Conference 2013 Organised by: Indian Society of Interventional Radiology When: 14 – 17 February 2013 Where: Kovai Medical Center and Hospital, Coimbatore
IT & Automation in Healthcare When: 10 February 2013 Where: Bengaluru
ISKSAA 2013 When: 22 – 24 February 2013 Where: India Habitat Centre, Delhi
Smart Healthcare India Summit 2013 18 - 19 April, 2013, Bengaluru Contact: Alysha Lobo, Project Manager, 09769616685
Watch out for HospiArch 2013
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fter resounding success in Chennai, Hyderabad, Mumbai, Bengaluru, Kochi and Delhi in 2012, HospiArch is set to roll out a series of bumper conferences in 2013. HospiArch, India’s biggest conference series on hospital planning, design and architecture, is slated to be held at 12 different places this year, starting with Vijayawada on 24 January 2013. The list of places for 2013 include: • Vijayawada • Chandigarh • Pune • Coimbatore • Kolkata • Ahmedabad • Indore • Guwahati • Lucknow • Jammu •Jaipur • Trivandrum This month, the event will be held at Chandigarh on 16 February 2013 at the Coliseum Theatre, Chitkara International School, Udyog Path, Sector 25 (West), Chandigarh (chitkara.edu.in). The last date for registration is 6 February 2013.
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A HospiArch event held in 2012
ABOUT THE ORGANISERS HospiArch, the brainchild of Paniel Jayanth and Tarun Katiyar, respective founders of AMEN and HOSPACCX India Systems, was designed to create a platform for healthcare professionals, who are aspiring to build new hospitals.
THE JOURNEY The first HospiArch Conference was conducted at Chennai in January 2012. From there it went to Hyderabad (April), Mumbai (June), Bengaluru (August), Kochi (September) and Delhi (November). Each event saw a participation of over 150 delegates comprising entrepreneurs,
hospital promoters, CEOs, administrators, architects and students. Some of the key topics included: • Architectural challenges involved in building a new hospital • Planning and designing a new hospital • Re-planning and re-designing existing hospitals • Budgeting and financial planning for new hospital projects • Quality standards for hospital planning • Planning a green hospital • Manpower planning for a new hospital • Planning and designing lab and other diagnostic areas of the hospital.
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POWERED BY
Event report
A roaring success Governor of Madhya Pradesh Mahamahim Ramnaresh Yadav inaugurated the event
Over 500 exhibitors including big plyers in the segment participated in the show
Everybody was happy to be a part of IRIA 2013—the organisers, the attendees, the speakers and the exhibitors. For those who missed being at the event, here’s a recap…
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s many as 2,500 radiologists and over 500 exhibitors attended the 66th Annual Conference of Indian Radiological & Imaging Association (IRIA) 2013, held in Indore from 4 to 7 January, making it a huge success. The show was as much feted for the latest technology display as it was for the knowledge imparted on various aspects of radiology and imaging. “The success of the show was the result of two years of meticulous planning,” informed Dr RK Sodani, organising secretary, IRIA 2013. The event was a mix of an exhibition, graced by some of the biggest names in the industry
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and conferences, presided over by some bigwigs. Here’s what some of the leading speakers presented at the event. DR PETER CAVANAGH Dean, faculty of clinical radiology and vice president, Royal College of Radiology Topic: Delivering Radiology Services in 2030 — Who, What, Where, How? Elaboration: The recent past has seen a wide change in the role of radiology in healthcare. Much of this has been due to the major developments within the specialty
IRIA 2013 saw the best in imaging and radiology
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Event report
itself. However, there are other powerful drivers for change that will have a major influence on the future of radiology. These drivers will outwit health science itself and include the changing population demography, economic challenges and changes in culture. Added to this, there are the technological advances that are making the world a smaller place and changing the way we communicate.
evaluation of patients with elevated PSA, as well as those with biopsy proven cancer.
DR TONY NICHOLSON, Consultant vascular and interventional radiologist, Leeds Teaching Hospital, UK Topic: Lower GI Intervention Elaboration: Good knowledge of the vascular anatomy of the bowel is key to understanding and preventing ischemic complications after transarterial embolization (TAE) in patients with lower gastrointestinal bleeding (LGIB). The risk of infarctions post TAE is based on the sparse intramural arterial network of the colon behind the level of the vasa recta. If TAE includes proximal arcades or the marginal artery in a way that permanent occlusion of more than 4 – 5 vasa recta (1 vas rectum per cm bowel length) results, the risk of insufficient intramural collateralisation increases.
DR S C RANKIN Consultant radiologist, Guy’s and St Thomas’ NHS Foundation Trust Topic: The value of 18F-FDG PET/CT in oesophageal cancer Elaboration: FDG PET/CT is recognised as a useful adjunct to conventional imaging with CT and endoscopic ultrasound (EUS) in the staging of oesophageal CT. It provides information for response assessment, can identify recurrent disease and may provide prognostic information. Most recurrences of oesophageal cancer are both distant and loco-regional with approximately 30 per cent being loco-regional alone. Usually, EUS, CT and MRI may be limited in value because they are associated with post therapy fibrosis, oedema and scarring and PET/ CT is more accurate than CT for both local and distant metastases, although CT is better for small lung metastases. Furthermore, anastomotic recurrence is best assessed with EUS. PET scans are also helpful in providing prognostic information in patients with recurrent disease.
DR HERBERT Y KRESSEL Editor, Radiology and RSNA Science Editor Topic: MRI of the Prostate Elaboration: Despite the potential lethality of prostate cancer, in most men, it has an indolent course and may not be lethal. Thus, controversy exists about its appropriate management. Currently, a multi-parametric MR examination of prostate is performed. While MRI cannot detect microscopic spread of tumours beyond the prostate, it is helpful in tumour staging and in surgical planning. MRI is particularly accurate in detecting tumours larger than 7mm and those with Gleason grades greater than 6. MRI is increasingly becoming an important component of the
DR RAJEEV JYOTI Associate professor, Australian National University Medical School and Medical Imaging in The Canberra Hospital, Australia Topic: Imaging guided interventions in pain management — MSK and SPINE Elaboration: With ageing population and increased physical activity across population sub-sets, clinical presentations of musculoskeletal and spinal pain are rapidly increasing. Imaging has traditionally played a significant role in diagnosis of underlying pathology or excluding sinister pathologies. With evolution of high-resolution ultrasound and dynamic CT, imaging guided interventions have extended the role of radiologists into pain management.
A FIRST AT IRIA 2013
Carestream Health India showcased e-Radiograph, the first bi-yearly radiology publication of its kind in an e-book format at IRIA 2013, and received an overwhelming response. e-Radiograph is one of Carestream Health's knowledge sharing and education tools. The launch issue focuses on “Imaging of the Bowel “ by Dr Anirudh Kohli. To get a free copy log on to: carestream.in/eradiograph.
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Event report
A platform for learning Over 2,500 radiologists from all over the country congregated in Indore to attend the 66th annual IRIA event. We spoke to a few of them to understand what drew them there DR BHAVIN JANKHARIA, Jankharia Imaging Center, Mumbai President Elect, IRIA 2014 Since how many years have you been attending the event? I have been attending since 1990 with only two gaps.
DR JIGNESH DUBAN, consultant radiologist, HCG Cancer Center, Ahmedabad
Since how many years have you been attending the event? I have attended four IRIA events.
What has been your association with the event? Being the joint-editor and secretary and then editor-in-chief of the Indian Journal of Radiology & Imaging, I could not have missed attending the conference since I had to attend the central council and general body meetings. Currently as president elect and next year as president, I would need to be attending as well. Virtually every year, I am asked to deliver some talk or the other as well and so I land up attending the event.
What draws you to the event? Multiple factors. First of all, it’s a mega event organised by the foremost body on radiology in the country. It involves eminent speakers from all parts of India as well as international faculties. Secondly, I get to know new radiological updates in all fields of radiology (MRI, CT, USG, interventional radiology and recent advances). Thirdly, vendors from all major companies display their products here. Fourthly, I get accreditation points given by the CME, by attending the event.
What was the learning from this year’s event? Nothing specific as far as core academics is concerned. However, a lecture on ‘Humanities in Radiology’ by Dr Ravi Ramakantan and another one by ‘Radiology Publishing’ by Dr Herbert Kressel were noteworthy.
Which new technologies impressed you this year? Most impressive thing for me in this event was closing the gap between the major players in the field of USG and PACS system, which have blossomed beyond imagination. They make life easy for radiologists, clinicians and patients.
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DR ANIRUDH KOHLI, radiologist, Breach Candy Hospital
Since how many years have you been attending the event? I have been attending IRIA for the last 27 years. What draws you to the event every year? It was a pleasure to attend IRIA in Indore in January 2013 as compared to most previous IRIAs. This year’s event was well organised — the venue was excellent and the hospitality, par excellence. I go to IRIA every year not just because I am a faculty but because it is a social event. A meeting point for old colleagues, friends and a place to meet the trade. What was the learning from this year’s event? The one drawback year on year is the dwindling attendance in lecture halls. When I spoke on an important topic, there was a handful of audience. This has been the case over the years. Perhaps, this is because many sessions are conducted at the same time possibly to accommodate a wide range of topics.
DR PANKAJ ARORA, radiologist, BSR Healthcare, Raipur
Since how many years have you been attending the event? This year, I attended the event after a gap of six years. For the last few years, I missed the event as the timing of the event did not match with my work schedule. What draws you to the event? The event is an ideal platform for learning the latest technology and advancements in the field of radiology and use the learning in my every day practice. I look for events, which would provide me dedicated sessions on USG or MRI. Which new technologies impressed you this year? ARFI technology from Siemens in ultrasound, which is used for quantification of liver fibrosis and differentiating benign from malignant tumours What was the learning from this year’s event? We don’t have enough guidelines in India. So, I liked the session on guidelines for foetal USG.
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‘Everyone appreciated the scientific content and hospitality’ Dr OP Tiwari, chairman of organising committee of IRIA 2013, spoke on the efforts that went behind making IRIA 2013 a grand success THE SPEAKERS
Dr O P Tiwari
The organising team that was behind the success of IRIA 2013
When did you start planning the event? During the Delhi IRIA conference, two years back, it was decided that the event would be held in Indore. The MP chapter of IRIA was to organise the event. It was the first time that the event was being held in a non-metro, so we were aware of the challenges but were equally determined to surpass them and make the event a grand success.
identified and their topics finalised. We selected speakers based on their experience, lectures and their publications. We had 200 speakers, of which 60 faculties were from abroad. We had experts from The Asian Oceanian Society of Radiology (AOSR) and Radiological Society of North America (RSNA). Moreover, we got Ram Naresh Yadav, the Governor of Madhya Pradesh, to inaugurate the event.
How did you go about it? Our first job was to identify the venue that had large seating arrangements. Also, we had to run 10 parallel conference sessions. No hotel in Indore has a massive auditorium or that many conference halls. We finally zeroed in on Daly College, which is a heritage public school. The venue spread over 100 acres of lush greenery has a capacity to seat 1,500 people in the main hall while boasting of sufficient mid-sized and other small halls. It was thus the perfect venue for the event of our scale. Once the venue was decided, we needed experts to put together the infrastructure like large food courts for the delegates, registration desk, exhibition space and a dais for social function. We also spent some time and effort finalising on the audio visual set-up. For each auditorium, we had two large LCDs and one screen with back projection at the centre. For both, we hired people from Delhi. Simultaneously, eminent speakers were
What was the feedback from the attendees? The attendees appreciated the scientific content as well as the hospitality. The scientific sessions were held from 8 am to 6 pm. There was plenty of appreciation for the pre-conference workshops on interventional radiology, USG, breast imaging, vascular imaging and CT imaging. In fact for the interventional radiology workshop, Sri Aurobindo Institute of Medical College had teamed up with us for a live demonstration of cases, which was widely appreciated.
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What kind of hospitality was offered? Hospitality was one of the highlights of the event. We booked 900 rooms at Indore’s leading hotels, from where we had arranged pick and drop to the venue from 7 am to 11 pm. The wide expanse and the lush green venue added to the delight factor. In terms of cuisine, there was a wide spread of Malwa food, the speciality of MP. We also offered food from all parts of the country, in
Some of the leading speakers were: • William Bradley • Dr Mark D Murphy • Dr Richard Wiggins • Dr Klaus Irion • Dr Peter Cavanagh • Dr Sheila Rankin • Dr Herbert Y Kressel • Dr Tony Nicholson • Dr Lil Valentin • Dr Ravi Kashyap • Dr Shrinivas Desai • Dr Deepak Patkar • Dr Aniruddh Kohli • Dr Bhavin Jhankaria • Dr Ravi Ramakantan • Prof K Subbarao • Dr Saurabh Jha • Dr Rajeev Jyoti • Dr Mini Pathria
addition to continental fare. Food was available at the venue right from breakfast, lunch, high tea and dinner. For all the three days, there was a cultural function. We had organised Malwastyle folk songs and dance, besides Bollywood and western performances. How did you manage logistics? This was an area we particularly worked on. For the pick-up and drop, we had hired one travel agent, booked around 14 school buses and around 60 four wheelers to ply the delegates to and from the venue. Were there recreational activities? The venue itself had many facilities, like a swimming pool and badminton and squash courts. For the delegates, we had organised quiz programmes. For the family accompanying the delegates and speakers, we had organised games at the venue to keep them entertained. How does the team feel now? To pull off such a massive conference and that too in a city like Indore, one needs to have foresight, patience and courage. We are happy that everyone appreciated our efforts and went back well-informed and pleased.
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Product paradise
The 66th IRIA had as many as 500 exhibitors. Here’s a peep into who displayed what ALLENGERS MEDICAL SYSTEMS LTD Allengers Medical Systems Ltd unveiled RollX DR, a cost-effective mobile DR system with no retrofit, at the IRIA event. It also displayed Fairy DR, a full field Digital Mammography System- and Alldent- a dental OPG system. Features • Light weight sleek design. • 17” touch console. • Windows based user friendly work flow. • 14” x 17” flat panel detector (wired / wireless). • Heavy duty capacitor pack high frequency x-ray generator (15 KW / 200mA). • USB / CD-DVD output. • LAN connectivity with DICOM printer. • Power requirement: Standard wall socket (15 Amps / 230 Volt). • Full DICOM 3.0 connectivity. Said Ajay Mohan, head, strategic marketing, Allengers, “The delegates who visited Allengers stall had shown great interest in our newly launched mobile DR. The Digital Mammography too was appreciated for its aesthetics. The improvement in the range and quality of products being manufactured by Allengers were the talk of the event.”
KS BIOMED SERVICES KS Biomed Services, Ahmedabad, introduced for the first time in India a unique, life-size virtual dissection table. This advanced virtual anatomy table is developed by Stanford Medical University and Anatomage Inc, USA. The product was launched at the National conference of Anatomical Society of India (NATCON 60) held at Bhubaneswar, Odisha and was also displayed at IRIA 2013. The table offers an unprecedented realistic visualisation of 3D anatomy and interactivity. Delivering accurate anatomic details, it complements cadaver based dissection courses. Turn patients, remove portions or completely change the view with the swipe of a finger. The table offers both, a natural and an interactive experience. The table allows students to visualise skeletal tissues, muscles, organs and soft tissue. These various tissues and views can be customised by virtually slicing, layering and segmenting the anatomy. Custom annotations can be easily added to the visualisations of anatomical structures. With flexible annotation tools, institutions can create innovative programmes, quizzes, and new methods of study. In addition to anatomy education, it also offers a unique advanced application of case review on table, either through image library given or by loading DICOM image of CT/MRI of abnormal cases. The table will restructure the image with actual internal organs, which can be further studied in detail and can be dissected as well.
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VARIAN MEDICAL SYSTEMS PHILIPS HEALTHCARE Philips Healthcare displayed a range of products and solutions, some of them for the first time in the world.
MRI • Multiva 1.5T, showcased for the first time in the world at IRIA Indore, meets radiologists’ need for fast, high-quality routine MR imaging, while excelling in advanced clinical areas so that they can tap new The Philips ClearVue opportunities and expand their referral base. Flex 650 ultrasound system launched at IRIA 2013 stream with IQ (Smart Select, Smart Exam, Smart Assit, Smart Link) helps reduce patient/coil set-up time by up to 40 per cent and can halve the number of repetitive tasks for greater efficiency. • Ingenia 1.5T and 3.0T was launched last year. It is a 70 cm bore, world’s first-ever digital broadband MRI that offers up to 40 per cent increase in SNR, as much as 30 per cent improvement in workflow and Philips showcased Multiva 1.5 T for up to 50 per cent reduction in costs due to the first time in the world at IRIA clinical expansion with channel indepen2013, Indore dent system.
Varian displayed replacement CT scan tubes including: GE CT/e – 2 MHU, GE ProSpeed/Solarix NP 3.5MHU, MCS-6074 GE LightSpeed 6.3 MHU and for GE Lightspeed VCT MCS 8064 X-ray tube . The digital X-ray imaging products highlighted were: • PaxScan® 4336X featuring Varian's proprietary, state-of-the-art sixth generation architecture, improved low dose imaging and 16-bit data acquisition. • i5DR Digital Radiography imaging system, designed for installation into new or existing radiographic rooms or mobile X-ray systems. i5DR has built in flexibility with advanced imaging algorithms to support multiple flat panel detectors
PROGNOSYS MEDICAL SYSTEMS PVT LTD Prognosys displayed two products — one a futuristic high frequency Xray system, the Prorad Atlas, and the other a value DR - the Prorad 2FC.
ULTRASOUND Philips launched ClearVue 650 ultrasound system for the first time in the world at IRIA, Indore. ClearVue 650 is equipped with Active Array technology and its 3D/4D capabilities are designed to be easy to use and easy to learn, so that 3D/4D fits seamlessly into Indian radiologists’ routine clinical workflow.
CT • IMR or Iterative Model Reconstruction is a unique model-based, knowledge-based approach that moves CT imaging from data approximation to data restoration. IMR sets a new direction towards virtually noise-free image quality with improvements in low contrast imaging. • iPatient is an advanced platform that delivers focused innovations to facilitate patient-centered imaging, now and in the future. • iDose, an iterative reconstruction technique, gives you control of the dial, so that radiologists can personalise image quality based on patient needs at low dose. It is now available with metal artifact reduction for large orthopedic implants (O-MAR).
PRORAD ATLAS The Prorad Atlas is a single phase 30 KW true high frequency X-ray system engineered to work on any house line of 12/15 amps socket and yet deliver a 425mA/125 KV output. This technology is unique and time tested in the global market. Prognosys has introduced this system into the Indian market to help hospitals, diagnostic centres and clinics to overcome the power shortages that prevail across India. Not only does this help in ensuring that work in the radiology room continues uninterrupted but it also provides an ideal solution for rural India when combined with a CR/DR and Tele- Radiology.
PRORAD 2FC Prorad 2FC, a floor mounted single detector ‘value DR system’ that has all the features that one would expect in a full-fledged modern DR system.
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The melting pot Here are some compelling reasons why you must attend Medicall 2013
F
rom 8 – 10 February, the Gujarat University Exhibition Hall will be abuzz with activity. Thousands of visitors from all over India will come to Ahmedabad just to be there. And for a good reason, the 10th edition of Medicall is being hosted there. Organised by Medexpert, this show is considered a must-visit among industry-related events.
THE SHOW IS SPECIAL BECAUSE... 1. It continues to draw the highest percentage of decision makers, hospital owners, doctors, medical directors and purchase heads. It also attracts dealers and suppliers. The fact that its previous hosting attracted over 430 exhibitors and had over 8250 quality visitors mostly from the its core target group, speaks volumes about the show’s brand value. For these three days, Medicall will serve as the nerve centre of healthcare business in India, and is expected to surpass 10,000 footfalls. Says Dr S Manivannan, CEO Medicall, “The steady growth in participation at Medicall every year, in terms of numbers already achieved, is an indication of the benchmark it is about to set in terms of business volumes and visitations.” 2. The event offers the perfect business setting for the healthcare fraternity. It offers deliberations, networking sessions with pre-scheduled opportunities between key stakeholders, buyers and sellers. It is an ideal B2B platform for manufacturers, buyers, traders, distributors, as well as government dignitaries. 3. It provides delegates an opportunity to familiarise themselves with companies like Philips, Godrej, Sai Infosystems, Mahindra and Mahindra Ambulances and Vissco India. The profile of exhibiting equipments/services represents a wide variety of the sectors participating. For instance, ambulances, consumables, energy saving equipment, healthcare consultants, laboratory equipment, dental equipment, OT and ICU equip-
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Last year, Medicall had over 430 exhibitors and over 8250 quality visitors
SEMINARS TO WATCH OUT FOR Theme: Good to Great • Date: 9 February Significance: Focuses on transforming family-owned good hospitals into bigger healthcare institutions. “In India, family-owned hospitals form a major component of the healthcare delivery mechanism. It is essential to formulate a system for family-run hospitals in order to provide measureable outcome benefits to the patients, stakeholders, various healthcare providers, and business partners. A doctor’s successful clinical practice, which has been built over a period of time, has to be converted into a more professional healthcare delivery system,” explains Dr Manivannan. Topics: Ways of converting a family-owned hospital into a professionally-managed healthcare institution, succession planning of practice when the progeny are not doctors, allowing professionals or family relatives to manage hospitals, converting the hospital into a system-driven rather than a peopledependent organisation, managing differences of opinion between siblings managing the hospital and managing funds for expansion. Theme: Hospital materials management • Date: 9 February Significance: Materials and consumables account for 40 per cent of total expenses in a hospital. The profitability of any hospital depends on how judiciously this department is handled. Topics: Setting up a materials management department in a hospital, functions of the department, role of IT in materials management and sourcing, and optimum stock level, reducing pilferage and increasing profits Theme: Internal audit • Date:10 February Significance: Hospital owners don’t generally take active part in annual audits, which help in effective management of hospitals. The seminar will underscore the importance highlighting how audits help. Topics: Comprehensive reviews of the various systems and processes to determine their effectiveness in achieving the objectives set, KPIs of various departments in hospitals, pricing and designing packages for various procedures by utilising activity- based costing, controlling revenue leaks and use of audit as an effective tool.
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ment, patient monitoring systems, physiotherapy and orthopaedics, refurbished equipment, surgical instruments, telemedicine, wound care products, life support systems, laundry equipment, implants, housekeeping solutions and healthcare IT solutions. 4. For exhibitors, this is an important platform to meet potential clients. “Don’t miss the chance to meet the market,” says Dr Manivannan. The organiser has positioned the show as “prescription for accelerating business success.” 5. The event also comprises seminars on key topics: a) ‘good to great’ on transforming family-owned good hospitals into greater healthcare institutions, b) materials management c) audits.
MEDICALL 2012 AT A GLANCE
WATCH OUT FOR ZIQITZA HEALTH CARE LIMITED
Ziqitza Health Care Limited (ZHL), has been a pioneer in the emergency medical response services and patient transport services in India since 2005. ZHL was setup by a group of young professionals who, after their education/training in the US and professional employment/entrepreneurial projects in India, realised the acute need for organised and networked ambulance service in India. ZHL’s vision is to assist in saving human lives by providing a leading network of fully-equipped advanced and basic life support ambulances across the developing world. Its vision reflects in its commitment to meet international standards for quality in emergency medical services and be accessible to everyone regardless of income bracket. Its value lies in being ethical and transparent and in fostering teamwork. ZHL operates the Emergency Medical Response (Ambulance) Services under two models: Dial ‘1298’ for Ambulance: Fee for service model with cross subsidy, where the rich and affordable pay more and the poor pay less. For very poor/accidents/emergencies, the service is free of cost. Currently, this service is operational in Maharashtra (Mumbai), Odisha, Punjab, Bihar and Kerala. Dial ‘108’ in Emergency: This model is usually offered in Public Private Partnership with state governments. This could be either free for the patient or on a user fee, as per the contract with State Governments. The service is provided to emergency victims. The model is operational in Bihar, Kerala (Trivandrum), Punjab and Rajasthan. ZHL has realised that today hospitals and organisations are focusing on their core competency and are outsourcing other aspects of operations. ZHL provides fully-equipped ambulance with trained drivers and paramedics to hospitals/organisations to cater to their outsourcing requirements. ZHL is currently operating more than 860 ambulances across six states and have served more than 1.9 million people till date. ZHL is part of EMSC – the world largest ambulance company. Its strategic partners are London Ambulance Services, Life Supporters Institute of Health Science and New York – Presbyterian Emergency Medical Service (NYP-EMS). Contact: Ruchika Beri Email: contactus@zhl.in Website: zhl.org.in
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The event received a great response last year and organisers are optimistic that this year's event will be even better than the last
HOSCONNN.COM
APPROACH
This is an online healthcare consultancy portal that aims to use internet Tech-know-logy to: Simplify the inherent complications in various strata of healthcare Provide value-based decision-making Provide expert advice to the medical fraternity throughout the nation
Through the online route, HOSCONNN offers advisory consultancy and solutions to clients and provides guidance to the team implementing and executing the project on behalf of the client. On implementation issue, it wishes clients to have more comfort levels, ease and leverage visa-vis the resource mix. Its key responsibility would be to advise clients to manage/optimise project costs.
HOSCONNN is dedicated to the mission of optimising resources and minimising wastage.
PERCEPTUAL BALANCING
HOSCONNN strongly feels that “hospitals should be built not only as per the market potential, but also as per clients competency, capability, adaptability and resource mix.” It suggests that there should be not only an entry plan but also an exit plan.
Over the years, knee-jerk /ad-hoc responses (to the issues, challenges and even opportunities) have been quite common across various strata of healthcare. The expert and experienced knowledge pool of Hosconnn. com strives to analyse and grade the operational and opportunity issues and calibrate the strategies.
RELEVANCE OF ONLINE HEALTHCARE CONSULTANCY
SPEED IS THE NEED
On-line ‘Case Studies Driven’ healthcare consultancy is relevant in changed perspectives (Competitiveness, Quality, Commercials, Cost, and Technology) because: It brings in fresh perspectives to the issues to be undertaken and prevent intellectual and creative inertia. It keeps CCP (cut, copy and paste) syndrome in check. It helps make up for the lack of experienced consultancy professionals across the nation. It goes beyond infrastructural limitations since it is based on the internet . It allows thinking out-of-the- box and healthy debate and cross examination among the experienced professionals.
Being online enable it to have more time and sharper focus, resulting in quality deliverables in two to four weeks, irrespective of issues/location.
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CONSULTANCY SERVICE PORTFOLIO
The company provides comprehensive consultancy services for: Hospital Construction/Project Consultancy (Sans PMC) Hospital Administration Hospital Environmental ,Regulatory & Statutory compliances Hospital Quality Benchmarks like ISO, NABH etc, Hospital IT Infrastructure Hospital HR solutions Contact: Manish Rastogi Email: info@hosconnn.com M: 09845208778
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