Healthcare Radius Magazine- May 2013

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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 48 of every previous month. Posted at Patrika Channel Sorting OfďŹ ce, Mumbai-400001, Posting date: 30th & 31st of every previous month

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Embracing modern thinking Published by ITP Publishing India

PATIENT RELATIONS

>>>FIRST LOOK NH WHITEFIELD HOSPITAL

ROLE OF ACTIVE LISTENING IN HEALTHCARE DELIVERY

TECHNOLOGY ADVANTAGES OF OPEN STANDING MRI

CASE STUDY HOW COLUMBIA ASIA USES IT FOR EFFICIENCY

SPOTLIGHT

BSR PLANS 200 IMAGING CENTRES

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Contents 08 NEWS

24 PROFILE

This month’s important news updates

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14 PREVIEW

26 STRAIGHT TALK

Smart Healthcare Conference, Bengaluru

Dr V Mohan, chairman, Dr Mohan's Diabetes Specialities Centre, on his diabetes centres

16 PROJECT SPOTLIGHT Dr Kshetrapal Eye Hospital, Ajmer

42 40 VIEWPOINT

32 TECHNOLOGY >RO LOXO ^] YP YZOX ]^KXNSXQ 7<3

In case of an error, hospitals shouldn't hesitate to apologise, says Dr AK Khandelwal

34 INFORMATION TECHNOLOGY

42 LEGAL EYE

How Columbia Asia integrated all its processes PY\ K ]WYY^R aY\U Ya KXN SWZ\Y`ON OP MSOXMc

Key legislations applicable to a hospital

17 FIRST LOOK Narayana Hrudayalaya's upcoming project in ARS^O OVN ,OXQKV_\_

18 CORPORATE AFFAIRS BSR Healthcare plans to storm the market with 200 diagnostic centres, all in tier-II cities

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Healthcare Radius May 2013

44 EVENT REPORT 38 PATIENT RELATIONS ARc NYM^Y\] ]RY_VN LO KM^S`O VS]^OXO\]

PeopleHosp conference in Delhi focussed on getting skilled manpower and retaining them

Editor's Note

, 8 o 5.+ o (224$ 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

A study in contrasts

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Group editor: Shafquat Ali

EDITORIAL Consulting editor: Rita Dutta T +91 9980 588199 rita.dutta@itp.com Managing editor: Shiv Joshi T +91 22 6154 6034 shiv.joshi@itp.com

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Rita Dutta -YX]_V^SXQ ONS^Y\ \S^K N_^^K*S^Z MYW WRITE TO THE EDITOR :VOK]O KNN\O]] cY_\ VO^^O\] ^Y$ >RO /NS^Y\ 2OKV^RMK\O <KNS_] 8Y^KX :VKdK >RS\N 0VYY\ "#" >_\XO\ <YKN ,KXN\K AO]^ 7_WLKS Y\ OWKSV \S^K N_^^K*S^Z MYW :VOK]O Z\Y`SNO cY_\ P_VV XKWO KXN KNN\O]] ]^K^SXQ MVOK\Vc SP cY_ NY XY^ aS]R _] ^Y Z\SX^ ^ROW >RO YZSXSYX] ObZ\O]]ON SX ^RS] ]OM^SYX K\O YP ZK\^SM_VK\ SXNS`SN_KV] KXN K\O SX XY aKc K \O OM^SYX YP ^RO Z_LVS]RO\t] `SOa]

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Healthcare Radius May 2013

and published at ITP Publishing India, Notan Plaza, 3rd floor, 898 Turner Road , Bandra (West), Mumbai – 400050 Editor: Rita Dutta

Published by and Š 2013 ITP Publishing India Pvt Ltd 7LWOH YHULĂ€FDWLRQ QR 51, 1R 0$+(1*

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 (HONY) BRIGADIER DR ALOK ROY DR ARVIND LAL Chairman, NABH and Chairman, Medica advisor, Fortis Healthcare Chairman and managing Synergie director, Dr Lal PathLabs

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

DR GIRDHAR J GYANI Director general, Association of Healthcare Providers

DR RAVINDRA KARANJEKAR CEO, Global Hospital and chairman, NABH accreditation committee

DR G BAKTHAVATHSALAM DR MK KHANDUJA

Chairman, KG Hospital & Post Graduate Medical Institute

Chairman, BSR Healthcare

DR GUSTAD B DAVER Director, professional service, PD Hinduja Hospital

BRIGADIER JOE CURIAN CEO, SevenHills Hospital

DR DURU SHAH Eminent gynaecologist

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

Healthcare Radius May 2013

7

NEWS TRACK

CANARA BANK INVESTS IN GNRC PIRAMAL FORGES ALLIANCE WITH TATA MEMORIAL

Canbank Venture Capital Fund Limited (CVCFL), Bengaluru, a wholly-owned subsidiary of Canara Bank, has picked up stake of Rs200 million in Guwahati-based GNRC Ltd. GNRC has two leading tertiary care hospitals: GNRC – Dispur and GNRC Six Mile with a total of bed capacity of 215.

FOGSI TO TRAIN NORTH EAST GYNAECOLOGISTS The Federation of Obstetric & Gyneacological Societies of 3XNSK 091=3 ^RO KZOb LYNc of obstetricians and gynecologists in the country, has announced the roll out of YUVA–Towards Tomorrow (YTT)– a programme aimed at strengthening the healthcare services delivery in ^RO 8Y\^R /K]^ \OQSYX C>> aY_VN LO providing technical training to young gynaecologists from all the seven states YP ^RO 8Y\^R /K]^ YX `K\SY_] K]ZOM^] YP aYWOXt] ROKV^R 091=3 MRY]O ^Y launch the YTT programme from Guwahati as the health indicators in ^RO 8/ \OQSYX S] ZYY\ K] MYWZK\ON ^Y the rest of the country. Over a three-day conclave in 1_aKRK^S SX +Z\SV 091=3 SWZK\^ON knowledge to gynaecologists on topics like ultrasonography, laparoscopic surgery, infertility, and other key aspects of obstetrics and gynaecology.

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The investment raised as ven^_\O XKXMO P\YW /WO\QSXQ 3XNSK Growth Fund, a Rs500 crore fund managed by CVCFL, will be used ZK\^Vc ^Y XKXMO ^RO _ZMYWSXQ 300-bed super–specialty hospital at north Guwahati and partly for modernisation, up gradation and expansion of existing facilities.

:S\KWKV /X^O\Z\S]O] 6SWS^ON :/6 KXN >K^K 7OWYrial Centre (TMC) recently decided to collaborate to enable the development of valuable tools for better understanding disease biology and predict responses to various treatments for cancer patients. The alliance will focus on the development of preclinical cancer models to enhance the understanding of disease biology, treatment response/resistance and biomarkers as they relate to diagnosis, prognosis and response to drugs. These models will be based on tumour tissues from cancer patients and are predicted to have better translational relevance than the currently used human cancer MOVV VSXO WYNOV] =MSOX^S]^] K^ >7- KXN :/6 RYZO ^Y QKSX K LO^^O\ _XNO\standing of the mechanisms through which various drugs work on different cancers. This research could lead to new therapies and predict the medicine best suited to treat an individual cancer patient.

FMRI OPTS FOR OXIDISED KNEE IMPLANTS + # cOK\ YVN VKNc ]_PPO\SXQ P\YW Ob^\OWO NSP M_V^c SX aKVUSXQ XSQR^ pain and restricted daily activities underwent bilateral knee replaceWOX^ K^ 0Y\^S] 7OWY\SKV <O]OK\MR 3X]^S^_^O 07<3 1_\QKYX ^Y LO able to walk to a pain-free life. The challenge with the patient was that she could not undergo routine knee transplant as she was allergic to nickel since childhood. >R_] .\ 4,= 4KQQS ]OXSY\ Y\^RYZKONSM MYX]_V^KX^ 07<3 \OMYWmended the patient to use nickel-free components for knee transplant. “When metal allergy is a concern, we prefer to use components that are made from one of the most biocompatible metals available (oxidized zirconium),� said Dr Jaggi. Generally, cobalt chrome knee implant are used for knee replacement, which over time, can become roughened by bone movement and wear out sooner than other imZVKX^] VK]^SXQ PY\ cOK\] 3X MYWZK\S]YX YbSNS]ON UXOO SWZVKX^] are stronger and last for 25 – 30 years. They are made of biocompatible metal, similar to titanium, which is 4,900 times more abrasion \O]S]^KX^ ^RKX MYLKV^ MR\YWO \O^KSXSXQ ^RO ^Y_QRXO]] KXN ObSLSVS^c YP the material for long.

Healthcare Radius May 2013

27 MILLION DELIVERIES ARE REGISTERED EVERY YEAR IN INDIA. HOWEVER, THE NUMBER OF GYNAECOLOGISTS IN THE COUNTRY IS JUST 30,000

Health and hygiene are a clear priority for the healthcare sector, but it’s also important to create a comfortable environment for patients, and good working conditions for staff. Tarkett has a solution for every area, from brilliant colours for children’s wards to static-control for an operating theatre, from traffic and stain-resistance for reception to slip-resistant and waterproof floors. Hygienic and ultra-hard, easy to clean and maintain, our floors offer optimum return on investment while reducing staff workloads and improving patient comfort and care. www.tarkett.com

Flooring solutions for healthcare

Health and hygiene are their priority We provide the solutions they need Tarkett India 132, 1st Floor, Rec.-1, D-4 District Center Saket, New Delhi + 110017, India Tel: 011 435 240 73 Fax: 011 435 240 79 E-mail: thomas.schneider@tarkett.com

NEWS TRACK

AT A GL ANCE BMT, LEUKEMIA AND LASER CLINIC LAUNCHED AT BGS GLOBAL BGS Global Hospitals, Bengaluru, has launched a Bone Marrow Transplant (BMT) and leukaemia clinic as well as a laser clinic re-

cently. The clinic was inaugurated by its CMD Dr K Ravindranath and vice chairman Dr NK Venkataramana.

SUPER-SPECIALITY TREATMENT IN GOA The Government of Goa will soon introduce super speciality cardiac treatment, including cardiac surgery, at the Goa Medical College and Hospital in Bambolim. It plans

to add super-specialty treatments for various other ailments like cancer in the next four years, health minister LaxmikantParsekar has recently told at the assembly.

RAMESH HOSPITALS TIES UP WITH PIRAMAL Ramesh Hospitals, Vijaywada, has signed an agreement with Piramal Group’s India Venture Trust to expand its services to coastal districts of Andhra Pradesh. Together they will will open a 350-bed multi-speciality

hospital in Guntur and set up several tertiary care centres. In the next three years, the group proposes to scale up its bed strength to 1,000 beds capacity through acquisition of small hospitals/clinics.

PADMA SHRI FOR DR TP DAS Dr TP Das, vice chairman of LV Prasad Eye Institute, has been bestowed with the prestigious Padma Shri. Trained in medical and surgical management of vitreo retinal diseases, he has received 16 research grants and has led or currently leading a

number of research programmes in diabetic retinopathy and age-related macular degeneration. He also has active clinical and research interest in infective endophthalmitis.

CASE FOR GENERIC MEDICINE IN NAGALAND Expressing concern over the non-availability of medicines for patients in district hospitals, Nagaland Minister for Health and Fam-

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ily Welfare Imkong L Imchen has stated that he would work towards ensuring the availability of generic medicines in all the hospitals.

Healthcare Radius May 2013

PUDUCHERRY GOVT PARTNERS WITH ABBOTT FOR NCDS The Government of Puducherry and Abbott have signed a three-year agreement to improve awareness of non-communicable diseases (NCDs) like diabetes, hypertension and dyslipidaemia (cholesterol related disorders) and thyroid The parternship will help Puducherry. disorders; and implement SXS^SK^S`O] ^Y QR^ ^ROW KXN record their prevalence in the Union Territory of Puducherry. The partnership programme will reach out to the citizens of Pudhucherry and screen/monitor over seven lakh people, the general population of Puducherry that is older than thirty years. The partnership initiative also involves building the skills of local healthcare providers through continued medical education. >RS] ZK\^XO\]RSZ S] ^RO \]^ YP S^] USXN ^Y LO SXS^SK^ON Lc K QY`O\Xment in India to capture and assess reliable population level screening/ monitoring data. This data will help to create health risk maps to forecast the burden of these non-communicable diseases, facilitate early intervention, and ultimately help reduce disease burden in Puducherry.

APOLLO HOSPITALS LAUNCHES VACCINATION CAMPAIGN Apollo Group of Hospitals has recently launched 'Apollo Project’, a campaign focussed on encouraging vaccinations for the adolescent and adult population. The campaign will be driven across the group's integrated healthcare network of 50 hospitals, 1,500 pharmacies, 100 clinics, four cradle hospitals, day surgery centres, occupational health centres, telemedicine centres and patient information centres across the country. "Vaccination in India has primarily been administered to new borns. A large share of adults and adolescents are neglected leaving them susceptible to life-threatening, yet easily preventable maladies. This initiative will help save lives, improve epidemiological surveillance and also offer a reasonably inexpensive and valuable protection against diseases,” said Preetha Reddy, MD, Apollo Hospitals Group. Soon, dedicated vaccination bays will be set up across all Apollo hospitals and clinics and vaccinations will be a part of regular health check-ups.

NEWS TRACK

SPS APOLLO LAUNCHES PAEDIATRIC CARDIOLOGY UNIT

In a major boost to the medical facilities in the region, Ludhiana-based SPS Apollo Hospitals has launched a dedicated paediatric cardiology department, making it one of the few hospitals in the region to offer this specialised service. Dr Anurakti Srivastava, earlier with Apollo Hospitals Hyderabad, would be heading the department. According to her, “Congenital heart diseases form a major chunk of undetected and untreated cause of neonatal and infant mortality in India. The lack of proper diagnostic services during foetal life or after birth leads to under-detection and under reporting. Moreover, the centres offering appropriate treatment facilities are scarce and tend to be concentrated in metropolitan cities, which are out of reach for people of many states, including Punjab.�

VC FUNDING IN HIT CONTINUES Venture capital (VC) funding in the Healthcare IT (HIT) sector has continued to gain momentum in aS^R # WSVVSYX \KS]ON SX ^RO \]^ [_K\^O\ There were 104 funding deals in the quarter compared to 51 in the previous quarter. There were also 42 early stage deals this quarter compared to 14 in Q4 2012, pointed out a report on funding and mergers and acquisitions by Mercom Capital Group, LLC, a QVYLKV MYWW_XSMK^SYX] KXN MYX]_V^SXQ \W “The trend we began to see last year of VCs investing in consumer-focused companies like mobile health, tele-health, personal health, social health, and scheduling, rating and shopping has become much more pronounced,� said Raj Prabhu, CEO, Mercom Capital Group. “The enormous market opportunity in consumer-focused health has appeared to pique the interest of investors and is likely to continue to grow as witnessed by the surge in VC activity,� he added.

AN EYE HOSPITAL IN SRI CITY

CARESTREAM BAGS FROST & SULLIVAN AWARD

FREE HEALTHCARE CASHBACK PROGRAMME

The Medical Research Foundation of Chennai’s Sankara Nethralaya has signed an MoU with Sri City, a business city near Chennai, to establish an eye care hospital and research facility inside the industrial complex. The hospital, named as Sri City Sankara Nethralaya, would cater to the people of the region and the employees of the industries inside Sri City. While the hospital is slated to start after three months with a 20-bed unit, the P_VV ONQON ]ZOMSKVS^c OcO MK\O hospital will be commissioned after three years.

Frost & Sullivan has again recognised Carestream Health for market growth, this time with its 2013 +]SK :KMS M 7K\UO^ :OXO^\K^SYX Leadership Award for the Digital and Computed Radiography Market. This award is presented to the company that has demonstrated excellence in capturing the fastest rate of change of market share within its industry from one year to the next. “Carestream’s DRX technology is a successful product that aided in market penetration in the region,� said Poornima Srinivasan, consultant at Frost & Sullivan.

Online cashback portal, Pennyful.in is allowing users to shop through the website and earn real money cashback rebates. To address the persistent problem of health care expenditure, it has rolled out InNSKt] \]^ KXN YXVc P\OO ROKV^RMK\O cashback programme - Medicash. in. Run jointly by Pennyful Online Pvt Ltd and MDA Healthcare India Pvt Ltd, Medicash allows consumers to save on all their healthcare expenditure with associated healthcare partners across India through real money cashback or upfront discounts at their facilities.

12

Healthcare Radius May 2013

NEW PASSIVE NEEDLE GUARD TECHNOLOGY BD Medical, a segment of BD (Becton, Dickinson and Company) has commercially launched a new passive needle guard technology, BD UltraSafe PLUS. The BD UltraSafe PLUS Passive Needle Guard has received 510(k) clearance as an anti-needlestick safety device. This product, in addition to offering needlestick safety in an easy-to-use one-handed device, claims to have enhanced ergonomic features to facilitate comfort and support for healthcare providers and patients. In addition, this safety device is designed to meet complex biotechnology drug requirements, including higher viscosity.

NEWS TRACK

FACILITATING PATIENTS FROM MYANMAR Treating as many as 40 Myanmar nationals in a month, Shija Hospital, Imphal, has suggested ways to improve convenience of pa^SOX^] YMUSXQ ^Y S^] RY]ZS^KV P\YW 7cKXWK\ During a recent goodwill visit of delegation from Myanmar to Shija Hospital and other healthcare facilities in Manipur, Shija Hospital has submitted a proposal to include free cleft lip and palate surgery under the ‘Smile Train Shija Cleft Project’ in a hospital in Monywa, the capital of Sagaing Region. Said Dr Kh Palin, managing director, MD, Shija Hospital, “We have proposed that the ‘Smile Train Shija Cleft Project’ project be undertaken with regular visits by a team of doctors from our hospital.” In March this year, an application with the same proposal had been submitted to the Chief Minister of Sagaing Region. With more than one lakh people estimated to be suffering from cleft lip and palate in Myanmar, Dr Palin has also suggested setting up of a dedicated stay facility for Myanmar patients and their attendant within the premises of Shija Hospital, besides establishing 12 Shija information centres in various towns of Myanmar to facilitate transportation and logistic support. Additionally, for convenience of patients, he has proposed a bus service between the two countries. “The Myanmar patients are brought to our hospital by our bus after `O\S MK^SYX Lc 7KXSZ_\ ZYVSMO K^ 7Y\OR YX the border between India and Myanmar) on humanitarian grounds. Thus, we have requested both India and Myanmar to start a bus service between Mandalay in Myanmar and Imphal,” he added.

JAGRUTI BHATIA BECOMES KMPG'S SENIOR ADVISOR Jagruti Bhatia, who used to be director of healthcare advisory services at KPMG India, has now become senior advisor for the same division. “I will play a more advisory and mentoring \YVO aRSMR aSVV KV]Y SXMV_NO VOKN YZZY\^_XS^c SNOX^S MK^SYX supportive role on proposals or projects, assisting in client presentation / pitch discussion and closure. Review and guide both national and international pursuits and overseas opportunities,” said Bhatia. In her new role, she will also assist in \W aSNO ROKV^RMK\O SXS^SK^S`O]

GE PARTNERS WITH HCG Healthcare Global Enterprises Ltd (HCG) and GE Healthcare have announced a new partnership agreement in cancer care. Under this partnership, as a pilot project, a cancer care centre is being set up in Bengaluru with GE as the technology partner. This new partnership adds to the existing collaboration between GE and HCG on cancer bio-markers for improved cancer management.

Healthcare Radius May 2013

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Preview

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LIST OF SPEAKERS

Rajen Padukone, CEO, Manipal Health

Dr Umapathy Panyala, CEO, Apollo

VP Kamath, COO, Wockhardt Hospitals

Enterprises Pvt. Ltd., Bengaluru

Hospitals– Karnataka Region

Limited, Mumbai

Dr Ravindra Karanjekar, CEO, Global

Dr RR Pulgaonkar, CEO, Jaslok Hospital

Dr Sameer Khan, CEO, Rockland

Hospitals, Mumbai

& Research Center, Mumbai

Hospitals Group, New Delhi

Anupam Verma, group CEO, DM

Dr Mudit Saxena, COO, Healthcare

Brig Joe Curian, CEO, Seven Hills

Healthcare, Mumbai

Global Enterprises, Bengaluru

Hospital, Mumbai

Udayan Lahiry, president & CEO,

Dr Raja Sekhar Gujju, medical director,

Dr Chandy Abraham, group head ,

Medica Synergie Pvt. Ltd., Kolkata

Global Hospitals & Health City, Chennai

Quality, NH Hospitals

AT A GLANCE Date: 23 - 24 May, 2013, Venue: Sheraton Bangalore Hotel, Bengaluru Contact: Sagar Mushrif, GM, conferences +91 98201 53334, sagar.mushrif@itp.com; Alysha Lobo, project manager +91 9769 616685 or Anjali Shetty, sales manager, conferences, +91 22 6154 6010 for registrations.

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Healthcare Radius May 2013

PROJECT SPOTLIGHT

A TERTIARY CARE HUB Project: Dr Kshetrapal Eye Hospital Mission: To bring world class eye care within common people’s reach with quality and affordable cost. Location: Panchsheel Nagar Scheme, Ajmer, Rajasthan. Promoted by: Dr Ramesh Kshetrapal, Rajasthan’s leading eye surgeon. Type of hospital: State-of-the art tertiary care hospital that will provide a wide range of healthcare services with focus on eye, cardiac, neuro, urology and others. Bed strength: First phase, 200 beds. When fully commissioned, 300 beds. The number of ICU beds is 50. Type of project: 1\OOX OVN Status of the project: Under construction. To be commissioned by: Third quarter of 2014. Cost of the project: Rs64 crore, inclusive of land, equipment and building. Type of funding: Term loan and equity. Land measurement: 77,472 square feet. In-built area: 1,85,500 square feet.

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Healthcare Radius May 2013

Infrastructure: OTs and ICU facilities, private and general ward along with other services. Patient catchment area: Ajmer and around 150 km. Staff strength: About 900, including doctors. Designed by: Hospaccx India Systems. Ajmer is hotter in summers and colder in winter. So, the building is designed in such a fashion that the inside temperature will be cold and comforting in summers and warm in winter as compared to outside temperature. Such measures will reduce the operational cost as well as create comforting zones for patients. >cZO YP YY\SXQ$ -YWLSXK^SYX YP `S^\S ON KXN Q\KXS^O 3X M\S^SMKV K\OK] vinyl as per NABH and JCI norms. Air-conditioned areas: All the OTs and critical areas will be centrally air-conditioned. The rest will be decentralised, but in totality, the whole hospital will be air conditioned. Type of rooms: General wards, private, semi-private, deluxe and super deluxe rooms.

First look

This is how the reception will look once the hospital is ready

The under-construction hospital.

Making a difference Narayana Hrudayalaya’s upcoming project is a boutique multi speciality RY]ZS^KV K^ ARS^O OVN SX ,OXQKV_\_ BY TEAM HR The LDRP suite is designed with patient comfort in mind.

A

tad different from its low-cost no-frills project, Bengalurubased Narayana Hrudayalaya is slated to commission a multi speciality boutique hospital next month at Mahadevapura area of White OVN ,OXQKV_\_ While the OPD will start early this month, the IPD is slated to start within a fortnight after ^RK^ >RS] S] K L\YaX OVN Z\YTOM^ aRO\OLc ^RO land and building are provided by Nandhini Deluxe Hotel, while the equipment and manageWOX^ YP ^RO Z\YTOM^ S] Lc 8K\KcKXK 2\_NKcKVKcK Says Dattatreya KS, facility director, NH ARS^O OVN 2Y]ZS^KV uARSVO LON] aY_VN LO MYWWS]]SYXON SX ^RO \]^ ZRK]O aROX P_VVc MYWZVO^O S^ aY_VN LO K LON _XS^ v >RO PYcus of the hospital is on short-stay multi-speciality surgical services, along with services PY\ aYWOX KXN MRSVN\OX >RO OX^S\O \]^ YY\ RK] LOOX NONSMK^ON PY\ aYWOX KXN MRSVN MK\O

NH IN BENGALURU A quick look at the Narayana Hrudayalaya’s footprints in Bengaluru Hospitals „ Narayana „ Narayana „ Hospital „ MS

Hrudayalaya Cardiac Hospital Hrudayalaya Multispecialty

and Mazumder Shaw Cancer Centre

Ramaiah Narayana Cardiac Care Hospital

„ Chinmaya Narayana Hrudayalaya Clinics „ NH „ NH

Hosur Clinic HSR Layout Diagnostic Centre

„ NH

Electronic City Diagnostic Centre

>RO RY]ZS^KV aY_VN KV]Y PYM_] YX WONSMKV SXtensive care, coronary care with catheteriza^SYX PKMSVS^SO] KXN XOYXK^KV SX^OX]S`O MK\O >RO unit has 19 beds kept for medical ICU, nine LON] PY\ --? KXN ]Sb LON] PY\ 83-?

>RO _XS^ S] aOVV ]_ZZY\^ON Lc ]^K^O YP ^RO K\^ radiology and cross-sectional imaging facilities SX ^RO PY\W YP " ]VSMO -> ]MKX KXN >O]VK MRI facilities and dialysis among other equipWOX^ 0_XNSXQ PY\ ^RO Z\YTOM^ S] ^R\Y_QR K WSb YP NOL^ KXN O[_S^c >RO RY]ZS^KV RK`SXQ Q\Y_XN ZV_] PY_\ YY\] S] ]Z\OKN Y`O\ !! KM\O] KXN RK] K L_SV^ _Z K\OK YP ][_K\O POO^ u>RO ZK^SOX^ MK^MRWOX^ K\OK S] ARS^O OVN and the surrounding areas in a radius of about " UW 3^t] KX _X^KZZON ZY^OX^SKV WK\UO^ aS^R LY^R WSQ\KX^ K] aOVV K] VYMKV ZYZ_VK^SYX v KNN] .K^^K^\OcK >RO Z\YTOM^ RK] LOOX NO]SQXON Lc ^RO 8K\KcKna Hrudayalaya projects team, and the interiors RK`O LOOX NYXO Lc <=: >RO RY]ZS^KV RK] MRY]OX K WSb YP `SXcV KXN Q\KXS^O PY\ YY\SXQ =SXMO ^RO hospital is built as a boutique hospital targeting the affording class, it has only private and semiZ\S`K^O \YYW]

Healthcare Radius May 2013

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Corporate affairs

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Healthcare Radius May 2013

Corporate affairs

Imaging boom BSR Healthcare plans to take the Indian diagnostic landscape by storm by launching 200 diagnostic centres, not in metros but in B and C class towns BY RITA DUTTA

I

n the quaint and sleepy tribal town of Jagdalpur in Bastar district of Chhattisgarh, it is hard to believe that there exists a state-of-the-art diagnostic centre that houses a 16 slice CT, digital X-Ray, colour doppler, EEG, ECG, EMG, BERA, spirometry and a pathology lab. This high-tech diagnostic centre of Bhilai Scan Research Limited (BSR) has no swanky feel; it sports a Spartan and utilitarian look, housed in a non-decrepit rented building. The centre, commissioned a year ago, offers radiology and pathology tests _XNO\ YXO \YYP PY\ ^RO \]^ ^SWO SX ^RS] PK\ _XQ tribal region. The availability of CT scan equipment has come as a boon to the local populace, who had to trudge 300 kilometres to Raipur in Chhattisgarh or Vishakhapatnam in Andhra Pradesh,

just for a CT scan. Though the district hospital does provide CT scan facility, often the functioning of the equipment is riddled with poor maintenance or unavailability of timely report. The fact that the BSR diagnostic centre here attracts a monthly patient footfall of around 2,000 is symptomatic of the acute demand that the integrated diagnostic centre is catering to in this region. >RO ]^OKNc ZK^SOX^ SX Ya RO\O RK] ]Z_\\ON ,=< 2OKV^RMK\O ^Y \W _Z ZVKX] YP SX^\YN_Ming a 0.2 to 0.3 Tesla MRI within the next three WYX^R]y^RO \]^ 7<3 SX ^RO ,K]^K\ \OQSYX >RS] diagnostic centre is one of the 31-odd diagnostic centres that BSR Healthcare has established under its diagnostic wing, Bhilai Scan Research Limited, which is being re-christened to BSR Diagnostics.

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Corporate affairs

Spurred by the success of its diagnostic centre in Cuttack, BSR is setting up a two centres in Odisha’s Rourkella and Sambalpur regions.

T

he BSR Healthcare group has indeed come a long way, starting its diagnostic arm with a mere EEG machine in a garage set-up in the steel city of Bhilai, exactly two decades back. Then, in 1994, the Bhilai Research Scan Ltd was founded in Bhilai, by shifting the EEG machine from the garage set-up, but soon the group went

on to add X-Ray, ultrasound and a conventional CT scan. For an investment of around Rs one crore (out of which Rs75 lakh were spent on acquiring the CT scan), the breakeven was attained in the second year. >R\OO cOK\] KP^O\ ^RO \]^ MOX^\O ^RO ]OMYXN diagnostic centre came up in Raipur. “Since

imaging is a capital-intensive business, paucity of funds plagued our growth plans in the initial phase. So from 1994 to 2010, in a span of 15 years, we could start a mere six centres,” says Dr MK Khanduja, chairman, BSR Healthcare. It was from 2010 onwards when the group received private equity funding, an amount of Rs40 crore in two trenches from Aureos International, the group accelerated its roll out of diagnostic centres, unveiling 14 more centres in the last two and half years. Today, the group has created a network of 31 diagnostic centres, spanning Chhattisgarh, Odisha, Madhya Pradesh, Maharashtra and Paschim Banga. All along, BSR has been a pioneer in ushering in cutting edge technology to Chhattisgarh state — be it 1.5 Tesla MRI or 128 slice CT Scan or Colour Doppler — in the OVN YP SWKQSXQ Y\ SX^\YN_MSXQ ]ZOMSKV ^O]^] KXN tumour markers on fully automated machines SX ^RO OVN YP ZK^RYVYQc 3^] <KSZ_\ MOX^\O aSVV shortly be installing a 3 Tesla MRI, once again a \]^ SX -RRK^^S]QK\R Today, consolidating its position in central and eastern India, the group has drawn a blueprint of unveiling 40 more owned diagnostic centres in the next three years. By end of this year, 10 diagnostic centres will be unveiled in Ambikapur, Kawardha and Raipur (the second centre with a 3 Tesla MRI) in Chhattisgarh, in Sambalpur and Rourkela in Odisha, in Nagpur and Amravati in Maharashtra and in Chindwara in Madhya Pradesh. (See box on page 23 for the areas where the diagnostic centres are being planned)

Establishing diagnostic centres Preferring the asset light model, all the diagnostic centres of BSR are established in a rented place, taken on long-term lease of 10 to 15 years. All centres offer both radiology and pathology, but the focus clearly is on high-end imaging. Each centre has at least one full-time radiologist, and is backed by visiting or full-time pathologist. All centres are linked with other centres through tele-radiology solutions by GE, so that unavailability of radiologist in a centre does not impair its functioning. The cost of establishing a centre ranges between Rs3 crore to Rs12 crore, 90 per cent of which is for imaging and the rest for pathology. The group strategically decides on the choice of equipment, based on the population and patient catchment area. The diagnostic centres have different levels of equipment ranging from X -Ray, ultrasound, colour Doppler, EEG, EMG, ECG to high-end equipment like multi-slice CT (ranging from 16 to 128 slice) and 1.5 T MRI.

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Healthcare Radius May 2013

The cost of establishing a diagnostic centre ranges between Rs3 crore to Rs12 crore.

Corporate affairs

THE GROUP HAS DRAWN A BLUEPRINT OF UNVEILING 40 MORE OWNED DIAGNOSTIC CENTRES IN THE NEXT THREE YEARS. It is interesting to note that in the beginning, the BSR Healthcare group was more inclined towards building an empire of hospitals and was less aggressive about its diagnostic business. Thus, it built BSR Caner Hospital in 2001, the ]^K^Ot] \]^ Z\S`K^O MKXMO\ RY]ZS^KV KXN ^ROX Apollo BSR Hospital in 2007, a 200-bed multi speciality hospital. Eventually, it chalked out plans of starting a series of secondary care hospitals across Chhattisgarh, Maharashtra and Madhya Pradesh. Though the group will be commissioning a secondary care hospital in Rajnandgaon district of Chhattisgarh in the next six months, and has recently inked an MoU with the government of Chhattisgarh for setting up three more hospitals under the PPP model, the Q\Y_Zt] ZVKX PY\ NSKQXY]^SM `O\^SMKV RK] XKVVc gathered steam. What propelled the change was the realisation that the diagnostics vertical scores over hospitals in more ways than one. States Dr Khanduja, “In comparison with setting up a hospital, setting up a diagnostic centre S] PK\ WY\O Z\Y ^KLVO v 0Y\ YXO SX NSKQXY]^SM] the investment is lower — anything between Rs3 crore to Rs12 crore — depending on the equipment. Also, preparing a centre to house diagnostic equipment takes just around two to three months, which is way lesser than starting a hospital. Additionally, the EBIDTA margin for a hospital is around 20 per cent, while that of a diagnostic centre is around 35 to 40 per cent. AS^R ]_MR aOVV NO XON KN`KX^KQO] ^RO Q\Y_Z has decided to unveil 8 to 10 diagnostic centres on its own, every year.

Infrastructure of the diagnostic centres z

z

z

Small-sized centre The group opts a small-sized diagnostic centre in C class cities or remote areas, like the one in Bastar. Such a centre is spread over a built up area of around 2,000 to 3,000 square feet and is manned by staff of 15 to 20. The equipments installed for radiology and imaging are multi slice CT, colour doppler, digital X-ray, EEG, ECG and EMG. Mid-sized centre A mid-sized lab, set in a built up area of around 3,500 square feet, is meant for tier-II and tier-III cities or bigger C Class and B class cities. It has imaging facilities like multi slice (up to 16 slice) CT, 0.2 Tesla to 0.3 Tesla MRI, digital X-ray, colour doppler, digital X-ray, EEG, ECG and EMG. The investment is around Rs5 crore to Rs7 crore. The centre is manned by 20 to 25 people, one to two among them being radiologists. Big centre A big sized lab, set in bigger B class and A class cities, is spread over 4,000 square feet. It has equipments like 1.5 Tesla to 3 Tesla MRI, 16 to 64 slice and sometimes even 124 slice CT, besides digital X-ray, high end colour doppler, digital x ray, EEG, ECG and EMG. The investment is around Rs 8 to 12 crore. The staff strength for such a centre is around 25. The group is planning to also introduce a PET scan in its Raipur unit.

The 1.5 Tesla MRI at the group’s centre in Bhilai.

T

he group is also scouting for opportunities to roll out over 150 more diagnostic centres through the PPP mode. Says Prashant Naidu, executive director and president, corporate strategy and new initiatives, BSR Healthcare, “We have participated in a tender by the Chhattisgarh Government for installing 150-digital X-rays, 10 number of 16 slice CTs and 75 colour dopplers at various Government healthcare facilities, mostly in remote localities.” For this

The group’s multi speciality hospital

Healthcare Radius May 2013

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Corporate affairs

How it all started

In India, the key to the success of the imaging business is the volumes and not cost of the tests”

Interestingly, Dr MK Khanduja's foray into diagnostics just happened. In the ’90s, he used to be a busy paediatrician. Then in 1993, a salesperson sweet-talked him into purchasing an EEG for Rs1 lakh to be paid in 10 instalments. To recover the money he had invested, he started an EEG centre from his garage. However, at the time there was no EEG machine in Bhilai, except the one at the Bhilai Steel Plant Hospital, where patients would queue up for two to three months just to take an EEG. And this worked in the favour of BSR. Soon, patients started flocking to Dr Khanduja's EEG centre, and the profit surged steadily with each passing month. Once the EEG centre took off, Dr Khanduja gave serious thought to firmly setting his foot in the diagnostics domain. The world of diagnostics also promised to pave the path for entrepreneurship, a journey that Dr Khanduja aspired to experience. “I wanted to come out from the demands of my busy profession, where I was toiling from 7 in the morning till 11 in the night. My other option was to start a nursing home, but in comparison the role of an entrepreneur in diagnostics was far more exciting in an era when the concept of diagnostic centre was unexplored and novel,” explains Dr Khanduja.

project, the equipment installation, maintenance and manpower would be provided by the private player. While the Government would pay the private player for the BPL patients, the provider would be charging CGHS rate to APL patients. The group has already established its expertise in the PPP mode by managing the CT scan equipment of Civil Hospital at Chindwara, a 300-bed public hospital in Madhya Pradesh, whereby the CT scan equipment, installed by the hospital, is manned by BSR staff. As per the MoU with the Madhya Pradesh Government, BSR is offering the facility free of cost to the BPL patients but charging the paying patients. To fund the roll out of 40-owned centres, and another 150 under the PPP approach, the capital outlay is around Rs 350 crore, with the cost of establishing a centre with MRI and CT ranging between Rs3 crore to Rs12 crore, depending YX ^RO MYX Q_\K^SYX ,=< S] ]OOUSXQ K WSb YP debt and equity to fuel its expansion plans. The group is looking for more PE funding, as according to Dr Khanduja, though equity is costlier ^RKX NOL^ K^ ]YWO SX OM^SYX ZYSX^ ^Y Q\Ya KXN grab opportunity it is necessary to take the route of PE funding.

located at the hospital premises. The license for the centre, its maintenance and up gradation comes under BSR’s purview. This business model works by sharing a percentage of the top line with the hospital. BSR has already tasted success in this territory by managing imaging departments of Medica Synergie and Kothari Hospital in Kolkata and West Bank Hospital, Howrah. According to Manish Trivedi, executive director (projects), BSR Healthcare, the hospital, which outsources its diagnostic facility to BSR gains from its wide expertise, be it quality re-

W

hile most of the diagnostic centres from ,=< RK`O LOOX Q\OOX OVN ^RO Q\Y_Z is now open to acquiring diagnostic centres in metros and non metros of central and eastern India. It is also keen on strengthening its outsourced business, with many private hospitals opting for outsourcing of its imaging departments. “Managing an imaging department in a hospital set-up is a lucrative model as the ZK^SOX^ SX Ya SX K]]_\ON P\YW ^RO RY]ZS^KV v explains Dr Khanduja. In a managed diagnostic lab set-up, BSR puts up the equipment and mans the centre

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Healthcare Radius May 2013

It is hard to believe that BSR has set up a state-of-the-art diagnostic centre in Bastar, a tribal district of Chhattisgarh.

Corporate affairs

BSR’s Diagnostic Network

List of firsts p #URRENT /PERATIONS n n n n n n n n

Nagpur - 2 Bhandara-1 Gondia-1 Rajnandgaon -2 Bhilai-6 Raipur- 3 Dhamtari-1 Bilaspur - 2

n n n n n n n

Korba -2 Kolkata-3 Jagdalpur Cuttack - 2 Rewa-1 Jabalpur – 2 Chindwada - 2

p 5PCOMING 6ENTURES n n n n n n n n n n n n n n n n n n n n

Besides the one in Gondia, the group has three other diagnostic setups in Madhya Pradesh.

Vizag Goa Jaipur Bikaner Jodhpur Coimbatore Kanpur Varanasi Roorkee Dehradun Durgapur Asansol Howrah Ahmedabad Surat Vadodara Hazaribagh Ranchi Jamshedpur Dhanbad

n n n n n n n n n n n n n n n n n n n n

Balaghat Katni Sagar Ashoknagar Bhopal Indore Satna Seoni Ratlam Gwalior Khandwa Shirdi Mumbai Thane Bhubaneswar Jharsuguda Rourkela Amrtisar Jalandhar Ludhiana

porting, streamlined process, speedy reporting and its wide and experienced pool of 40 radiYVYQS]^] uAO RK`O bON Z\YMO]]O] KXN [_KVS^c standards that are replicable for all diagnostic centres,” says Trivedi. Like any healthcare business, running a chain of diagnostic centres comes with some unique challenges and how one navigates through them becomes the deciding factor for longterm sustenance. While the imaging business is capital intensive, the cost of the scan in India is one of the lowest in the world. While the US charges around $800 to $1,000 for a MRI scan, the charges in India are almost one-tenth of this. “In India, the key behind the success of the imaging business is the volumes and not cost of the tests,” reveals Dr Khanduja. For a capital-intensive business, how does the group cope with technology obsolescence

o In 1993, BSR was the first to start the concept of a complete diagnostic centre in Chhatttisgarh, whereby all diagnostic services in radiology and pathology were provided under one roof. o (MRS@KKDC SGD EHQRS "3 RB@M @S !GHK@H HM o 3GD EHQRS ,1( HM SGD TMCHUHCDC ,/ V@R installed by BSR at Raipur in 1997. o 3GD FQNTO V@R SGD EHQRS SN RS@QS @ BNLprehensive cancer hospital – BSR Cancer Hospital in the private sector at Bhilai in 2001. o 3GD FQNTO V@R SGD EHQRS SN RS@QS SGD MTBKD@Q medicine department in Chhattisgarh with Gamma camera facility at Bhilai in 2001. o %NQ SGD EHQRS SHLD HM "GG@SSHRF@QG !21 VHKK shortly be installing a 3 Tesla MRI and a PET CT at Raipur.

^RK^ YMM_\] O`O\c PY_\ ^Y `O cOK\] SX SWKQSXQ) BSR deals with it by installing advanced models in bigger towns and shifting older models to peripheral towns, where the patient load is less. Furthermore, to meet the acute shortage of radiologists and technicians, especially for periphery centres, BSR has created a pool of 40 radiologists. They ensure 24X7 availability of reporting by hi-end tele-radiology solutions and PACS system. BSR is also planning to start a technical training institute. Besides diagnostic, plans are on the anvil to strengthen its pathology business. BSR is also scouting for opportunities of setting up high-end diagnostic centres and pathology labs in Africa, Bangladesh and Sri Lanka. It is also interested in establishing a chain of single speciality hospitals and clinics in the domain of ophthalmology, dentistry, diabetics, dialysis and cosmetology. However, right now, the focus is on India and diagnostics. “Soon, we would be a pan Indian diagnostic player in the same league as Dr Lal Pathlabs and SRL Diagnostics,” states Dr Khanduja.

Healthcare Radius May 2013

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3URoOH

Columbia Asia arrives in Pune BY TEAM HR

T

he Columbia Asia group has extended its presence in India by launching its ninth facility. The 100-bed tertiary care hospital is located close to the IT Parks in the 5RK\KNS K\OK YP :_XO >RS] 1\OOX OVN Z\YTOM^ RK] LOOX built at a cost of Rs90 crore, which is inclusive of cost of land, building equipment biomedical component and utilities. The hospital offers a wide range of clinical services such as cardiology, obstetrics & gynaecology, minimally invasive surgeries, medical and surgical oncology, paediatrics and neonatology, ophthalmology, urology, gas^\YOX^O\YVYQc \OXKV ^\KX]ZVKX^] Y\^RYZKONSM] TYSX^ \OZVKMOWOX^] ZVK]^SM surgery and bariatric surgery. According to Tufan Ghosh, COO, Columbia Asia Hospitals India Pvt. Ltd, “The hospital is well equipped to tackle infectious diseases and seasonal illnesses, such a dengue and H1N1.” The hospital has four OTs, which are modular with ASHRAE standards KXN RK`SXQ VKWSXK\ Ya 2/:+ V^O\ >RO RY]ZS^KV S] LKMUON Lc K ^OKW YP RSQRVc [_KVS ON WONSMKV ZO\]YXXOV KXN X_\]SXQ ]^KPP aRY aY_VN LO Z\KMticing globally benchmarked standards of medical, nursing and operating protocols. “Our focus is on quality and ensuring that every person who steps through our doors is given the best possible attention and treatment,” says Col (Retd) Dr Sunil Rao, general manger, Columbia Asia, Pune.

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Healthcare Radius May 2013

The state-of-the art ICU.

3URoOH

The ER room of the hospital.

Every aspect of the hospital has been built, keeping patient comfort and convenience in mind.

INFO SHEET

The nursing staff is trained to practice globally benchmarked standards.

Green building: All energy saving devices such as CFL bulbs, solar water heating system, green DG sets and rain water harvesting scheme are being used at the hospital. The hospital also has a waste water recycler to flush water and do waste segregation at source. The building material used are green certified. Patient-friendly: With an aim of offering patient-friendly care, the hospital offers a well-designed physical environment to help reduce the stress levels of people with health problems as well as their family members, accompanying them. IT: A proprietary hospital information system and electronic medical record management assures error free and convenient patient records management, thereby greatly minimising patient waiting time. Diagnostic facilities: Some of the facilities available are 16 slice CT scan, mammography, Digital X-ray, 1.5 T MRI, automated biochemistry, haematology analysers and all types of routine pathology lab tests.

The Hospital has a spacious reception manned by an able and eager staff.

T

The diagnostic wing offers facilities like CT, MRI and mammography.

he hospital promises to bring to Pune a hospital environment and service standards that is truly world class. According to Ghosh, “The state-of-the-art facilities, comprehensive health check-up packages and a completely patient-centric approach intend to change the face of healthcare services in Pune. The hospital’s infrastructure, along with internationally benchmarked standards of medical, nursing and operating protocols, are the key components that will make it a preferred RY]ZS^KV SX :_XO >RO PKMSVS^c KV]Y \O OM^] ^RO Q\YaSXQ SWZY\^KXMO YP :_XO as a healthcare destination in Maharashtra, as well as for international patients turning to India for quality medical services. According to Ghosh, “Our public healthcare system is not equipped to deal with the healthcare situation in the country. Private players, hence, RK`O KX SWZY\^KX^ \YVO SX VVSXQ ^RS] QKZ 7Y\OY`O\ :_XO S] KV]Y OWO\QSXQ K] K WKTY\ WONSMKV ^Y_\S]W NO]^SXK^SYX KXN Y_\ OXNOK`Y_\ S] ^Y ^KZ SX YX this development by providing high-class medical care.”

Healthcare Radius May 2013

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Success formula

Straight talk

What makes us grow at a steady pace is our strong brand name, created over four decades�

While most diabetes hospitals are caving in to commercial pressures, Dr V Mohan, chairman & chief diabetologist, Dr Mohan's Diabetes Specialities Centre, is managing to not just retain his chain of diabetes centres but also expand it INTERVIEWED BY RITA DUTTA

Several diabetes hospitals have now become multi-speciality. Why? This phenomenon is being witnessed not just in India but also abroad. A case in point is the renowned Joslin Diabetes Center in Boston, which started as a large diabetes hospital, but over the years, kept on reducing its number of beds. Today, it’s more of an OPD clinic. This is happening because it’s less viable to run a dedicated diabetes hospital of over 100 beds. For one, hospitalisation for diabetic MYXNS^SYX S] VO]] K WO\O `O ^Y ZO\ MOX^ YXVc aRSMR WKUO] S^ NSP M_V^ ^Y VV up beds. Besides, with improved medication, standard diagnostic tests KXN VSPO]^cVO WYNS MK^SYX there is hardly any need today for a diabetic patient to be hospitalised, save for complications. Second, even in these cases, insurance companies are reluctant to the foot bills for diabetics-related hospitalisation, which is KXY^RO\ RSXN\KXMO ^Y Z\Y ^KLSVity of a diabetes hospital. Third, diabetic patients often require other healthcare facilities, compelling many healthcare providers to change from single speciality to multi speciality hospitals. I had many experts advising me on adding on facilities like GI, urology and cardiac to our hospitals to ramp

up our revenue. However, I have opposed such a move as I want to remain focused on diabe^O] AO K\O ^RO ZSYXOO\] SX ^RS] OVN KXN SX Wc lifetime, the hospitals will not become multi speciality hospitals. So, what’s the secret behind your group’s sustained growth? What makes us viable is that we have created two medium-sized diabetes hospitals, one each in Chennai and Hyderabad, totalling to 120 beds. All our other centres are OPD centres KXN MVSXSM] ,OSXQ ^RO ZSYXOO\ SX ^RO OVN YP NSKLO^O] aO RK`O ^RO \]^ WY`O\ KN`KX^KQO as well as experience and lead. What makes us grow at a steady pace is our strong brand name, created over four decades. I have been in ^RO OVN YP NSKLO^YVYQc ]SXMO " cOK\] YP KQO K]sisting my father Prof M Viswanathan, an iconic Q_\O SX 3XNSKX NSKLO^YVYQc ARK^ aO M\OK^ON over 40 years, others cannot replicate over night. +V]Y 3 KW XY^ SX^Y ^RS] OVN PY\ WYXOc ARSVO others would close shop when centres take years to breakeven, we hold fort. Some of our centres have taken as long as seven years to attain cash breakeven, but I have continued with

Patient profile of DMDSC 60% from the metropolitan city of Chennai 20% from the southern region of India 10% from the northern and eastern India 10% from other countries like Singapore, Sri Lanka, Malaysia, Saudi Arabia, Dubai, etc.,

Healthcare Radius May 2013

27

Straight talk

we have started offering healthcare products like brown rice and footwear for diabetes. One would hear of more centres and products in the years to come. If running a diabetes hospital is unviable, why is there is a sudden spurt of diabetes clinics? Because the clinics require less investment— while the investment for a 100-bed diabetes hospital with an OT, ICU, path laboratory and ^RO VSUO aY_VN LO K VS^^VO WY\O ^RKX <] `O crore, the investment for a diabetes clinic is only around Rs40 lakh to Rs2 crore, depending on the facilities. However, I must point out that many of the diabetes clinics that have mushroomed of late are run by physicians, who claim to be diabetologists. Such inimical practice has resulted in improper management of diabetes.

Dr Mohan with his daughter Dr RM Anjana, who is the joint managing director of the group.

Rapid fire Business decisions you regret We had tied up with AVP group to offer Ayurveda treatment to our patients at our Coimbatore unit, but that did not work out as patients did not appreciate the idea of coming to an Allopathic centre for Ayurvedic treatment. It was a grave mistake. Regrets about leaving MV Hospital? No regrets because I was able to pursue my dream of setting up DMDSC with my wife. Secondly, MVH is now in good hands and being looked after by my younger brother, Dr Vijay Viswanathan. Succession after you step down Our board of directors will look after the institutions.

28

Healthcare Radius May 2013

You have created a chain of diabetes centres over two decades. How has the journey been? Oh, it has been an exciting one, with many successes and some failures. In 1971, I set foot SX ^RS] OVN Lc ROVZSXQ Wc PK^RO\ ]O^ _Z ^RO 7@ Hospital for Diabetes (MVH) at Royapuram, Chennai and worked for him for nearly two decades to build up that centre. Eventually, my wife Dr Rema and I wanted to start a centre that would focus on research and provide comprehensive diabetic care. That’s why I left MVH in September 1991 to set up Y_\ YaX MOX^\O P\YW K ]SXQVO YY\ YX K \OX^ON building at Royapettah High Road in Chennai. This centre is now known as Dr Mohan's Dia-

In the coming months, we would have

clinics in Puducherry, Trichy, Kolkata, Bengaluru and Muscat, which would be our oUVW LQWHUQDWLRQDO YHQWXUH” them due to my passion for diabetes. We continue to grow as we provide comprehensive and total diabetic care, which is not only includes routine treatment of diabetes but also treats its various complications. We also continue to evolve. Recently, under brandname Dr Mohan’s Health Care products, we have added healthcare products such as brown rice to our offerings, which add to our revenue. In fact, We have recently opened Dr Mohan’s Obesity and Weight Management Centre at our Gopalapuram unit in Chennai. Under the brand name Dr Mohan’s Health Care products,

betes Specialities Centre (DMDSC). It was only in September 1997 that we moved into a new building with 70 beds. For the new project, the cost of the land was around Rs 1.5 crore, out of which Rs30 lakh came from me, my family and friends and the rest from loans. Eventually, the hub hospital became saturated, and we created a satellite centre at Anna Nagar in Chennai in September 2003. It took us 12 years to create our second centre because of the high interest rate that we had to pay for the VYKX ^KUOX PY\ ^RO \]^ MOX^\O /`OX^_KVVc Y_\ ^RS\N MOX^\O KXN ^RO \]^ YXO Y_^]SNO -ROXXKS

Straight talk

came up in 2005 in Hyderabad. Today, we have MOX^\O] ]Sb SX -ROXXKS `O SX Y^RO\ ZK\^] YP Tamil Nadu and two in Hyderabad. We are the only diabetes centre in the world approved both by the WHO as a WHO Collaborating Centre and by the International Diabetes Federation (IDF) as an IDF Centre of Education. We have Y`O\ " ZK^SOX^] \OQS]^O\ON aS^R _] KXN about 13,000 new patients are added every year. Dr Rema Mohan played a key role in setting up DMDSC. Who has taken up the responsibilities after her passing away? We lost her after a decade-long valiant battle against cancer. What a setback it was! She had, however, handed over all her responsibilities before she left us. Now, the academic activities are being looked after by my son-in-law, Dr Ranjit Unnikrishnan, who is the vice chairman of the research activities at Madras Diabetes Research Foundation (MDRF), and a part of the administration is handled by my daughter Dr RM Anjana, who is the joint managing director and my wife’s sister Rekha Thankappan, our CEO. What have been the major hurdles to growth? The primary obstacle has been the acute shortage of well-trained diabetologists. We just have about 5,000 diabetologists in the country and every year, only about 20 to 25 endocrinologists pass out. Also, it takes time to train diabetologists, and after we train them, often competitors poach them, disturbing our functioning.

The group’s second project outside Tamil Nadu was in Hyderabad.

Focus on research Dr V Mohan established the Madras Diabetes Research Foundation (MDRF) in 1996 at the Gopalapuram unit with a vision of providing a world class environment for research in diabetes and its complications. Today, the main research centre, the Kallam Anji Reddy Centre, is located at Siruseri in the outskirts of Chennai. It has 13 departments and over 15 research scientists working on different projects. The activities of MDRF cover a wide range from simple clinical research to clinical trials, to epidemiological trials, including the large ICMR–INDIAB study covering the whole of India, studies on complications of diabetes, genomics of diabetes, cell and molecular aspects of diabetes, vascular complications of diabetes, food and nutrition research including development of healthier food products for diabetes, gestational diabetes, and translational research including prevention of diabetes with community empowerment. Nearly 40 projects are currently ongoing at MDRF and it has completed an equal number of projects. The quality of its research in diabetes is reflected by its numerous original publications in reputed journals.

Nearly 40 projects are currently ongoing at the MDRF, located at Siruseri, in the outskirts of Chennai.

Healthcare Radius May 2013

29

Straight talk

The various types of DMDSC centres Hospitals: The centres at Gopalapuram in Chennai and Domalguda in Hyderabad are major hospitals with in-patient beds, ICU, OT, and other facilities. Such set-ups are planned in metros with an investment of around Rs5 to 10 crore. Large centres: It has large out-patient centres without any in-patient facilities, but with all other facilities. Such facilities are there for smaller towns like Coimbatore with a capital outlay of around Rs1 to 2 crore. Mid-sized centres: These are full-fledged clinics, with all diabetes facilities but some departments like ophthalmology may be done through videoconference with the main centre. The investment for clinics is around Rs 50 to Rs 60 lakh. Small clinics: They cater to diabetes only, offering basic facilities. These are mostly evening clinics.

The group’s flagship hospital in Chennai continues to thrive at a time when many dedicated diabetes hospitals are changing to multi speciality ones.

tion with the Public Health Foundation of India KXN ^RO MO\^S MK^O MY_\]O SX O`SNOXMO LK]ON diabetes management, we have trained over 5,000 physicians in the practice of diabetes. How many more centres are you planning? Two clinics a year, on an average. In the coming months, we would have clinics in Puducherry, >\SMRc 5YVUK^K ,OXQKV_\_ KXN 7_]MK^ Y_\ \]^ international venture. We are different from our competitors, many of whom have announced a set target to roll out x number of diabetes clinics. For them, the number of clinics is their USP. Our strength is our skilled diabetologists KXN Y_\ [_KVS^c ?XVSUO Y^RO\] aRY \]^ MRYY]O K VYMK^SYX KXN ^ROX RS\O NSKLO^YVYQS]^] aO \]^ look at roping in experienced diabetologists in an area and then start a clinic there.

WE FIRST LOOK AT ROPING IN EXPERIENCED DIABETOLOGISTS IN AN AREA AND THEN START A CLINIC THERE. So, you are not aggressive in starting clinics? One may say so. We are slow on starting new clinics as we focus on research as well. A major chunk of our revenue from DMDSC goes towards funding research activities. Also, we undertake a lot of charity in collaboration with the Sri Sathya Sai Organisation, involving dispensation of free medicine and conducting free screenings and providing treatment. Our expansion plans are plagued by lack of funds, but I am not complaining. I would rather have it this way than divert my attention from research and charity. What is the USP of DMDSC clinics? The centres have an integrated team of diabetologists, endocrinologists and bariatric physicians, ophthalmologists, surgeons, podiatrists, radiologists, dental surgeons and others, who work in sync to provide ‘total diabetes care’.

for them under our brand name. The investment is all ours for such a set-up. We have also started evening clinics in some areas, where the doctor earns more due to the extra hours that RO Z_^] SX >RO MOX^\O] ^KUO K\Y_XN `O ^Y ]O`OX years to attain cash breakeven.

What is the business model for the centres? We have four types of centres: hospitals, small centres, large centres and clinics. All our 13 centres are owned by us. We don’t believe in the franchisee route as quality suffers in such a mode. All our doctors are full-timers. When some of our diabetologists wanted to shift to their native towns and cities, we started clinics

Training has been your forte. So, how many diabetologists has your institute trained so far? Our academy offers specialised training in diabetes and its complications to doctors, nurses, lab technicians and other paramedical personnel. For doctors, we offer a fellowship programme on diabetes. So far, DMDSC has trained over 100 diabetologists. Through our collabora-

30

Healthcare Radius May 2013

Are you exploring PE funding for expansion? 7KXc :/ \W] MYX^SX_O ^Y MRK]O _] L_^ K] YP now, we are not keen on PE investment as they only understand the bottom line and not our panache for research. I am afraid that our research activities would slow down if we go the PE way because we would be forced to hold back pumping in of funds into MDRF and charity. Where do you see DMDSC a few years down the line? As one of the largest diabetes management institute in the world, with equal focus on healing, research, education and charity.

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Technology

Improved standing The open standing MRI technology gives hospitals a never-before advantage in diagnosis and treatment BY TEAM HR

H

itherto, it was not possible to capture images of the spine in its natural weightbearing position or the vertical position with the help of MRI. Capturing images in this position S] M\_MSKV K] ]SQXS MKX^ LSYWOMRKXSMKV MRKXQO] take place when a person moves from a lyingdown to the vertical weight bearing position, and these need to be factored in for accurate diagnosis. Thanks to open-standing MRI, imaging of the spine in its natural weight bearing position is now possible. This new imaging tool is dedicated specially for attaining images of the spinal and musculo skeletal areas, ankle joint, knee joint and various spine joints. Open standing MRI is popular in both in Europe and the US. In India, it was introduced around two years ago and Delhi-based Mahajan Imaging, a chain of seven imaging centres, was

The open standing MRI enables imaging of the vertical position, which is a boon for spinal and joint patients.

YXO YP ^RO \]^ MOX^\O] ^Y QY PY\ S^ >RO WKMRSXO was acquired at Rs3 crore by Mahajan Imaging and is installed in the centre’s Huaz Khas unit in Delhi. Already, 2,500 patients have undergone this scan. Recently, Indraprastha Apollo Hospital and Dr Kohli's G-Scan Imaging Centre too have installed these machines. All these institutes have installed G (Gravity) Scan, an open standing MRI developed by Esaote, based at Genoa, Italy. This is the only company that manufactures the standing MRI, which uses the principle of gravity, thereby providing added advantages in the diagnosis of patients.

The G-Scan machine with a patient at a 45 degrees angle.

32

Healthcare Radius May 2013

The machine comes with a table that allows taking scans in tilting positions, such as 0 degrees, 90 degrees as per patient’s need. The scan takes 20 to 20 minutes, depending on the study requested by doctor, as against conventional MRI that takes around 15 to 20 min. While Indrapastha Apollo offers the standing scans for Rs7,500, Mahajan Imaging charges Rs6,600 for standing scans and Rs9,900 for scans in both supine and standing positions. According to Dr Harsh Mahajan, director, Mahajan Imaging, the ROI on this O[_SZWOX^ MYWO] K\Y_XN `O ]Sb cOK\] SX comparison with conventional MRI that takes K\Y_XN `O cOK\] “Even if open standing MRI is required for only 20 per cent cases, we wanted to introduce ^RS] PY\ ^RO LOXO ^] YP NSKQXY]S] KXN ZK^SOX^ convenience for spinal and joint cases. By introducing an open standing MRI, we wanted to position our centre as one that houses high-end SWKQSXQ ^OMRXYVYQSO] v ObZVKSX] .\ 7KRKTKX The nine-ton machine can also perform scans in a lying down position, giving added diagnostic advantage for spine and joint patients. Says Dr SK Sogani, neuro surgeon, Indraprastha Apollo Hospital, “By allowing scanning in standing position, the technology

Technology

BENEFITS GALORE

The equipment can perform a lying down and standing weight bearing MRI of the same patient There are multiple benefits for open standing MRI for

evaluate the role and effect of patients' weight on

both diagnostic and patient comfort.

the curvature of spine, which cannot be accurately analysed with conventional MRI machines. Such

Better diagnosis

patients can now hope to get proper and accurate

First, open standing MRI allows the ability to scan

spine surgery done as with this scan the surgeons

patients in a weight bearing position. Says Dr SK

would have an exact idea and better analysis of the

Sogani, neuro surgeon, Indraprastha Apollo Hospital,

extent and nature of injury, visualised along with the

“This machine provides a better overview and

effect of gravitational forces.

pathological analysis to doctors and surgeons than the conventional lying-down MRIs. When lying down,

Enhanced patient comfort

the patient hardly puts weight on the lower limb

As there is no tunnel in an open standing MRI, there

because of which a conventional MRI scan cannot

is less anxiety for patients who are claustrophobic

detect some vital problems. The open standing MRI,

and those who dislike confined spaces. “Around five

on the other hand, enables true weight-bearing

per cent patients refuse MRI scan for fear of being

examination.�

enclosed in conventional. So for those patients, the

Its flexible positioning and dedicated coils allow imaging of the ankle and foot with optimal comfort. Traumatic and degenerative lesions are accurately imaged with high spatial resolution. Second, there are spinal disorders, which are

open-end MRI machine is a boon,� says Dr Harsh Mahajan, director, Mahajan Imaging. The lack of tunnel means there is no restriction on the weight and proportions of the person being scanned, thus making this machine ideal for the

not apparent while lying down, but are extremely

plus-sized individuals. Another unique feature is the

obvious in a standing position. This technology

‘instant positioning’. “Once the patient has been

enables doctors to see these differences practically

positioned on the table, the button of the joint under

for the first time, and plan treatment accordingly.

investigation is pressed, which automatically moves

“Not only can we use this machine as a diagnostic

the patient and coil in the iso-centre,� says

tool, it can also help doctors understand the patient's

Dr Mahajan.

recovery process after the procedure,� says Dr Sogani. Third, the open standing MRI machine is a

Further, unlike the conventional MRI, there is almost no din with the open end MRI, thus further

— DR HARSH MAHAJAN, DIRECTOR, MAHAJAN IMAGING

By DOORZLQJ VFDQQLQJ LQ VWDQGLQJ SRVLWLRQ WKH WHFKQRORJ\ KHOSV GRFWRUV DQG VXUJHRQV GLDJQRVH IXQFWLRQDO DOLJQPHQWV RI SDWLHQWV MRLQWV� — DR SK SOGANI, NEURO SURGEON, INDRAPRASTHA APOLLO HOSPITAL

dissipating any additional fears/apprehensions of the

critical diagnostic tool for patients who continue to

patient. Patients can even read a newspaper or listen

experience pain after spine surgery because it can

to music while the scan is in progress.

helps doctors and surgeons diagnose functional alignments of patients’ joints — how they will behave, progress and whether the condition will get worse.� With around one million spine surgeries performed each year, this technol-

Around oYH SHU FHQW SDWLHQWV UHIXVH 05, VFDQ IRU IHDU RI EHLQJ HQFORVHG LQ FRQYHQWLRQDO 6R IRU WKRVH SDWLHQWV WKH RSHQ HQG 05, PDFKLQH LV D ERRQ�

ogy promises to help improve the outcomes of these surgeries by identifying the pain generating pathology. It is also convenient for patients, especially claustrophobic ones as the equipment is not ‘closed’ or does not have a tunnel.

Will this technology become more popular? After all, only a few institutes are using it in India, right now. According to Dr Mahajan, the technology would become popular in tertiary care hospitals, orthopaedic and spine hospitals and high-end imaging centres. However, he cautions, “It should be used prudently and not for all types of MRI cases.�

Healthcare Radius May 2013

33

Information Technology

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34

Healthcare Radius May 2013

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Information Technology

OVERCOMING CHALLENGES The IT journey of the group was marked with multiple challenges, during adoption of computerised physician order entry system (CPOE) process, ICD coding and clinical documentation, but the group has overcome them with help of ongoing feedback, mainly from various practicing physicians. In general, following are the methods that the group adopts to overcome an implementation hurdle: o Change in process: Create process ownership and policy level guideline changes with the senior leadership acknowledgement. o Hardware changes: Identify the areas of change and take budget approvals for such change as a part of solution implementation, rather than a separate IT hardware budget.

Columbia Asia is one of the few healthcare groups to have a group CIO-Ashokkan VRS (sitting)

o End user training: Identify knowledge champions in both operations and IT team to

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Healthcare Radius May 2013

35

Information Technology

DATA SECURITY This is a focus area for the group, be it user authentication to controlled release of EMR records to application vulnerability. It is continuously improving security using industry best practices like ISO and IT Act 2008. “We recognise that data security is one part of the Information Assurance framework that we need to put in place to address information from data capture, processing, storage, and destruction. A holistic view of the security has emerged as our view of data has changed from being zeroes and ones at the storage level to an organisation asset,” says Ashokkan.

The group envisages creating systems that will support its physicians to have access to relevant clinical data on demand. MKX WSXO ^R\Y_QR NS]^\SL_^ON \OZY]S^Y\SO] ^Y PO^MR WOKXSXQP_V SXPY\WK^SYX K\O KX KL]YV_^O LVO]]SXQ + MVK]]SM ObKWZVO S] ^RO NK^KLK]O YP N\_Q N\_Q N\_Q PYYN N\_Q KVVO\Qc SX^O\KM^SYX ^RK^ KVVYa ZRc]SMSKX] ^Y WKUO ]_\O ^RK^ ^RO N_ZVSMK^O Y\ MYX^\K SXNSMK^S`O N\_Q] K\O XY^ Z\O]M\SLON ^Y ^RO ZK^SOX^] v ObZVKSX] +]RYUUKX

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36

Healthcare Radius May 2013

Y_] OVSWSXK^SXQ ^RO XOON PY\ WKX_KV [_O\SO] ^R\Y_QR SX^O\XKV WOWY] Y\ ^OVOZRYXO u>RO\O S] \YVO LK]ON KMMO]] ^Y `SOa KXN _ZNK^O ZK^SOX^ MK\O SXPY\WK^SYX \SQR^ P\YW LON WKXKQOWOX^ ^Y ZKcWOX^ =SXQVO `SOa YP ZK^SOX^ \OMY\N] YXO LSVV ZO\ `S]S^ KM\Y]] KXc KXN KVV ]O\`SMO] \OXNO\ON K\O ]YWO YP ^RO ]KVSOX^ POK^_\O] ^RK^ 3> L\SXQ] ^Y MK\O NOVS`O\c ObMOV VOXMO v SXPY\W] +]RYUUKX 2Ya K\O NYM^Y\] Z\OZK\ON ^Y KNYZ^ ]_MR ^OMRXYVYQc KN`KXMOWOX^] SX ^RO ROKV^RMK\O ]ZKMO) u9_\ ZRc]SMSKX] K\O ZY]S^S`OVc NS]ZY]ON aROX S^ MYWO] ^Y KNYZ^SXQ ^OMRXYVYQc SX^Y ^ROS\ MVSXSMKV Z\KM^SMO +NYZ^SYX S] ^RO VK]^ KXN WY]^ SWZY\^KX^ VOQ SX KXc 3> Z\YQ\KWWO AO VKc NYaX K VY^ YP PYM_] YX ^\KSXSXQ R_WKX PKM ^Y\] OXQSXOO\SXQ KXN \O]ZOM^ ^RO MRKVVOXQO] ^RO ZRc]SMSKX] PKMO YX NKc ^Y NKc ZK^SOX^ SX^O\KM ^SYX v ]Kc] +]RYUUKX

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VENDOR SELECTION The group follows a well-defined process map for choosing the right solution and vendor Business need (from end users) J Converted to solution need J Request for Information stage J Review of products and features J Evolve system requirements J Request for Proposal J Technical evaluation J Commercial evaluation and finalisation

RO Q\Y_Z S] ZVKXXSXQ K MYWZ\OROX]S`O Z\YQ\KWWO YX SXPY\WK^SYX K]]_\KXMO +XN YXO K]ZOM^ YP ^RO Z\YQ\KWWO S] ^Y O]^KL VS]R KX K_^RY\S]ON MRKXXOV YP MYWW_XSMK^SYX LO^aOOX ZRc]SMSKX] KXN ZK^SOX^] u3^ S] SWZY\ ^KX^ ^RK^ SXPY\WK^SYX K]]_\KXMO WOK]_\O] K\O XY^ ]OOX K] SXRSLS^Y\] ^Y L_]SXO]] Y\ M_]^YWO\] 8+,2 \OMYWWOXNON [_KVS^c K]]_\KXMO WOK] _\O] K\O ^\KMUON ^R\Y_QR WKX_KV KXN ]c]^OW NK^K POON] v ]Kc] +]RYUUKX >RO Q\Y_Z S] KV]Y NO`OVYZSXQ K ,3 P\KWOaY\U ^Y Z\Y`SNO SX^OVVSQOX^ KNWSXS]^\K^S`O SX]SQR^] uAO ]^SVV RK`O ]YWO Q\Y_XN] ^Y MY`O\ SX ^RO ,3 TY_\XOc WY`SXQ P\YW \OZY\^SXQ ^Y KXKVc^SM] v ]Kc] RO

Patient relations

Learn to listen The ability to lend a sympathetic ear is vital for healthcare professionals BY DR AJAY SHETTY

A

s a young intern being rotated through the Department of Medicine, I was delighted that I was posted in the second unit. This meant that I got a wonderful opportunity to work under one of my favourite professors. He was a brilliant academician and a gifted teacher. Not only was he popular among us students, but word in the hospital was that his popularity with the patients had ^Y LO ]OOX ^Y LO LOVSO`ON 3X ^RO \]^ POa aOOU] of my internship, I saw with my own eyes this unique phenomenon of healing. I interviewed all of his patients, asking them, “What is it about this doctor that makes you want to come back to him?” The answers I got from the vast majority of the patients were a revelation. They taught WO K VO]]YX ^RK^ `O cOK\] YP \OKNSXQ WONScal textbooks hadn’t. The patients said, very simply: “He listens.” My professor would get so engrossed in listening that often, even when

38

Healthcare Radius May 2013

auscultating a patient’s chest, the earpiece of his stethoscope would not have moved from its normal resting position (behind the ears)! I realised that day that listening to a patient’s words and emotions was far more important than listening to their heart or breath sounds. My professor used that kind of listening to make it the single most effective way to establish trust and build relationships with his patients. American psychologist Carl Rogers, who founded the Humanistic School in modern psychology, coined the term ‘active listening’ for this kind of listening. The International Listening Association NO XO] VS]^OXSXQ K] ^RO uZ\YMO]] YP \OMOS`SXQ constructing meaning from and responding to spoken (verbal) and unspoken (nonverbal) messages.” Although speaking skills are crucial for effective communication, it cannot substitute listening skills. Listening skills are concerned with the ability of a person to

recognise and distinguish the relevance and relationship of spoken words.

T

here are two kinds of listeners: active and passive. An active listener is one who participates fully in the communication process. He listens attentively, provides feedback and strives to understand and remember the messages in the communication. A passive listener is genuinely interested in hearing and understanding the speaker’s view but does not participate actively in interactions. He assumes that he can absorb information even when he does not contribute to or verify the messages in the communication. With passive listeners, the responsibility of successful communication rests completely with the speaker. Genuine or active listening cannot be faked. To be an active listener, it is vital to be fully present – and, by that, I mean, to be physically, mentally and emotionally present – in the communication.

Patient relations

I

f active listening is hard, it can be practised only if one is cognisant of the factors that SX _OXMO S^$ Motivation. Judi Brownell in the book Listening: Attitudes, Principles and Skills found that effective listeners are “open-minded and interested in a wide variety of subjects. They tend to like people and generally have a positive attitude.” Thus, motivation is crucial for competent active listening. In order to be motivated all the time, one must have an inherent desire to understand the other’s perspective. Lack of motivation automatically leads to lack of interest which, in turn, results in a gross inability to sustain one’s K^^OX^SYX 3X Y^RO\ aY\N] ^RO \]^ ]^OZ ^Y LOSXQ an active listener is to want to listen. Empathy. /WZK^Rc S] NO XON K] YXOt] KLSVS^c ^Y experience the feelings, thoughts and attitudes of someone else as if they were one’s own. In the book The Seven Habits of Highly Effective :OYZVO =^O`OX < -Y`Oc ]^K^O]$ u=OOU \]^ ^Y understand, then to be understood.” Empathy is the key to effective interpersonal communication and empathetic listening goes far beyond the comprehension of a spoken language. It entails listening with your ears, eyes and heart, which is possible only if one is fully present. Sample this conversation a surgical oncologist had with a 45- year-old lady with a lump in RO\ \SQR^ L\OK]^ VKNc aRY RO RK] T_]^ XS]RON examining. As he breaks the news to her that she will need a biopsy, she starts crying. Patient:Doctor, why me? What have I done to deserve this? Doctor: Look, Madam, there’s no need to overreact. In all likelihood, it is going to be benign but, in order to be absolutely sure, we need to do a biopsy. Patient:But what if it is cancer?! Doctor: Even if it is cancer, we will be able to salvage your breast and remove only the lump. A majority of patients come in at a fairly advanced state, when we have to remove their entire breast. So consider yourself lucky.

Misconceptions about active listening “Listening and hearing are the same thing.” Hearing is essentially a physiological process. It involves three interconnected stages: the reception of sound waves, the perception of sound in the brain, and auditory association, says Brownell.

“Listening skills can be switched on when needed.” To believe that we can turn on our hearing skills when needed is probably true to an extent. But genuine listening is hard, needs a lot of practice, consistency and constant

Hearing is only the first step of the intricate listening process. It is well-known that hearing ability is

revision. It’s not something one can master effortlessly, especially not when one practises it

principally unrelated to listening proficiency. So it would not be far from the truth to state that some people with hearing loss are in fact more accomplished listeners than others whose hearing is unimpaired. Listening encompasses hearing, concentrating on the message, understanding and inferring, scrutinising and appraising, and responding and remembering. It is a complex

casually and sporadically. “The speaker is primarily responsible for the message communicated.” That’s probably true if we aim to be passive listeners. But if we choose to be active listeners, then both speaker and listener share the responsibility for the communication of the messages. In fact, the active listener may have to make up for a

process that requires energy, effort and skill.

speaker’s lack of communication ability.

Did the clinician demonstrate empathy for the patient’s predicament? Sadly, no. Concentration. Active listening requires utmost concentration on the part of the listener. On an average, people speak at a rate of 150-175 words per minute, while the mind can process 400-500 words per minute. So the mind of the listener works faster than the speaker can speak, which gives the listener ample opportunity to wander. Therefore, it’s imperative for effective communication that the listener stays focused on what is being said. Emotions. The listener’s emotional state has a huge bearing on effective communication. For example, in an optimistic, cheerful mood, even the dullest of conversations seems interesting. On the other hand, when a person is sad, distressed, anxious, nervous or apprehensive, then major communication barriers come into play and active listening takes a backseat. Compartmentalising emotions. Sometimes, to listen well, we must allow only those emotions into the situation that would help the other

person in a conversation. Take the example of K ZRc]SMSKX aRY RK] T_]^ XS]RON RS] WY\Xing rounds. One of his patients is a 20-year-old boy who attempted suicide, consuming poison because he failed in his exams. After battling for life for nearly three days, the boy succumbs and is declared dead by the physician that morning, who is faced also with the arduous and emotionally draining task of conveying the news of the death to the grief-stricken parents. The physician now sits in the out-patient clinic, waiting ^Y ]OO K VYXQ VSXO YP ZK^SOX^] 2O aSVV XN S^ `O\c challenging to listen to them well unless he can compartmentalise his emotions. Knowledge. In becoming a good active listener, there is no substitute for knowledge. The old adage applies: “What the mind does not know, the eye will never see.” Adapting this to listening, we may add: “And the ear will never hear.” Lack of knowledge will only result in the listener misreading the situation and misconstruing the emotion.

Dr Ajay Shetty is consultant urologist and assistant chief of medical staff (OPD) at Bangalore Baptist Hospital.

Excerpted with permission from the chapter ‘Listening with undivided attention- An effective prescription for Healing’ from the book, Communicate. Care. Cure ... A Bangalore Baptist Hospital Initiative for the Nation.

Healthcare Radius May 2013

39

Viewpoint

Save it with a Whether you are an independent doctor or an organisation, tendering an apology in case of an error is the best way to salvage relationship with patients BY DR AK KHANDELWAL

H

ealthcare services are highly depended on skilled manpower. With outcomes depending on multiple variables like man, methods, machines and materials, errors are unavoidable. Literature reports that error is an inevitable accompaniment of the human condition, even among conscientious professionals with highest standards. But in healthcare, errors often result in complaints by customers. Needless to say, in the aftermath of an error or failure, an apology is needed to provide much-needed comfort to the patient and his family. It is, therefore, important for healthcare practitioners to be adequately trained in open disclosure and apology, to be provided with adequate support in the aftermath of an adverse event. Apology, after all, is a tool that is used by all professionals and practiced in every profession. + MYWZVO^O KZYVYQc RK] `O OVOWOX^]$ expression of regret, acknowledgment of expected behaviour and sympathy for the reproach, repudiation of the behaviour and the person committing it, promise to behave correctly in the future, and atonement and compensation. It should be tendered when an error has occurred that has resulted in harm or could result in harm. When errors and adverse events intersect, there is no way around an ‘apology’. It should be made within 24 hours of the occurrence of the event. An early apology that communicates genuine concern and sympathy for a patient’s physical and emotional wellbeing is both, valuable and essential.

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Healthcare Radius May 2013

Primarily, patients want two things when ^RSXQ] QY a\YXQ$ \]^ KX KZYVYQc% ]OMYXN the reassurance (to the extent possible) that steps have been taken to reduce the likelihood of the event being repeated. Disclosure and apology can help healthcare professionals and hospitals heal and preserve relationships with their patients. The American Medical Association Code of Ethics states that a physician is required to disclose to a patient when a mistake is made. General Medical Council (2006) provides helpful guidance for doctors related to patients, who complain about the care or treatment they have received. It states that the patients have a right to expect a prompt, open, constructive and honest response, including an explanation and, if appropriate, an apology. When patients feel they have received a sincere statement, saying sorry, they feel respected and validated, and their trust is often restored.

A

ccording to Dr A Lazare in his article s+ZYVYQc SX WONSMKV Z\KM^SMO$ KX OWO\Qing clinical skill’ in JAMA 2006, an apology ]RY_VN RK`O `O OVOWOX^]$ Recognition of the event that caused harm. An expression of regret and sympathy (the partial apology). An acknowledgement of responsibility— where appropriate—once the facts are fully understood (the full apology). Effective reparation. One or more opportunities to meet again KP^O\ K ZO\SYN YP \O OM^SYX John Kador, an accomplished business writer,

^KVU] KLY_^ ^RO `O NSWOX]SYX] YP KZYVYQc$ 1. Recognition. 2. Responsibility. 3. Remorse. 4. Restitution. 5. Repetition. An apology made by or on behalf of a person in connection with any matter, does not, in law, constitute an express or implied admission of fault or liability by the person in connection with that matter. Internationally, a number of studies support the view that a policy of open disclosure coupled with a sincere apology may actually reduce the likelihood of time-consuming and expensive legal disputes. Internationally, a number of organisations have instituted training programmes to help medical students and doctors who are “illiterate in the language of apology”. Many adverse events cannot be prevented KXN MK_]O ZK^SOX^] ]SQXS MKX^ ]_PPO\SXQ KXN distress. Customers often feel betrayed by the very people they have entrusted for providing them with care. So, an apology can bring comfort to the patient, forgiveness to the health practitioner, and help restore trust. Literature points out that customers have more trust in the healthcare system after an adverse event, than before it, if the event is handled with transparency and maturity.

Dr AK Khandelwal is medical director at AnandaLoke Hospital & Neurosciences Centre, Siliguri, West Bengal.

EVENT CALENDAR

HospiArch Organised by: Amen Business Solutions When: May 2013 Where: Jaipur XVth National Seminar on Hospital / Healthcare Management, Medico-Legal Systems and Clinical Research Organised by: Symbiosis Centre for Healthcare When: 3 – 4 May 2013 Where: Pune Social Media & Facebook Marketing Workshop Organised by: Amen Business Solutions When: 4 May 2013 Where: Bengaluru III Internationl congress on patient safety When: 6 – 7 September 2013 Where: Hyderabad International Convention Centre, Hyderabad 4th International Conference on Transforming Healthcare with IT When: 6 – 7 September 2013 Where: Hyderabad International Convention Centre, Hyderabad

Smart Healthcare India Summit 2013 23 - 24 May, 2013,Sheraton Bangalore Hotel, Bengaluru Contact: Mushrif, general manager, conferences on +91 98201 53334 or sagar.mushrif@itp.com For speaking opportunities, contact Alysha Lobo, project manager on +91 9769 616685. For registrations get in touch with Anjali Shetty, sales manager, conferences on +91 22 6154 6010 Bangalore Palace, Bengaluru

Healthcare Radius May 2013

41

Legal eye

Know the Acts A lowdown on the legislations applicable to a hospital BY DR PARAM HANS MISHRA

here are many acts and legislations that guide a hospital. And it’s important to get a good understanding of them for effective functioning. Here are some of the key legislations:

T

tion standard and requirements for registration of nurses. w Pharmacy Act, 1948, looks into establishment of pharmacies and drug stores, registration of pharmacists and dug license, which is mandatory to sell drugs.

MEDICAL/PROFESSIONAL ACTS

GENERAL ACTS/LEGISLATION

w Indian Medical Council Act, 1933, lays down the code of ethics for medical practitioners, regulates medical education and entails registration of doctors. w Indian Dental Council Act, 1948, lays down the code of ethics for dental practitioners, regulates dental education and overlooks registration of dentists. w Nursing Council Act, 1947, looks into educa-

w Industrial Dispute Act, 1948, is applicable to hospitals as healthcare is an industry. It is applicable to institutions that employ 50 or more people. It helps deal with disputes arising in a hospital. w Minimum Wages Act, 1948, lays down WSXSW_W aKQO] ^RK^ K\O bON PY\ NSPPO\OX^ categories of workers. w Employee Provident Fund Act,1952, in which the employer (the hospital) is required to recover from its employees at a prescribed rate, contribute an equal share, credit the fund regularly with the government and applicable for all employees having 20 or more people. w Payment of Bonus Act,1956, which is applicaLVO aROX OWZVYcOO] K\O Y\ WY\O L_^ ObOWZ^ON PY\ MRK\S^KLVO XY^ PY\ Z\Y ^ RY]ZS^KV] w Payment of Gratuity Act,1972, which states that gratuity @15 day's pay for every completed year of service at superannuation or death. The act is applicable for employees 10 or more of service and those who completed `O cOK\] YXO cOK\ SX MK]O YP NOK^R w Payment of Wages Act, 1936, makes it man-

Legislations ensure fair practices and smooth functioning in a hospital

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Healthcare Radius May 2013

datory that the statement of wages showing all details should be given to every employee. It also mandates that wages be paid within ^RO \]^ ]O`OX NKc] YP ^RO WYX^R aS^R YXVc authorised deductions. w Equal Remuneration Act, 1976, states equal pay for equal work. w Employees State Insurance Act, 1948, includes social and health insurance, provides WYXO^K\c KXN WONSMKV LOXO ^] PY\ ]SMUXO]] maternity and employment-related injury. It also states that a hospital has to contribute four per cent of the total wage and that hospital provide complete and free treatment to employees and their dependents, when provisions of ESI is not applicable w Workmen’s Compensation Act, 1923, states that in case a personal injury is caused to a workman by accident arising out of and in the course of his employment, his employer is liable to pay compensation in accordance with the provision of the Act, within 30 days from the date when it fell due. Otherwise, he would also be liable to pay interest and penalty. It also states that in case of death, an amount equal to 50 per cent of the monthly wage multiplied by the relevant factor as given in Schedule IV of the Act or Rs 80,000, whichever is more. In case of permanent total disablement, it is 60 per cent or Rs 90,000 –whichever is more. In case permanent partial disablement occurs, then the compensation is proportionate to the disability arrived at as above.

Legal eye

With regards to sexual harassment As defined by the Supreme Court guidelines

NQ NSGDQ RTOONQS RDQUHBDR 3GD BNLOK@HMSR

(Vishakha v/s the State of Rajasthan, August,

committee must be headed by a woman and

1997), sexual harassment includes such

MNS KDRR SG@M G@KE HSR LDLADQ RGNTKC AD VNLDM

unwelcome sexually determined behaviour as:

Complaints mechanism o /GXRHB@K BNMS@BS

All workplaces should have an appropriate

o CDL@MC NQ QDPTDRS ENQ RDWT@K E@UNTQR

complaints mechanism with a complaints

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woman and not less than half its members should

nonverbal conduct of sexual nature, like leering,

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Anti-sexual harassment policy

dirty jokes, sexual remark about a person’s body

NGO/individual familiar with the issue of sexual

%NQLTK@SD @M @MSHèRDWT@K G@Q@RRLDMS ONKHBX 3GHR

@MC SGD KHJD

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Guidelines

Complainants/witnesses should not experience

o (S HR SGD CTSX NE SGD DLOKNXDQ NQ NSGDQ QDRONMRHAKD

victimisation/discrimination during the process

to prevent sexual harassment, and to provide

Preventive steps

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receive an honorarium, or work in a voluntary

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capacity in the government, private sector or

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unorganised sector come under the purview of

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measures including legislation to ensure that private

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o (S HR SGD DLOKNXDQlR QDRONMRHAHKHSX SN QDBNFMHRD

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sexual harassment as a serious offence and

the complaint committee must be prominently

recognise the responsibility of the company/

CHROK@XDC

factory/workplace to prevent and deal with

o 1DBNFMHRD SGD KH@AHKHSX NE SGD BNLO@MX ENQ RDWT@K

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o (S HR L@MC@SNQX SG@S @KK VNQJOK@BDR G@UD @M

Employers are not necessarily insulated from that

appropriate complaints mechanism with a

liability because they were not aware of sexual

complaints committee, special counsellor

G@Q@RRLDMS AX SGD RS@EE

MISCELLANEOUS

Payment of Wages Act, 1936, makes it mandatory that the statement of wages showing all details should be given to every employee�

to a workplace free of unlawful discrimination @MC G@Q@RRLDMS o "KD@Q CDEHMHSHNM NE RDWT@K G@Q@RRLDMS TRHMF

persons in the workplaces or other institutions

o KK VNLDM VGN CQ@V @ QDFTK@Q R@K@QX

should includeo BKD@Q RS@SDLDMS NE SGD DLOKNXDQlR BNLLHSLDMS

w =RYZ] KXN /]^KLVS]RWOX^ +M^$ Hospitals falling have to be registered with the local municipal corporation. w >\KNO ?XSYX] +M^ # $ The act lays down a detailed procedure for the registration and working of the trade unions. w 7K^O\XS^c ,OXO ^ +M^ # $ The objective of the Act is to provide healthy maintenance of pregnant women employee and her child compensation management. The scope and coverage of the Act includes every establishment wherein 10 or more persons are emZVYcON 7K^O\XS^c LOXO ^ SXMV_NO] ZKcWOX^

examples),and prohibition of such behaviour as an offence o RS@SDLDMS SG@S @MXNMD ENTMC FTHKSX NE harassment after investigation will be subject to CHRBHOKHM@QX @BSHNM o 3GD Q@MFD NE ODM@KSHDR SG@S SGD BNLOK@HMSR BNLLHSSDD B@M KDUX @F@HMRS SGD NEEDMCDQ o $WOKHBHS OQNSDBSHNM NE SGD BNMEHCDMSH@KHSX NE SGD victim of harassment and of witnesses o FT@Q@MSDD SG@S MDHSGDQ BNLOK@HM@MS MNQ witnesses will be subjected to retaliation o /TAKHRG SGD ONKHBX @MC L@JD BNOHDR @U@HK@AKD @S SGD VNQJ OK@BD #HRBTRR SGD ONKHBX VHSG @KK MDV QDBQTHSR @MC DWHRSHMF DLOKNXDDR o 3GHQC O@QSX RTOOKHDQR @MC BKHDMSR RGNTKC @KRN AD @V@QD NE SGD ONKHBX o "NMCTBS ODQHNCHB SQ@HMHMF ENQ @KK DLOKNXDDR VHSG @BSHUD HMUNKUDLDMS NE SGD BNLOK@HMSR BNLLHSSDD

to a woman at the rate of average daily wage for the period of her actual absence, i.e. the period immediately preceding the day of her delivery or following that day. To enjoy this, the woman must have worked for a period of at least 80 days in the preceding 12 months. 6OK`O aSVV LO Q\KX^ON ]Sb aOOU] LOPY\O Z\OQXKXMc KXN ]Sb aOOU] ZY]^ Z\OQXKXMc

Dr Param Hans Mishra is medical superintendent, Indian Spinal Injuries Centre, New Delhi

Healthcare Radius May 2013

43

Event report

Staff concerns :OYZVO2Y]Z MYXPO\OXMO SX .OVRS PYM_]ON YX VVSXQ ^RO `YSN YP ]USVVON manpower in the industry and retaining employees

W

hile there is a slew of healthcare projects in the pipeline that require skilled manpower, the industry is grappling with a dearth of skilled manpower and high attrition. In such a scenario, the ef MKMc KXN ]_MMO]] YP KX Y\QKXS]K^SYXt] 2_WKX <O]Y_\MO 7KXKQOWOX^ 2<7 Z\YQ\KWWO turns out to be a key determinant for the success of the hospital, whether upcoming or established. =_MR ^YZSM] MKWO ^Y ^RO PY\O K^ :OYZVO2Y]Z K MYXPO\OXMO YX ]^\K^OQSM 2<7 PY\ RY]ZS^KV] For the conference, which was recently organised in Delhi, Healthcare Radius was one of the WONSK ZK\^XO\] 2O\Ot] aRK^ K POa ]ZOKUO\] spoke on:

!! Dr Preeti Pradhan Dean, Chitkara Institute of Health Sciences, Chandigarh Topic: Manpower requirement and planning for hospitals Gist: 2_WKX \O]Y_\MO ZVKXXSXQ MYX]S]^] YP putting the right number of people, right kind of people at the right place at the right time and doing the right things. The challenge is not in the number but in the quality of each of those numbers.

44

Healthcare Radius May 2013

Dr Preeti Pradhan

2< ZVKXXSXQ S] WY\O ^RKX UXYaSXQ ^RO X_WLO\] 2< KMMY_X^] PY\ K\Y_XN ZO\ MOX^ YP YZO\K^SYXKV MY]^ PY\ KXc RY]ZS^KV 2< ZVKXXSXQ KPPOM^] K RY]ZS^KVt] ]O\`SMO [_KVS^c KXN brand image. For a new hospital, the planning depends on the type of hospital (secondary, tertiary, quar^OXK\c YaXO\]RSZ ]O\`SMO WSb VYMK^SYX ^cZO YP MVSOX^OVO ZK^SOX^ `YV_WO YXO ZVKX] ^Y MK^O\ ^Y Z\O`KVOXMO YP Z\YLVOW] SX ^RO ]O\`SMO K\OK ZVKX] PY\ KMM\ONS^K^SYX KXN MO\^S MK^SYX +^ ^RO WSM\Y VO`OV YXO RK] ^Y VYYU SX^Y PKM^Y\] VSUO space planning, bed break up, the number of OPDs and ORs, diagnostic facilities, adminis^\K^S`O ]O^ _Z KXN ZRK]O] YP MYWWS]]SYXSXQ +^ ^RO NOZK\^WOX^ VO`OV YXO RK] ^Y MYX]SNO\ PKM^Y\] VSUO NS`S]SYX] YP ^RO NOZK\^WOX^ O[_SZment in the department, functioning details, ObZOM^ON aY\UVYKN aS^RSX ^RO NOZK\^WOX^ NSPferent work personnel required for the job and standards applicable to the department.

!! Dr Pradeep Bhardwaj Executive director & CEO Six Sigma Star Healthcare Gist: There are many ways in which hospitals can take care of their employees and dependants. These include, wishing them on birthdays KXN KXXS`O\]K\c SX]^S^_^SXQ sLO]^ OWZVYcOO KaK\Nt MOVOL\K^SXQ KXX_KV NKc YPPO\SXQ NS]-

Dr Pradeep Bhardwaj

MY_X^ON WY`SO] ]ZYX]Y\]RSZ SX MYXPO\OXMO] short courses, group health insurance, medical LOXO ^] P\OO ^OK KXN MYPPOO PYYN K^ NS]MY_X^ON rates and publishing an in-house journal that RSQRVSQR^] ]^KPP KMRSO`OWOX^] The key reason behind attrition are low salary, better prospects in other hospitals, poor working conditions, transport or housing problem, marriage (in case of female employOO] ROKV^R Y\ PKWSVc S]]_O] P_\^RO\ ]^_NSO] WKV^\OK^WOX^ Lc ]_ZO\SY\] SX^O\XKV ZYVS^SM] and unfriendly relation with colleagues. The healthcare sector employs four million people. But the real problem lies in the quality and not quantity of manpower. It is important that a hospital has wellNO XON TYL \O]ZYX]SLSVS^SO] MYXN_M^] \OPO\OXMO checks and performs induction and re-induc^SYX KXN ObS^ SX^O\`SOa] +V]Y ^RO\O ]RY_VN LO ]O\`SMO \_VO] OWZVYcOO RKXNLYYU Z\O OWZVYcWOX^ ROKV^R MROMU] KXN QYYN VOK`O ZYVSMSO] SX ZVKMO 3X KNNS^SYX OWZVYcOO ]RY_VN LO Ob^OXNON :0 /=3- LOXO ^] ^YY >RO\O ]RY_VN LO K MYWWS^^OO SX ZVKMO PY\ KNN\O]]SXQ OWZVYcOO Q\SO`KXMO] SXMV_NSXQ ]Ob_KV RK\K]]WOX^

!! Dr Param Hans Mishra Medical superintendent Indian Spinal Injuries Centre Topic: Statutory and legal aspects of human resource Gist: 2<7 S] ^RO WKXKQOWOX^ YP KX Y\QKXS]Ktion's workforce, or human resources. It is responsible for the attraction, selection, training, assessment, and rewarding of employees, aRSVO KV]Y Y`O\]OOSXQ Y\QKXS]K^SYXKV VOKNO\ship and culture, and ensuring compliance with employment and labour laws. >RO 2<7 S] OPPOM^S`O aROX ^RO\O S] 2< planning, recruiting and socialisation of the XOa OWZVYcOO] aROX ^\KSXSXQ KXN NO`OVYZment relates to the performance in the present and anticipates future responsibility and when ^RO OWZVYcOO] K\O Z\Y`SNON aS^R YZZY\^_XS^SO] ^Y KN`KXMO ZO\]YXKVVc K] aOVV K] Z\YPO]]SYXKVVc 2<7 S] OPPOM^S`O aROX WY^S`K^SYX relates to job design, performance appraisal

Event report

Dr Param Hans Mishra

and discipline and maintenance relates to safety and health of the employees. Other aKc] YP OX]_\SXQ OPPOM^S`O 2<7 S] ^Y RK`O K well-documented disciplinary procedure, a Q\SO`KXMO RKXNVSXQ WOMRKXS]W ^RK^ OWZVYcOO] are aware of. The organisation should address the health needs of the employees as well with health checkups.

!! Kavitha V Zonal Head HR Fortis Escorts Heart Institute, New Delhi Topic: Training programmes for hospital staff Gist: Training of an employee begins with his entry into the organisation. It starts with the induction programme, employee hand book and checklist. The induction programme ]RY_VN SXMV_NO K_NSY `S]_KV Z\O]OX^K^SYX RY]ZS^KV ^Y_\ KXN SX^\YN_M^SYX Lc `K\SY_] NOZK\^WOX^ \OZ\O]OX^K^S`O] The employee handbook should include L\SOP KLY_^ `S]SYX WS]]SYX `KV_O] PKMSVS^SO] QOXO\KV Q_SNOVSXO] VOK`O ZYVSMc N_^c RY_\] and attendance recording, safety measures, ID MK\N Q\SO`KXMO \ON\O]]KV OWZVYcOO \SQR^] KXN emergency codes. On the job training should include coaching or under study method, job rotation, apprenticeship training, informal learning, job instruction training, lectures and programmed learning, simulated training, computer based training and electronic performance support system. The training methods can be distance and SX^O\XO^ LK]ON ^\KSXSXQ ^OVO ^\KSXSXQ KXN `SNOY MYXPO\OXMSXQ `S\^_KV MVK]]\YYW KXN _]O YP e-learning. One of the key impacts of training is reduced medical error. The Institute of Medicine

Kavitha V

-YWWS^^OO YX ;_KVS^c 2OKV^R-K\O SX +WO\SMK Z_LVS]RON K \OZY\^ >Y /\\ S] 2_WKX$ ,_SVNSXQ a safer health system, which implied on the LK]S] YP Z\O`SY_]Vc Z_LVS]RON \O]OK\MR XNSXQ] ^RK^ ^Y #" SXNS`SN_KV] NSO OKMR year as a result of medical errors that could RK`O LOOX K`YSNON >RO WKTY\ ZYSX^] WKNO Lc the report were that the causes of medical er\Y\] S] XY^ N_O ^Y MVSXSMSKX]t SXMYWZO^OXMO L_^ due to faulty system factors, such as unrealistic reliance on human memory, poor communication systems, unrealistic demands on human `SQSVKXMO KXN ^YY VS^^VO \OQK\N PY\ ^RO MYX]Oquences of fatigue. The other implications are immediate costs ]K`SXQ /WZVYcOO ]K`ON P\YW VOK`SXQ ^RO Y\QKXS]K^SYX SX ^RO \]^ POa WYX^R] KVYXO aSVV YP^OX MY`O\ ^RO ]^K\^ _Z MY]^] 3^ KV]Y \O]_V^ON SX SWZ\Y`ON WY\KVO KXN OWployee satisfaction, enhanced communication, LO^^O\ ^OKW aY\U KXN SWZ\Y`ON aY\U VSPO balance. It helped decreasing the debilitating MY]^] YP L_\XY_^ KXN RSQR OWZVYcOO ^_\XY`O\ + WY\O ]K^S] ON KXN Z\YN_M^S`O ]^KPP aSVV SWZ\Y`O ZK^SOX^ MK\O VO`OV] ^R_] QOXO\K^SXQ high patient scores and reducing patient length YP ]^Kc KXN SWZ\Y`SXQ ^RO .<1 ZO\PY\WKXMO aRSMR MKX MYX^\SL_^O ]SQXS MKX^Vc ^Y ^RO Z\Y ^] of the hospital. In one of the hospitals when OWZVYcOO] aO\O K]UON KLY_^ ^RO `KV_O ^ROc RKN \OMOS`ON P\YW ^RO ^\KSXSXQ Z\YQ\KWWO] ^RO most common answer was: “Now, I know that the hospital really cares for me.”

!! Dr Umesh Gupta Vascular surgeon & JCI Consultant Topic: Quality standards applicable to hospital 2<7$ 4-3 8+,2 Gist: Incompetent people are, at most, 1 per

Dr Umesh Gupta

MOX^ YP ^RO Z\YLVOW >RO Y^RO\ ## ZO\ MOX^ are good people trying to do a good job, who WKUO `O\c ]SWZVO WS]^KUO] KXN S^t] ^RO Z\Ycesses that set them up to make these mis^KUO] 3^t] KVV KLY_^ ]O^^SXQ _Z QYYN Z\YMO]]O] ^Y Z\O`OX^ WS]^KUO] +MM\ONS^K^SYX S] XY^ KLY_^ aRK^ WONSMK^SYX ^Y QS`O Y\ aRK^ ]_\QSMKV Z\YMON_\O ^Y perform. It is about how that medication will be administered or how that surgical procedure will occur to make sure that a patient gets the right treatment at the right time, by the right people, with the right documentation, using the right hardware and in a safe OX`S\YXWOX^ 2Y]ZS^KV] ]RY_VN ^KUO SX^Y KMMY_X^ ]^KPP ZVKXXSXQ Z\YMO]] O`SNOXMO KXN WYXS^Y\SXQ \OM\_S^WOX^ M\ONOX^SKVSXQ Z\S`SVOQSXQ KXN M_\\OX^ TYL NO]M\SZ^SYX SXS^SKV KZZ\KS]KV Y\SOX^K^SYX RY]ZS^KV NOZK\^WOX^KV _XS^ SX ]O\`SMO ^\KSXSXQ KXN OWZVYcOO VOK\XSXQ needs, appraisals (monthly, half yearly and KXX_KVVc KQO ]ZOMSPSM MYWZO^OXMSO] YMcupational health and employee satisfaction, MYWZVKSX^ KXN Q\SO`KXMO \ON\O]] <OM\_S^WOX^ ]RY_VN SX`YV`O M\ONOX^SKVSXQ KVV NS\OM^ MK\O Z\Y`SNO\] KXN `O\SPSMK^SYX P\YW ]Y_\MO 3^ ]RY_VN SX`YV`O \YVO Y\ _XS^ specific job descriptions, which are precise and up-to-date. +ZZ\KS]KV] PY\ KVV OWZVYcOO] ObMOZ^ consultant doctors should conducted prior to starting independent work. It should be performed on an annual basis. Furthermre, it should match job descriptions and age-specific competencies. With regards to consultant doctors, the appraisals should be objec^S`O NK^K N\S`OX KXN RK`O \O M\ONOX^SKVSXQ KXN Z\S`SVOQSXQ

Healthcare Radius May 2013

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Product showcase

COBAS P 312 PRE- ANALYTICAL SYSTEM Roche has launched its new cobas p 312 fully automated pre-analytical system, specially designed for small to medium sized laboratories faced with limited space or lack of skilled manpower. The system is a stand-alone solution with online connectivity, enabling aY\U Ya OP MSOXMc KXN NYO]Xt^ YMM_Zc WY\O ^RKX YXO square meter footprint in the laboratory. Features of Cobas p 312 Intelligent lab automation: Pre-analytics describe ^RO Z\YMO]] YP OP MSOX^ KXN ]OKWVO]] ]ZOMSWOX Z\OZKration, routing and handling of laboratory samples. It KSN] OP MSOXMc WSXSWS]O] WKX_KV RKXNVSXQ KXN YPPO\] accurate sample tracking throughout the whole process. For improved control, safety and service to clinicians, the cobas p 312 provides decapping, sorting and

archiving of all common types of sample tubes within the laboratory´s serum work area (SWA), hematology, coagulation and urinalysis. ?XS[_O M_]^YWS]ON VKcY_^ ObSLSVS^c$ The cobas p t] O\QYXYWSM NO]SQX KVVYa] K M_]^YWS]ON ]KWZVO rack layout and management. Such innovation in sample preparation and sorting offers maximum OP MSOXMc K^ WSXSWKV ]ZKMO \O[_S\OWOX^] PY\ RSQRO]^

ObSLSVS^c aS^R K ^R\Y_QRZ_^ YP ]KWZVO] ZO\ RY_\ Seamless online connectivity: Full online connectivity to the LIS enables managers to seamlessly SX^OQ\K^O ^RO MYLK] Z SX^Y ^RO VKLY\K^Y\ct] 3> infrastructure. Its easy IT connectivity to the cobas pre- and post-analytical systems family allows labo\K^Y\SO] ^Y ObSLVc SX^OQ\K^O SX^Y K >Y^KV 6KLY\K^Y\c Automation (TLA).

DRYVIEW 5950 LASER IMAGING SYSTEM -K\O]^\OKW RK] VK_XMRON S^] XOa .<C@3/A # 6K]O\ 3WKQSXQ =c]^OW aRSMR S] KX KN`KXMON SWKQO\ ^RK^ Z\YN_MO] " ZSbOV] ZO\ SXMR Y_^Z_^ PY\ QOXO\KV \KNSYVYQc KXN WKWWYQ\KZRc SWKQO] >RO SWKQO\ MKX ]_ZZY\^ OP MSOX^ Z\SX^SXQ KXN ^SWO ]K`SXQ VW MK\^\SNQO] >RO .<C@3/A # VK]O\ SWKQO\ KV]Y MKX NOVS`O\ KX OXRKXMON [_KVS^c MYXtrol system for mammography images. It includes a built-in densitometer that produces test prints and display data needed to support mammography quality control charting, eliminating the need for an external densitometer. The imager offers DICOM connectivity and can be used to output images from a PACS XO^aY\U Y\ .3-97 WYNKVS^c -K\O]^\OKWt] =WK\^ 6SXU \OWY^O ^OMRXYVYQc ]YV_^SYX] MKX remotely provide software updates and real-time response and analysis of service issues. >RO VK]O\ SWKQO\ YPPO\] ^aY VW MK\^\SNQO] YX VSXO KXN ]_ZZY\^ `O VW ]SdO]$ b ! SXMR b MW b SXMR b MW b SXMR " b MW b SXMR b MW KXN " b SXMR b MW .KcVSQR^ VYKNSXQ VW MK\^\SNQO] WKUO MRKXQSXQ ]SdO] PK]^ KXN OK]c KXN ^RO SWKQO\ MKX Y_^Z_^ _Z ^Y VW] ZO\ RY_\ PY\ " b SXMR SWKQO]

CARDIOVIT AT-102 PLUS Schiller India has launched a 12 Channel ECG Machine with Color LCD display called CARDIOVIT +> ZV_] 3^ RK] MYWZ_^O\ KSNON SX^O\Z\O^K^SYX measurement and thrombolysis software for adult and pediatric ECGs. It also has internal memory of /-1 \OMY\NSXQ] According to V Balakrishnan, senior vice president,� This revolutionary ECG machine with a bigger color display, direct function keys that are spill proof, is very rugged in design, especially targeted for use in large general hospitals.� Features of CARDIOVIT AT-102 plus w =SW_V^KXOY_] VOKN /-1 KM[_S]S^SYX w " v MYVY\ 6-. ]M\OOX aS^R 6/. LKMUVSQR^ w AK^O\ \O]S]^KX^ N_]^ Z\YYP KVZRKX_WO\SM UOcpad w .O^KSVON SX^O\Z\O^K^SYX WOK]_\OWOX^ KXN thrombolysis software

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Healthcare Radius May 2013

w :KMOWKUO\ NO^OM^SYX w <Rc^RW \OMY\NSXQ w 3X^O\XKV WOWY\c YP /-1 \OMY\NSXQ] w @K\SY_] Z\SX^Y_^ PY\WK^] YX SX^O\XKV ^RO\WKV Z\SX^O\ + ]SdO Optional w =ZS\YWO^\c w =/7+ x =MRSVVO\ .K^K Management System

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