Express Healthcare March, 2013 by Indian Express

INDIA’S FOREMOST HEALTHCARE PUBLICATION VOL. 7 NO.3 PAGES 98

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INDIA’S FOREMOST HEALTHCARE PUBLICATION VOL. 7 NO.3 PAGES 98

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INCREASE PATIENT SAFETY, IMPROVE QUALITY OF CARE

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VOL 7. NO 3, MARCH, 2013

Chairman of the Board Viveck Goenka Editor

Market

Strategy

Viveka Roychowdhury* Assistant Editor Neelam M Kachhap (Bangalore) Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Delhi Shalini Gupta

Industry stalwarts speak-up MARKETING

for women ....................................58-60

Deputy General Manager

Radiology

Harit Mohanty Senior Manager Tushar Kanchan Assistant Manager Kunal Gaurav PRODUCTION General Manager B R Tipnis Production Manager Bhadresh Valia Asst. Manager - Scheduling &

Thoracic imaging for Boerhaave’s syndrome ..........................................64

Coordination Arvind Mane Photo Editor

Life

Sandeep Patil DESIGN Asst Art Director Surajit Patro

Page 9

Chief Designer Pravin Temble Senior Graphic Designer Rushikesh Konka Layout Vivek Chitrakar

NABH – Safe-I certification programme goes national ....................................14 Pushpanjali Crosslay Hospital organises free infertility checkup camp ............15 An Xpert to detect tuberculosis ....................................................................16

CIRCULATION Circulation Team Mohan Varadkar

Gartner says Indian healthcare providers to spend Rs 57 billion on IT in 2013 17 Care Hospitals on an expansion mode ..........................................................18

Dr Duru Shah,

Indo-Russian collaboration for genetic research to prevent heart disease ........19

Chairperson,Gynaecworld ..................70

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Regulars Letters ............................................................................................................................................................8 People...........................................................................................................................................................72 www.expresshealthcare.in

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Editorial

Caring for the caregivers

The health of women in India is not just about availability but also empowering access to healthcare facilities

hile the March issue of Express Healthcare commemorates the 102nd International Women's Day, we reflect on the fact that caring and nurturing being second nature to a woman, the many women who have chosen to serve the healthcare sector are valuable assets of India's booming healthcare sector. 'Caring for the caregivers' is the thought that runs through this issue. Therefore, it is an irony that most women in healthcare remain unsung heroes. Profiling the role of nurses in India, Assistant Editor, M Neelam Kachhap's story, 'Looking after the ministering angels' (page 61 of this issue) finds that nurses are overworked, underpaid and in many cases under-appreciated; all factors contributing to an exodus of nurses from India to greener pastures. They may be the best 'ambassadors' for India's talent in healthcare but unless we lift the status of nursing staff, and acknowledge their pivotal role in bettering clinical outcomes, the exodus will continue, and worse, nursing in India will cease to attract top drawer talent. The health of women in India is not just about availability but also empowering access to healthcare facilities. For instance, a study in the December 2012 issue of International Perspectives on Sexual and Reproductive Health found that continued childbearing driven by son preference accounts for seven per cent of all births in the country. The study titled “The Desire for Sons and Excess Fertility: A Household-Level Analysis of Parity Progression in India” by Sanjukta Chaudhuri, found that Indian women without any sons are more likely to continue having children than those without any daughters. Despite wanting to have smaller families, women whose first child was a daughter were more likely to have another child than those whose first child was a son, and women whose first two children were daughters were more likely to have another child than those whose first two children were sons. Thus, it is no surprise that India's maternal mortality ratios (MMR) are worrisome. As Raelene Kambli, Senior Correspondent, found when she tracked India's efforts to meet the Millennium Development Goals (MDGs) for MMR (see story 'MMR in India & the race against time', page 9 in this issue), the issue is a complex one, with traditional practices and prejudices as well as poverty and illiteracy queering the pitch. At the other end of the spectrum, we have specialised birthing centres, with spa-like infrastructure to take the birthing experience to a different level. (See story on page 67). Midst the gloom, women leaders/entrepreneurs in healthcare provide a glimmer of inspiration and hope. Senior Correspondent Lakshmipriya Nair's interview (see page 71) with Kanchan Naikawadi, founder, Indus Health Plus as well as messages from women in leadership roles like Sangita Reddy, Executive Director - Operations, Apollo Hospitals Group and Ameera Shah, MD & CEO – Metropolis Healthcare (pages 58-60) among others, prove that while women leaders in healthcare are still the exception rather than the norm, they are in an enviable position to urge Indian women to be more proactive about their health issues. Dr Duru Shah, Chairperson, Gynaecworld is already on this path, spearheading quite a few social initiatives aimed at empowering women, ranging from rape victims to adolescents vulnerable to sexual abuse to increasing awareness on legal rights. In her interview, (page 70) she says that women are the mothers of tomorrow's children so by taking care of women's health today, we are also ensuring the good health of the next generation and building a healthy nation. So on that parting thought, let's hope that Express Healthcare's status check on next year's Women's Day will find more cause for cheer. Viveka Roychowdhury viveka.r@expressindia.com

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MARCH 2013

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Letters EALTHCA REMOST H INDIA’S FO

ATI RE PUBLIC

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S 90 VOL. 7 NO.2 PAGE

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HCAR ESS OF HEALT O THE BUSIN INSIGHT INT

specialists who have earned a reasonable name for themselves, and more importantly, retaining them while we talk about Tier II and Tier III cities. Good article none the less. Anurag Dev Kashyap Fortis Healthcare, New Delhi

ROIs and Healthcare IT

Interesting article! here are issues in PPP in DBFOT (Referring to the article titled ‘BOT in Healthcare: Will it be the catalyst?’ in EH Feb 2013). Issues regarding pricing of the services and appraisal mechanisms. Another pertinent topic that needs a separate discussion is attracting core medical

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ll said, the situation is slightly different in the US. (Referring to the article titled 'ROI in healthcare IT' in EH Feb 2013) Any IT enabled product has always had a positive RoI in the near term. Long term benefits cannot be calculated as technology changes fast and new innovations bring in different set of RoI....

“When the rest of the world has moved ahead, public health in India has remained stationery. Public health in the country is so alarmingly poor that we immediately need a fresh approach. While India spends only 1.2 per cent of its GDP to public health, China spends around 2.7 per cent. Unless there is solid foundation of public health system backed by greater governmental funds, public health in the country will not improve.”

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UPFRONT

Market

WB Government to set up 11 mother and child hubs

‘India’s healthcare system represents a mix of the outstanding and the dismal

'In the next five years, the Rockland group plans to scale up to a total of 10000 beds'

Rs 20 crore has been invested for the mother and child hub being set up at the Calcutta National Medical College

Professor K Srinath Reddy, President, Institute of Public Health of India

Rajesh Srivastava, CMD, Rockland Hospitals Group

Page 20

Page 21

he West Bengal government plans to set up 11 state-of-the-art mother and child hubs in various districts, informs Chandrima Bhattacharya, Minister of State for Health & Family Welfare, Government of West Bengal. “We have taken up a project for setting up 11 mother and child hubs in various districts of the state. Soon we will be working upon it and I think they will be operational very soon,” said Bhattacharya She also said that the Maternal Mortality Rate (MMR) has come down drastically in the state and efforts like this will help in bringing down further. The mother and child hubs are supposed to provide all the healthcare facilities right after conception to delivery of the newborn and also make provision for special treatment for the infants in case of any abnormality. According to the minister, Rs 20 crore has been invested for the mother and child hub being set up at the Calcutta National Medical College. For setting up these hubs, the State Government has to bear 25 per cent of the total project cost, while the remaining 75 per cent will come from the Central Government. For better treatment of mothers and newborns, mother and child hubs have been planned at 11 government-owned hospitals across the state, Calcutta Medical College and Hospital, Midnapore Medical College, Suri Sadar Hospital, Uluberia Hospital, Bankura Sammilani Medical College, Malda Sadar Hospital, Krishnanagar Sadar Hospital, Burdwan Medical College and Hospital, Jalpaiguri Sadar Hospital, Cooch Behar Sadar Hospital and Murshidabad Sadar Hospital. EH News Bureau MARCH 2013

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'Jab khush khabri ka pata chale tab, paanch gaantt bhandh lo....'. This catchy slogan is a television commercial promoted by the Ministry of Health and Welfare and has a special social message to give away. In line with the Millennium Development Goals (MDGs)-5A set by World Health Organisation (WHO); this ad is initiated to improve maternal health and reduce maternal mortality rate (MMR) in India. Interestingly, the ad these days is being flashed every half an hour on India’s popular television channels, leaving a powerful impact in the minds of lakhs of Indians across the country. Kudos to the government for using television, the fastest and most preferred means of mass communication in India, as a medium to create awareness on maternal mortality and educate every expectant parent of his/her responsibilities during the crucial nine months. Perhaps, this technique of reaching out to people would help in augmenting the initiatives taken to bring down the toll of MMR across the country, which despite the various health programmes made available by the government continues to be a major cause of concern for India. The MDG-5A, in the year 1990, prescribed a level of 109 maternal deaths/100,000 live births by 2015, in order to curb the growing incidence of MMR across the globe, especially in developing countries including India. Sadly, the MDG Report issued by the UN Secretary General last year reported that every 10 minutes an Indian woman dies from complications related to pregnancy and childbirth and meeting the MDG seems to be a pipe dream.

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The problem The reasons behind the disturbing number of maternal deaths in India are mainly anaemia caused by malnutrition, lack of family planning, unsafe abortions, ante and post-partum haemorrhage, obstructed labour, hypertensive disorders,post-partum sepsis and lack of healthcare facilities in reproductive health in the hinterlands. As per the Planning Commission of India the percentage attributable to the causes are stated below: Causes for maternal mortality Percentage Haemorrhage

Anaemia

Sepsis

Obstructed labour

Abortion

Toxemia

Others

The Government of India, for this reason, has created a Maternal Health division under the Department of Health and Family Welfare which has introduced safe motherhood programme in the year 2005 which is also called the Janani Suraksha Yojana (JSY). This scheme was launched under the umbrella of National Rural Health Mission (NRHM) and proposed by way of modifying the National Maternity Benefit Scheme (NMBS). While NMBS is linked to the provision of better diet for pregnant women from below poverty line (BPL) families, JSY integrates the cash assistance with antenatal care during the

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pregnancy period, institutional care during delivery and immediate post-partum period in a health centre by establishing a system of coordinated care by field level health worker. With the help of this initiative the MMR toll in India has been reduced a bit. As per the Registrar General’s Govt of India report, MMR in the country was 327 per 100,000 live births in 1999 but it has come down to 212 per 100,000 live births in 2007-09 i.e. a decline by 115 points in the last 10 years. Thus, the country has reduced MMR by an average of 11 points per year. In view of this there is likely to be a decline of another 50 to 60 points by 2015 i.e. country may attain MMR of 162. However, this is just a small drop in the ocean. There is still a very long way to go. Statistics from the National Population Policy of India reveal that India still accounts for over 20 per cent of the world’s maternal deaths. According to the National Health Profile report, states such as Kerala, West Bengal, Tamil Nadu and Maharashtra, have succeeded in bringing down the numbers; however, Assam, UP/Uttarakhand, Rajasthan, MP/Chhattisgarh, Bihar/Jharkhand and Orissa lag behind, which adversely affects the average rate of MMR of the country.

Deterrents to progress The current state of MMR in India raises numerous questions. Regardless of continuous efforts and rapid economic progress, India still falls short of meeting the set MMR target, so what has actually gone wrong? Were the efforts taken under the JSY not up to the mark? Were these efforts taken up too late in the day? Or is

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India expecting the “revised” MDG? And why is it that only few states in India have been able to succeed in undermining MMR? Addressing these questions, Dr Ranjit Chakraborti, Obstetrician, Gynaecologist and Laparoscopic Surgeon, Fortis Hospital, Kolkata says, “Geographical vastness and socio-cultural diversity in India indicates that maternal mortality varies across the states, and therefore uniform implementation of health-sector reforms is a tall task.” Pointing out the other factors that have been detrimental to the progress of these initiatives, he goes on to say, “Maintaining healthcare standards at the grassroots level requires interdisciplinary cooperation and collaboration among doctors, midwives, auxiliary nurses and other paramedical staff. The provision of healthcare at the terminal end of healthcare system in the rural areas urgently requires a well intended political drive to improve the present scenario. The high MMR is due to large number of deliveries conducted at home by unskilled persons with zero compliance to basic hygiene standards. Added to this, lack of adequate referral facilities to provide emergency obstetric care for complicated cases also contribute to high MMR. Other prominent concern areas are the age of marriage and child bearing, child spacing, family size and fertility patterns, literacy, socio-economic status and the age-old customs and beliefs.” Dr Sujata Datta, Consultant Obstetrician and Gynaecologist, Fortis Hospital -Anandapur, Kolkata also blames it on the poor healthcare system in our country. She opines, “Lack of transport and infrastructure that would ensure delivery of service at grassroot level, lack of trained manpower, sociocultural and political factors which together determine the status of the woman, her health, fertility and access to healthcare, unmet need for contraception of women resulting in unplanned pregnancies, unsafe terminations causing sepsis and maternal deaths, as well as lack of emergency care facilities at the rural level causing deaths from eclampsia are some of contributors to the slow progress in achieving the goal against MMR in India.” On the same lines, Dr Neena Bahl, Sr Consultant, Obstetrics and Gynaecology, Max Hospital feels that the MARCH 2013

increase in rate in maternal mortality is a reflection of poor health facilities in rural areas. Lack of knowledge, prevalence of home delivery by dai maas, low preference to female health in rural setting leads to increase in MMR. Taking umbrage at the absence of ambulance services in the rural areas, Dr Asha Singhal, Consultant Obstetrician & Gynaecologist, Bombay Hospital Institute of Medical Sciences, Mumbai states, “We need better roads

Kerala, West Bengal, Tamil Nadu and Maharashtra, have succeeded in bringing down the numbers; however, Assam, UP/Uttarakhand, Rajasthan, MP/Chhattisgarh, Bihar/Jharkhand and Orissa lag behind

and transport facilities for quick transportation to provide urgent medical attention. It is not uncommon to see pregnant women in rural areas being transported on bicycles, motorcycles, handcarts, bullock carts, auto rickshaws, and tractors to the medical centres which are not within easy reach. Quick ambulance services should be available in all regions. With the use of cell phones it should be possible, in today’s day and era, to call the ambu-

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lance (equipped with trained paramedical staff) to transport the patients,” she points out. Apart from lack of organised healthcare systems and infrastructure at the primary level, marriage and childbirth at an early age has also been one of the leading reasons for the problem in India. About 50 per cent of the women in India marry before they are 18 and by 19 years of age half of them have their first child, states the millennium goal report of last year. Dr Vivek Padgoankar, Director, Organization of Pharmaceutical Producers of India (OPPI), flagged another important issue. He draws attention towards the mindset that people living in the rural areas have. “Women here, go by the beliefs of their mothers and grandmothers who delivered babies at home. This mindset becomes the biggest challenge that healthcare workers working in these areas face. The other challenge related to the mindset of people, is that the preference for a male child in comparison to a girl child. People in rural

India keep having babies till they have a male child. This, again, is one of the major causes for maternal deaths in India. I personally feel that if we can change this mind set we will be able to overcome many women related issues in India,” he alludes. However, if there are so many road blocks in the path to achieve the set targets for MMR, how have the states of Maharashtra, Tamil Nadu, West Bengal, and Kerala scored well in curtailing the growing incidence?

Tightening loose ends... Like every dark cloud has a silver lining, the declining numbers of MMR within the states of Maharashtra, West Bengal, Tamil Nadu, and Kerala, indeed brings some respite. These states have really done well on reducing MMR. After all, health is the matter of the each state and it is the primary responsibility of the state government to build the necessary infrastructure and manpower to meet the needs of its people. Some learning lessons from these states include:excel-

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Case study: MMR in Maharashtra ccording to Suresh Shetty, Minister of Health, Maharashtra, the state has already achieved the set target of 109/100000 before time. He lists down various programmes introduced by the Public Health Department of Maharashtra to reduce MMR. Some of them are as follows: Strengthened ante-natal care (ANC): This was done by conducting maternal medical campaign that included early registration of ante-natal case (i.e. pregnant mother) before 12 weeks, conducting baseline investigations – haemoglobin, blood pressure, weight, height, body-mass index, urine-albumin/sugar, HIV testing, sonography. These investigations are done for identifying high risk factors such as high BP, protienuria, anaemia, twins, hydramnios, IUGR etc. Distributing free medicines, conducting screening programmes for high risk pregnancies such as short stature, multipara, elderly primigravida, through clinical examination of ANC is done during these ANC visits and by creating a mother & child tracking system (MCTS) wherein all mothers and children are tracked and provided services from time to time, resulting in increasing ANC coverage. Strengthen intra-natal care and post natal care (PNC): This was done by ensuring 100 per cent deliveries at institutions by micro – birth planning by way of keeping a track of the mother throughout the pregnancy term and well up following up with the delivered mother on 2nd, 7th, 10th Day and for baby on Day – 7, 14, 21, 28 and 42 day Infrastructure strengthening: The government has mapped all health facilities available in the state. The government has also strengthenied sub centres, primary health centres (658) as per Indian Public Health Standard (IPHS) norms, strengthening of first referral units (220). In addition, the government has also provided for blood transfusion facilities at most of these centres, free referral transport services for these women, free diagnostics and medicines, free diet during stay, and adequate PNC care is being implemented across the state. Strengthening of manpower: The government of Maharashtra provides forvarious trainings are being taken such as,skilled attendant at birth - (ANM/LHV/Staff Nurse): 7038 trained Basic emergency obstetric care training: 4372 trained Comprehensive emergency obstetric care training :133 trained Life saving anaesthesia skill training of MOs:173 trained Janani Suraksha Yojana (JSY): Under the JSY, the state provides for conditional cash transfer scheme. The beneficiaries must be BPL. In case of SC and ST, benefit should be given to all pregnant women (including non BPL). The age of pregnant mother should not be less than 19 years. The benefit should be given to the beneficiaries up to two living children. For home delivery, Rs 500 is to be given to the BPL beneficiary only. The beneficiary from urban area, if she delivered in a health institution gets an amount of Rs 600 within seven days and those from rural areas get Rs 700 within seven days. In case of Lower Segment Cesarean Section (LSC S), Rs 1500 is to be given to the beneficiary if she has undergone caesarean section delivery in private accredited hospital. There are 5370 private accredited hospitals in the state. Human Development Programme: Human Development Mission was established in 2006 and initially the Human Development Programme was launched in 25 talukas of 12 districts. With success and improvement in the Human Development Index (HDI) the programme was extended to 125 blocks in 22 districts in the year 2011. Through this programme, various schemes for pregnant and delivered mothers such as specialist camps are implemented. Through these schemes BPL and SC/ST mothers are paid Rs 800 as loss of wages, at the end of eighth month of pregnancy so that she can take rest during ninth month of pregnancy and to encourage them for institutional delivery. Indira Gandhi Matrutva Sahayog Yojana (IGMSY): It is being implemented on pilot basis in the districts of Amravati and Bhadara. This is also a conditional cash transfer scheme under which Rs 4000 are given to pregnant mothers for antenatal checkup, institutional delivery, and post natal follow up including immunisation of new born and follow up for six months.This will help in reducing maternal mortality as well as neonatal and early infant mortality. Maternal death review is a tool used to review all facility-based and community-based maternal death. Started in the state since 2010 as per government regulation dated May 28, 2010. This process has helped the state in identifying the type of delays, reasons for delay and the system gaps which are responsible for maternal death. State has been identifying gaps and implementing the corrective measures.

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lent implementation of the JSY by way of strengthening the ante-natal care (ANC) and intra-natal care provided under this scheme as well as creating partnerships with various private players and NGOs to create infrastructure for the same and provide manpower. A case study of how the state of Maharashtra was able to achieve the MDG-5A is quite revealing. (See box: Case study: MMR in Maharashtra). Citing an example of a successful PPP in this sphere, Dr Padgoankar informs that the Government of Maharashtra has partnered with the OPPI, the Rotary Club of Mumbai, the Indian Medical Association (IMA) and a NGO Pragati Pratishthan to initiate a pilot project for reducing MMR in the rural areas of the state. This campaign aims to reduce maternal and new born child mortality through collaborative action and training at all levels, from basic emergency obstetrics and new born care (BemONC), following the World Health Organisation (WHO) standards. So far, 10 medical camps have been organised in the areas of Jawhar, Mokhada, Vikramgarh and some more- the result of which are really gratifying in certain parts of the state,. A noteworthy effort indeed. If these efforts can be duplicated within the states with high MMR rate, we can certainly move faster towards meeting the goal. Nevertheless, each state has a different set of problems and on a larger scale; a cumulative effort by all stakeholders is the need of the hour. Suggesting strategies that need to be adopted to improve the present scenario within states with high MMR, Dr Chakraborti prescribes forging partnerships between the public and private sector. He says, “PPP in this sphere is the way forward for the healthcare sector in India. There is also an urgent need to improve the transparency and accountability on the cost of delivery of healthcare services.” Agreeing to the same, Dr Padgoankar also feels that if all healthcare stakeholders work together in partnership , this concerted effort will get a pushover. Dr Singhal, says, “Government should allocate adequate funds especially to primary health centres (PHC). MARCH 2013

All PHCs should have periodic supervision from more advanced centres.” Further on, the Health Minister of Maharashtra advices other states to promote institutional delivery and conduction of delivery by skilled birth attendants who may be a nurse or a doctor and for this, training of Auxiliary Nurse Midwife (ANMs)/NMs/ lady Health Visitor (LHVs)/staff nurses in skilled birth attendant training and medical officers in basic emergency obstetric care

training is essential. Accredited Social Health Activist (ASHAs) must be actively involved in promotion of institutional delivery. States also should have schemes from their own budget such as Human Development Programme in addition to central assistance. Also, the central government should give more and more emphasis on the underveloped states with regard to their development in different socio-economichealth and infrastructural

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aspects in order to achieve the revised goals. Over and above, educating each and every woman of India will help in curbing a lot of women related health issues. Education women will not only bring about the necessary change in the outlook and encourage women to take every possible step in safeguarding herself during childbirths, but will also help in resolving the current state of MMR in India. Let’s not forget that a healthy woman

builds a healthy family and this in turn builds a healthy community.

Lastly... With just three years in hand, there is a lot more to do. If all of the above mentioned strategies are put in perspective, India can certainly cut the red tape and further its efforts in meeting the MDG on maternal health. raelene.kambli@expressindia.com

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Partnerships

Aarogyasri Health Care Trust partners with SAS arogyasri Health Care Trust (AHCT), a government initiative offering health insurance scheme to below poverty line families (BPL) for treating catastrophic illness, has partnered with SAS, a company dealing in business analytics software and services, to optimise performance and reduce operating expenses. SAS' analytics solution reportedly provides realtime access to AHCT on understanding the lead time between pre-authorisation approval and surgeries conducted across hospitals. Claims, financial and clinical data are constantly leveraged in forecasts to root out fraud, spot disease trends, and lead to preventive health measures. The solution also apparently enables AHCT to forecast funds requirement to implement the scheme and enables in mapping the infrastructure needed and other key requirements. Sudipta K Sen, Regional Director - South East Asia, CEO and MD SAS Institute (India) said, "We are happy to be associated with the Government of Andhra Pradesh in a bid to address health related issues of poor families. We are confident that our solutions will enhance the effectiveness in Aarogyasri Health Care Trust's overall process by streamlining and analysing the massive data and empower Aarogyasri Health Care Trust to gain valuable insights for fact-based decision making." "In the long term, our aim is to eliminate preexisting disease loads in the areas of catastrophic health needs, and extend benefit coverage as premium costs come down," explains N Srikant, CEO Aarogyasri Health Care Trust. "The goal is to provide universal BPL population coverage and enable government hospitals to improve infrastructures and services."

EH News Bureau

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M|A|R|K|E|T INITIATIVE

NABH – Safe-I certification programme goes national The first hospital to get the certification is Tagore Hospital in Jalandhar, Punjab hospital knows when it's ready to invite NABH assessors. Speaking on the occasion, Dr KK Kalra, CEO, National Accreditation Board for Hospitals (NABH) said, “NABH is currently operating in India with nearly 864 hospitals in various phases of accreditation and 156 large hospitals are already accredited. There is a need for increased awareness among the healthcare facilities across India so that more healthcare organisations start participating in quality initiatives. There is a role for all the concerned stakeholders towards raising awareness and involving healthcare organisations to adopt quality standards.” The first hospital to get the certification, Tagore Hospital of Jalandhar, Punjab is one of the 21 hospitals

ABH has started the NABH-Safe-I Certification programme for infection control in association with BD India (Becton, Dickinson & Co.). The programme, so far confined to Kerala and Punjab, will now go national. Under this programme, NABH recommends safe injection and infusion practices, biomedical waste management, healthcare workers safety and sterilisation and disinfection, to name a few. NABH also provides a consultant through its technical partner – BD to help applicants build capability to run a robust infection control programme, providing training content and surveillance tools, as well as conducting a baseline and an endline assessment post the training, basis which the applicant

undergoing the NABH-Safe-I accreditation programme from Punjab and Kerala, the two states under the pilot started in March 2012. Dr Narottam Puri, Chairman, NABH said, “NABH is the hallmark of quality of care in hospitals in India. I am glad that hospitals are realising the importance of getting NABH accreditation and have started working towards it. I congratulate Tagore Hospital for beginning their journey of providing quality healthcare in their state.” Manoj Gopalakrishna, Managing Director, BD India said, “BD has always worked toward achieving our purpose of ‘Helping all people live healthy lives’. The NABH-SafeI certification is an innovative collaboration for enhancing patient safety and healthcare

worker safety and will augment infection control standards in the hospitals of India.” NABH and BD had entered a memorandum of understanding (MoU) in 2012 to support hospitals in attaining quality-of-care standards for infection control in three phases. During Phase One, initial workshops were to be carried out across hospitals in India to ensure adoption of ‘Safe-I’ by hospitals. The second phase will offer Centers of Excellence (CoE) and health economic models to be developed for the benefit of Indian healthcare after dissemination of NABH-Safe-I programme. The last phase will augment national capability of standards dissemination by developing additional Centres of Excellence. EH News Bureau

COLLABORATIONS

BACC Healthcare and Motherhood come together to launch Parenthood It is a new infertility management centre at Indiranagar, Bengaluru hea Healthcare, which operates a speciality birthing boutique centre in Bengaluru under the brand name “Motherhood”, and Dr Kamini Rao of BACC Healthcare have joined hands to launch “Parenthood”, a infertility management centre at Indiranagar, Bengaluru. This joint initiative between Dr Kamini Rao of BACC Healthcare and Dr Rehan Sayeed of

Motherhood offers a complete range of infertility management solutions. The facility reportedly has the latest medical infrastructure including a full fledged embryology lab, operation theatre, ultra sound machines, recovery wards etc apart from well trained and experienced doctors in this field to address the complete infertility management process.

Dr Kamini Rao, Medical Director, BACC Healthcare said, “We are pleased to be associated with Motherhood and expand our foot prints to this new centre. This facility will continue the tradition of BACC Healthcare in extending its time tested and proven infertility treatments to couples who will need the treatment in an efficient and ethical manner.” Dr Rehan Sayeed,

Chairman, Rhea Healthcare reiterated the need for such specialised centres to assist couples with infertility treatment and management. He said, "I firmly believe that the coming together of Rhea Healthcare with Dr. Kamini Rao whose expertise along with her credible success rate, will provide ethical and expert care to couples in need of infertility treatment.” EH News Bureau

MEDICAL TECHNOLOGY

HCG introduces breast cancer app in India In the next few months HCG intends to create apps for all types of cancer which will be freely available on a Google play and I store ealthCare Global Enterprises (HCG) has introduced an application (app) called HCG BCA on breast cancer in India. This will reportedly help in dispelling the myths and misconceptions about cancer. Ragini Dwivedi, actor, launched the breast cancer app which explains about various self breast examination techniques for women, facts on breast cancers and FAQs on breast cancer. The

app can be freely downloaded. For Android phones it can be downloaded from Google play store and I phone from I store. Dr BS Ajaikumar, Chairman, HCG Group, said, “Myths are major hindrance for cancer treatment. Patients believe the treatment is painful and try to avoid it. Fear is a major factor, overcoming fear is important to overcome cancer. The social stigma around the disease www.expresshealthcare.in

can only be eradicated by educating the public. We have to bring about a change by creating awareness that cancer is treatable and is more like a chronic disease.” Speaking about her particiaption Dwivedi said, “I am pleased to be associated with HCG and its initiative in creating awareness on cancer. The people of Karnataka look up to me and I am sure my support to this initiative will help many women to come

forward for self examination and early diagnosis.” This initiative is likely to help many women to be educated on cancer. Breast cancer is an urban disease and rising at an alarming rate. Through this app, the idea is to promote awareness on self examination as it is important to identify early signs and symptoms of breast cancer to beat it, claims a company release. EH News Bureau MARCH 2013

M|A|R|K|E|T INITIATIVE

Pushpanjali Crosslay Hospital organises free infertility checkup camp Around 50 couples residing in East Delhi and from areas of Ghaziabad attended the checkup programme free infertility checkup camp was organised recently by the Pushpanjali Institute of IVF and Infertility at the Pushpanjali Crosslay Hospital (PCH). The camp provided free consultation, counselling, USG and semen analysis for all infertile couples who attended it. Around 50 couples residing in East Delhi and from areas of Ghaziabad, who were facing infertility issues, attended the checkup programme. Some of them were evaluated and recommended for intra uterine insemination (IUIs), few will require to undergo diagnostic laparoscopy to evaluate tubal blockage and few patients were suggested to opt for in vitro fertilisation (IVF). Dr Poonam Goyal, Head IVF programme said that

tioned that quite a high percentage of infertile couples suffer from male factor infertility because of lower and inadequate sperm counts. Factors like smoking, alcohol consumption

and longer use of laptops have been known to cause decreased sperm counts in males. The camp was inaugurated by Dr Vinay Aggarwal, CMD, PCH who highlighted

the importance of creating appropriate infrastructure and provision of latest equipment, especially in a sensitive field like IVF for it to succeed. Dr Vijay Agarwal, Executive

Director, PCH complimented the team for achieving 55 per cent success rate in the last batch of patients who underwent IVF cycle in January at Pushpanjali. EH News Bureau

The camp provided free consultation, counselling, USG and semen analysis for all infertile couples who attended it the rise in infertility is due to changing lifestyles, late marriages and requires mass campaign to raise awareness on the causes of Infertility. Dr Sowjanya Aggarwal, Consultant Infertility specialist commented on the role of minimal invasive surgical procedures like laparoscopy, hysteroscopy for diagnosing fibroids, polyps and tubal blockages. Dr Bhavana Mittal, consultant infertility specialist highlighted the importance of techniques like intra cytoplasmic sperm injection (ICSI) and coordinated team work for achieving good success rates in IVF programme. Dr Shailesh Sahay, consultant urologist and male infertility specialist menMARCH 2013

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M|A|R|K|E|T MEDICAL TEST

An Xpert to detect tuberculosis The WHO-endorsed test offers rapid detection of TB and resistance to rifampicin, as an indicator of multidrug resistance diagnostic test for tuberculosis (TB) can accurately and quickly detect both TB and drugresistant strains, according to a new study. The authors of a new systematic review assessing the diagnostic accuracy of the Xpert MTB/RIF test published in The Cochrane Library claim that their study can provide timely advice for clinicians and policymakers in countries where TB is a major public health problem. Millions of people develop TB every year. Moreover, drug resistance is a major public health problem that further complicates efforts to control TB. Multidrug-resistant TB is defined as resistance to rifampicin and isoniazid, which are two of the most effective and widely used anti-TB drugs. Xpert (Cepheid, California) is a diagnostic test endorsed by the World Health Organization (WHO) that simultaneously detects TB and resistance to rifampicin, as an indicator of multidrug resistance. The test takes around two hours, with min-

imal hands-on technical time required, claim the makers of the test. Xpert requires a sample of sputum but it can reportedly detect TB bacteria at much lower concentrations. The researchers, from the Cochrane Infectious Diseases Group, McGill University and the Foundation for Innovative New Diagnostics (FIND), analysed data from 18 studies involving a total of 7,816 people, with most studies being carried out in low-and middle-income countries. The results show that when Xpert is used to screen 1,000 people, 150 of whom have TB, it picks up 132 of the 150 cases (88 per cent) and falsely diagnoses 17 (two per cent) with TB. This is in a scenario where it is being used as a replacement for smear microscopy. In a scenario where Xpert is being used as a replacement for culture-based drug susceptibility testing, it is also able to detect the equivalent of 141 out of 150 cases (94 per cent) of rifampicin resistance. When Xpert is used as a follow-on test, after con-

ventional smear microscopy has already produced a negative result, it picks up 101 out of 150 cases (67 per cent). By definition, smear-negative TB is not picked up by smear microscopy because microscopy cannot detect small numbers of bacteria. Xpert picked up 67 per cent of this group that would have been missed by microscopy. “This study represents the most comprehensive review on the diagnostic accuracy of Xpert to date and may help countries make decisions about scaling up its use for management of TB and drug-resistant TB,” said lead researcher, Karen Steingart, of Cochrane Infectious Diseases Group. Karin Weyer, Coordinator, Laboratories, Diagnostics and Drug Resistance at the WHO said, “This Cochrane Review provides high quality evidence that reinforces WHO’s endorsement of this test. Recent price reductions have greatly facilitated roll-out of this technology, including a new three-year initiative called the TB Xpert Project,

funded by UNITAID and executed by WHO and the Stop TB Partnership. 1.4 million test cartridges and over 200 GeneXpert instruments for the rapid detection of TB and rifampicin resistance will be distributed in 21 countrieswith a high burden of TB.” Lucica Ditiu, Executive Secretary, the Stop TB Partnership said, “We welcome the Cochrane Review of Xpert, an innovation that represents a major milestone in our quest to achieve the goal of zero deaths from TB – which is curable but still takes the life of three people every minute. The Stop TB Partnership is making every effort to help countries understand how best to use this new technology. Our TB REACH initiative is deploying Xpert to numerous countries through projects that seek to increase the number of TB cases detected and treated, and these projects will deliver data that can provide an evidence base for determining how Xpert should be used for the greatest impact.” EH News Bureau

HOSPI NEWS

Kokilaben Dhirubhai Ambani Hospital launches new liver transplant centre in Mumbai The team of doctors at this centre is headed by Dr Vinay Kumaran okilaben Dhirubhai Ambani Hospital has launched a comprehensive centre for liver transplant in Mumbai, which is reportedly equipped to treat the entire spectrum of liver disorders involving dedicated and full time specialist surgeons, physicians (haepatologists), anaesthetists, radiologists and intensivists etc. supported by dedicated operation theaters (OTs), intensive care units (ICUs) and other high-tech infrastructure and equipment necessary for such complex procedures. The unit was launched by Dr Tehemton E Udwadia, eminent gastrointestinal surgeon, at the convention centre of the hospital. The team of doctors at this

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centre is headed by Dr Vinay Kumaran who has over a decade of experience involving over 700 liver transplants. In the past two years, he has independently performed over 150 living donor liver transplants with no mortality, informed a news release from the hospital. Dr Udwadia said, “The medical fraternity has often contended the lack of dedicated liver facility in Mumbai, but we attributed it to high cost and the present visiting- doctors models that cannot support the comprehensive liver transplant care which is critical for the survival of patients, as living donor liver transplants (LDLTs) require specialised and comprehensive centers for www.expresshealthcare.in

the success of the procedure.” The hospital is the first in western India to be able to offer both living donor and deceased (cadaver) donor liver transplants for adults as well as children with end-stage liver disease. The unit also offers emergency liver transplants for patients with acute fulminant liver failure. Dr Vinay Kumaran, Head, HPB and Liver Transplant Surgery said, “It has been estimated that about 2,00,000 Indians die of liver failure every year. In an ideal world, most of these would be candidates for a life-saving liver transplant. Around 25,000 liver transplants need to be done every year in India. However about 1,100 trans-

plants were performed in India, that too mostly in Delhi and centres in South India.” He further added, “The need for liver transplant in the western India, including Mumbai, is estimated to be about 5000 - a demand almost impossible to meet through cadaveric organ donation, emphasising the importance of the LDLT team.” “The centre of excellence for a comprehensive living donor liver transplant programme, being set up by Kokilaben Dhirubhai Ambani Hospital was the best way to meet the requirement of transplants for the suffering patients,” added Dr Kumaran. EH News Bureau MARCH 2013

M|A|R|K|E|T INVESTMENT

Gartner says Indian healthcare providers to spend Rs 57 billion on IT in 2013 Internal services segment to lead growth this year ealthcare providers in India will spend 57 billion on IT products and services in 2013, an increase of seven per cent over 2012 revenue of Rs 53 billion, according to Gartner. This forecast includes spending by healthcare providers on internal IT, hardware, software, external IT services and telecommunications. Te l e c o m m u n i c a t i o n s, which includes telecommunications and networking equipment and services, will remain the largest overall spending category throughout the forecast period within the healthcare providers sector. It is expected to grow by 3.9 per cent in 2013 to reach Rs 17.2 billion in 2013, up from Rs 16.6 billion in 2012 – most of this growth will be in enterprise communication equipment. Internal services will achieve the highest growth rate amongst the spending

healthcare. Large national and state government programmes will spur growth along the primary (and secondary) care sector and public health domain,” said Anurag Gupta,

Research Director at Gartner. “Hospital information systems, picture archiving and communications systems, electronic health records and mobile technologies will be

high on the agenda. We expect to see providers benefit by offering cost effective business models which show quick returns on capital by improving patient coverage and

improving quality of care. Health insurance growth will also catalyse technology adoption in healthcare provider segments.” EH News Bureau

This forecast includes spending by healthcare providers on internal IT, hardware, software, external IT and telecommunications categories – forecast to be 18 per cent in 2013. Internal services refer to salaries and benefits paid to the information services staff of an organisation. The information services staff includes all company employees that plan, develop, implement and maintain information systems. IT services will achieve the next highest growth rate amongst the spending categories – forecast to grow 9.7 per cent in 2013 to reach Rs 14.5 billion in 2013, up from Rs 13.2 billion in 2012 led by growth in process management and consulting. “Rising demand from the growing middle class in India’s large cities is fuelling growth in private sector MARCH 2013

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Care Hospitals on an expansion mode To invest Rs 400 crores in next 2.5 years and double bed capacity Lakshmipriya Nair EH News Bureau ARE Hospitals plans to invest around Rs 400 crores in the next two and half years to expand its network and grow as an integrated healthcare provider. Dr Krishna Reddy, Director and CEO, CARE Hospitals informed that the investments would be raised through debt and equity. Advent International, a UKbased PE firm has already invested $105 million into

this hospital chain. CARE Hospitals are present in five states of India i.e. Andhra Pradesh, Orissa, Chattisgarh, Gujarat and Maharashtra. Its expansion strategy is to consolidate and strengthen their foothold in these states. The recently inaugurated CARE Outpatient Centre in Hyderabad is one of the steps to achieve this objective. The centre, inaugurated by Dr APJ Abdul Kalam, the 11th President of India, is the 13th facility from CARE and

sprawls across six floors and covers 185000 sq feet. Dr Reddy informed that this outpatients centre was built with an investment of Rs 30 crores and is part of CARE Hospitals' long term plans. This outpatients centre is expected to offer an array of services under one roof and pave the way for more such outpatient centres. Dr Reddy revealed that henceforth all the greenfield projects by CARE Hospitals would have separate outpatient centres. The next centre is coming up

near the CARE Hospital in Nampally, Hyderabad. The hospital chain also intends to double their bed capacity i.e. from the present 1600 to 3200 in the next three years. Plans to achieve this target is already underway. Some of the new CARE hospitals coming up in Gachibowli (300 beds) and Vishakapatnam (300 beds) in Andhra Pradesh, Bhubaneshwar (200 beds) in Orissa and Raipur (425 beds) in Chattisgarh . lakshmipriya.nair@expressindia.com

Hinduja Hospital receives with TB Champion Award The award was conferred for the awareness generated by Hinduja Hospital's research paper on TB D Hinduja National Hospital and Medical Research Centre, Mumbai has been conferred the first TB Champion Award by Global Health Strategies (GHS), an international consulting company. Hinduja Hospital was recognised for the importance the organisation has given to accurate diagnosis and treatment and to optimally manage TB patients, provide reliable diagnos-

tics and develop techniques for rapid diagnosis of TB and drug susceptibility testing. The research report by Hinduja Hospital was published in January 2012. On winning the award, Pramod Lele, CEO, Hinduja Hospital said, “Hinduja Hospital has always been known for its cutting edge research. TB is a sensitive topic and we are glad that the outcome of our research

could fix some root problems which had been plaguing the society till now.” Dr Camilla Rodrigues, Consultant Microbiologist and Chairperson Infection Control Committee said, “Hinduja Hospital has always shown corporate social responsibility for a noble cause, and has invested in both rapid TB diagnostics and research for over 15 years.” Hinduja Hospital was the

first hospital in India to have come out with a research report that found 12 TB patients to be resistant to most anti TB drugs. The certificate credits Hinduja Hospital for bringing out the report resulting in a major restructuring of the National TB Control Program in Maharashtra state and Bombay Municipal Corporation to enhance case detection. EH News Bureau

Apollo Cancer Hospitals conducts fashion show on cancer prevention NIFT was declared the winner and Raffles Millennium International the runner-up pollo Cancer Hospitals hosted ‘Apollo Cancer Hospitals Fashion Show on Cancer Prevention’ an unique fashion show on the occasion of World Cancer day on Feb 4, 2013 at Apollo Hospitals, Hyderabad. This fashion show for a cause was

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hosted to send a message to the youth on lifestyle modifications necessary to prevent cancer. The show with the theme of cancer prevention had students from top fashion institutes in the city - National Institute of Fashion Design (NIFD); National Institute of Fashion Technology (NIFT); Hamstech Institute of Fashion & Interior Designing; Lakhotia Institute of Design and Raffles Millennium International, vying for best design themes conveying the message of cancer prevention most effectively. The designs presented by a bunch of promising upcoming fashion designers was adjudged by panel comprising cine actress Shriya Saran, Fashion Designer and former Mrs India Shilpa Reddy, Fashion Designer Asmita www.expresshealthcare.in

Marwah and Dr Vijay Anand Reddy, Director, Apollo Cancer Hospital. The jury selected the top two themes presented by institutions. The event had students depicting five themes each, representing cancer prevention through fashion designing. The five cancer prevention themes were ‘No Smoking or Chewing of tobacco’, ‘Moderation in alcohol consumption’, ‘Enhancing vegetables and fruits component in diet’, ‘Avoiding fried and non-veg foods’ and ‘Making adequate exercise a lifetime affair.’ If we can modify our life styles, we can prevent almost two-thirds of Cancers. To create awareness on life style modification, we are hosting this unique Cancer Prevention theme based Fashion Show on the occasion of World

Cancer Day, says Dr Reddy. We run cancer awareness campaigns to sensitise the community, but the percolation of the message amongst the youth seems to be disappointingly minimal. This fashion show is our endeavor to communicate the message in the way the youth understands the best, added Dr Reddy. Shriya Saran speaking on the occasion said, it was a great effort to spread awareness by the fashion design students. This is a beautiful marriage of fashion and message. The enthusiasm shown by the students is commendable, their creative says it all, said Shilpa Reddy. Asmita Marwah said that they are very talented and creative, have put across the message succinctly.. EH News Bureau MARCH 2013

M|A|R|K|E|T RESEARCH

Indo-Russian collaboration for genetic research to prevent heart disease Frontier Lifeline and Russian scientists collaborate to find the gene responsible for strokes n order to find a cure for heart disease and stroke, Frontier Lifeline Hospital has entered into a scientific research collaboration with the Institute of Atherosclerosis Research, Moscow, Russia. A team of expert scientists from Frontier Lifeline (Dr KM Cherian Heart Foundation) will collaborate with experts in the field of genetics and molecular biology from Russia to identify the genes responsible for atherosclerosis that lead to strokes and heart attacks. This collaboration aims at understanding why people both in India and Russia are prone to heart attacks and stroke. As the factors and instances of heart ailments are similar in both populations, researchers are now looking at learning from each other. Researchers from Russia will support scientists from Frontier Lifeline in genetic research and share data from their Russian study. Both teams will study the onset of atherosclerosis (narrowing of arteries) in patients, explore the reason for the accumulation of cholesterol in arteries, and aim at isolating the genes responsible for it. Through gene manipulation, both teams will explore the possibilities of discovering an effective method of reducing the incidence of strokes and heart attacks. “Heart disease is the most common cause of death worldwide. This collaboration between Russia and India will open up new avenues at treating heart disease by understanding its genetic aspects. Given the current lifestyle that most people lead, the incidence of heart attacks is increasing. It is now imperative that we find a viable solution to this growing problem,” said Dr Sanjay Cherian, VP – Frontier Lifeline Hospital. This mutual research project will see expert scientists Igor A Sobenin, leading researcher at the Institute of General Pathology and Pathophysiology, Academy of Medical Science, Russia; Ekaterina V Chernova, Project Director for Clinical Research Associate, Institute for Atherosclerosis Research, Moscow and Varvara A

MARCH 2013

Orekhova, General Director of Natur – Medica, Russia, traveling to the India to facilitate the collection of research data and inspect the research facilities and infrastructure available at Frontier Lifeline. Commenting on the

research, Dr KM Cherian, CEO and Chairman of Frontier Lifeline Hospital said, “Through this research we are attempting to discover a permanent solution for heart attacks and strokes. By isolating the core gene

responsible for fat accumulation in arteries and manipulating them, we will significantly reduce the risk of heart attacks and strokes. Through our collaboration with Russian researchers, we can leverage and gain

immense insights into strokes and genetics while helping each other reach an effective cure. We look forward to a fruitful partnership between India and Russia.” EH News Bureau

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

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M|A|R|K|E|T IN FOCUS

‘India’s healthcare system represents a mix of the outstanding and the dismal’ Professor John Wong, PRESIDENT, WORLD HEALTH SUMMIT; CO-CHAIRMAN, WHSRMA 2013 ORGANISING COMMITTEE; VICE-PROVOST (ACADEMIC MEDICINE), NATIONAL UNIVERSITY OF SINGAPORE

Professor K Srinath Reddy, PRESIDENT, INSTITUTE OF PUBLIC HEALTH OF INDIA

sia is becoming one of the major global economic engines for the coming decade. This development also indicates that there will be unprecedented healthcare challenges in this region. Raelene Kambli talks to Professor John Wong, President, World Health Summit; Co-chairman, WHSRMA 2013 Organising Committee; Vice-Provost (Academic Medicine), National University of Singapore and Professor K Srinath Reddy, President, Institute of Public Health of India who would be participating the World Health Summit 2013 in Singapore on healthcare issues and their impact on sustainable development within Asian countries; especially in India

What are the emerging health threats in Asia? Can you give us statistics of these diseases country wise? What is the impact of these diseases on the economies? Asia’s health threats span the entire spectrum from those associated with poverty and poor maternal, child, and public health, to those associated with urbanisation and increasing affluence. The emerging health threats are those associated with the latter – with a rapid rise in chronic non-communicable diseases such as hypertension, diabetes, cardiovascular and cerebrovascular disease, and cancer. Infectious diseases remain a constant threat exacerbated by urbanization, unsafe animal husbandry, and climate change, with spread accelerated by burgeoning air travel in the region. The spectrum of diseases in developed parts of Asia, such as Singapore, is best captured by Disability Adjusted Life Years (DALYs) – a measure of overall disease burden expressed as the number of years lost due to ill-health, disability or early death. Alternatively, one can look at the leading causes of death in the following Asian countries:

India (WHO, 2009) Cause Of Death

Rank Deaths

Coronary Heart Disease

1,416,858

Diarrhoeal diseases

1,231,478

Lung Disease

1,122,417

Stroke

940,052

Influenza & Pneumonia

760,422

Tuberculosis

317,108

Low Birth Weight

279,828

Suicide

243,661

Liver Disease

236,053

Road Traffic Accidents

223,524

Thailand (Porapakkham Y, Rao C, Pattaraarchachai J et al, 2010) We notice a huge shift (from infectious diseases) towards chronic diseases and disability during the recent years, especially in Asia.This is largely due to the change in lifestyle – one comprising little exercise and a diet of processed food as well as many taking up smoking. This has led to the rise in high blood pressure and diabetes which are all direct causes and risk factors for chronic diseases. The rise of chronic diseases will deprive individuals and thus, countries, of their health and their ability to reach their full productive potential because the quantity and quality of the workforce is reduced. Countries could also increasingly be faced with the challenge of financing healthcare as their population age and become more burdened with diseases. Conferences such as the World Health Summit Regional Meeting – Asia, that will be held in Singapore in April, are now becoming critical for countries to come together to address the growing tide of chronic diseases and what can be done to stem and manage the issues facing Asia.

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What strategies do you suggest to improve health in Asian countries? What should be the role of both government and private sector, in improving a country's healthcare system? Some of the best strategies revolve around preventive medicine and public health. Good sanitation with clean drinking water and proper disposal of sewage and industrial waste, vaccinations, tobacco control, good maternal and child health, universal education and literacy, proper animal husbandry, and meaningful, safe employment will go a long way to improving health in Asia. Similarly, investment in developing solutions to the problems faced by individual societies will result in greater innovation and ensuring relevance to any work that is done. Both governments and the private sector need to be fully engaged for this to be effective – no government or organisation can do this on their own. For instance, governments and the private sector can look at working in concert to help people change their mindsets about living healthy lifestyles.

What are the challenges faced by governments and healthcare providers in managing these health threats?

You are involved in hosting the World Health Summit Regional Meeting – Asia (WHSRMA) in April. What are the highlights of this summit? Any special announcement to be made during the summit or is there any imitative to be launch at the WHSRMA?

There are several, ranging from educating the public and changing behaviour, having individuals take

Some of the highlights include the opening address from Singapore’s Prime Minister, Lee Hsien Loong, keynote lectures,

Males

responsibility for their own health, and governments and healthcare providers being able to provide equitable, accessible, affordable, quality healthcare. There is a need for good governance, appropriate legal and regulatory frameworks to develop and enforce public health measures, the capacity to monitor and respond to changing patterns and determinants of disease, the ability to determine outcomes and cost of healthcare delivery, and having sufficient quantity and quality of healthcare providers.

Females

Cause of Death

% of Deaths

Cause of Death

% of Deaths

HIV/AIDS

22.6

HIV/AIDS

30.7

Road traffic accidents

19.0

Road traffic accidents

6.5

Cirrhosis of the liver

6.6

Cervix cancer

5.8

Suicide

5.7

Stroke

4.1

Homicide

4.8

Diabetes mellitus

3.6

Stroke

3.9

Suicide

3.3

Liver cancer

3.2

Cirrhosis of the liver

3.0

Ischaemic heart disease

2.7

Liver cancer

2.9

Drowning

2.3

Breast cancer

2.8

Lower respiratory infections

1.9

Nephritis and nephrosis

2.5

Other causes

27.3

Other causes

34.9

Total (N)

83,419

Total (N)

36,503

www.expresshealthcare.in

MARCH 2013

M|A|R|K|E|T an industry leaders roundtable, a ministerial panel discussion, and a stellar faculty of key opinion leaders from around the world whom the audience can interact with during the various sessions. We plan to issue a statement from the M8 Alliance of academic health centres and medical universities summarising key healthcare issues affecting the region and providing integrated action points for delegates to take home.

Tell us about summit’s theme ‘Health for Sustainable Development in Asia’? The summit will focus on four sub-themes: ● The impact of health on Asian economies ● Innovations in health in Asia which may change healthcare delivery, prevention and treatment ● Financing healthcare in Asia – What is and is not working in Asia ● Emerging health threats in Asia – Infectious diseases, impact of climate change, and increasing incidence of chronic non-communicable disease Speaking on the Indian context, Prof Reddy explains...

Where does the Indian healthcare sector stand on the global map? India’s healthcare system represents a mix of the outstanding and the dismal. While there are some world class hospitals in both public and private sectors, which the

urban population (especially the rich) can access in large cities, much of the rural population has poor access to high quality health services. There is also considerable disparity among the states, with southern states like Kerala and Tamil Nadu performing far better than central and northern states like Madhya Pradesh and Uttar Pradesh. Apart from inequities in access and wide variations in quality, there are also financial barriers, with high levels of out of pocket spending and impoverishment resulting from the unaffordable costs of healthcare. The contrast of hospitals vying for medical tourism in the cities and with high levels of maternal mortality in the villages sums up the paradox of India’s health system.

How can India promote better health policies? India should increase the level of public financing of health (from one per cent GDP at present to at least 2.5 per cent) in the near term and spend 70 per cent of the health budget on rural and urban primary healthcare. It needs to progressively advance Universal Health Coverage (UHC), beginning with an essential package of primary and secondary services funded through tax based financing and provided through cashless services. It should rapidly expand the health work force, prioritising the development and deployment of technology enabled non-physician providers of primary healthcare. It should also establish effective regulatory systems that

establish and monitor the quality, cost and equity dimensions of healthcare. Community participants too should be proactively promoted. Even as health services are being strengthened and expanded, other sectors such as water, sanitation, nutrition, education, environment and urban development must be engaged to improve the social determinants of health.

Suggest some sustainable healthcare financing strategies adopted in Singapore which can be duplicated in India? Singapore has achieved a remarkably high level of healthcare through investments in health promotion and high quality healthcare services. Its universal health coverage draws on public and private financing, while keeping the out of pocket expenditure low. Innovative schemes such as the Medisave account provide for flexible, need based spending without the risk of catastrophic expenditure. Although medical saving accounts (MSA) addresses the issue of prepayment, absence of risk-pooling is still a major cause for worry, but in a country with high formal sector, this may not be significant challenge. While India’s economic level and size will require it to devise its own framework of health financing for universal health coverage, Singapore’s example of prioritising public financing for health promotion and primary healthcare are exemplary. raelene.kambli@expressindia.com

INTERVIEW

'In the next five years, the Rockland group plans to scale up to a total of 10000 beds' Rajesh Srivastava, CMD, ROCKLAND HOSPITALS GROUP

ecently, Rockland inaugurated a new hospital at Manesar, launching the ambitious Rs 300 crore project, Rockland Health Network. Rajesh Srivastava, CMD, Rockland Hospitals Group talks to M Neelam Kachhap about the new hospital, ongoing investments and the innovative expansion plans

Recently, Rockland inaugurated a new hospital at Manesar. Congratulations. Tell us why you chose Manesar to build this hospital? There are several reasons for choosing Manesar which is already being recognised as the ‘New Gurgaon’ due its development potential. The development in and around IMT Manesar due to the presence of hundreds of factories and some of the most MARCH 2013

respected names like Maruti, Honda, Hero Motors, NSG colony, Amity University and several other well known institutes, has shown an impressive growth in the past few years. The current population in a one hour driving distance is estimated to be over 25 lakhs with only clinics and small hospitals. With the private colonisers building over 10 lakh dwelling units and the Government of Haryana’s notified plan of creating 32 lakh additional units, this area needed a healthcare hub of its own. The traffic jams on NH8 makes it very difficult for the commuters from either side to cross over from the Manesar toll booth and then the Hero Honda crossing. Patients from Manesar and the adjacent areas need better healthcare facilities through a healthcare delivery system that www.expresshealthcare.in

can connect with the clinics, nursing homes and small hospitals. Rockland Manesar will fill this gap by being a model health care delivery centre providing back up to the entire chain of health care delivery through state-of-theart equipment, diagnostic systems and super specialist doctors. Rockland Manesar will reach out to patients through a network of trained health volunteers, quality certified doctors, nursing homes and small hospitals who can not make large investments in technology and super specialist doctors. In the first phase of its launch, it will connect with 400 clinics, 40 nursing homes and small hospitals.The network partners would include private players as well as the government through a public private partnership (PPP) model. Dwarka-Manesar

Expressway will soon connect Dwarka city and the international and domestic airport with Manesar. Through this expressway, the commuters will reach Manesar in a shorter timeframe than to Gurgaon‘s main areas due to the traffic chaos on the National Highway. Rockland Manesar will serve this additional catchment area and will also be a convenient destination for international patients and domestic patients from other states. Rockland Manesar has created exclusive facilities for the outstation patients by building an ancillary building with a hotel like environment with a swimming pool on the top floor and complete with assisted living facilities and a travel, foreign exchange and visa facilitation desk for the domestic as well as international patients. The International Patients Centre EXPRESS HEALTHCARE

M|A|R|K|E|T in the ancillary unit will house offices of the international facilitators and will ensure translators back up and food according to the requirement of different nationalities.

What was the cost of building this hospital? The cost of building the 505-bed hospital and an ancillary unit with assisted living centre and medical tourism centre has been Rs 500 crores.

Tell us about the services available and the reach of this hospital? Rockland Manesar will have all the basic specialities and super specialities in onco (cancer), neuro, ortho, cardio, gastro, nephrology, urology, ENT and cochlear implant, laproscopic surgery and GI surgery, plastic surgery and cosmetic surgery. Facilities at this hospital include state-ofthe-art imaging and lab services.

Tell us about the Rockland health network (RHN)? What is your investment in RHN? The Rockland Health Network will reach out to patients through a network of trained health volunteers, quality certified doctors, nursing homes and small hospitals. Doctors operating from clinics, nursing homes and small hospitals will be able to link up with the super specialist doctors and equipment for better care of the patients through a 24 x 7 information technology and telecom interface. The first phase investment in the Rockland Health Network has been budgeted at Rs 10 crores which will gradually be increased to over Rs 300 crores in the next five years. This model will be replicated in phases to cover the entire North India, North East India, SAARC Countries, Middle East, Africa and several other countries. With the launch of Rockland Manesar the group will be able to leverage the entire Rockland Medical Corridor which will now have three multi-speciality hospitals, assisted living facilities and medical tourism centres in Manesar, Dwarka and South Delhi which currently has a bed capacity of 800. The benefits to the network doctors and small hospitals will be in several forms. A centralised diagnostic team of doctors, for example, can read and interpret the reports generated at far off locations where finding a good radiology

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doctor may not be easy or could be a very costly affair. This can help reduce wrong diagnosis which can lead to wrong treatment many a times. The network doctors would be able to update their knowledge through the continuous medical education (CME) programmes of Rockland and can collaborate with super specialist doctors by leveraging their advice on patient treatment.

Tell us about your existing business. Rockland Hospitals have been engaged in a lot of construction activity at its old hospital in South Delhi and inaugurated its Dwarka unit in June 2012. Rockland Manesar has been inaugurated on January 24, 2013. The year 2012-13, compared to last year, shows a revenue growth of over 50 per cent and the number of patients have doubled up in spite of only a partial addition of revenues from the newly launched Dwarka unit and reduction of beds in the old hospital due to expansion activity. Total monthly inflow of patients for the last 12 months was over a lakh in OPD and IPD services.

Tell us about expansion plans?

your

In the next five years the Rockland group plans to scale up to a total of 10000 beds through its own hospitals and in alliance with the network partners. To ensure quality manpower the Rockland Group has already initiated plans for setting up medical colleges attached to its two 505-bed hospitals in Manesar followed by an institute to train para medical staff in Noida.The group is exploring opportunities for further expansion through the PPP route too. An MOU has already been signed with the State of MP to set up a medical college attached to a hospital in Indore. The first phase of expansion will include North and North East India and the second phase of expansion will cover the entire country.

How would you fund this expansion? All the current projects are already funded and the expansion plans now need funding only for the Rockland Noida project. This project needs a total funding of Rs 500 crores. Equity component will be 40 per cent and debt 60 per cent.

What steps is Rockland taking to make healthcare more affordable? www.expresshealthcare.in

Affordability in healthcare relates directly with quality of diagnosis and treatment from the primary stage itself. Once the patient is wrongly diagnosed the costs begin to rise and by the time the patient reaches a good hospital treatment becomes a challenge for the doctors as well as the patient and his attendants. Right diagnosis will also filter out patients for primary, secondary and tertiary care and then only patients needing tertiary care would need to come to the metros. This is where the RHN will help the patients by improving the quality of diagnosis and thereby bringing down the cost of treatment. The patients and their attendants will benefit by getting access to the best advice and diagnostic analysis at far off places and those coming to NCR for treatment will have complete arrangements for travel and stay at reasonable costs. The Manesar Hospital has taken special care in building an ancillary block which will house all the travel and hospitality services and has 65 rooms for international and domestic patients.

Do you plan to have an all India presence in future? Which states would you target? Yes, we do have plans for an all India presence after the completion of our first phase which will cover the North and North East India. Our plans will include all the states however our priority right now are the states of Delhi, Haryana, UP and MP.

Many players in India are tying-up with foreign hospitals or service providers. Do you have any similar plans? We are keen to establish cooperative relationships with foreign hospitals and medical specialists. Both can benefit by collaborating in the areas of education, training and sharing of research data. Latest and emerging technologies can be introduced in India as itâ&#x20AC;&#x2122;s an emerging but very large market. Indian doctors are exposed to treating a very large population mix which now has a good mix of patients coming from Africa and the Middle East. Sharing of his data can be of great value as it can open collaborative routes to a very large base outside of India too.

Where do you see Rockland hospital five years from now? Five years from now the

Rockland Hospitals Network would have a minimum of 10000 beds, five lakh health volunteers, 4000 clinics and 400 nursing homes and small hospitals are connected to the five super speciality hospitals in the Rockland Medical Corridor in Delhi NCR. The network would cover the entire North, North East India, Nepal, Bhutan and Bangladesh.

Will Rockland be venturing into any other healthcare vertical other than hospitals? The Rockland network will offer a lot of opportunities for medical equipment manufacturers, pharma companies, diagnostic companies, insurance companies, international patient travel management companies and others to create collaborative models for diverse healthcare verticals. We are open to all possibilities which can help us in taking quality health care to the village levels at affordable costs.

Any last words? India has the potential to become the medical care hub for the world due to its world class doctors, comfort with technology and a huge low cost advantage compared to the developed economies. The advantages are similar to what we have witnessed in the IT sector. Flying the patients and doctors from some of the developed countries with stay and treatment would still be far more economical for the insurance companies and governments who are finding it a challenge to meet the health care expenses in their own countries. What is needed is a world class healthcare delivery model with the state of the art infrastructure which is already there in Delhi NCR and some other metros. The foreign exchange earning potential in this sector is very high and we are already witnessing an over 100 per cent growth year on year in the incoming international patients. On the other end a good health delivery mechanism can allow the large hospitals to leverage their capabilities to help the doctors in the clinics, small nursing homes and hospitals to reach out up to village levels. This will improve the quality of healthcare at all levels and will generate the necessary volumes for the larger hospitals too, creating a good mix of social and economic sustainability. mneelam.kachhap@expressindia.com MARCH 2013

M|A|R|K|E|T INTERVIEW

'We are targeting to extend our presence in smaller cities' Shinya Tomoda MD, ASIA PACIFIC OMRON HEALTHCARE

MRON has been on a rapid expansion plan in India with a second product launch in the span of two months. Shinya Tomoda, MD, Asia Pacific OMRON Healthcare shares his plans for India and explains why OMRON considers India as a key region for its growth, in conversation with M Neelam Kachhap

What is the size of OMRON Healthcare business in India? OMRON healthcare is the global leader in healthcare products. We established our offices in India in 2005, and more recently, Gurgaon has been established as the focal point. The unit contributes little more than Rs 2.5 crores to our corpus and we plan to take it further.

What is the size of blood glucose monitoring products market in India? Globally, the self blood glucose monitoring industry is valued over $1.5 billion. With 40 million diabetic patients and an equal number of people estimated to be diabetic prone, India is emerging as a major market for blood glucose monitoring solutions. In the US, people having the disease check their blood glucose levels even up to six times a day, whereas in India, the patients don't even check their blood glucose levels on a regular basis unless directed by their doctor. Studies say that diabetes induced death can be brought down by 52 per cent if the insulin levels in the body are regularly monitored and controlled. Indian medical devices and diagnostics market is estimated to reach Rs 275 billion and the country is fast emerging as the diagnostic capital of the world.

What share of this market is held by OMRON Healthcare? We have 57 per cent (unit base) market share in the blood pressure monitor market in India. With the launch of our new range of blood glucose monitor our range of healthcare products is complete and we look forward

23 M A R C H

2013

to continue being the market leader with similar impetus. We are looking towards increasing our company’s healthcare retail network by 25 per cent in the next 12 months. This in turn will help us to reach a target of 33,900 retail stores including pharmacies and surgical shops in the Indian market by FY15.

How is OMRON’s product different from the current products available in the market? All our home-use healthcare devices, health management services, and testing devices for medical institutions are based on our propriety biometric sensing technology. Designed on superior technology, we have not compromised in any of the attributes of quality product and at the same time our products are very easy on the pockets. We believe that monitoring starts at home, for which, ease of accessibility is

penetrate the market exceptionally well with our strength of coupling quality with competent pricing and our results have showed it to be the best strategy to enhance our reach in Indian healthcare market.

What are OMRON’s revenue expectations in India through this product? We are aiming for nearly three—fold increase in revenues in India by FY15 for which we will expand presence in the country. We are present in the country through a wholly— owned subsidiary, currently sell our healthcare products through 17,500 retail stores across India. Our aim is to reach $43 million in sales in India by FY15 from the $14 million in FY12.

Are you are looking to expand OMRON's presence in India. Please elaborate? As mentioned above, we

We are looking towards increasing our company’s healthcare retail network by 25 per cent in the next 12 months. Our aim is to reach $43 million in sales in India by FY15 from the $14 million in FY12 of utmost importance without compromising on the quality. Our recently unveiled products HGM-111 and HGM-112 are very economically priced, ultra light weight (26 gms only!) and uses auto – coding technology.

How would you address the price point issue as India is demanding less expensive diagnostics? Our market analysis says that in India, there are two price zones for home use diagnostic tools and machines – especially for blood glucose monitors. Below Rs 1000 is one price zone and the other is below Rs 2000. Our products cater to both segments and of course even to higher end consumers. We have managed to www.expresshealthcare.in

are convinced that India is going to be one of the main economic forces in the near future. In line with above fact, OMRON's new 10-year strategy "Value Generation 2020" held in July 2011, emphasises on achieving growth in emerging markets such as China, Brazil, and India. We plan to better understand our client needs in India market and build new products or services that will help healthcare organisations have better information that will lead to better decisions and healthcare outcomes. We are keen to contribute to areas such as patient safety, increasing quality and efficiency of care and making it affordable to a larger section of society.

It was reported in the media that OMRON Healthcare will shift its focus to hospitals from pharmacies. Please comment OMRON is a company that cultivates tomorrow by anticipating future societies. Anticipating the needs of future generations is our daily inspiration and a way of doing business. Continuous innovation, both in our products and marketing strategy, coupled with benefit to society is the core of OMRON. Currently, our products are through ‘over the counter’ channel and OMRON conducted seminars to demonstrate to heads of pharmacies on how to use our devices, augment their understanding and disseminate knowledge on the appropriate role of instruments in health management. We also collaborated with the Indian Society of Hypertension to support a large scale clinical study involving leading doctors from Japan, Canada and India. However, we also have future plans to launch products for hospital use. OMRON is a major supplier of home-use healthcare devices and talks with big hospitals are on to supply our products. This requires doubling of our efforts and broadening our horizons with keeping our focus on mass reach.

Would OMRON be hiring new employees? India has been a key region for growth for OMRON and we are quite bullish about the market. We are currently moving rapidly to reinforce operations in India by increasing the number of industrial automation and healthcare equipment sales bases and boosting the number of system engineers and sales personnel. We are targeting to extend our presence in smaller cities. We are present in Tier-I cities but we are concentrating on going to Tier-II cities as part of our growth strategy. This, inevitably calls for more investments and more skilled resources. mneelam.kachhap@expressindia.com

EXPRESS HEALTHCARE

M|A|R|K|E|T PREEVENT

Seminar@Symbiosis The XVth National Seminar on hospital/healthcare management, medico legal systems and clinical research is expected to be a great platform for knowledge-sharing and networking with an impressive line-up of speakers ymbiosis Institute of Health Sciences (SIHS), a constituent of Symbiosis International University (SIU), Pune will be hosting the XVth National Seminar on hospital/healthcare management, medico legal systems and clinical research on May 3-4, 2013 at Symbiosis Knowledge Village, Lavale, Pune. The Indian healthcare sector is expected to become a $280 billion industry by 2020 with spending on health estimated to grow 14 per cent annually. To elaborate on this phenomenon, a pre-conference symposium on 'Successful Healthcare Models' has been structured and is expected to be attended by stalwarts of the healthcare industry covering the hospital, medical equipment manufacturing, clinical research, pharma and IT sectors. The session will be anchored by Dr Ratan Jalan, Founder & Principle Consultant, Medium Healthcare Consultancy while Dr Nagendra Swamy, MD, Medical services and MHS, COO will represent the hospitals. Other speakers include Dr Shankar Haveri, Head-Siemens Healthcare who will speak on medical equipment manufacturing; Dr Deven Parmar, CEO and Medical Director, Karmic Lifesciences on clinical research; Dr Chaitanya Dutt, Director, Torrent Research Centre, on the pharma sector and Dr Vishal Gupta, VP, Global Health Care Solutions, CISCO who will address the audience on IT. The national seminar will also include master classes wherein delegates will get to interact with stalwarts on a one-to-one basis for knowledge sharing. Eminent speakers like Dr Raajiv Singhal, Regional Director, Fortis and Col SKM Rao, GM HR, Columbia Asia Hospital will speak on ‘the importance of human capital and its viability’. Dr Nagendra Swamy, MD, Medical services, MHS and Dr Santosh Shetty, COO, Kokilaben Dhirubhai Ambani Hospital will speak on 'strategic management'. Dr Amir Shaikh, Founder, ASSANSA and Dr Dhananjay Bakhle, Executive, Vice

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Dr Nata Menabde, WHO Representative to India was the Chief Guest at last year’s National Seminar President, Lupin will speak on 'recent trends in clinical research'. Dr Nikhil Datar, Consultant, Kay Legal & Dr. Sanjay Gupte, Director, Gupte Hospital will speak on 'healthcare and law'. Dr Achintan Bhattacharya, Director, National Insurance Academy, will share his views on 'healthcare insurance'. Dr CL Kaul, Ex Director, National Institute of Pharmaceutical Education & Research (NIPER) will speak on 'clinical trials: phases, tribulations and challenges'. Dr Raman Gangakhedkar, Deputy Director, NARI, will light on 'regulatory affairs in clinical research'. Dr Sanjay Zodpey, Director, Public Health Foundation of India, will speak on 'clinical epidemiology'. Dr Gopinath N Shenoy, Medico Legal Consultant, will share his expertise on legal aspects of healthcare. Dr Vivek Desai, MD, Hosmac, will elaborate on 'futuristic hospital designing'. Zahabiya Khorakiwala, MD, Wockhardt, will give a talk on building a chain of hospitals. Dr Vivek Shukla, Healthcare Marketing Consultant, will discuss 'healthcare communication’, touching on branding and marketing issues while Dr Deepak Phalgune, Consultant, DEP, Public Health, FoHBS will share his expert opinion on 'fundamentals in clinical research'. The seminar will conclude with a valedictory cerwww.expresshealthcare.in

emony. Dr Mohan Das, VC, Kerala University of Health Sciences will be the Chief Guest at the ceremony and advocate Ram Jethmalani, Former Union Law Minister will be Guest of Honour, presided over by Dr SB Mujumdar, President and Founder Director, Symbiosis. In addition to these sessions, this year Symbiosis has organised a consortium meeting which would bring together academia as well as industry experts. It is being organised with a view to reinforce and enhance the overall quality of healthcare education management in India. It will help to study healthcare management programmes being offered across universities in India with regard to uniformity and standardisation of curriculum. The consortium will comprise plenary sessions featuring stalwarts from the hospital sector such as Dr Rajeev Singhal, Dr Nagendra Swamy, Dr Santosh Shetty, Col SKM Rao and Dr (Col) RR Pulgaonkar, CEO, Jaslok Hospital. Representatives from the consultancy sector include Tarun Katiyar, Principal Consultant, Hospaccx; Faisal Siddique, VP, Healthcare Strategy, Technopak and Dr Vivek Desai. Representatives from institutes like Dr D Obul Reddy, Principal, Apollo Institute of Hospital Administration; Dr PN Mishra from Institute of Management Studies;

Indore; Professor RN Saha, Dean, Educational Development Division, BITS, Pilani; Dr Jayant Sonwalkar Professor, Director (Academics) and Director, Directorate of Distance Education, Faculty of Management Studies, Delhi and Dr Anil Naik, Dean, Welingkar Institutes. The pharmaceutical sector will be represented by Satish Mehta, Founder Member, Emcure; MB Kapadia, Senior Executive Director, GSK and Ganesh Nayak, COO & Executive Director, Zydus Cadilla. Exchanging their views on the healthcare management education from the government and NGO sectors will be Dr Abhay Shukla, Senior Programme Coordinator, Socio Educational Health & Allied Team (SEHAT). Also partaking in the plenary sessions, from the insurance and TPA domain will be Gautam Nag, Regional Manager, National Insurance Company. Dr Achintan Bhattacharya and J Hari Narayan from IRDA would also attend the event. Besides Gupta from CISCO, IT industry experts scheduled to be at the event include Gyana Ranjan, Accenture and Shikhar Sood, GE India Technology. Wellness industry experts such as Juhee Sinha, Head, VLCC will also share their expertise. Making the plenary sessions well rounded would be representatives from the medical equipment industry such as Anjan Bose, Secretary General, Healthcare Federation of India and Shankar Haveri, Head of Healthcare Academy, Siemens. The plenary sessions will be chaired by Dr Lakhwinder Singh, Director, IIHMR, New-Delhi; Professor S Parsuraman, TISS; Dr Rajesh Bhalla, Dean, IIHMR and Dr Siddhartha Satpathy, Professor-Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS). With such an exhaustive line up of industry experts as speakers, the National Seminar promises to be a stimulating event sure to open up several opportunities. MARCH 2013

M|A|R|K|E|T PRE EVENT

Healthcare IT India Summit The summit, organised by Fleming Gulf Conferences, aims to bridge the gap between healthcare and IT leming Gulf Conferences, leading providers of business intelligence through industry specific conferences, webinars and skills enhancement training courses, for seven consecutive years has brought together industry leaders, decision makers and leading solution providers from across the globe to learn, network and do business. And this year is no exception! They are back with their anticipated and one of its kind Healthcare IT summit. One of the objectives of the Healthcare IT India Summit is to bring in the industry experts and regulators to converse and present the scope for the Healthcare Informatics. The summit will be held on April 2324, 2013, in Hyderabad and will focus on integrating healthcare with information technology (IT) to make way for the future of healthcare management system. The Healthcare IT Summit will see established professionals from the IT and medical groups from across the country participate in erudite panel discussions and lectures. The speakers will share their personal views which will be backed by their credibility and exposure to the technological advancements. The motive is also to understand the best viable alternative model for delivering medical care and

expertise. Professor K Ganapathy, President, Apollo Telemedicine Networking Foundation, Director, Apollo Tele Health Services and Past President of Telemedicine Society of India; Adi Codaty, Vice President, Global Sites, United Healthcare International;

Inderjith Davalur, Group CIO, Global Hospitals; Dr Sanjay Bedi, President, Indian Association for Medical Informatics; Devender Manral, Global Head – Information Technology Data Center & Infrastructure Management

Services, Fortis Healthcare; Dr Ruchi Dass, Health Specialist & Council Member, Commonwealth Connect Program, DIT, Govt of India; Dr SB Gogia, President, Society of Administration of Telemedicine and Healthcare Informatics, India are some of the prime speakers for the two-day summit. Baljit Singh Bedi, Advisor, Health Informatics, Centre for Development for Advanced Computing (CDAC), President, Telemedicine Society of India (TSI) will open the session with a talk on ‘Integration of Information Technology with Healthcare management systems’. In an age of hard core professionalism and digitisation, it is important for one to not lose the personal touch, especially in a service industry. To address the issue, Dr Dass will deliver a talk on ‘Personalising the experience to drive consumer engagement’. ‘Standards and interoperability: connected healthcare in a hybrid environment’ is one of the intriguing subjects lined up for the panel discussion.

Contact: Tikenderjit Singh Makkar Deputy Marketing Manager - India E: tikenderjit.singh@fleminggulf.com T: + 91 20 6727 6403 W: www.fleminggulf.com

PRE EVENT

National conference on quality improvement and patient safety The two-day conference will cover clinical and administrative topics related to patient safety and quality ditya Birla Memorial Hospital, Pune, is organising a National Conference “ABMH QIPS 2013” on quality improvement and patient safety on March 9-10, 2013 at Aditya Birla Memorial Hospital Auditorium, 2 nd Floor, Aditya Birla Hospital Marg, Chinchwad, Pune . The twoday conference will cover clinical and administrative topics related to patient safety and quality. The conference will also include many innovative thought provoking, evidence-based discussions along with a paper and poster presentation on Day -2. The speakers list includes Dr Umesh Gupta, Niramaya Hospital, New Delhi; Dr Tarang Gianchandani, Jaslok

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Hospital, Mumbai; Dr BK Trivedi, ABMH, Pune; Dr Anupam Sibal, Apollo Hospitals, New Delhi; Dr Uma Maheshwar Reddy, SRMC, Chennai; Dr Rohini Kelkar, TMH, Mumbai; Dr Mohammad Naseem, Zon Healthcare; Suresh Lulla, IMC, Mumbai; Dr Saajan Nayar, NH, Ahmedabad; Dr Sanjeev Singh, AIMS,

Cochin; SN Shukla, Healthfore; Dr Tamorish Kole, Max Hospitals, New Delhi; and Dr Rajiv Menon, Care Hospitals, Hyderabad. Rekha Dubey, COO, Aditya Birla Memorial Hospital says, “Aditya Birla Memorial Hospital’s mission is to improve the quality of healthcare and patient safety is central to achiev-

QIPS 2013 is an initiative by Aditya Birla Hospital to provide a common platform to review the current status of quality and safety in healthcare programmes in India www.expresshealthcare.in

ing our mission. We know that reducing harm and preventable medical errors saves lives and lowers healthcare costs, a goal shared by everyone that touches the healthcare system. Patient safety has also been one of the national priorities. QIPS 2013 is an initiative by Aditya Birla Hospital to provide a common platform to review the current status of quality and safety in healthcare programs in India and identify strategies to improve the quality and safety in healthcare and sensitise the policy makers, health mangers and health professionals on the concepts and strategies on quality and patient safety in India”. MARCH 2013

M|A|R|K|E|T PRE EVENT

Indian Health Summit A thought-leadership event for healthcare professionals, it promises to be a platform that would encourage discussions, knowledgesharing and peer-to-peer networking osmos Forums and PE Insights are organising the India Health Summit, which is scheduled to be held on March 14, 2013 at the JW Marriott, Mumbai. As Indian healthcare companies try to scale up, availability of capital has become a major issue. The Indian Health Summit seeks to address this key challenge for entrepreneurs in the healthcare space. With a dedicated focus on expansion through PE funding, the event is expected to witness participation from key decision makers from leading PE/VC funds actively investing into the healthcare space. The India Health Summit promises to be a thoughtleadership event focused exclusively on professionals in the healthcare domain. The event is reportedly formulated in a manner which

would encourage discussions, knowledge-sharing and peer-to-peer networking. Some of the leading entrepreneurs and healthcare executives are expected to share their experiences and perspectives about creating a successful business in this growing sector. The India Health Summit aims to be platform for bringing together some of the top entrepreneurs and investors from the healthcare space to discuss best practices and strategies to build successful companies. It is likely to be of help for fast growing companies who want to take their organisation to the next level. Contact: Abhishek P Salvi, HeadCosmos Forums, Mob: +91 98191 68995, Email: abhishek@cosmosforums.com

Speakers

Dr. Ashutosh Raghuvanshi CEO Narayana Hrudayalaya

Brig. Joe Curian CEO Seven Hills Hospitals

Ameera Shah CEO Metropolis Healthcare

Dr. A Velumani CEO Thyrocare

Sameer Mehta Director Dr Mehta Hospitals

Rajat Goel CEO & MD Eye-Q

Dr. BK Murali MD & Founder Hope Hospitals

Dr. Praneet Kumar CEO BLK Hospital

Ratan Jalan CEO Medium Healthcare

Ritesh Banglani VP,Helion VC

POST EVENT

Dr LH Hiranandani hospital conducts a breast cancer care conference ‘The Pink Meet, 2013’ was an initiative to create a platform for cancer specialists to share their experiences in breast cancer care and treatment ver 150 doctors reportedly assembled at Mumbai’s Trident, BKC for ‘The Pink Meet– 2013’, a two day comprehensive breast cancer care conference organised by Dr. L H Hiranandani Hospital and International Oncology Services. Member of Parliament Priya Dutt inaugurated the conference. The agenda of the conference was to discuss the diagnostic and therapeutic modalities in breast cancer. Leading cancer specialists including Dr Rajendra Badwe, Dr Suresh Advani, Dr Arun Chitale, Dr PSRK Sastry, Dr Shripad Banavali and Dr Girish Muzumdar shared their research and insights on the practices in diagnoses, treatment and preventive measures and the evolving treatment modalities in breast cancer. Niranjan Hiranandani, Chief Managing Trustee of Dr L H Hiranandani hospital was the guest of honour at the conference.

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Inaugurating the conference and addressing the doctors present at the event, Dutt said, “Breast cancer incidences are today over taking cervical cancer in our country; many young girls are becoming victims of breast cancer in India. In urban India, the major reason for rise in the incidence is the changing lifestyle. Affordability and accessibility are an area of concern in rural areas. We are striving to address these issues at our level; however, it is only www.expresshealthcare.in

with the help of all the doctors and the medical fraternity that we will be successful in our crusade and initiatives towards fighting breast cancer” In his key note address, Dr Badwe said “I appreciate the initiative of ‘The Pink Meet’ for breast cancer as incidences of breast cancer are growing in India. In cities the incidences are around 94 per hundred thousand and in rural it is 42 per hundred thousand. We need more hospitals for breast

cancer treatment; hospitals like Dr L H Hiranandani Hospital are instrumental in bridging this gap” Dr Sujit Chatterjee, CEO, Dr L H Hiranandani hospital and also the Chief coordinator of ‘The Pink Meet – 2013’ stated, “Our objective behind organising the conference was to create a platform for doctors to share knowledge about the medical advances made in the field of breast oncology and their experiences. This would help them render the best possible treatment to their patients”. Dr Neeraj Mehta, Coordinator, ‘The Pink Meet – 2013’ said, “The risk of developing breast cancer can be reduced by a change in lifestyle but cannot be avoided completely. The only saviour is early detection of the disease and an advanced treatment for the same. The Pink Meet focused on discussing the recent advances made in the field of breast oncology”. EXPRESS HEALTHCARE

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Ministry of Health calls for action to reduce IMR Several strategy documents and operational guidelines were released by the Ministry of Health and Family Welfare during the summit he three-day Call for Action on Child Survival and Development ended with a call for renewing the promise towards further reducing under-five mortality rate (U5MR) in India. The summit was held in the presence of Ghulam Nabi Azad, Minister of Health and Family Welfare and Krishna Tirath, Minister of Woman and Child Development at Mammallapuram, Tamil Nadu. The summit organised by the Ministry of Health and Family Welfare, in partnership with the UNICEF and USAID, was a follow up of the ‘Global Child Survival Call to Action: A Promise to Keep’ Summit in Washington DC in June 2012, co-convened by India, Ethiopia and the US. Over 60 national and international experts and 300 delegates participated in the summit. The summit arrived at a set of agreed actions that will sustain the momentum and promote accountability in India’s journey towards achieving the Millennium Development Goals related to maternal and child mortality. Pledges for renewed commitment for ensuring healthcare continuum from

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childhood to motherhood through adolescence were given on the final day by prominent participants like Dr Rajiv Shah, Administrator, USAID; Geeta Rao Gupta, Deputy Executive Director, UNICEF; Dr Babatunde Osotimehin, Executive Director UNFPAHQ; Dr Elizabeth Mason, Director- MNCH, WHO; Helen Evans, Deputy CEO, GAVI Allianc and Mariam Claeson, Deputy Director, Bill & Melinda Gates Foundation. Azad, who inaugurated the summit, announced an incentive programme for states performing well in the new born and under five children’s health and development initiatives. Significantly, he also cautioned that under-performing states would be dis-incentivised. Tirath while chairing a session on Social Determinants of Child Survival, revealed that a maternity cash benefit scheme has been launched for empowering pregnant women and adolescent girls. She announced that a National Mission for Empowerment of Women has also been started. Anuradha Gupta,

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Additional Secretary and Mission Director, National Rural Health Mission pointed out that the narrowing of the rural – urban gap in child mortality in India is reflective of the improved equity in health care. She also said that the rate of decline of U5MR was faster in India than the global average. She said that the summit has been an opportunity for sharing experiences and celebrating successes in the area of maternal and child health. In a pledge delivered on the final day of the summit, Rao Gupta pointed out that ultimately it is the citizens of a country who need to come forward and play an enormous role. “UNICEF will continue to support the Government of India in its effort to scale-up highimpact strategies and innovations through our country programme, with its focus on neonatal mortality, nutrition, sanitation, quality basic education and protecting children from the risks of child marriage, child labour and exploitation, focusing throughout on adolescents who represents the next generation that will lead to socio-economic

change in India,” she added. Several strategy documents and operational guidelines were released by the Ministry of Health and Family Welfare during the summit. These include Strategic Roadmap on Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH +A), Maternal Health Toolkit, guidelines for preservice nursing and midwifery education, infant and young child feeding practices, child health screening and early intervention service and the National Iron plus initiative. Improving accountability and transparency through a National Child Survival Score Card, an innovative Dashboard for tracking progress, Supportive Supervision Model, Child health screening and early intervention processes, Newborn Health – Continuum of care, MDG and beyond, prevention of diarrhoea and pneumonia, social determinants of child survival, role of communication in child survival, partnership and leadership dialogue were some of the core themes discussed during the three-day summit.

MARCH 2013

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CII hosts a Health Summit in Karnataka The Health Summit, held for the first time in Karnataka, raises issues plaguing the healthcare industry in India he Confederation of Indian Industry (CII) organised Karnataka Health Summit with the theme 'Tipping point for Healthcare System' on January 24, 2013 at Bangalore. The summit was inaugurated by Dr Devi Shetty, Chairman, Narayana Hrudayalaya Hospitals. The other dignitaries present at the inaugural session included S Chandrashekar, Immediate Past Chairman, CII Karnataka State Council and MD, Bhoruka Power Corporation; Dr Varma Vegesna, Chairman-CII, Healthcare Subcommittee and MD, Lazarus Hospitals; and Dr KK Kalra, CEO NABH. In his key note address Dr Shetty spoke about how taxes were raising the cost of healthcare in India. Explaining the taxes levied on hospitals he said that excise duty of 12.36 per cent, customs duty of 7.13 per cent which can go up to 12.36 per cent, central sales tax varying from two per cent to 14 per cent and sales tax were charged from hospitals. Added to these basic infrastructure taxes there is taxes on medical devices that cover 18 per cent of local taxes, 19 to 24 per cent of import duty for equipment, value added tax of 5.5 per cent, and dietary service tax of 14.5 per cent. Stating the startling fact that the govenment categorises hospital under entertainment segment Dr Shetty pointed out that the hospitals payed same fare for power as entertainment industry – Rs 7 per power unit. “The government has failed to comprehend that the use of power is primarily to save patients' lives," he said. In addition to the above tax components, the state government’s electricity boards mandates paying up a refundable deposit of Rs.1 crore when the hospital is commissioned and the irony is that the hospitals could never get the refund unless these are shut down, he pointed out. He also spoke about the importance of empowering women and recruiting more female staff in the healthcare sector. Chandrasekhar welcomed the gathering and stressed on the need for good quality healthcare at afforadable prices. Dr Vegesna delivered the

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L-R: S Chandrasekhar, Immediate Past Chairman, CII Karnataka State Council & MD, Bhoruka Power Corporation; Dr Devi Shetty, Chairman, Narayana Hrudayalaya Hospitals; Dr Varma Vegesna, Chairman-CII, Healthcare Subcommittee & Managing Director, Lazarus Hospitals; Dr K K Kalra, CEO , NABH

M Maheshwar Rao, IAS Commissioner of Industrial Development & Director- Industries & Commerce Government of Karnataka; Alok Gupta, MD, Gerken Capital Associates, Mohan Kumar, Executive Director, NVP India theme address at the summit. He spoke about the importance of having green hospitals in healthcare sector. Dr Vegesna also spoke about the huge potential of Karnataka to develop into a medical tourism destination. Dr Kalra, CEO, NABH attributed the growth of the healthcare sector to the growth in technology, lower direct taxes and increasing insurance coverage. He also spoke about the importance of safety in healthcare. He mentioned that lot of action is needed in terms of accessibility of healthcare service and quality of patient care. “Quality health systems lead to patient safety and public satisfaction,” he said, adding that the NABH had a local assessor in Bangalore to coordinate with hospitals. The summit hosted a technical session on investment opportunities in the health sector and a panel www.expresshealthcare.in

discussion on varied topics like healthcare infrastructure and availability of medical personnel, current healthcare ecosystem in India – 360° perspective of different healthcare stakeholders, FDI in healthcare and its impact, and innovations in healthcare. Dr Santanu Chattopadhyay, Founder and MD, NationWide Primary Healthcare Services, who was one of the panelists said, “Along with economic development, the government should focus on primary healthcare to ensure sustainability of healthcare. The need of the hour is to create good, cost-effective and accessible healthcare. For instance, on a per capita per annum basis, a developing nation like Cuba spends only $300 on a patient whereas a developed nation like the US spends $6,000. This difference indicates the lack of pri-

mary healthcare in countries like the US.” He added, “In a country like India where much importance is given to secondary and tertiary healthcare, there is a huge scope to enhance primary healthcare. This could result in a drop in healthcare expenditure.” The other speakers included Mohan Kumar, Executive Director, NVP India; Dr Kishore Kumar, CEO & MD, Cloudnine Maternity Hospitals; Dr Pankaj Gupta, Partner, Taurus Global Consulting; and Shyam Rajan, Senior Manager, GE Healthcare; to name a few. The summit was attended by doctors, CEOs/CXO, medical directors, medical and paramedical fraternity, healthcare professionals, medical service providers, and representatives of hospitals, medical colleges/institutes, and insurance companies. EXPRESS HEALTHCARE

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Med device companies from Victoria come calling Keen to explore partnerships with med device players in the Indian healthcare market osted by the State Government of Victoria, Australia, representatives of 14 companies comprising the Life Sciences Mission toured India in early February. Visiting four cities over two weeks, the Mission also included the medical device sector. In Mumbai on January 31, the delegation, led by Professor Andrew F Wilks, the mission spokesperson and Founder, Chairman &

Members of the life sciences delegation from Victoria

CEO, SYN|thesis met with representatives from the Indian industry, aiming to “understand the India market better.” The organisers saw a complimentary synergy between the many medical device companies based out of Melbourne/Victoria and India’s healthcare market. For instance, Peter Lewis, Director, Hydrix, which develops advanced biomedical products, like point of care devices, in vitro diagnostic devices, laboratory and test equipment, as well as a range of implantable, insertable and wearable devices, was keen to assist Indian companies develop medical devices for international markets Jose Cotta, Technical Director, Largos Services, is working on a pre-filled syringe system, which is designed to prevent needle stick injuries. At present, the company has a platform patent, samples and proof of concept. The importance of safe

injection devices is also the mission of Michelle Carr and Elaine Carr, Directors, Telezon whose polymerbased product range offers commercially attractive alternatives to steel draw-up needles, as well as risk reduction or elimination of needle-stick injury for the practitioner. Other important benefits of the company’s flagship product SoloFlow which is a noninjection plastic needle, registered with the US FDA and the European Union CE mark, are the reduction of medical waste costs, manufacture, transport and needlestick related costs as well as simplification of recycling procedures. Their goals on this mission were to understand the India market, increase visibility of their company with existing clients as well as develop new contacts. The company already has two arrangements for sale and supply in India with Serum Institute for vaccine kits and with Hindustan Syringes &

Medical Devices, New Delhi, makers of Dispovan for packaging and assembly. Luke Whelan, Director, VPatch profiled the company's intra-lifestyle ECG monitoring device which is a necessary innovation in arrhythmia diagnosis and management. Fitted with Wireless Asymptomatic Event Detection (WAED), the device increases effective patient care and treatment through accurate diagnosis (or exclusion) of arrhythmias responsible for symptoms. Similarly, Richard Walmsley, CEO, Ingeneus, spoke about his company's expertise in developing and manufacturing medical equipment ranging from ophthalmic devices to web based diagnostic platforms. He specified that the company is highly experienced in developing medical products for international markets as per clients' specifications besides working on internal projects where the intellectual property remains with Ingeneus.

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MEDICALL 2013 Gujarat gets a good response Held on February 8-10 February 2013 at Gujarat University Exhibition Hall, Ahmedabad, Gujarat, it attracted a large number of professional visitors and manufacturers he recently concluded MEDICALL 2013 was held in Gujarat for the second time and was attended by 200 medical equipment manufacturers from India, Germany, and China. A wide range of medical equipment and technology products were displayed to over 4500 serious business visitors from all over India. MEDICALL 2013 offered a focused business platform for three days to explore business opportunities to an exclusive B2B audience. The visitors were the doctors, medical administrators, representatives from procurement department of hospitals, nursing homes, biomedical engineers, HOD’s of the hospitals, trade dealers and distributors etc. Healthcare professionals could find the entire range of medical equipment and technology under one roof. Some hospitals have reportedly already placed orders with Indian medical manufacturers at MEDICALL 2013.

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It also had an exclusive dental pavilion called Famdent, with live conferences and seminars on dental issues, which was reportedly a huge success and was well received by the industry. MEDICALL 2013 Ahmedabad also comprised conferences and seminars by top industry professionals as speakers. Seminar on 'Good to Great – How to convert a family owned hospital to a professionally managed healthcare institution' was very well received by the healthcare www.expresshealthcare.in

industry. Other topics like 'Hospital Material Management' and 'Internal Audit' were also well received by the industry. MEDICALL brought leading players from different segments like ALS ambulances, clean rooms, climate control systems, hospital kitchen equipment, ICU and operation theatre equipment, refurbished equipment, trolley, wheel chairs, cots and other furniture, hospital linen and laundry, hospital charts and stationary, office automation

equipment, printers dealing with pamphlet and file designing, communication equipment, medical disposables, hospital information system, solutions, surgical and examination furniture, rescue and emergency equipment, diagnostic/laboratory, OT equipment and cleaning equipment. Special products displayed were ambulances, mannequins and other teaching aids for nursing, hospital management software, energy saving equipment, hospital flooring, housekeeping equipment, nurses alarm system, liquid oxygen and central pipeline, physiotherapy equipment, autoclave and sterilisers. Medexpert, the organisers of MEDICALL are also organising a show in Srilanka from March 1517, 2013 and in Chennai from August 2-4, 2013.

Contact Yogita Panchal Email: info@medicall.in, panchal@medicall.in Website: www.medicall.in MARCH 2013

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BD conducts seminar on safety and quality improvement in lab medicine Held in Bangalore, the seminar was attended by several eminent pathologists from Karnataka o help pathologists and lab diagnostic experts, improve specimen quality and subsequently patient care, recently, Becton, Dickinson and Company (BD) organised a seminar on 'Safety and quality improvement in laboratory medicine', at Bangalore,. Dr Adarshpal Singh, Director Medical Affairs – Asia Pacific, BD Diagnostics – Preanalytical Systems delivered the welcome address which was followed by interesting session by eminent faculty. Dr Ana K Stankovic, World Wide Vice President, Medical Affairs and Associate Clinical Professor, Vanderbilt University, BD Diagnostics – Preanalytical Systems spoke about the 'Importance of Preanalytical Processes in Achieving Quality Healthcare –Role of BD Laboratory Consulting Services'. During her presentation she said, "Laboratories today are increasingly taking initiatives to improve patient care. BD can help identify the problem

areas in a laboratory and show the benefits from overall improvements gained in sample quality, work-flow, turnaround time, patient safety and employee satisfaction." Dr Elizabeth Frank, Director, Biochem Diagnostics Laboratory, Mysore spoke about 'Preanalytical Challenges'. During her presentation she stressed on the

need of quality checks and said, “Improvement in specimen quality is the key to reduce preanalytical errors. The preananlytical performance check becomes critical to identify areas of improvement. If an error reporting system is put in place, it can enhance quality throughout the entire laboratory process. Training and best practices

can go a long way in upgrading the preanalytical processes. BD has helped us realise what quality checks and monitoring systems are required to improve patient outcomes and have helped us in process change seamlessly.” Speaking on the occasion on the topic 'Quality Assurance in Laboratory Practices', Dr Swati Pai, Consultant HematoPathologist and Lead Assessor, NABL, Manipal Hospitals, Bangalore said, “There needs to be a continual improvement in lab procedures to be able to keep up with the healthcare demands. Today the consciousness of labs is far greater that it was earlier. This seminar today has emphasised the significance of safety for both healthcare workers and patients. I am glad that BD is conducting such knowledge sharing initiatives that will benefit us in the long run.” The seminar was attended by 65 eminent pathology experts from Karnataka.

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Rejuvenating medical minds The conference conducted by Brahma Kumaris’ Global Hospital was attended by the representatives of the entire healthcare spectrum conference on “Rejuvenating Medical Minds” was held on Sunday February 10, 2013. It was organised by Brahma Kumaris’ Global Hospital, Mumbai. Professor Dr Arun Jamkar, Vice-Chancellor of Maharashtra University of Health Sciences (MUHS) inaugurated the conference. BK Shivani, host of the TV programme ‘Awakening with Brahma Kumaris’ spoke about ‘Living with passion and purpose’. Speakers included eminent doctors from UK and US who spoke on ‘Latest Insights from Neuroscience’, ‘Living outside the box’, ‘In search of harmony – the flow!’ etc. It was also announced that a new department of Mind Body Medicine (MBM) will be added to the hospital as a value addition for holistic treatment. More than 3,000 healthcare professionals attended the conference, including doctors, nurses, paramedics and administrative heads.

MARCH 2013

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EVENTS UPDATE ABMH QIPS 2013

Venue: AIIMS Organiser: Department of Radiodiagnosis, AIIMS

Date: March 9 & 10, 2013

Organisers: AUM MEDITEC A hospital planning, management consultancy, Six Sigma deployment consultancy and training organisation

Topic: Recent advances and applied physics Venue: Aditya Birla Memorial Hospital (ABMH) Auditorium, 2nd Floor, Aditya Birla Hospital Marg, Chinchwad, Pune – 411033 Organiser: ABMH Summary: The conference includes provoking, evidence-based discussions on clinical and administrative topics in patient safety, quality and a paper and poster presentation on Day 2. The speakers list boast of eminent CEO’s, COO”s, Medical Administrators, Quality Heads of esteemed healthcare organizations across India. For registrations & accommodations call: +91 9881123008 Email: abmh-pune.qips@adityabirla.com

Indian Health Summit

Speakers: Eminent speakers from AIIMS, MAMC, PGI Contact: Dr. Sanjay Sharma, Dr Ashu Seith Bhalla, Organising Secretary, Department of Radiodiagnosis, AIIMS, Ansari nagar, New Delhi-29 Tel: 011-26594889, 011-26594925 Email: aiimsmamcpgi2013@gmail.com

Healthcare IT India Summit Date: April 22-23, 2013

Summary: The Healthcare IT India Summit will have a dedicated focus on ICT innovations

Contact details: Meeta RuparelEmail: meeta@meditecindia.com / meetaruparel@hotmail.com Website:http://www.meditecindia.com/Sixsig ma.htm

Contact: Tikenderjit Singh Makkar Deputy Marketing Manager-India Tel: +91 20 6727 6403 Email:tikenderjit.singh@fleminggulf.com Website: www.fleminggulf.com

XVth National Seminar on Hospital/Health Care Management, Medico Legal Systems & Clinical Research

Date: March 14, 2013

Organiser: Cosmos Forum in association with PE (Private Equity) Insights Summary: Indian Health Summit is a knowledge platform for rich insights from some of India’s leading healthcare companies and investors in creating successful organisations. With a dedicated focus on expansion through PE funding, the event will witness participation from key decision makers from some of the leading PE/VC funds actively investing into the healthcare space. It is a thought-leadership event focused exclusively on CXO's in the healthcare domain. Speakers: Dr Ashutosh Raghuvanshi, CEO, Narayana Hrudayalaya; Dr Velumani, CEO, Thyrocare; Ameera Shah, CEO, Metropolis Healthcare; Brig Joe Curian, CEO, Seven Hills Hospitals; Dr BK Murali, MD & Founder, Hope Hospitals; Ratan Jalan, CEO, Medium Healthcare; Sameer Mehta, Director, Dr Mehta Hospitals; Dr Praneet Kumar, CEO, BLK Hospital; Rajat Goel, CEO & MD, Eye-Q

iPHEX 2013 Date: April 24-26, 2013

Contact: Abhishek P Salvi Mob: +91 98191 68995 Email: abhishek@cosmosforums.com

AIIMS-MAMC-PGI imaging course on "Recent Advances and Applied Physics in Imaging"

Organiser: The Pharmaceuticals Export Promotion Council of India (Pharmexcil) Summary: iPHEX 2013 is expected to be an industry exposition in India showcasing diverse range of products and will include formulations, APIs, AYUSH, nutraceuticals, health services, biotechnology and biotechnology products, R&D Services

Green lean six sigma certification training for healthcare First session date: 25 April – 5 May, 2013 (9 days, Residential program) Hostel accommodations available on request & on additional charges payment)

Last date to register: March 22, 2013 Venue: Mumbai: Kalina, Santacruz (East)

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Venue : Symbiosis International University – Lavale, Pune Organisers: Symbiosis Institute of Health Sciences (SIHS) Summary: Seminar on hospital/healthcare management, medico legal systems and clinical research Participant profile: healthcare industry medical equipment research, pharma and

Representatives of the covering the hospital, manufacturing, clinical IT sectors

Contact: Dr Rajesh Shinde Web: www.schcpune.org Email: info@schcpune.org Call: 020 – 25655023/20255051/ +91 8888892258

To tie up with

Second session: Upgradation to Black Belt (additional 10 days) tentatively in September 2013

Date: March 29-30, 2012

Date : May 3-4, 2013

Venue: Mumbai

Website: www.pharmexcil.com Participants: Promoters/Directors/CEOs/CFOs/ CMOs/Head- Strategy from various healthcare companies, PE /VC funds, Investment bankers etc.

Participant profile: Hospital CEOs/COOs, management executives, hospital operations managers, quality in charge, MHA/ PGDHA/ MBA (HCM) final year students

Venue: Hyderabad, India Organiser: Fleming Gulf Conferences

Venue: JW Marriott, Juhu, Mumbai

Summary: This programme module is specially designed for hospital managers and other healthcare professionals and shall focus on six sigma methodologies, lean concepts in healthcare systems and service delivery. The uniqueness of this program is in it's module that smoothly integrates healthcare service delivery with six sigma, lean management concepts and in its ability to build six sigma professionals to cater to three most important aspects of healthcare service delivery (safety, efficiency and efficacy) and at the same time maintain an equilibrium with customer satisfaction, costs and sustain the quality achieved.

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for Media Partnerships Contact tushar.kanchan@expressindia.com

MARCH 2013

IT@Healthcare MAIN STORY

Exploring an EMR Ramesh Devare, COO, Rxoffice Inc elucidates about the importance of maintaining electronic medical records and elaborates on the criteria to look for while exploring an EMR software

RAMESH DEVARE COO Rxoffice Inc

hy do you need an electronic medical record (EMR)? Digitisation has helped many industries to move away from traditional tools/ techniques to innovative systems/applications. Healthcare industry has adopted technology to a greater extent and electronic medical record (EMR) is one of the digital age innovations. Electronic medical record (EMR) software exists in the healthcare industry since past few years. In US, EMR software has been adopted by various clinics, physicians and hospitals and it has been a support system to meet regular data need of physicians, clinics, hospitals, patients and government compliance. In India, awareness about the EMR softwares have increased in the recent years and physicians have started exploring the need for an EMR. While exploring EMR softwares the following are the most important questions that come to mind.

wares are equipped to handle day-to-day situations at clinics and hospitals. The figure below provides information about the critical elements that EMR handles for a physician’s practice.

Questions after exploring an EMR

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Questions before exploring an EMR Software

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Question: Do we really need an EMR Software? Answer: The above question can be answered differently based on the type of practice, priority and need for the health records . The possible answer could be “Yes”, “No” or “Do not know”. Question: How will an EMR software help? Answer: Again the answer would be based on the type of practice, priority and need for the health records. The possible answer could be “Yes, surely it will help”, “No, it will not help” or “Do not know”. However, to answer these questions, it is important to know what an EMR software can offer.

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cians or clinic or hospital Using existing records for physicians/patients/clinic s/hospital needs Maintaining confidentiality of patients’ health records Extraction of data for R&D purpose Lab report analysis and future reference Study patients’ medical history and come up with trends Patients’ medication study and analysis Review patient reports Study patient trends and analyse patterns Share patient education information Provide relevant patients’ health records to referred physicians Provide data to state/central government agencies on need basis Generate periodic reports

at clinic or hospital level Practice management Above mentioned are situtions which physicians come across every day, and with the traditional devices it is difficult and challenging to manage these on a regular basis. But, with EMR adoption these situations can be handled very efficiently.

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How can an EMR software help with day-to-day situations? The purpose of an EMR software is to help physicians to organise patients’ medical records, manage physicians practice records and meet compliance and regulatory needs at the practice level. Based on the choice of the EMR software, it also helps in handling patient billing, claims management and eprescription needs. Most of the EMR soft-

After understanding the importance of EMR for dayto-day circumstances, physicians shall have better answers. Question: Do we really need an EMR? Answer: Yes, to organise day-to-day, patients’ medical records maintenance EMR can surely help. It will also help to improve the overall patient’s care. Question: How will EMR help me? Answer: EMR will help physicians to improve their productivity, efficiency and improve the overall patient care by providing patient portal and educating patients.

Conclusion Having understood the purpose of an EMR software and how it helps physicians, it is advised that clinics and hospitals should adopt EMR. Choosing the right EMR software will be a challenge. However, based on a physician’s need, EMR experts at RxOffice Inc can set up a demo on request for interested parties to walk through the RxOffice-EMR. The author can be reached at ramesh.devare@rxoffice.us

Why should you explore an EMR software? Following are some of the typical situations that physicians come across in their day-to-day work: ● Store and maintain patient medical records ● Sharing of patient health records with other physiMARCH 2013

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Northern (R)evolution The privatisation of the healthcare space in the North began some two decades ago, even as it has reached a breakneck speed today with players vying to get better than the next, new strategies, business models, and trends are emerging to help redefine quality care and services. Shalini Gupta finds out how is healthcare in the North is shaping up in this churning nce home to small and mid-sized nursing homes as well as doctor-owned hospitals, the last decade has been a watershed for the North India region with major corporate chains scrambling to grab a pie of the huge opportunity. A rising middle class that’s growing increasingly health conscious, a steep rise in lifestyle diseases such as diabetes and heart ailments coupled with an increasing penetration of medical insurance has further helped the growth of the healthcare sector. While corporate hospital chains such as Max Healthcare, Fortis and Apollo have extended their reach in the landscape, other players are not far behind even as they are devising ways and means to tap this dynamic market. Home to some of the well known government hospitals such as AIIMS which attracts the best of medical fraternity, the Delhi NCR region in the northern part of the country is witnessing new and innovative business models as healthcare providers are going back to the drawing board to look at how better to position themselves in this burgeoning market. Although the region has lagged behind its Southern counterpart as far as modern medical technology, infrastructure to match and services to complement it all, contend analysts, the race to providing better quality and attracting patients to the counter is heating up.

Movers and shakers ● Renowned South India based groups such as Vasan Eye Care (aggressive expansion in tier-1,2 cities like Amritsar, Narayana Hrudyalaya (Jaipur, Raipur), Care Hospitals (Raipur), HCG (Delhi) etc ● Corporate groups such as Max, Fortis, Apollo, Centre for Sight with presence in North, moving to smaller cities such as Bathinda, Mohali, Dehradun (Max), Kangra (Fortis), Ludhiana, Indore (Apollo), Panchkula, Patiala, Meerut, Moradabad (Centre for Sight) etc ● North-India based corporate hospitals such as Medanta, Indus, Ivy, Sahara, Moolchand, etc. which have been stand-alone set-ups till recently developing into chains by expanding their footprint into cities such as Nawanshahr, Khanna, Hoshiarpur, Agra etc ● Diagnostic chains such as Metropolis and Dr Lal Path Labs have presence even in TierIII- IV cities of Uttar Pradesh, Himachal Pradesh, Uttarakhand, Punjab, J&K etc ● Nova Medical Centres setting up day care surgical centres across Delhi and other cities. Bharat Family Clinics in collaboration with Johns Hopkins International setting up primary family clinics in NCR to provide a family doctor to everyone

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According to a pan-India hospital study covering 63 cities by IMS Health Information and Consulting Services, there are close to 3450 hospitals with almost 1,54,850 hospital beds spread across the top 19 cities of North India. While this implies an average bed strength of 45 per hospital, an encouraging insight to note is that more than 50 per cent of these beds are concentrated in hospitals with bed strength greater than 100. The need gap in Northern India is further highlighted by the fact that almost 50 per cent of the total hospital beds are concentrated in the Delhi NCR (Ghaziabad, Faridabad, Noida, Gurgaon) region. Meanwhile, stakeholders continue to make new inroads into the region which can be assessed by the fact that over the last one year, more than half a dozen new hospitals have come up in the capital including Aapka Urgicare, Saket City Hospital, Apollo Cosmetic Clinic, FMRI, Fortis CDOC Chirag Enclave to name a few.

From multispeciality to superspeciality Most hospital chains initially started off as multi speciality centres to cater to each and every need of patients and invested huge sums of money towards such set-ups. But increasingly the trend seems to be gearing towards hospitals which are positioning themselves as super speciality centres. This includes clinics for IVF, eye care, kidney care, diabetes and cardiology etc. Focussed on a particular field, these centres provide all the basic and advanced services related to healthcare under one roof. Analysts opine that this is driven by the consumer need to have Centres of Excellence (CoE), that are super specialised and cater to the needs of a particular patient population. Sensing the spurt in chronic metabolic diseases, diabetes and related conditions, Fortis came up with Fortis C-DOC in 2010 that now has three centres in Delhi. Headed by Dr Anoop Mishra, the centre offers the latest treatment including hyperbaric therapy for chronic wounds, laser coagulation therapy for severe eye diseases www.expresshealthcare.in

Our data reveals that beds in super-specialty hospitals still constitute a meager 3 percent of the total hospital beds in top cities of North India Vikram Anand

Healthcare has to go to the doorstep and the future lies in Tier I, Tier II cities. Technology will be the gamechanger for this market with telemedicine, virtual ICUs and the like Dr Mahesh Inderveer Singh

PRINCIPAL PROVIDER IMS HEALTH

CEO, SAKET CITY HOSPITAL

(proliferative diabetic retinopathy, macular oedema and eye haemorrhage) and special vascular surgery for diabetic vascular block to name a few. Aditya Vij, CEO, Fortis Healthcare adds, “Speciality disease management programmes have been a key new initiative taken by Fortis under the brand names of Renkare and Fortis CDOC which focus on therapy support and treatment options for specific chronic ailments.” Renkare, launched in 2011, focuses on providing quality dialysis support for patients suffering from dysfunctional kidneys through a network of renal care centres closer to patients’ homes offering a non-hospital like ambience without compromising on quality. Others like Dr Pervez Ahmed, sighted the need for emergency medical services for acute illnesses and major traumas and set up Aapka Urgicare to bridge that gap. “There are only a few big trauma centres. While delivery models may change, the issue of access needs to be addressed. While we need to build more primary care centres, greater access to tertiary care centres is also required”, he adds. Vikram Anand, PrincipalProvider, IMS Health, sums up this trend by saying, “Business economics are forcing the leadership to go back to the drawing board and look at service lines that aren’t achieving critical mass. Top management is increasingly becoming cognizant of the

operational ease and benefits accrued by developing expertise and repeat clientèle in one or a handful of clinical programmes rather than spreading too thin.” He adds that the seeds were sown in the South with hospitals such as Narayana Hrudyalaya, Arvind Eye Care, Nephroplus, Vasan Eyecare etc. having led the trend. It is not only the private sector which is riding this wave, the government also doesn't want to be left behind. The Delhi government has commissioned two super speciality hospitals with a bed capacity of 1000, whose construction was completed in 2009. Janakpuri Super Speciality Hospital and Rajiv Gandhi Super Speciality Hospital will offer specialised healthcare facilities in the field of cardiology, nephrology, urology, cancer, renal transplant, gastroenterology, radiology, pathology and microbiology. Currently, these super-speciality centres enjoy a presence in the metros and Tier-I cities fuelled by a financially secure and health conscious population. Tier-II and Tier-III cities though are gradually flourishing as areas of opportunity for the speciality centres backed by the rise in earning capacity of the people in these cities and increasing urbanisation. However, Anand feels that this is an emerging/nascent shift which will take a few more years to mature. “Our data reveals that beds in super-speciality hospitals still constitute a meagre EXPRESS HEALTHCARE

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three per cent of the total hospital beds in top cities of North India,” he adds.

Interiors ahoy! Gaining a foothold in the metros is just a part of the growth story in North India, hospitals now are foraying into the interiors after having tasted success in cities. Semiurban areas are on the expansion list of almost every corporate hospital chain. While Apollo Hospitals, through its Apollo Reach initiative plans to set up 25 hospitals over the few years, Fortis, started a multi-speciality centre in Kangra in Himachal Pradesh late last year. Fortis is looking at starting 25 such multi-speciality hospitals with 100-200 beds in Tier II and III towns in the coming few years. While the trend is nascent, analysts see a lot of potential here and perhaps this could be the way forward to take quality healthcare to the masses. Business models are changing, technology is being used to streamline protocols so that the model can be replicated at newer centres. Most of the the hospital units are based on a hub-and-spoke model, focussed on local needs and demands offering secondary level care with tertiary care being offered at the main centre, elaborates, Rana Mehta, Pricewaterhouse Coopers, PwC. Profit to cost ratio is high in Tier II, Tier II cities with low manpower, land and operational costs albeit

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high margins, which might be slightly lower in comparison to those in the metros. Clearly this makes business sense. Fortis launched a secondary care format brand ‘Fortis General’ last year to cater to the middle class in cities outside metros to broaden the geographic and demographic reach of its delivery network. Pitches in Vij, “It will open up a new segment as more than 46 per cent of patients in TierII and Tier-III cities travel over 100 km from small towns and rural areas to seek medical care.” While it cannot be denied that there is an immense need-gap and potential opportunity that exists beyond metros, a near plateauing of demand from within Delhi is also one of the reasons why investors are lining up. While many are taking the plunge, business models vary, although each wants to customise their services to suit the needs of the consumer. Moolchand Healthcare completed the acquisition of Pankaj Apollo Hospital, a tertiary care hospital based in Agra with a capacity of 200 beds earlier this year. The move is a part of a Rs 500 crore expansion plan to assemble a portfolio of close to 10 hospitals to expand its footprint beyond NCR according to Shravan Talwar, MD, Moolchand Healthcare. “Eye chains such as EyeQ, Vasan, Centre for Sight etc., represent a trend of unbundling of the hospitals

Speciality disease management programmes have been a key new initiative taken by Fortis under the brand names of Renkare and Fortis CDOC which focus on therapy support and treatment options for specific chronic ailments Aditya Vij, CEO-INDIA, FORTIS HEALTHCARE

space. Asset light models with shorter gestation periods, these chains have a network of centres that replicate the models of their counterparts to break even. We might see mother child centres and dental chains along the same lines in the future,” feels Mehta. Competition is going to be there but what would differentiate one player from another in these markets is delivering high quality in clinical outcomes across all levels of care, asserts Dr Mahesh Inder VS, CEO, Saket City Hospital. “Healthcare has to go to the doorstep and the future lies in Tier-I and Tier-II cities. Technology will be the gamechanger for this market with

Eye chains such as Eye-Q, Vasan, Centre for sight etc represent a trend of unbundling of the hospitals space. Asset light models with shorter gestation periods, they have a network of centres that replicate the models of their counterparts to break even Rana Mehta, EXECUTIVE DIRECTOR, HEALTHCARE, PWC

telemedicine, virtual ICUs and the like,” he adds. Even as each entrant standardises services to position itself, the tariffs and maintenance costs can be kept lower by providing low-frill services and keeping the size of the facility at a manageable level with 100150 beds, advises Anand. The next few years will reveal how the healthcare market shapes up in the smaller towns in the North, but one thing is for sure, all major players might soon have a formidable presence there signalling the arrival of 'healthcare at the doorstep'. Let’s wait and watch. shalini.g@expressindia.com

Apollo Hospitals launch cosmetic clinic in North India The clinic offers myriad world-class cosmetic treatments under one roof tarted in 1983, under the aegis of Dr Prathap C Reddy, the first corporate hospital in India, Apollo Hospitals Chennai was launched. Over the years, Apollo Hospitals Group has grown to become one of Asia’s largest integrated healthcare organisations with over 8,500 beds across 50 hospitals, more than 1350 pharmacies and over 100 diagnostic clinics. The Group also offers medical business process outsourcing services, health insurance services and clinical research divisions with a focus on epidemiological studies, stem cell research and genetic

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N|O|R|T|H research. Apollo Hospitals Group has earned several accolades, including the Centre of Excellence from the Government of India and recognition from the Joint Commission International (JC)I). The Government of India has also issued a commemorative stamp in recognition of Apollo’s contribution, the first for a healthcare organisation. Apollo Hospitals Chairman, Dr Prathap C Reddy, was conferred with the prestigious Padma Vibhushan, in 2010. Adding another feather to its cap, Apollo Hospitals Group have recently launched its first Apollo Cosmetic Clinic in North India. The major treatments offered at the Apollo Cosmetic Centre are as follows:

whether it is in the face, body or limbs. Cosmetic surgery, in my opinion is an art of enhancing one’s beauty and self esteem without any significant risk, under the experience of the artistic talents of the cosmetic surgeons.” Dr Shahin Nooreyezdan, Senior Consultant, Cosmetic Surgery, Indraprastha Apollo Hospital said, “Being a leader in the industry, it is quintessential for us to provide our customers with innovative and high

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quality service offerings that cut across the healthcare spectrum. Cosmetic treatments worldwide are becoming a preferred choice of many to acquire the much-desired beauty; however, the biggest deterrent for such treatments continues to be quality and the safety of patients. Our foray into cosmetic treatments with the Apollo Cosmetic Clinics aims at bridging this gap to offer a seamless solution for beauty treatments with absolute care that

reflect the same passion, commitment and credibility that the Apollo Group of Hospitals has extended over the last three decades to its patients.” Dr Lokesh Kumar, Senior Consultant, Cosmetic Surgery, Indraprastha Apollo Hospital said, “Moreover Apollo Cosmetic Clinic abides by the philosophy of ‘YOU FIRST’ by ensuring world-class medical attention and care to its patients making the centre one of the finest in its

category.” The specialised team at Apollo Cosmetic Clinic includes Dr Kuldeep Singh, Dr Shahin Nooreyezdan, Dr Lokesh Kumar, Dr RK Seth, Dr IP Singh and Dr Anup Dhir. The Apollo Cosmetic clinic, backed by the Apollo Hospitals Group, intends to live up to its legacy of touching and enriching lives that stems from the pillars of the Apollo philosophy experience, excellence, expertise and research.

Cosmetic surgery ✤ ✤ ✤ ✤ ✤

Liposuction Hair transplant Rhinoplasty (nose job) Tummy tuck (abdominoplasty) Breast augmentation (silicon implant)

Cosmetic medicine ✤

Lasers (hair removal, skin resurfacing, laser rejuvenation, mole/tattoo removal, skin tightening and colour toning) ✤ Dermal fillers ✤ Botox ✤ Peels A brand new offering from one of the most trusted names in healthcare; the Apollo Cosmetic Clinic is now open in Delhi after the runaway success of the maiden centre in Chennai. Coupled with the clinical excellence spanning three decades, the clinic offers world-class cosmetic treatments under one roof to the discerning people of the city. Equipped with the best specialists in the country, state-of-the-art infrastructure, cutting-edge technology and techniques, zeroinfection zones, stringent quality control and international-standard protocols, abundant precautions have been taken to ensure patient safety and complete confidentiality. Dr Kuldeep Singh, Senior Consultant, Cosmetic Surgery, Indraprastha Apollo Hospital said, “Over the years cosmetic surgery has become a much safer, effective and popular trend. The improvement of the human figure is now almost limitless with the advancement in the medical surgery, MARCH 2013

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Paras Hospitals: Born to care One of the leading neurosciences centre in the region, Paras Hospitals has emerged as a superspeciality hospital with 55 speciality departments aras Hospital is a state-of-the-art multi super speciality hospital providing a depth of expertise in the complete spectrum of advanced medical and surgical interventions with a comprehensive mix of inpatient and outpatient services. The hospital is dedicated to provide competitive, accessible and affordable world class healthcare services. With a mission to provide competitive, innovative and accessible medical care to its patients, Paras Hospitals strive to achieve the best possible health outcomes for its patients and community by integrating clinical practice with research and education. The hospital has taken a step ahead with the announcement of two projects in the second half of 2011, one in Bihar with a 350-bed hospital at Patna and a 100-bed facility at Darbhanga. This endeavour will enable Paras Hospitals to provide state of the art healthcare facilities encompassing cardiac care, neurosurgery and oncology as well all other super specialities in Bihar making them the single largest private healthcare provider in the state.

enabling patient, families, guests, healthcare professionals, associates to make the best use of the facilities and environment consistent with the hospital philosophy and commitment of the patient care, health education and strategic initiative.

Vision To become the preferred healthcare provider for all - Partnership in caring and curing. Providing excellent medical care to the customers through their faith in values, integrity, respect, teamwork, and innovation to achieve complete patient satisfaction. Paras Hospitals started operations with focus on neurosciences, joint

Mission ● To improve the health of the patient by providing quality service through expertprofessionals that is affordable and delivered ✤ Compassionately ✤ Appropriately ✤ Responsibly ✤ Efficiently ● To exhibit stewardship and creativity in the management of all available resources for patient care. ● To ensure the delivery of our services

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Dr Dharminder Nagar, MD, Paras Healthcare

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replacement and mother & child care. The Department of Renal Sciences was started in November 2006 with six dialysis machines, uro-flowmetry etc. Interventional cardiology and oncology with radiotherapy started in early 2008. There are 55 speciality departments including internal medicine, minimal invasive surgery, gynaecology and obstetrics, ophthalmology, dermatology and cosmetic surgery and plastic surgery, apart from the super specialties. Today, Paras has one of the leading neurosciences centres in the region with all the facilities under one roof. Paras Institute of Neurosciences is a super-speciality tertiary care centre located at Paras Hospitals, India. The Institute believes in the dictum that neurosurgery is special, and efforts must be made to keep it so. Neurosciences have the highest priority and maximum focus at Paras Hospitals, Gurgaon. Paras Institute of Joint Replacement & Orthopedics comes with the motto "Springing to Life". At Paras Institute of Joint Replacement & Orthopedics, patients receive pain free and super efficient joints in place of diseased, damaged and degenerated joints. The hospital strives to heal every fracture and join every broken bone. The hospital is a partner in health for every stakeholder in the healthcare industry - patients, doctors, health insurance companies. "Our USP is 'Quality Healthcare at affordable prices," says Dr Dharminder Nagar, MD, Paras Healthcare. The hospital is still growing in popularity and the OPD numbers are increasing with every passing month. At present approximately 10,000 patients come to the hospital every month. This rise in footfall is a result of good patient care service. The numbers in the OPD are highly encouraging and already departments of neurosurgery, cardiology, orthopaedics, obstetrics and gynaecology, gastroenterology, oncology, and others like dental and dermatology are being moved to bigger areas to accommodate the rising numbers. The hospital has taken a dispensary from the Government of Haryana, which provides facilities like free consultation and free distribution of medicines from the dispensary. The dispensary gets a lot of patients from the adjoining village areas and they have benefitted a lot with the availability of specialist doctors and free medicines. The dispensary organises camps in rural areas where super-specialists from the hospital give free consultation and medicines to poor patients. The hospital has a separate international patient services department, which provides end-to-end solutions for both national and international patients, which includes pick-up and return to the airport or railway station, currency conversion, visa assistance, providing package prices, local accommodation and more. The patients are mostly from the Middle East, South East Asian countries and African nations. MARCH 2013

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Batra Hospital: Caring for all Combining the best medical care with warmth and tenderness atra Hospital & Medical Research Centre, set up under the aegis of Aishi Ram Batra Charitable Trust, is one of the important landmarks in the delivery of healthcare in private sector. Late Rajeev Gandhi inaugurated the hospital on the April 24, 1987 which has today grown into a state-of-the-art, 495-bed multi-speciality hospital. The hospital has been a pathbreaker in delivering quality and affordable healthcare to all sections of the society. It established the first oncology, cardiac (cardiac surgery and non-invasive cardiology and nephrology centres in the city of Delhi. Subsequently, multi-superspecialities like gastroenterology, neuro and neuro-surgery with state-of-the-art equipment were established. Highly trained doctors, nurses and technical staff carefully selected from all over the world and a dynamic leadership paved the way for multisuper-speciality hospitals in India. The hospital has been accredited by ISO certification since 2005. In 2007, the laboratory services of the hospital got NABL Accreditation. In 2010, the hospital received NABH accreditation as well. Batra Hospital & Medical Research Centre commits itself to provide efficient, effective, timely and userfriendly healthcare to its patients, through best medicare practices in a clean, healthy and rejuvenating environment. The hospital strives to provide world class medical care within the reach of a common man. The management of Batra Hospital has set its vision, mission, quality objectives and values which are as follows:

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Compliance with the highest standard of medical ethics Continuous skills upgradation and keeping abreast of latest developments To carry out all processes right the first time, on time and every time

Quality values ✤ ✤

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Care, compassion and courtesy Community health provider—patient centric care with value for money to all sections of society Timely intervention Effectiveness—Sharing knowledge and best

practices Efficiency—Never ending improvements ✤ Maintenance of highest standard of hygiene and cleanliness Today, the hospital offers tertiary level care in 42 specialities with an infrastructure comprising 495 beds, 13 oper✤

ation theatres, 112 ICU beds, 24x7 emergency facilities, full range of state-of-the-art diagnostic laboratories and comprehensive rehabilitation facilities with the finest medical talent – physicians, surgeons, nursing professionals and technicians. The skills of the medical professionals are

Mission To continuously engage itself in upgrading its comprehensive multi-speciality healthcare delivery system through quality intervention, involvement of all functionaries and excellent leadership

Vision Strive to be the leader in the area of providing quality healthcare

Quality objectives ✤ ✤

Best quality patient care Judicious use of drugs and appropriate interventions

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AL Batra, President Batra Hospital & Medical Research Centre

enriched with international experience. This is in line with the continuing ethos of the hospital to combine the best medical care with warmth and tenderness which is essential to the healing process. The faculty at Batra Hospital & Medical Research Centre which is of international repute has decades of clinical research and academic experience which is now linking with medical fraternity across continents. They see a distinct synergy in healthcare and believe that the greatest reward is the patient’s recovery. Batra Cancer Centre: It was was the first private healthcare set-up to offer the radiation facility in Delhi way back in 1987. It is fully equipped with linear accelerators, IMRT, IGRT, 3D CRT, Rapid arc, brachytherapy, CT simulator etc. Batra Gastrosciences Centre provides comprehensive, state-of-the-art GI services which include haepatology, surgical gastroenterology, paediatric gastroenterology, pancreatiobiliary and GI oncology.

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Batra Heart Centre: It is one of the largest and technically advanced institute of Cardiac care in the country. Its facilities cover the complete spectrum of invasive and noninvasive procedures with the most modern cardiac emergency services, CCU’s and state-of-the-art cardiac cath labs, including equipment for 3-dimensional arrhythmia mapping (CARTO). The Department of Nephrology & Kidney Transplantation: It can accommodate upto 50 patients with round-the-clock supervision. The state-of-thestate haemodialysis unit for 14 patients at a time includes two machines designated for hepatitis patients with isolation and barrier nursing with the other two for critically ill patients on haemodialysis/ continuous renal replacement therapy (CRRT). A separate facility for continuous ambulatory peritoneal dialysis (CAPD) for training of patients and personnel is also available. The kidney transplant track record at the Batra Hospital generates tremendous confidence and reassurance for patients with nearly irreversible kidney ailments. Supported by two operation theatres, the surgery unit is geared to meet any emergency at any hour. A recent addition to the hospital is the use of laparoscopic techniques for donor’s operations using that minimises the discomfort to the donors. Batra Neurosciences Centre: The senior faculty in the department of Neurosciences at Batra Hospital handles the entire gamut of neurological disorders with the latest infrastructure and state-of-the-art equipment including digital video EEG, nerve conduction study,

EMG, evoked potentials (VEP/BEAR/SSEP/P 300), decremental response test, blink test and others. Department of Neuro & Spine Surgery: This department is manned by highly experienced senior neuro surgeons, with all types of complicated neuro surgical operations carried out with most modern operating equipment. Department or Urology: This department undertakes all kinds of open surgeries and minimally invasive endoscopic work. This department also specialises in the management of infertility and sexual dysfunction. Use of HIFU for surgeries and laser surgeries are routinely undertaken. Department of Orthopaedics: This department is well equipped and carries out all orthopaedic surgeries ranging from trauma surgery, spine surgery, joint replacements (including knee, hip, shoulder and elbows) paediatric, sports medicines and arthroscopic surgery. Department of Anaesthesiology & Critical Care: Batra Hospital has 16 large and extremely well equipped operating rooms (ORs) with climate control with laminar flow, HEPA filters and dehumidifiers. Low flow anaesthesia work stations with advanced ventilators, multi parameter monitors, ultrasound for vascular access and nerve blocks, TCI for computer controlled delivery of anaesthetic agents and patient and fluid warming systems are utilised for providing optimal care in the ORs. Multiple image intensifiers, Carm compatible OR tables, heart lung machines, navigation system, harmonic scalpel, CUSA, holmium, yag and diode lasers and high definition videoscopic equipment for minimal access gynaeco-

logical, urology, orthopaedic, neuro and general surgery help in carrying out a wide spectrum of advanced surgical procedures. Besides pre-operative and post anaesthesia care units, there is a 15 bedded surgical intensive care unit manned by a dedicated team of nurses, residents and consultants. The department runs a PAC and pain clinic, and an acute pain service. It is recognised by the National Board of Examinations for Post graduate training (DNB) and has 15 post graduate residents on its rolls. Department of Ophthalmology: This deaprtment has the most modern medical equipment. The department boasts of a highly sophisticated Zeiss operating microscope for performing various microsurgical procedures. The hospital has an accredited license to do corneal transplant as well. Department of Plastic & Cosmetic surgery: This department offers a wide range of procedures like reconstructive surgery, microvascular surgery, cosmetic surgeries, hair transplant etc. Batra Hospital has expanded its horizons as it is now catering to patients from Fiji, Congo, Nigeria, Russia and Afghanistan as well. The hospital has a dedicated Hospital Infection Control Department which lays down antibiotic policy and infection control measures, continuous monitoring of hospital acquired infections is done and suitable corrective and preventive actions are taken. Continuous training of all staff is done in rotation for HIC, CPR, fire safety, etc. The hospital has set patient and safety objectives and goals and regular monitoring is done for the same.

Columbia Asia: Delivering wellness Offering ‘best care’ with ‘best technology’ practices, all under one roof olumbia Asia is an international company engaged in the delivery of modern healthcare services across Asia. The company currently has 23 facilities across Malaysia, Vietnam, Indonesia and India. Columbia Asia combines technology, innovative healthcare management and global healthcare expertise with the human touch. The Columbia Asia ‘model hospitals’ are the result of a 12-year development effort that combined ‘best care’ with ‘best technology’ practices, all under one roof. These models are rapidly being

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replicated throughout Asia. Established in 2005 in India, Columbia Asia Hospitals today has seven multi-speciality hospitals, one referral hospital and one clinic with a presence in Bangalore, Mysore, Kolkata, Gurgaon, Ghaziabad, Pune and Patiala. The vision of Columbia Asia is to be the “Best Managed Healthcare Company in Asia” and mission is to deliver effective and affordable medical services in a clean and caring environment. The innovative design of Columbia Asia hospitals, from its manageable size to its

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advanced technology, is focused on creating the most positive experience for customers. Customer service, efficiency and medical excellence are all part of Columbia Asia’s model to deliver the best customer experience. It has three hospitals in North India—Gurgaon, Ghaziabad and Patiala. While Gurgaon hospital was commissioned in 2008, Patiala and Ghaziabad were commissioned in 2010. Besides having all diagnostic, medical, and surgical specialities under one roof, these 100 bed multi-speciality hosMARCH 2013

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pitals have medical and support teams that are highly qualified and have been trained in some of the best institutions in the world. The capabilities of these hospitals include obstetrics and gynaecology, internal medicine, intensive and critical care, general and laparoscopic surgery, paediatrics and paediatric surgery, ophthalmology, neurology, neurosurgery, nephrology, pulmonology, vascular surgery, ENT, urology, gastroenterology, dermatology, and plastic and reconstructive surgery. Cardiology, orthopaedics and joint replacement, bariatric surgery, cochlear implants and kidney transplants are some of the areas of special expertise in these hospital. All three hospitals in North India have more than 30 specialties each. The hospital has a 10-bed intensive care unit (ICU), two-bed isolation intensive care unit, three-bed high dependency unit and a six-bed neonatal intensive care unit. Each of these hospitals started with a good acceptance from the community and now see around 500 customers a day in the OPD in Gurgaon to around 200 customers a day in the OPD at Patiala. The specialities at Columbia Asia Hospitals in North India includes: ✤ Anaesthesiology ✤ Clinical psychology ✤ Dermatology ✤ Endocrinology ✤ ENT ✤ Gastroenterology ✤ General surgery ✤ Internal Medicine ✤ Maxillo-facial surgery ✤ Medical oncology ✤ Nephrology ✤ Neurosurgery ✤ Minimally invasive (Laparoscopy) surgery ✤ Non-invasive and invasive cardiology ✤ Obstetrics & Gynecology ✤ Ophthalmology ✤ Orthopedic surgery ✤ Plastic & reconstructive surgery ✤ Paediatrics ✤ Paediatric surgery ✤ Pulmonology (chest medicine) ✤ Psychiatry ✤ Renal transplant ✤ Cochlear implant ✤ Urology ✤ Vascular surgery Some of the features at the Columbia

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Asia Hospitals include: ✤ Electronic medical record (EMR) system which enables paperless records and unique patient ID’s which are applicable across all Columbia Asia Hospitals in the country ✤ Modern medical equipment with latest technological advances ✤ International standard infrastructure including automated building management systems ✤ Labour delivery recovery (LDR) suite ✤ Internationally benchmarked standard protocols including infection control and hygiene ✤ Plasma TVs to aid the queuing system and scheduling ✤ Operating theatres designed to conform to America Society of Heating, Refrigeration and Air-conditioning Engineers (ASHRAE) standards. ✤ Spacious intensive care unit, neonatal intensive care unit and high dependency unit. ✤ Café Columbia which caters to quality food needs of the customers. Columbia Asia takes pride on the infection control measures that have been adopted. With the help of these, they have managed to minimise hospital acquired infections. Some of the measures which are implemented include: ✤ Evidence-based medicine ✤ Antibiotic policy and rationale use of antibiotics ✤ Maintaining hand hygiene

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World class protocols for cleaning, disinfection and sterilisation ✤ Use of personal protective equipment ✤ Vaccination of healthcare workers ✤ Isolation precaution ✤ Surveillance for emerging infection ✤ Continuing education on infection control protocols and management Every Columbia Asia Hospital ensures compliance with regulatory and quality standards and accreditation from the National Accreditation Board for Hospitals & Healthcare Providers (NABH). Among the hospitals in north India, Columbia Asia Hospital, Gurgaon is already accredited by NABH and NABL. The hospitals in Patiala and Ghaziabad are also in a process of accreditation. In the near future, Columbia Asia Hospitals will commission a multi-speciality hospital in Ahmedabad and a large super-tertiary hospital in Bangalore. “The healthcare industry is developing rapidly with several national and international players investing in the growth. Quality of care will be the differentiating factor with an ever so strong emphasis on medical delivery as well as the service standards. At Columbia Asia Hospitals, we look forward to delivering effective and affordable healthcare in a clean and caring environment, ” said Madhur Verma, Area General Manager, North, Columbia Asia.

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Rockland Hospital: Quality care Equipped with the latest technology, Rockland Hospitals have developed a model of healthcare delivery mechanism to connect its state-of-the-art tertiary care hospitals Vision: To be the most trusted healthcare brand nationally and internationally.

Mission:

Rajesh Shrivastava Chairman, Rockland Hospitals

To create a network of quality healthcare service providers up to village levels at affordable costs Rockland Hospital's Qutab unit was launched in 2004 with a bed strength of 100 with specialities such as orthopaedic, gastroenterology, gynaecology, paediatrics, internal medicine, nephrology, cardiology and oncology. The Rockland Hospital brand has grown from a single unit to four units with a bed capacity of over 800. Rockland Hospitals now have all the basic specialties and super specialties in oncology (cancer), neuro & neuro surgery, orthopaedics, cardio invasive and non invasive, gastroenterology, nephrology, urology, ENT and cochlear implant, laparoscopic surgery and GI surgery, plastic surgery and cosmetic surgery including state-of-the-art imaging and lab services.

Opening new facilities

Rockland Qutub

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Rockland Hospitals have been engaged in a lot of construction activity at its old hospital in South Delhi and inaugurated its Dwarka unit in June 2012. Rockland Manesar was inaugurated on January 24, 2013. The year 2012-13 saw a growth of over 50 per cent and the number of patients doubling up inspite of only a partial addition of revenues from the newly launched Dwarka unit and reduction of beds in the old hospital due to expansion activity. Total monthly inflow of patients for the last 12 months was over a lakh in OPD and IPD services. Rockland Hospitals are fully equipped with the latest

Rockland Dwarka Hospital technology-based imaging and diagnostic equipment. The facilities at Rockland include latest modular operation theatres, cath labs, MRI machines, the best cardiac scanners (CT), ultrasonography, mammography, bone densitometry. The main lab at Rockland Manesar has a high end referral laboratory which includes molecular and cyto-genetic lab. Radio diagnosis is supported by high end technology and infrastructure. Rockland Hospitals follow the quality standards as laid down by NABH, NABL and other bodies around the world.

Rockland Health Network Rockland Hospitals model of healthcare delivery mechanism will connect its state-of-the-art tertiary care hospitals with the health volunteers, clinics, nursing homes and hospitals to reach out to the needy up to village levels with a quality certified health network within India and through its international network in other countries. Creation of the Rockland Health Network has begun with the launch of Rockland Manesar in Delhi NCR. It will connect with 400 clinics and 40 nursing homes and small hospitals in the first phase. The network partners would www.expresshealthcare.in

include private players as well as the government through a public private partnership model (PPP),â&#x20AC;? said Rajesh Srivastava, Chairman, Rockland Hospitals Group. Doctors operating from clinics, nursing homes and small hospitals will be able to link up with the super specialist doctors and equipment for better care of the patients through a 24 x 7 information technology and telecom interface. This model will be replicated in a phases to cover the entire North India, North East India, SAARC Countries, Middle East, Africa and several other countries. With the launch of Rockland Manesar the group will be able to leverage the entire Rockland Medical Corridor which will now have three multispeciality hospitals, assisted living facilities and medical tourism centres in Manesar, Dwarka and South Delhi with a total bed capacity of over 800.

Benefits to doctors and patients alike The patients and their attendants will benefit by getting access to the best advice and diagnostic analysis at far off places and those coming to NCR for treatment will have complete arrangements for travel and stay at reasonable costs. The

Manesar Hospital has taken special care in building an ancillary block which will house all travel and hospitality services and has 65 rooms for international and domestic patients. The benefits to the network doctors and small hospitals will be in several forms. A centralised diagnostic team of doctors, for example, can read and interpret the reports generated at far off locations where finding a good radiology doctor may not be easy or could be a very costly affair. This can help reduce wrong diagnosis which can lead to wrong treatment many a times. The network doctors would be able to update their knowledge through the continuous medical education (CME) programmes of Rockland and can collaborate with super specialist doctors in several by leveraging their advice on patient treatment. Patients can reach out to the network partners near their homes for OPD consultation and for treatment which can be done in their city of residence and get referred to NCR only in cases where tertiary care is required and so on. To ensure quality manpower the Rockland Group has already initiated plans for setting up medical colleges attached to its two 505 bed hospitals in Manesar followed by an institute to train para medical staff in Noida. The group is exploring opportunities for further expansion through the PPP route too. The Rockland Group believes that India has the potential to become the medical care hub for the world due to its world class doctors, technology and a low cost advantage. Flying the patients and doctors from some of the developed countries, with stay and treatment, would still be far more economical for the insurance companies and governments who are finding it a challenge to meet the healthcare expenses in their own countries. The Rockland Group is creating a world class healthcare delivery model with a chain of state of the art hospitals in the Delhi NCR in the first phase and will replicate this model on a national level in the second phase. MARCH 2013

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Fighting disease with electronics Nihon Kohden, a leading medical equipment player have an eclectic range of products to serve the healthcare segment ihon Kohden is becoming an important player in the Indian medical equipment market after its direct Indian operations started in 2011. Nihon Kohden is Japan's leading manufacturer, developer and distributor of medical electronic equipment for last 60 years. Nihon Kohden offers a wide range of products including patient monitoring, defibrillator, ECG machines, wireless telemetry system, neurology diagnosis equipment including EEG, EMG, NCV, EP, sleep lab, intraoperative monitoring system and haematology cell counter. Nihon Kohden is fast penetrating into the emerging markets worldwide. Nihon Kohden products are being sold in the US, Germany, France, Italy, Singapore, South Korea, Middle East and Brazil by its direct subsidiaries. With the changing technology landscape, demand of improved healthcare delivery and changing patient profile, the Indian medical technology industry is on fast track growth and is creating scope to improve the way care is given to the patients. Patient monitoring is one of most occupants without which trauma and emergency, critical care and intensive care units of a healthcare delivery establishment cannot function. Emphasis on non-invasive techniques to measure important parameters like continuous cardiac output (CCO) is growing. Recent reports show that usage of the pulmonary artery catheter declined 65 per cent from 1993 to 2004 in the US (Wiener RS, Welch HG. Trend in the use of the pulmonary artery catheter in the US, 1993-2004, JAMA 2007; 298: 423-9). Nihon Kohden recently launched the esCCO, a novel technology to non-invasively measure continuous cardiac output from ECG and SpO2. esCCO is a new technology to determine the cardiac output using pulse wave transit time (PWTT) which is obtained by the pulse oximetry and ECG-signals from each cycle of the ECG and peripheral pulse wave. esCCO provides realtime, continuous and non-invasive cardiac output measurement. Ease of operating and ease of access to the technology will be the key in future. Nihon Kohden has substantially reduced the size of traditional mainstream sensor. It offers advanced miniaturisation Cap-ONE lightest Mainstream CO2 sensor technology for non-intubated and intubated patients. Cap-ONE is the smallest Mainstream CO2 sensor technology in world. It is highly durable and washable sensor with a distinctive anti-fogging membrane. This new sensor is attached to a disposable oral and nasal adaptor and placed directly at the point of expiration. Therefore, one can achieve the same level of quality and reliability found in traditional mainstream CO2 monitoring and apply these benefits to non-intubated patients with-

Anil Srivastava National Sales ManagerMedical Equipment Nihon Kohden India

MARCH 2013

Nihon Kohden has introduced many products in world market along with Indian market in the recent years out any of the hassle and cross-contamination concerns found in traditional sidestream technology. Wireless telemetry in patientâ&#x20AC;&#x2122;s care is also a technology which is fast gaining popularity. Vanderbilt University Medical Center, Nashville TN, US has

completed two year controlled clinical study involving 1,270 patients where they evaluated continuous vital sign monitoring of post-surgical hospital patients. A preliminary analysis of the study data has shown an 85 per cent reduction of unplanned ICU transfers and a 69 per cent reduction of unplanned step down unit transfers for the patients on the study versus nonstudy patients on the same floors during the same time period (p<0.001). Had all patients on the study floor been placed on the study during the study period, over $10 million in hospital charges could have been avoided. â&#x20AC;&#x153;Nihon Kohden India has recently launched a walk away high performance 5 part diff analyzer, which has additional parameters like RDW-SD, and

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immature granulocytes and unique features like both open and closed tube for blood sample aspiration, large colour display and upgraded data management software compatible with Window 7 and XP. Nihon Kohden has introduced many products in world market along with Indian market in the recent years. The leading products that are introduced include BSM3000 advanced multi parameter patient monitor, PVM2700 full touch screen multi parameter patient monitor, TEC8300 series, highend multi parameter defibrillator, ECG2250 synthesized 18 lead ECG system with full touch screen operations, world's first and only lightest Mainstream ETCO2 sensor for intubated

and non-intubated, patients, world's first and only aEEG module integrated in multi-parameter monitor for use in neuro ICU, NICU, PICU etc. Nihon Kohden has also lunched EEG1250 system dedicated for EEG monitoring at ICU/NICU.

Contact Anil Srivastava National Sales ManagerEquipment Nihon Kohden India 308, Spaze Tower-A, Spazedge, Sector-47, Sohna Road, Gurgaon -122002 India Mob: +91-98106-99223 Tel: +91-124-493-1000 Toll free no: 1800 103 8182

Medical

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POC Ultrasounds from Sonosite Pavan Behl, Director & General Manager, SonoSite India, elucidates on the advantages and applications of poin-of-care (POC) ultrasounds and gives details on the range of POC ultrasounds offered by Fuji Sonosite ltrasonography has been used by physicians for many years, but in the past twenty years the technology has improved significantly – it is now more compact, portable, can create higher-quality images and is less expensive. Point-of-Care (POC) ultrasound is a safe and effective form of mobile imaging defined as “ultrasonography brought to the patient and performed by the provider in real time”. It is used at the bedside or pointof-care for immediate diagnosis or procedure guidance purposes. Unlike other forms of imaging, POC ultrasound is performed by a clinician such as emergency medicine physicians, critical care physicians, and anesthesiologists rather than a technician, and interpreted by the same clinician as a component of an episode of care. The images can be obtained almost immediately, and the clinician may use real-time dynamic images to aid in diagnosis (particularly needle-based procedures such as venous access, paracentesis, thoracentesis, and regional anesthesia/nerve blocks). The time to action is immediate. POC ultrasound has many proven advantages. The evidence for benefits from use of POC ultrasound is strong and rapidly expanding. Advantages include improved diagnosis and treatment based on clinicianobtained real-time images, reduced risk of iatrogenic complications when used for procedure guidance, and decreased length of stay and cost of care as a result. It is not associated with exposure to ionising radiation and the risk of subsequent radiationinduced malignancy, which has emerged as a huge concern with other forms of imaging. In mass casualty disasters, POC ultrasound has emerged as a useful imaging modality to aid in clinical care and victim triage, and speedy identification of life-threatening injuries. FUJIFILM SonoSite the world leader in mountable and point-of-care ultrasound delivers solutions that meet the imaging needs of the

Pavan Behl, Director & General Manager, SonoSite India,

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POC ultrasound has many proven advantages. The evidence for benefits from use of POC ultrasound is strong and rapidly expanding

The M-Turbo ultrasound system offers striking image quality. It is one of our most versatile system for abdominal, nerve, vascular, cardiac, venous access, pelvic, and superficial imaging. The MTurbo ultrasound system gives you striking image quality with sharp contrast resolution and clear tissue delineation. This ultrasound equipment lets you visualise detail, improving your ability to differentiate structures, vessels and pathology.

S SERIES ULTRASOUND SYSTEMS medical community. Our various products available in the market are dedicated to bring high quality ultrasound to patients.

EDGE ULTRASOUND MACHINE The Edge ultrasound system’s enhanced image quality aids your diagnostic confidence. A solid aluminum

S Series ultrasound machines are the industry’s first mountable ultrasound. They offer a zero footprint and can be mounted on a wall, the ceiling, or a stand. Our mountable ultrasound systems have a simplified control that lets you focus in on your target areas in a matter of seconds. Highresolution images help see exactly where to perform procedures and allow for accurate diagnosis when treating patients. The S Series ultrasound machines are

core helps to protect your investment for the long term. And a splash-resistant silicone keyboard makes cleaning and disinfection that much easier. With the Edge® ultrasound system, you have access to a new generation of point-of-care ultrasound visualization.

built to meet US military standards for durability. They boot up quickly, are lightweight, and are built with intuitive designs for ease of use.

M-TURBO ULTRASOUND MACHINE

NANOMAXX ULTRASOUND MACHINE The NanoMaxx ultrasound system combines bestin-class performance with affordability and simplicity. With its uniquely simple control, high-quality diagnostic imaging, colour power Doppler and color-flow velocity, the NanoMaxx® ultrasound system helps physicians make clinical decisions or guide interventional procedures. Not only is the NanoMaxx a portable ultrasound machine, it uses

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proprietary technology so you can optimise many system settings at the touch of one dial.

MICROMAXX ULTRASOUND MACHINE The MicroMaxx ultrasound system offers impressive image quality with minimal keystrokes, wireless data transfer, fluid-resistance for easy cleaning and disinfec-

tion, and extreme durability. Designed to make your job easier, faster and more accurate, the MicroMaxx® ultrasound system makes point-of-care ultrasound an affordable reality. From busy offices and big-city hospitals to critical-care situations where seconds count, the MicroMaxx ultrasound equipment boots up within 15 seconds. The system software is hard-wired and purpose-built for faster boot-up times, faster digital image processing, and the ability to run for a long time. Power is efficiently used, extending battery life for use wherever needed.

Contact SonoSite India Unit 404-405, 4th Floor, Tower B, Global Business Park, Gurgaon 122002, Haryana, India Tel: +91 124-2881100 Fax: +91 124-2881110 E-mail: india@sonosite.com Website: www.india.sonosite.com MARCH 2013

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Salus Healthcare Resources: Medical recruitment partner for India Salus Healthcare Resources offer cost effective and high quality recruitment solutions for its clients alus Healthcare Resources is India’s leading provider of healthcare recruitment solutions to hospitals and healthcare providers located in Tier 1 as well as Tier 2 cities of the country. A sectoral focus on healthcare and functional focus on recruitment and talent management solutions has helped Salus Healthcare Resources to get specialised in this domain and offer cost effective and high quality recruitment solutions for its clients. Healthcare recruitment, especially those of physicians, is a highly specialised area that needs professionals who are specialised in this particular domain to handle these. In more mature markets like US, Europe and Australia there are organisations that specialised in healthcare recruitments. The US even has professional bodies like National Association of Physician Recruiters that cater to the professional development needs of people working in this area. Fuelled by medical travel from overseas and increase in domestic demand for high quality healthcare services from within the country, Indian healthcare industry has been growing exponentially over last decade at CAGR of more than 15 per cent. Whereas a lot of efforts are being put into creating physical healthcare infrastructure both by public as well as private sector players, the country is struggling with acute shortage of trained medical manpower especially doctors. Although India contributes

Sachin Gupta, CEO Salus Healthcare

MARCH 2013

towards training a significant percentage of global medical manpower, it is struggling with acute shortage of trained medical talent that can be attributed to brain drain to Western countries and Middle East. The number of physicians per thousand population in India is 0.6 approximately as compared to 2.7 per thousand in US and 2.1 per thousand in UK. With numerous healthcare delivery projects lined up across the country, the hunt for sourcing high quality medical talent in going to get tougher in coming years. The scarcity of professionally run healthcare talent management companies in this part of world makes talent sourcing and development further tough especially for the newer players in the healthcare market. Creating value for the nation: Salus Healthcare Resources aims to create value for India’s healthcare industry by filling in the void that has been created due to scarcity of professionally managed talent management organisations serving the healthcare industry. With physician and managerial recruitment being their forte, Salus offers comprehensive range of Talent Sourcing (Executive Search), Talent Planning and Talent development services for healthcare providers in India. The leaders h i p

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team at Salus has worked with world’s leading healthcare organisations both in India as well as overseas. The managerial and consulting team has rich experience of working in Human Resources, Operations and other domains in diverse industries. Collectively, the team at Salus Healthcare Resources has developed a complete understanding of complex organisation dynamics in healthcare industry. This unique understanding of healthcare industry dynamics helps the team at Salus to work effectively with organised private healthcare providers operating in tier1 cities as well as with the upcoming hospitals in Tier 2 and Tier 3 cities of the country. The organisation is also proactively engaged with Indian Medical Diaspora in countries like USA, UK and Singapore and is contributing towards reversal of medical brain drain in India by offering relevant opportunities in Indian healthcare industry to NRI doctors who want to come back home. While working with physicians of Indian origin, who want to come back home, the organisation offers them most appropriate opportunities that match their professional aspirations, clinical skills, expected compensation and geographical preferences within the country. Creating value for its clients: Being

specialised in medical and managerial recruitments in healthcare industry has helped Salus Healthcare Resources to create unique value for its clients by offering most efficient recruitment and talent sourcing solutions for them. With one of the largest database of physicians and healthcare professionals in this part of world and a professional team with global exposure along with complete understanding of industry dynamics, Salus Healthcare Resources offers one of shortest recruitment cycles for its clients. Shorter recruitment cycles transforms into better asset utilisation for hospitals and hence additional revenue, thereby improving overall efficiency of the client organisation. In addition to talent sourcing, the organisation offers plethora of talent management solutions under one roof for hospitals across India including manpower planning, development of HR standard operating procedures, compensation benchmarking, physician engagement, performance management, professional grooming and organisation of CME programmes. The availability of all these innovative solutions under one umbrella ensures that the client’s needs are catered in most efficient manner. Dr Sachin Gupta, CEO Salus Healthcare Resources says, “Our mission is to add value to India's growing healthcare industry by offering reliable and cost effective talent management solutions”

Contact Website: www.salushealthcare.in

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HIMS payoff to hospitals Sadananda Reddy, MD, Goldstar Healthcare elaborate on the uses and advantages of hospital information management systems he information technology/hospital information management system (HIMS) solutions when used as a tool, help hospital owners/entrepreneurs proactively, take corrective actions as the data available in the system without any deviations. To get accreditation from NABH and other governing bodies’ electronic data has been made mandatory. This in turn can save the image of the hospital and help it avoid financial implications. Hospital should update the existing solution with updates at par with the available technology to gratify both internal and external consumers. Hospital with multi-locations can have inter-connectivity and control the processes from single site and reduce the management cost. Data saved in a location can be retrieved as and when required at requisite locations through web-based browser solutions. Processes laid down based on the hospitals policy require customisation accordingly and well-documented processes of IT would aid in achieving the following benefits: ✤ Patients details are registered, stored and retrieved as and when required a click away ✤ Revenue cycle management of in-patients and accurate data shared with the clientèle ✤ Providing error free in-patient services ✤ Transparent billing payment collections ✤ Improving operations control Improved processes will influence the average length of stay (ALOS), a key indicator of efficiency, and a major driver of savings. Individuals familiar with hospital operations will recognise that many manual paper-based processes sustain delays in information flow. Through HIMS solution the order transmitted in seconds, reduces delays and ensures timely delivery of care. Computerised order physician entry (COPE) automated prescribing tools for the pharmacy and investigations in the HIMS improve safeguards reducing the number of medical

Sadananda Reddy MD, Goldstar Healthcare

EXPRESS HEALTHCARE

errors made due to poor or inaccurate documentation. The system also provides medication alerts for physicians and pharmacists to help reduce adverse drug events, that in turn stem from prescribing and transcribing errors. Implementing right HIMS solution will promote flawless and comprehensive clinical data capture and improves billable charges, including medical supplies, drugs, procedures, surgeries, and other ancillary services. The system produces information that is more granular about all out-patient and in-patient transactions that in turn reflect intensity of care accuracy and its automated charge capture enables earlier identification of transactions that are potentially billable. Though there are many less tangible, non-financial benefits through HIMS, they help in making investment decision in areas relevant to patient care, patient safety, improved communication and reduces human interface errors. The ready availability of patient information proves extremely beneficial to assure continuity of care during the patient’s stay in the hospital. Many doctors are diffident to use the HIMS solution in providing the treatment to their patients in many cases. User-friendly doctor module and electronic medical records will have a great impact on doctors while treating patients allowing them to concentrate on clinical activities than clerical activities, providing valuable information to the doctors in areas like research, clinical paper presentation and to serve better to their patients. Doctors also get access to their set-

Installing proven HIMS solution will enable the organisation to drive the profitable growth both financially and operationally www.expresshealthcare.in

tled and unsettled payment details against the services rendered through doctor accounting, which is beneficial to all the practising doctors. Laboratory and Radiology departments bring in revenue to the hospital. Quite often, due to lack of controls, inadequate diagnostic mechanisms and ill designed reporting structures, the hospitals tend to have huge leaks in the laboratory and radiology revenue in management of inventory of reagents, chemicals and other consumables. Outcome on implementation of Laboratory Information System (LIS) and Radiology Information system (RIS) are a part of HIMS and can be of huge advantage to the hospitals by helping increase the revenue stream as well as patient care. LIS and RIS helps in f ollowing payoff to the hospitals: ✤ Records to manage stock inventory of all departments and particularly laboratory reagents, chemicals, consumables, implants, re-used items etc. ✤ Bar code labelling for identification of laboratory samples for correctness of sample processing ✤ Design triggers on critical operating parameters ✤ Reduction of human error in entering the results with checks and balances Implementing standard HIMS solution as per the hospital policy in the material management and procurement department aids in reducing the pilferage, wastage, expiry of the item, etc., which would indirectly save cost and help in management. About 30 to 40 per cent of total expenditure spent in procuring and maintaining inventory-carrying cost even if one per cent of the total spending saved would increase the bottom line. The return on investment (ROI) is a factor which plays a vital role in procuring or/and replacing the existing equipment, decision sometimes goes on assumption as the complete life cycle cost of equipment is not available. These issues are addressed by HIMS solution in maintenance, calibra-

tions, and annual maintenance cost of the equipment. Planned preventive maintenance and calibration of equipment accuracy reports maintained to provide error free services. With the right people employed in the right areas will reduce work force cost with the usage of the HIMS solution in achieving the result-oriented outcome. With the right people, human errors can be minimised, healthy competition spreads among internal departments and leads to employee satisfaction. Employee turnover among the department is reduced because of motivate staff with ease at work leads to hasten up processes in providing patient services and backend processes ultimately increases more patient footfalls. Any untoward incidents happens in the patient care area and other backend process prompt alerts enables which in turn can be rectified and preventing further damage/loss to the hospital. HIMS solution enables hospital administrators to have significant improvement in operational control and achieve the laid down targets. Any deviation analysed against the laid down target is also available. Forecasting and executing plans with the help of fully automated and real time online and accurate MIS & FIS reports. Comparative performance reports and clinical pathways practicing help management in good decision-making.

Conclusion Installing proven HIMS solution will enable the organisation to drive the profitable growth both financially and operationally. It will also support the organisational mission by ensuring market competitiveness and by leveraging capacity and capabilities. In addition, helps in optimising services and key department processes; analyse data, forecasting results, optimising revenue cycle management, transparency, and patient satisfaction to boast competitiveness, which automatically creates the brand image of the hospitals/clinics/medical colleges. MARCH 2013

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New age flooring from Polyflor Polyflor offers a wide range of vinyl flooring that suits a range of healthcare applications olyflor– a leading manufacturer of commercial vinyl flooring from UK, is an ideal choice for a wide range of healthcare applications. Its attractive appearance has been inspiring designers throughout the world over several decades. Polyflor possesses excellent durability. Its highly abrasion-resistant formulation achieves the top European wear category, making it suitable for commercial and light industrial applications with a very

heavy footfall. With its unique polyurethane reinforcement (PUR), Polyflor provides a lifetime polish free maintenance guarantee, thereby significantly reducing maintenance costs. Polyflor also takes great pride in achieving the highest environmental rating of A+ BRE. This certifies the favorable impact of Polyflor on the environment on a “cradle to grave” assessment method. With a wide range of products and a 10 year war-

ranty, Polyflor is suitable for every application within a hospital – wards, corridors, OT’s, ICU’s, MRI and X-ray areas as well as wet areas such as bathrooms and food courts and cafeterias. Polyflor has been installed in leading hospitals in India such as Manipal Hospital, Narayana Hrudyalaya, Apollo, Artemis, Fortis, AMRI, ESIC, Sitaram Bhartia, Breach Candy, Icare Eye Hospital, Dharamshila Cancer Hospital, Neotia Healthcare,

Moolchand Hospital, Medanta etc. Polyflor is represented in India by Consolidated Carpet Industries who offer comprehensive supply and installation services.

Contact: Consolidated Carpet Industries 4A, Adhchini, Aurobindo Marg, New Delhi – 110017 Tel: 011 40697000 Email: sales @ ccil.in Website: www.ccil.in

Transport vs portable ventilators Demystifying the difference between transport ventilator and portable ventilators he medical device industry is confusing the end users of transport ventilators with portable ventilators. However, both of them have different applications. Internationally, transport ventilators are light weight and are used in emergency medicines – trauma, pre – hospital and war zone scenarios, where patient requires 100 per cent oxygen. This is only possible with the use of transport ventilators, as they are pneumatically (gas) driven. Portable Ventilators are mostly turbine or compressor driven and are on wheels, having definite application in ICU care and home care, but again to give higher concentration of oxygen they have to be connected with oxygen gas

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pipeline, through turbine or compressor, hence they are able to generate only 21 percent oxygen, which is again a big question mark, in case the ozone level is already polluted.

The myth about oxygen consumption in ambulances The medical device industry is also creating another myth about the role of oxygen in ambulances, since they are promoting turbine based ventilators, with the plea that in case the oxygen is empty in ambulance cylinders, then at least turbine base ventilators could generate natural gas with 21 per cent oxygen. First, of all we have to understand, when the patient compartment is already air conditioned and air tight, www.expresshealthcare.in

from where the turbine types of ventilators are going to drive air, when there is no air source is available, it is just a gimmick that 21 per cent oxygen will be generated. On the contrary it is not possible even as the patient require 100 percent oxygen in emergency situations. Secondly, in an ambulance, two jumbo cylinders are available, and each contains 7000 litres of oxygen. That means a patient weighing 100 kgs can be transported in a time frame of 17 hours on 100 per cent oxygen or in 34 hours on 50 per cent oxygen rich is recommended during long transport to avoid EtCo2 build up.

Technology available to suit tough demands Weinmann

products

meets tough demands as they work on land, water or in the air, Weinmann brands such as MEDUMAT, MEDUCORE, LIFE – BASE, and ACCUVAC have set the standards for years and have started new trends. Even in India Weinmann are the brand leaders in user friendly transport ventilation technology, having installed base in VVIP Ambulances, CATS 102 Ambulances, GVK EMRI Ambulances, Ziqitza Ambulances, and Falck Ambulances, besides operating in government and corporate set up.

Contact PK Zalpuri Tel: +919810795762 Website : infomgmindia.net E-mail mgm.india@gmail.com EXPRESS HEALTHCARE

Stand Alone Legacy Since 1969

24 hrs Emergency & Critical Care Highly specialized Trauma Care Unit Largest Speciality Clinic in Eastern India Performed 2,50,000+ surgeries All Diagnostics Under One Roof 120+ Highly Reputed Consultants Treated over 6 Lac IN-PATIENTS NABL & CAP Accredited Laboratory Advanced Medical Infrastructure Latest Pneumatic Shoot System

Fully modernized Dialysis Unit Part of newly revamped Neo Natal ICU

CMRI Health Infra 12 State of Art Operation Theatres

100+ Bed Critical Care Unit Latest Neuro ICU Modernized Dialysis Unit PICU & NICU with Step Down CMRI hospital with its 400+ bed and rich heritage of 40+ years of service has made an erstwhile impression throughout all the sections of the society in the eastern part of the country. It has been made possible through its dedicated group of medical consultants backed by an ever modernizing diagnostic services. Being a C K Birla Group Health initiative has helped the institution to grow to its full potential with the help of an ever improving and adaptable health administration.Through its recent expansion into 100+ bedded critical care, CMRI can now boast of having one of the largest critical care unit in eastern India. No wonder that CMRI has been selected to be the venue of one of the biggest critical care workshop in upcoming ISCCM National Conference 2013, being held at Kolkata.

High level delegation from Royal College of Surgeons of England visiting CMRI on educational interaction mission. Seen in the picture the president, vice president and the counsel

â&#x20AC;&#x153;CMRI continues its commitment to provide quality care at affordable priceâ&#x20AC;?

Rupak Barua Chief Operating Officer

members including local organizers of RCS, England.

On Sustainable Development Our idea of making a sustainable hospital is a bit different. We believe that providing quality medical services at affordable rates is the best way to make a sustainable hospital. Besides, we have invoked 'Lean Management' principles in our operations to cut down the operating costs and time and to enhance the processes. The benefits which we accrue are passed down to the patients.

On Patient Safety Issues Patient Safety has been accorded the utmost priority in our hospital and the Board of Trustees, has made it clear in no uncertain terms that the hospital will not compromise with safety and security of the patients under any circumstances.It is an ongoing process in the Hospital and we have thoroughly revamped and strengthened our fire-fighting mechanism over the last couple of months.

On Future Planning

CMRI recently felicitated cricket maestro Sachin Tendulkar and dedicated one free bed for the national level cricketers in presence of Mr.Saurav Ganguly, ex-captain of Team India.

The Group is setting up another 200-bed state-of-the-art multispecialty hospital at Jaipur in Rajasthan which is likely to become operational by the end of this year. It also plans to set up a midsized 100-odd bed super-specialty hospital at Siliguri in North Bengal, the land for which has been already acquired.

Facilities at CMRI

CMRI Institute of Urology CMRI Institute of Neuroscience CMRI Institute of Nephrology & Kidney Transplant Unit CMRI Institute of Gastroenterology CMRI Institute of Orthopedic & Joint Replacement CMRI Institute of Pediatrics Suryodaya - The Eye Centre ( in collaboration with LV Prasad, Hyderabad )

Find Us 7/2 Diamond Harbour Road, Kolkata 700027 West Bengal | IN

Helpline: 033-3090 3090 Fax: 033-2456 7880 info@cmrihospitals.co.in w3.cmri.in

Mercy Hospital Providing comprehensive medical services under one roof ercy Hospital was created with the aim of providing comprehensive medical services under one roof, while maintaining the highest standards of excellence. Hence Mercy Hospital’s motto is “Compassion with Excellence”. Since its inception in 1977, for the past 36 years, Mercy Hospital’s main aim has been to provide affordable healthcare to all. Currently, it is a 173-bed multi-speciality hospital. The hospital has a variety of services like five advanced surgical facilities, four critical care centres (including a level II NICU), 24-hour emergency services, a comprehensive blood bank, critical care, ambulances, pharmacy, diagnostics and imaging services. In pursuit of maintaining excellent standards, the hospital is continuously raising clinical expertise, human talent and upgrading to current equipments. Today, the Mercy Team, under the dynamic leadership of Sanjay Prasad, Executive Director & CEO of the hospital, comprises more than 100 eminent consultants on panel. Mercy Hospital is known for its clinical excellence and

SANJAY PRASAD

Executive Director & CEO Mercy Hospital

EXPRESS HEALTHCARE

innovations. It believes in complete transparent doctorpatient relationships, another key to Mercy Hospital’s consistent success. Mercy Hospital’s consultants across

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various specialties are persistently offering their proficiency and service to the people of Eastern India with benchmarked medical treatment.

Mercy Hospital Outdoor Patient Department on Park Street, Kolkata, has been appreciated by the people in the neighbourhood. It offers top of the line medical consultancy at an affordable price with a goal to reduce patient waiting time. Mercy Hospital’s association with more than 100 doctors across disciplines is with an objective to serve patients in the very best way possible. At this Mercy Hospital OPD, Mercy Team has set a benchmark of specialty clinics like chest, diabetes, kidney, cancer screening and infertility. Besides the Department of Medicine, the hospital also offers neurology, psychiatry, gastroenterology and endocrinology. The Department of Obstetrics & Gynaecology excels in its ability to provide gynaecological cancer treatment, laparoscopic treatment and the services that are provided to expectant mothers and new born babies. Other notable services are: orthopaedics, dermatology, ophthal mology, ENT, dental and oral as well as maxillofacial surgery. Mercy Hospital’s mission is to improve the hospital to become the finest affordable medical facility in and around Kolkata. MARCH 2013

Subodh Mitra Cancer Hospital Providing cancer care at affordable cost ubodh Mitra Cancer Hospital & Research Centre, situated in Salt Lake, Kolkata has been providing quality cancer care and treatment to people of the city and its adjoining areas since its inception through ultra modern facilities at an affordable cost. Set up in memory of renowned gynaecological cancer surgeon, Dr Subodh Mitra, the hospital is run by a trust in his name and provides services to patients, specially the poor and downtrodden, with a human touch round-the-clock with its highly qualified and experienced team of doctors, well trained nursing with para-medical staff and excellent support staff. The hospital provides most advanced cancer treatment protocol to not

only the needy and poor patients from the Eastern region but also from the neighbouring countries like Nepal, Bangladesh, etc. The 30-bedded hospital has facilities for medical oncology, surgical oncology, radiation oncology, cardiology, pathology, anesthesiology, physiotherapy and dentistry. Some of the leading oncologists of the city are

associated with the hospital. It has a five-bedded state-ofthe-art intensive care unit (ICU) and a separate unit for performing haemodialysis, manned by a team of experienced doctors, welltrained nurses and paramedical staff. The hospital is also equipped with state-ofthe-art infrastructure, modern OT, along with laparoscopic machine and Carm, USG, colour doppler,

digital X-ray, endoscopy, colonoscopy, well equipped pathology laboratory, dialysis unit and chemotherapy unit. The vision of the hospital is to become an epithet of matchless excellence in the sphere of cancer treatment. The mission is to generate awareness among different sections of the society regarding the causative factors of cancer and to make them realise the fact that 'Cancer has got an Answer'. The hospital, based in Salt Lake has now emerged as a leading centre for cancer care and treatment in the country within a very short span. Latest equipment are being inducted to keep pace with the growing technological advancements. To further the cause of research and development in cancer care, the hospital is in

collaboration with Tata Memorial Hospital, Mumbai and National Cancer Institute of the US. The hospital also owns an ambulance for medical transportation of the patients to the hospital from nearby locations. It also has a wellstocked chemist shop within the hospital premises. In the words of Asok Kumar Basu, Secretary and the main strategist, â&#x20AC;&#x153;All possible measures have been taken to ensure safety and security of the hospital. Infection control protocols are stringently followed in the hospital.â&#x20AC;? The hospital is setting up a 'radiotherapy unit', construction of which is already in progress on the ground floor as per the specifications laid down by Bhaba Atomic Research Centre (BARC), he added.

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MARCH 2013

Demystifying cancer Dr Arnab Gupta elaborates on the common facts and misconceptions on cancer

ancer is as old as mankind yet even now, people are unaware about its nature, cause, prevention. Most importantly, misconceptions make the problem more complicated.

What is cancer? The body has the inherent capacity to repair a dead or damaged tissue by multiplication of cells and there is a control system for this. When there is lack of control, the cells multiply excessively and form a lump called tumour. This can be benign, grow slowly, does not damage the neighbouring structure, do not spread to other organs and are usually not fatal. The other type of tumour is malignant (cancer), where the lump grows very rapidly, involves neighbouring and distant organs and can be fatal if not treated early.

What are the common types of cancer? In male, where tobacco addiction is a common problem, common cancers are of oral cavity, lung and prostate. Cancer in uterine cervix is most common in rural women, whereas it is breast cancer in urban women.

What are the causes of cancer? Unfortunately, causes in two-third of all cancers are still not clear, and several researches are going on worldwide to determine this. In onethird cases, the causes are proved beyond doubtâ&#x20AC;&#x201D; of which the most important is tobacco in any form- smoking (bidi, cigarette, etc.) and smokeless (paan, paan masala, ghutka, khaini, jarda etc.). The other less common causative agents are diet (adulterated

food, high fat and less of fruits, vegetables and vitamins, stored and charred food), sunlight (causes skin cancer especially in the white race), western lifestyle (lack of or delayed pregnancy and less breast feeding can cause breast cancer). For uterine cervical cancer the common causes are early and multiple children, multiple partners, low personal hygiene, infection by a virus (human papilloma virus). In some cases (less than five per cent), a genetic abnormality is found which can predispose to cancers in many members of the same family (breast, ovaries and bowel).

What are the symptoms of cancer? Loss of appetite and body weight, an ulcer which is not healing, lump which is rapidly increasing, persistent change of voice, bleeding with cough,

vomitus, stool or urine, intermenstrual bleeding, difficulty in swallowing etc.

How to diagnose cancer? Any symptom which is persisting and not responding to standard treatment, should be seen by a specialist doctor and appropriate tests should be done. Depending upon the symptoms, the tests are ordered accordingly. Common tests that are done are- blood, stool & urine tests, chest X-ray, USG and sometimes CT scan of the abdomen, endoscopy, mammography (X-ray of the breasts) etc. Good clinical examination and appropriate tests lead to a quick diagnosis. Biopsies are often ordered to confirm a suspicion before advising any treatment.

What are the treatments of cancer? Surgery (by removing the

DR. ARNAB GUPTA Director & Consultant Surgical Oncologist, Saroj Gupta Cancer Centre

tumour along with a chunk of normal tissue and local glands) is the gold standard in early stage of most of the cancers. Additional treatment in the form of radiotherapy (blasting the cancers cells with special rays) and chemotherapy (some specific medicines to kill the cancer cells scattered around in the body) may be needed in more advanced cases. Treatment with hormones is also important for cancers of breast and prostate.

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Industry stalwarts speak-up for women There are two ways to spread the light — to be the candle that spreads the light or be the mirror that reflects the light. Women in their day-to-day life prefer to be the candle. As we gear up to celebrate International Women’s Day this month, Express Healthcare presents the view of industry leaders on the health problems among women and how women working in the healthcare sector can be enpowered to optimally utilise their capabilities for the betterment of the healthcare sector and the nation’s health

Indian healthcare sector understands the role of women as backbone of the care-giving system

T SANGITA REDDY, Executive Director - Operations Apollo Hospitals Groups

he essence of healthcare is healing. It is all about caring. And that is why women are so ideally suited for healthcare. This is being reflected in the ground reality of the sector– more and more women are being sought after for various roles in different facets of healthcare. This is a highly promising trend - a broader outlook towards quality healthcare is imperative to improve care-giving standards in India. The healthcare industry is evolving and the increasing role of women in the health system is a significant aspect in advancement of treatment standards in the country.

Today, majority of the staff, including doctors, other medical staff and management, in most medical facilities comprise women. Many of them are nurses who play a significant role in critical care areas where extremely ill patients require constant monitoring. Women staff are always more in demand when it comes to maternal and child care, crucial areas in which India has to improve. Accredited Social Health Activists, known as ASHA workers, are a key component of the National Rural Health Mission and provide every village with a trained female community health activist. The journey has begun, but there are many

bridges to be crossed. The critical need of the hour is to empower women professionals in the healthcare system so that their capabilities are optimally utilised for the betterment of the entire sector. Greater focus and cross-pollination of ideas can help nurture their talents and caregiving abilities. Doctors, academicians, policy makers and researchers must exchange ideas, policies and advancements for women professionals in healthcare sector by learning from the best, and adopting best practices in other sectors. Nursing education in the country needs to be systematised in a way that it provides continuous education to the

nurses for the growth and development in their careers. Moreover, hospitals and other medical facilities must take extreme care to understand the issues of their female staff as they are necessary for their functioning. With a broad enough canvas, and the tools to nurture their skills, and the environment to encourage their natural instinct to nourish and protect, women can naturally lead in the healthcare industry. They can apply their experiences, and help create a healthcare system that will shield and safeguard the nation’s health. That will ensure cutting edge healthcare, practiced with warmth and love.

‘Women play a key role in healthcare’

DR B S AJAIKUMAR, Chairman, HealthCare Global, Bangalore

omen play a key role in healthcare. G l o b a l l y, w o m e n working in the healthcare sector is increasing. The healthcare sector is a good place for women to work

and constitute a major work force with the sector. In the healthcare sector, we feel women can play an important role. We believe women overall are better and compassionate in their approach towards the patients. The number of

women doctors in the industry is also on the rise and are over taking men. Nursing has been a women forte. It is a belief that women are compassionate and concerned, where they are able to connect with the patients, more than males.

The increasing women in healthcare is a positive trend, from the view point of patient care. Also, now we see women occupying key positions in health care sector, which is encouraging.

Govt should take efforts to curb infertility in women

DR RASHMI SHARMA, Sr Consultant, Moolchand Hospital

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nfertility is rising over the time, especially among women. Today women are focusing on their careers and choosing to marry late due to which the very process of planning a baby is delayed. By the time they are ready in their marriage to have children; they may be past the reproductive age. Other factors that lead to rise in infertility are STD’s, rising number of abortion cases,

male infertility, increasing habit of mobile phones, laptops and smoking etc. There are many ways to overcome this problem like by initiating social programmes regarding sexual education, improving smoking habits and avoiding environmental toxins. It can also be curbed by going for medical assistance at right time and to meet this we have assisted reproductive technology (ART). Moreover, I would www.expresshealthcare.in

like to point out that there is no initiative taken by either private or government on this front. Government is focusing on population control and spending money on it but not ready to put money for infertility issue. They need to know the agony of infertile couple and should make balanced efforts towards population control along with infertility. But I believe that one need to provide sexual edu-

cation at school and college level especially to girls regarding giving birth to children at right age and also about the contraceptives to avoid STD’s which further leads to infertility. Moreover it will not lead to instant impact, it will take years to look at the results as adolescent girls getting educated from such initiatives will give birth to their children when they are at adult age. MARCH 2013

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‘Women health is also becoming an important concept in the modern world’

DR NK VENKATARAMANA, Vice-Chairman and Chief Neurosurgeon, BGS Global Hospitals, Bangalore

rom time immemorial, women have occupied a special position in Indian scripts. Women were conservative in the past even in healthcare industry, only the nursing professions had a significant number of women. But in the recent years women are actively participating in all the roles of healthcare like medical specialists, medical administrators, medical support services and also in the finance and business development areas. The medical profession offers variety of

opportunity for women. The gender difference is gradually disappearing even in surgical specialities. Their presence in all work areas adds care and compassion. Women need all encouragement to enhance their roles in various capacities particularly in healthcare. Women health is also becoming an important concept in the modern world. The disease burden affecting the women is increasing, so women welfare and women health has become an important sector in healthcare. In addition to all the possible diseases that can afflict a

human being, women are prone to certain specific diseases that can affect them at different ages. Preventive healthcare programme is very much essential to prevent some of these problems if possible, and early detection can certainly alleviate the complications. They also have additional responsibility of dealing with home and family. These dual or multiple roles can induce stress as their tolerance to stress is generally low. Healthcare being a demanding service, the physical as well as mental fitness for women

is essential to do their best. They need to give special attention to their nutrition and fitness. Those in healthcare should follow all the protocols and safe practices to protect themselves from known medical hazards. Women need to be respected at their work place. It is the responsibility of the management to create a congenial work atmosphere. Women are equally efficient in discharging their responsibilities and are better in some areas compared to men and cannot be replaced by anyone.

Career in healthcare sector is bright for women

T REKHA DUBEY, COO, Aditya Birla Memorial Hospital, Pune

oday, International Women’s Day is not just the day to remember the sacrifice a woman has made in times of need but to encourage her to move ahead in life with pride and élan. It is the day to celebrate the economic, political and social achievements of women. One of the industries that have thrived in India in recent years is healthcare. Today’s women

should definitely look at the healthcare sector as both prospective and lucrative career. Woman has been gifted with the power to create. The power of giving birth makes a woman very powerful. What better place than healthcare to show her authority. It is high time that women should engage themselves with earnestness to achieve benchmarks set by them personally, professionally and socially.

Women’s Day is the celebration of the identity of a woman. Though this identity accompanies the woman throughout the year, a particular day to celebrate it is something like an acknowledgement. We women are known for our multitasking image. She is capable of handling both personal as well as professional life. We at Aditya Birla Memorial Hospital have got many women who serve as doctors, assistants, trainee,

nurses, housekeeping help and some at the desk and they are doing perfectly fine. They know how to take care of both their home and their work place. Nothing should stop a woman from working. The career in the healthcare sector is really very bright for the women. They should really think of coming forward and working in this industry, as this industry will help them being independent.

‘Only four per cent of women are CEOs in the healthcare industry’

AMEERA SHAH, MD & CEO – Metropolis Healthcare Ltd MARCH 2013

In India, like most other countries, men and women have very distinctive familial roles. While men act as financial decision makers, women are more into care-giving roles. This distinct cultural aspect links health closer to a woman’s role. Yet it is ironical that this grass root reality doesn’t reflect in the managements of healthcare businesses round the globe. The limited number of women representatives in leadership roles is evidence to what I see in the healthcare industry. A study reflected that only four per cent of women are CEOs in the healthcare industry. Beneath these statistics may lay complex psychosocial and socio-economic reasons. However, if a woman believes that the focus of control is within her; then leadership positions might be a reality for her. Today’s

women are facing increasing burden of dual responsibilities, especially in the metros. The problem is when they internalise the need to do well in all their roles, socially or professionally; jeopardising their health and well-being. As an entrepreneur and being the CEO of Metropolis Healthcare; such problems are not alien to me. However, I believe that being in a leadership position largely depends on internal psyche, while other complex socio-structural factors are mere confounders. Striking a good work-life balance might mean being a champion in both family and professional roles for most women. How about another thought? A good-work life balance could actually mean doing a job that makes women feel more accomplished, balanced with a good and healthy self? www.expresshealthcare.in

Healthcare is an industry where women’s innate potential of sensitivity and sensibility could prove beneficial for not only the business she is in, but for the society at large. This industry is distinctive from other industries because of its reliance on understanding sentiments and being compassionate. In this industry women can potentially rise beyond the corporate glass ceiling. The earlier study that I mentioned, further depicted that the biggest reason for limited representation of women is not the lack of education or skill, but the lack of self-confidence. This locks women into mid-managerial roles. This also explains the reason behind even fewer women entrepreneurs. Initiating and managing a business venture is a challenge for anyone. Yet a man would go out and take the bold step

of venturing into a business. This boldness might be difficult for a woman because of the reasons I m e n t i o n e d e a r l i e r. Additionally they might face the dearth of good mentors and necessary familial and social support. There is a silver lining though. The growth that healthcare has showcased in the recent years is an opportunity for all those women who aspire for a leadership role. It is time that women in healthcare relate to this growth and consider it as an opportunity ripe enough to prove themselves. An opportunity to discover selfworth. When she works for her own happiness, is when she actually could do justice to her work and contribute to the economic development in her own small way. When the focus of control shifts within, is when the leadership in her would emerge. EXPRESS HEALTHCARE

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‘Indian woman is a national treasure, to be cared for, nurtured and given her place in the sun’

DR SUJIT CHATTERJEE, CEO, Dr L H Hiranandani hospital, Powai

rom time in memorial, women have been trailblazers in variety of careers including healthcare. The great names of Marie Curie and Florence Nightingale come to my mind immediately. In India too there have been the great in the field of healthcare; especially in obstetrics and gynaecology and infertility as the great Dr Dina Patel, Dr Nargis Motashaw and Dr Indira Hinduja. From the professional

scene, women have also started managing healthcare institutes and the Apollo Groups and the Reddy Sisters are an example of matchless efficiency. Today, women occupy position of responsibility and they are discharging their duties as well as, if not better, their male counterparts. Nursing has been traditionally the domain of Indian woman. It is well known that the ‘Care’ in healthcare is rendered by nurses. One of the miracles of the 20th century was

Florence Nightingale. Since then women have given succor to the sick with their gentle touch and loving care. No wonder then Indian nurses are amongst the most sought after in the world. In the field of pharmaceuticals and biotechnology women again are in the fore. Kiran Mazumdar Shaw is an example of what this great country can produce and deliver to the world. The Indian woman is a national treasure, to be cared for, nurtured and

given her place in the sun for the betterment of our country. In conclusion, I would like to add that we should honour the Indian woman, not only in the field of healthcare but across industries. They should be empowered and encouraged to lead as shoulder to shoulder with the male counterparts, women make a contribution that would enrich India in particular and the world in general.

‘Women can be health ambassadors for education about health issues’

S RAJIV TEWARI, Director, Health & Wellness, Rockland Hospital

peaking of the healthcare industry in India, I would say that the sector needs to be organised by networking the clinics, nursing homes, small hospitals and large hospitals so that the quality of diagnosis and treatment can be improved and health education programmes can be effectively shared. This would require a partnership model with private players, as well as with the Government through a public private partnership model. Government has the resources and the private

players have the managerial and entrepreneurial capabilities so a collaborative route is the answer. Neither of the two can reach out up to village levels on their own. In this regard, Rockland Hospitals Group has plans of launching a unique healthcare model at its Manesar unit in Gurgaon with an integrated healthcare delivery mechanism with a special focus on women. This network will reach up to village levels through a network of trained health volunteers, quality certified doctors, nursing homes and small hospitals in the state

of Haryana in the first phase. Network partners would include private players, as well as the government. Doctors operating from clinics, nursing homes and small hospitals in Haryana will be able to link up with the super specialist doctors and equipment for a better care of the patients through a 24 x 7 information technology and telecom interface. In the next phase of its plans, Rockland will equip the clinics, nursing homes and small hospitals with imaging equipment and also create sample collection facilities for laboratory tests.

Continuous medical education (CME) for the doctors and regular free health camps for educating the masses through the Rockland Network are an important part of the Rockland plans. Women are a special area of focus as they take care of the family’s health and would be health ambassadors for education about health issues. Rockland has already signed an MoU with Madhya Pradesh and has initiated talks with several states to carry this model forward.

‘Women in India participate equally to run the family; however, their health issues are neglected’

I DR UMA RANI, Senior Consultant, Obstetrics & Gynaecology, Delhi-based Sri Balaji Action Medical Institute

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ndian women are normally not concerned much about health issues and are least bothered about the preventive aspect of diseases. They prefer to take medical attention only when the disease reaches a painful condition. Even today in most of the households in India, though women participate equally to run the family, their health issues are neglected because her participation is not economically productive. The five most common diseases that women in India suffer from are anaemia, diabetes, hypertension leading to cardiac diseases, hormonal diseases like hypothyroidism,

polycystic diseases of ovary and breast cancer. All these medical problems need to be given equal attention. Within the rural areas, stress should be given on proper nutrition and sanitation. This also holds true for the low socioeconomic group in urban areas. Those belonging to high socio-economic group in the urban areas are prone to hypothyroidism, diabetes, hypertension and breast cancer. Hence, awareness should be created related to specific disease for the respective groups that they affect. Unfortunately due to excessive population in India, the health industry is mainly focused on diseased state and www.expresshealthcare.in

struggling with the treatment of sick people. More and more government and non-government organisations have to come forward to stimulate people regarding early state of diseases. Certain tests like haemoglobin, blood pressure, sugar level need to be done on a regular basis for early diagnosis of diseases. Further, self breast examinations should be taught to female health workers at dispensary level and involvement of more and more local girls and elderly ladies should be encouraged. For this, the government is continuously making efforts on its part to improve women health conditions. Addition of sodium

iodide in regular salt has reduced the level of hypothyroidism in India drastically. The distribution of iron and folic acid tablets to pregnant ladies has improved infant mortality. Moreover, various awareness generating initiatives like staging of Nukkad Natak (street plays) and holding other teaching programmes are gradually improving rural health. The private sector is engaged in activities like organising camps, public lectures, awareness walks etc. to make people more responsive to diseases. However, these initiatives are mostly limited to urban India.

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Looking after the ministering angels Though an integral part of the healthcare system, nurses in India often face several challenges in their day-to-day work. M Neelam Kachhap gives an insight on how nurses in India have to defy odds to overcome hurdles in their path ursing is an integral part of any healthcare system, which comprises the largest single component of hospital staff and are the primary providers of hospital patient care. They are the link between doctors and patients and are highly skilled professionals with interpersonal, critical and technical skills. Yet, nurses do not enjoy the same status as doctors or other medical workers in the healthcare segment. Overworked, underpaid and in many cases underappreciated, nurses in India constantly struggle to not only have their voices heard but also for conducive work environment. The profession is one of the most misunderstood careers in terms of the job demand and general perception. No wonder then, strike and agitation have become a regular part of their life. "The society identifies that any girl in a white uniform, whether qualified or unqualified, be addressed as a nurse. This gap between self-image and public image has caused a painful anxiety about the status and has made nurses aware of the injustice of it," laments Capt Valsa Thomas, Nursing Director, Dr LH Hiranandani Hospital, Mumbai. Echoing similar concerns Beena P Mathew, Nursing Superintendent, BGS Global Hospitals, Bangalore says, "A nurseâ&#x20AC;&#x2122;s job deals with life and death, which is most stressful and accountable but it has been least appreciated." It is quite disheartening to acknowledge the pathetic situations some nurses find themselves in. Nurses are underpaid, compelled to do bonded labour, forced to work in adverse environment, with no job security. They are sometimes physically and mentally harmed and work in difficult shifts with less time off duty. These are some of the issues that mar the dignified and humane profession started by Florence Nightingale. "Nurses today are paid lesser salary than a clerk at the billing counter, keeping

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in mind the skill and the degree of expertise with which she has to function, which is not justifiable. Long working hours, shifting duties, long commuting hours, family pressure, unreasonable expectation of patients/relatives from nurses etc are also disheartening factors faced by our nurses," adds Captain Thomas. Adding to this Captain Usha Banerjee, Director of Nursing, Apollo Hospitals says, "In India, this profession is slowly gaining importance as it plays a pivotal role in clinical outcomes. But itâ&#x20AC;&#x2122;s also important to build pride and honour in order to ensure that the best resources are retained and contribute to the Indian healthcare industry. Pay, power, recognition, empowerment and ideal working conditions are the points of discussion today."

the registered nurses are active because there is no system of live registration in India. In India, the nurses to doctor ratio is almost 1.5:1 while it is 3:1 in developed countries. Most nurses in service hold a diploma and some hold a bachelor's degree in nursing and midwifery. There are no specialist nurses in clinical practice. Twenty years back, nursing was seen as a lucrative profession, mainly dominated by the females. In contrast, today not many youngsters opt for the nursing profession. "The reason for not accepting nursing as a job-oriented profession by the youngsters are existing job insecurity, low pay and lack of conducive work environment in the healthcare set-up," explains Lt Col TG Chandrika, Nursing Coordinator, Kerala Institute of Medical Sciences (KIMS), Kerala.

Nurses in India Almost all hospitals, whether they are in public or the private sector face the challenge of attracting and retaining their nursing staff. According to Dileep Kumar, President, Indian Nursing Council, the nurse to population/patient ratio in India is low compared to other countries. The ratio was 1:110 in India and 1:100 in Europe. Many states in India face shortage of nurses and midwifes. Most states have no system for re-registration of nurses. About 13.28 lakh nurses and 6.18 lakh Auxiliary Nursing and Midwifery (ANMs) have been registered with various State Nursing Registering Councils. Only 40 per cent of www.expresshealthcare.in

Shortage There are many nursing colleges in India, both in the government as well as the private sector producing a sizable number of nurses every year. According to an official record, presently there are 2205 nursing schools, 1387 B.Sc. (Nursing) colleges and 414 M.Sc. (Nursing) colleges with a capacity of 88202, 68858 and 8000 students respectively functioning in the country. But, a sizeable chunk of the pass outs from these institutions go to the Western and Middle Eastern countries. The government has said that the Health Ministry is making concerted efforts to augment nurs-

ing personnel in the country. â&#x20AC;&#x153;We are setting up 269 new ANM and General Nursing and Midwifery (GNM) Schools, particularly in the remote and underserved districts of the country at a cost of Rs 2030 crores. This will significantly add to our training capacity and will result in an additional 22000 nurses being trained annually," said Union Health Minister Ghulam Nabi Azad in a recent press release. Another area of concern shared by the senior nursing staff is that newly trained nurses may not be industry ready and are bulldozed by the challenges faced on the job. "There has been mushrooming of nursing colleges across the country to tide over the issue of staff shortage. But the quality of nursing education that have been catered in these educational institutes need to be questioned. The nurses coming for practice in hospitals lack the skill as many of them have not got hands on training in hospitals. They have to be mentored into the clinical skills which cause a whole lot of stress as they are not able to complete their assigned task within their eight hours shift that they are in the clinical area," says Captain Thomas.

Migration Nurses are in high demand in developed countries such as the US and the UK, and recruitment of foreign nurses have become an attractive option as a quick fix to the ever growing national nursing shortages for these countries. Indian nurses are trained in English and are good workers. According to a report, 20 per cent of current Indian nursing school graduates go abroad. "Every year a good number of nurses pass out as graduates and post graduates, however, a majority of them find their way to other countries, not only for better pay and perks but also for their professional growth," explains Lt Col Chandrika. A survey conducted at the AIIMS of 448 nurse pracEXPRESS HEALTHCARE

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titioners, nurse educators and nurse administrators to a questionnaire administered to them in December 2004-January 2005 revealed that nurses working in the government sector seemed to be more worried about being unable to adjust to working conditions abroad, and therefore less keen to migrate. The fact that they enjoy better pay scales, a more relaxed work atmosphere and more facilities may have also played a part here. Apart from economic factors, dissatisfaction with working conditions and unhappiness with prevalent social attitudes towards nurses were identified as being of crucial importance for the international migration of Indian nurses. It was found that nurses working in the private sector and from some linguistic and religious groups were particularly prone to migration.

Safety Work-place induced injuries and illness are occupational health hazards for a nurse. The safety of nurses from such injuries and illnesses are not only impor-

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tant for them but also for the patients they serve. Nurses experience significant physical and psychological demands while working. Coupled with this, the organisation's pressure to multitask and establish quick turnaround time for patient care (early discharge, higher patient loads) are some of the problems that nurses face everyday. Individual nurses are overloaded with a number of tasks they perform. Both cognitive overload by engaging in multitasking and perceptional overload due to mechanical devices, illegible handwriting, long working hours, and patient demands lead to high incidence of unintentional errors, resulting in demotivating consequences. This has led the nurses to join various organisations to unite and fight against such events. Trained Nurses Association of India (TNAI) is one such organisation which seeks to uphold, in every way, the dignity and honour of the nursing profession; promote a sense of esprit de corps among all nurses; and enable members to take counsel together

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on matters related to their profession. On the occasion of the 73rd Biennial Conference of TNAI, Prof (Sr) Gilbert, President - TNAI in her presidential address said, “Safeguarding the nursing personnel at work place, be it mental or physical harassment of any form, TNAI’s council, governing board has taken serious cognizance of the improper policies, rules etc. of the hospital and institution e.g. keeping the bond, confiscating the original certificates, disparity in the pay structure, long working hours and so on.” “TNAI has presented these issues to the court by hiring a legal advisor (as per the resolution adopted in TNAI Council in November 2011). To fight for our rights and privileges we have to first understand our rights and privileges, make ourselves aware of these ‘rights’. Then only we can face these challenges through collective bargaining mode,” she added. “At TNAI headquarters we have one committee that deals with the grievances of nurses. Everyone needs to

understand that safety of our caregivers is vital to our clients-receivers of our care,” she further added. Most of the institutions and hospitals, are supposed to have grievance cell/committee where these issues can be tackled amicably in one to one meeting with the management/administrators of the concerned institution/hospital. However, the willingness of the institutes to address such matters is lacking in reality. Nurses will be able to overcome the challenges and enhance the quality of clinical nursing practice only if the management, administration focus on the betterment of nurses. "Healthcare is a changing field with constant new developments and industry is witnessing a shortage of nurses as a growing crisis situation. It is crucial that the healthcare segment focuses on the skill training recognition and retention of this critical resource. Continuing education and skill training is very important as it equips the nurses to handle these changes better,” sums up Capt Banerjee. mneelam.kachhap@expressindia.com

MARCH 2013

S|T|R|A|T|E|G|Y IN FOCUS

‘We need to think of women’s health as a human rights issue’ Leni Chaudhuri PROGRAMME HEAD, NAROTAM SEKHSARIA FOUNDATION

arotam Sekhsaria Foundation (NSF), a funding company was established in 2002 with a view to support individuals and organisations in the areas of education, health and livelihood. NSF works toward making a positive, that create a lasting and sustainable impact on society. Leni Chaudhuri, Programme Head, NSF, in conversation with Raelene Kambli, speaks about the domestic and health conditions of women in India and also elaborates on their endeavours in this sphere

What are the most important issues about women's health in India? Any medical conditions that need focus currently? Nearly 50 per cent of women suffer from anaemia related to under nutrition. Low BMI, under weight, stunting are all because of that. The other major concerns are HIV/AIDS, reproductive tract infections (RTI) and sexually transmitted infections (STI), medical implications of domestic violence and cancer of the breast and cervix. There is enough evidence to prove that poor general health leads to poor reproductive health. In India, fertility is intertwined with women’s health. It’s seen that a large percentage of maternal deaths and severe obstetric complications are because of the mother’s poor health conditions than facility related issues. High levels of maternal mortality are especially distressing because the majority of these deaths could have been prevented if women had adequate health services. While life threatening illnesses like cancers among women attract greater attention, more priority needs to be given to general health conditions and wellbeing of women. To begin with – nutrition related inadequacies. While at an individual patient level cancers and HIV are crucial, at the public health level, priority has be laid on adequate nutrition and access to healthcare.

Which are the social ventures that Narotam Sekhsaria Foundation (NSF) has initiated in the sphere of women’s health? The foundation believes MARCH 2013

that the health of Indian women is intrinsically linked to their status in society. Research on women’s status has found that the contributions Indian women make to families are often overlooked, and instead they are viewed as economic burdens.There is a strong preference for a male child in India, as sons are expected to care for parents as they age. This preference for a male child, along with high dowry costs for daughters, sometimes result in the mistreatment of daughters. Further, Indian women have low levels of both education and formal labour force participation. They typically have little autonomy, living under the control of, first their fathers, then their husbands, and finally their sons. Hence, any effort to improve their status has to deal with the totality of the situation. With this vision, the foundation aims to support programmes which have a comprehensive and holistic approach and are not aimed at episodic interventions. Some of them are as follows MASUM: To demonstrate a model on low cost and comprehensive method of screening for cervical cancer, women from communities have been trained in using the best technology at an absolutely low cost. The model has proven to be very efficient. SACH: Interventions to improve health status of women in an absolutely resource poor community in Barmer, Rajasthan SAMA: Advocacy against sex selection and use of technology for gender selection SNEHA: To strengthen the public health system for delivering better maternal and child health services VACHA: Research on adolescent sexual and reproductive health ARPAN: It is an initiative against child sexual abuse Nutrition Rights Programme: A model for community-based monitoring of health and nutrition related services in Maharashtra with special focus on women and children

Do you work in collaboration with the government? If yes, kindly elaborate. The foundation believes that in a country like India, to www.expresshealthcare.in

serve the length and breadth and to scale up initiatives, government is the only one who can do it. So the foundation always supports initiatives which are either planned in partnership with the government or aim at influencing/ strengthening government programmes. Our support to SNEHA, SAMA and the nutrition rights programme are geared towards advocacy with the government. The programme supported at SACH aims to enhance the reach of public health facilities. The programme at SNEHA is primarily towards strengthening the health posts to deliver ante natal (ANC) and post natal (PNC) services.

What has been the impact of these initiatives? SNEHA initiative has resulted in the increased utilisation of maternal and child health services at health posts in Mumbai. Cases of medical emergency and obstetric complications could be prevented and addressed early. MASUM has been able to demonstrate a model on low cost screening for CA Cervix. Through the health camps, thousands of women have been able to undergo examination and treatment for RTI and STI. Women diagnosed with early signs of CA have been referred for treatment thus avoiding the morbidities and mortalities. SACH has been able to help women in the underserved areas to access modern medicine and treatment for pregnancy and child birth, thus reducing the chances of infant and maternal mortality.

What are the challenges in delivering healthcare under these initiatives? Lack of responsiveness and accountability of the public health system which doesn’t have a gendered vision to healthcare, is often not in a position to upscale or integrate a good model which has been demonstrated by an NGO. The other challenges are underdevelopment and sheer lack of resources which make it difficult to sustain any innovation.

What is the biggest challenge in improving the health condition of women

in India? We have realised that societal factors and non medical factors in a major way contribute to the deplorable status of women’s health. Gender based inequality and discrimination plays a major role in negatively impacting women’s health. Lack of education, access to healthcare, lack of nutrition, gender based violence, poor economic conditions and the patriarchal nature of Indian society pose major challenges in successful delivery of health services to women. So, any intervention that doesn’t target the root cause, patriarchy, will not be able to achieve the desired result. The foundation believes that while innovations in modern healthcare for women need to be supported, programmes aiming at improving the social status of women should also be prioritised. If a woman has access to education, health, better nutrition and is free from discrimination, her health status with automatically improve.

What are NSF's plans for this year? To support programmes which aim at: ● Building strong leadership and a coherent institutional response ● Making health systems work for women ● Healthier societies: leveraging changes in public policy ● Building the knowledge base and monitoring progress

Any special message for people working for improving women health in India? We need to think of women beyond the Millennium Development Goals (MDG) and other global commitments that have focused primarily on the entitlements and needs of women. We need to think of women’s health as a human rights issue and not merely in terms of delivery of some essential services. A life of dignity, led with choices and free from social and person fears is the dream of every women ... we as advocates need to create a space for her to realise this dream. raelene.kambli@expressindia.com

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Radiology 'Tomosynthesis is the new gold standard in breast imaging' Recently, Rajiv Gandhi Cancer Institute & Research Centre (RGCI&RC), Delhi, installed the Digital Breast Tomosynthesis. M Neelam Kachhap talks to Dr Arvind K Chaturvedi, Director Radiology, RGCI&RC, to find out more about this new technique

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Thoracic imaging for Boerhaaveâ&#x20AC;&#x2122;s syndrome Dr Santosh Konde, Consultant Radiologist, Aditya Birla Memorial Hospital gives an insight into thoracic imaging, its role in diagnosis and treatment of Boerhaaveâ&#x20AC;&#x2122;s syndrome and the advantages that it offers over other imaging techniques horacic imaging is one of the advanced imaging techniques for evaluation of chest and lung diseases. It is an active service with close relationships with internal medicine, pulmonary and critical care, medical oncology, bone marrow transplantation, cardiology divisions, and cardiac as well as thoracic surgery services. Thoracic radiology is a speciality in radiology that looks at the structure of the lungs and heart. It uses the following imaging modalities: X-Ray plain

DR SANTOSH KONDE Consultant Radiologist Aditya Birla Memorial Hospital

Sagittal reconstructed oral dynamic CT scan revealed leak of oral contrast from esophagus (arrow) with pneumomediastinum

films, ultrasound, MRI, CT, and fluoroscopy. Need for thoracic imaging also occurs with conditions such as emphysema, pulmonary fibrosis, pulmonary embolism, diffuse lung disease, small airway disease, pulmonary nodules, dyspnea, pneumonia, and tuberculosis. In short, it includes lung disease, thromboembolic disease, and thoracic malignancies as it also incorporates functional imaging of the lung and cardiac imaging. In addition to conventional chest radiographs and CT, advanced imaging techniques include high-resolution CT scans for the evaluation of focal lung processes, diffuse lung disease and tracheobronchial pathology; digital

Axial oral dynamic CT scan revealed leak of oral contrast from esophagus (arrow) with pneumomediastinum and bilateral pleural effusion

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MARCH 2013

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and advanced multiple-beam equalisation radiography; and thoracic interventional procedures such as lung/mediastinal fine-needle aspiration and pleural drainage, and MR imaging of mediastinal and paracardiac pathology. Without the advance technique of thoracic imaging it would have been difficult to diagnose these diseases. Recently at our hospital, thoracic imaging was very helpful in the diagnosis of spontaneous esophageal perforation i.e Boerhaave’s syndrome, in a 59-year old male. The patient had no prior medical illness or addictions and was referred to the hospital due to progressive breathlessness and severe lower chest pain lasting over three days. Boerhaave’s syndrome is a condition, which is not easily diagnosed and usually confused with other diseases. Thoracic imaging goes a long way in the diag-

stent to close the perforation and thoracoscopic pleural drainage and toileting while feeding the jejunostomy at the same time. Post surgery elective ventilation was provided along with medicines. On the second day of surgery the patient was weaned off and extubated, he was shifted to the ward on the fourth day of surgery. Oral feeds were started after contrast study ruled out leakage and was then gradually increased.

Thoracic imaging improves the presentation of the organ by capturing two distinct images on a single sheet of double amulsion film with one exposure

ICD removed on the tenth day (right) and twelfth (left). The patient was discharged on 21 POD. Esophageal stent was removed one month after the surgery. Thoracic imaging improves the presentation of the organ by capturing two distinct images on a single sheet of double amulsion film with one exposure. This further assists in improving patient care with superior chest examinations without changing techniques or equipment.

Thoracic radiology is a speciality in radiology that looks at the structure of the lungs and heart

nosis of these kinds of diseases and curing it. The patient was admitted to the hospital and put on oxygen support with IV fluids and antibiotics to address his complaints. A chest X-ray was done which revealed pleural effusion and hydropneumothorax. Patient was then immediately admitted in the ICU. O n the left side, intercostal drain was inserted and 800 ml sero-purulent fluid was drained. Without wasting time, an urgent CT thorax with esophagogram was planned by the doctors with heamogram/biochemistry. Finally, the CT Thorax revealed esophageal rupture i.e Boerhaave’s Syndrome. After consultation with medical gastro specialist it was decided to cover the self expandable esophageal MARCH 2013

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R|A|D|I|O|L|O|G|Y INTERVIEW

'Tomosynthesis is the new gold standard in breast imaging' Dr Arvind K Chaturvedi, DIRECTOR RADIOLOGY, RGCI&RC

ecently, Rajiv Gandhi Cancer Institute & Research Centre (RGCI&RC), Delhi, became the first exclusive cancer care provider in North India to install the Digital Breast Tomosynthesis. M Neelam Kachhap talks to Dr Arvind K Chaturvedi, Director Radiology, RGCI&RC, to find out more about this new technique.

How many mamograms are done in a day/month at RGCI & RC? In a day, we do about 12 to 15 mammograms. In a month, approximately 30 new breast cancer patients come to RGCI. In Indian metro cities, breast cancer appears to be the most widespread cancer among womenâ&#x20AC;&#x201D; even leaving behind cervical cancer.

Why did you choose to install this new machine at the hospital? We installed this new machine to remain at the forefront of technology and for more accurate diagnosis of

breast cancer. Digital Breast Tomosynthesis is a step forward in breast cancer detection which can help spot cancers in dense breasts also as the breast is virtually sliced into multiple images in this imaging procedure. The X-ray arm sweeps in an arc over the breast to capture 30-40 images of each breast. The number of biopsies is drastically reduced as compared to after a mammography and the images are acquired in a single compression.

Is tomosynthesis the new gold standard in breast cancer imaging? Yes, I think it is the new gold standard in breast imaging, particularly for dense breasts.The conventional monogram technology delivers a twodimensional image of the breast which is then followed by continual investigation and at times unnecessary biopsies. Especially in the case of breasts with higher density which are composed of pockets of dense tissues surrounded by fat, overlapping of tissues makes it critical to judge the tiny spots called micro cal-

cifications, and other subtle signs of early cancer.

How much does the machine cost as compared to a mammography machine? The tomosynthesis machine costs about 250 per cent more than normal mamography machines.

As compared to mamography what radiation doses the patient is exposed to during tomosynthesis exam? Compared to mamography, the patient is exposed to almost same radiation dose during tomosynthesis.

What is the accuracy of tomosynthesis as compared to mamography? Tomosynthesis has about 70 per cent higher accuracy in dense breasts imaging. The accuracy comes down if the breasts are very fatty where mammography also does a good job.

When do oncologists suggest tomosynthesis? Is it

done simultaneously with mamography for all patients? Oncologists usually requests for tomosynthesis when mammography creates a doubt or when breast density is high.

How long does it take for tomosynthesis imaging? The entire procedure from undressing and changing into a gown will take about 10 minutes while the actual exposure lasts only a few seconds.

What are the benefits of tomosynthesis for the patients? The patient will benefit from a confident diagnosis and early detection of breast cancer. Also unnecessary biopsy is avoided due to accurate diagnosis using this technique.

How much would this tomosynthesis examination cost at RGCI & RC? It would cost Rs 3000 for tomosynthesis and Rs 4000 when tomosynthesis is done in addition to mammograhy. mneelam.kachhap@expressindia.com

'We make our products cost effective' Vivek Phalle, BUSINESS MANAGER-INDIA, X-RAY PRODUCTS, VARIAN MEDICAL INTERNATIONAL SYSTEMS

ivek Phalle, Business Manager-India, X-Ray Products, Varian Medical Systems International India speaks about the company's latest products and their contributions for the Indian radiology market, in conversation with Raelene Kambli

What is Varian's focus area in the field of radiology? Varian Medical Systems has proven performance in designing and manufacturing the critical components that enable high quality and dependable imaging systems in the radiology market. We specialise in X-ray tubes, flat

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panel digital detectors, image processing software and specialised hardware that provide solutions which enable our customers' success. This market has learned to expect Varian to develop and manufacture X-ray tubes and detectors to meet the ever increasing technology requirements for higher resolution imaging, faster patient throughput, longer life, smaller dimensions and greater efficiency.

Where would Indian radiology market rank globally ? The high level of service requirements combined with a www.expresshealthcare.in

competitive environment, makes the diagnostic imaging market in India different and unique.

What are the innovations that Varian wishes to bring to India? Varian is committed to provide our Indian customers exceptional value with quality products and X-ray tubes from local inventory. We have a dedicated facility able to guarantee rapid supply and valuable service to the India radiology market. This makes our products cost effective and readily accessible to the Indian market. We work closely with equipment

manufacturers in India to customise and develop solutions that enable them to compete within India and globally with world class technologies. Varian's flat panel detectors, image processing software and specialised hardware enable digital radiography which enables higher throughput and a lower cost on a per exam basis. Our high quality X-ray tubes support higher continuous power and shorter duty cycles that provide higher throughput and greater efficiency for more productive imaging systems, with a lower overall cost of ownership. raelene.kambli@expressindia.com

MARCH 2013

Hospital Infra Quality improvement: The elixir for hospitals Suresh Lulla, Founder & MD, Qimpro Consultants

Page 69 MAIN STORY

Prospering birthing centres Spa-like infrastructure at specialised birthing centres make the experience comfortable, joyful, and familiar. They provide a full continuum of family-centered care to mothers and their babies, beginning before conception and continuing after birth, reports M Neelam Kachhap

he event of childbirth and the marvel surrounding it, is a landmark experience that unites all. As childbirth has become more of a celebration, expecting parents look for a 'suitable venue for the event'. The new age 'birthing centres' sensing the opportunity are providing such venues. With protocols and facilities reflecting a drastic departure from traditional nursing homes and maternity wards at hospitals along with quick access to preferred gynecologist, these birthing centre are quickly gaining acceptance as the preferred destination to celebrate the birth of life. These birthing centres are adopting family-centered care model focussing more on the joy of birthing, a once in a lifetime event. It truly is a once in a lifetime event for many as urban couples today are increasingly adopting a nuclear family model, having only one child. Even if they have more than one birthing experience, couples want the experience to be less of an illness and more of happy memories.

Full package The new age birthing centres have a family-centered care model. This is emphasised by specific experiences programmed throughout the facilityâ&#x20AC;&#x201D;from greeting and guiding at the front reception desk to attentive, personalised well-baby services and pediatric acute care. While all birthing centers have Mother Care Packages, some offer specialised services like Education Programme, Health Spa, Antenatal Workshop and Management of Baby Affairs (MBA). "With advanced antenatal, birthing, postpartum, neonatal and gynaecological services, we MARCH 2013

Delivery suite at Hinduja Surgical Centre in Khar have revolutionised the concept of delivery, for the new generation of parents who wish to celebrate the experience, along with high standards of birthing care," claims Ravindra Pai, Senior Vice President, Apollo Health & Lifestyle (parent company of Cradle). These centres also offer special classes and programmes on childbirth preparation, Lamaze classes, parents and sibling education programmes, antenatal exercises including aerobics, yoga, diet and nutrition and genetic counselling by trained personnel. In addition, provisions for special request like culturally significant dates, valued for the good luck they imbue upon the newborn, result in a high number of scheduled c-sections. The length of stay is dramatically longer, as the new mom enjoys several days of post-natal care. A long list of visitors, childcare products, gift shop, cafe; all www.expresshealthcare.in

these concerns are incorporated into planning for every step of the patient journey and every facet of that experience. "In addition to the best quality of care, we provide a lot of unique infrastructural facilities such as in house Au Bon Pain cafĂŠ, branded mom and baby shops, Parentcraft room, flower shop, Momâ&#x20AC;&#x2122;s Lounge to pamper mothers, high end suites and a photo studio," explains Esha Tiwary, Chief Marketing Officer, Cloudnine.

Design considerations The traditional maternity unit were divided into labour and delivery and recovery rooms, in addition to postpartum room. In recent years birthing centres have replaced traditional multipletransfer room design to more contemporary facility design. This design offers mothers, fathers and their families a home-like non-hospital environment in which to give birth without compromising

medical care, with care provided by a well-integrated team of specialist and staff. They offer comfort, superior service and friendly hospital design that include patient and family-centered environment and provision of full continuum of Labour, Delivery, Recovery and Postpartum (LDRP). "Infrastructure facilities play a crucial role in providing quality maternal care. Providing round the clock maternity care is also essential to control neonatal mortality," reiterates Dr Deepa Krishnan, Consultant, Obstetrics and Gynaecology, Nirmala Nursing Home, Karur, Tamil Nadu. The new design offers an advantage to not only families, but also to nursing staff and medical staff alike allowing the center to meet customer and provider satisfaction. Other than the LDRP rooms these birthing centres also may have single room EXPRESS HEALTHCARE

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With advanced antenatal, birthing, postpartum, neonatal and gynecological services, we have revolutionised the concept of delivery Ravindra Pai SENIOR VICE PRESIDENT, APOLLO HEALTH & LIFESTYLE

New age birthing centres

Infrastructure plays a crucial role. Providing round the clock maternity care is also essential to control neonatal mortality Dr Deepa Krishnan

Birthing centres make business sense only if the choice of location and gynaecologist is made correctly Dr. Manika Khanna

CONSULTANT, OBSTETRICS AND GYNECOLOGY, NIRMALA NURSING HOME, KARUR, TAMIL NADU

GYNAECOLOGIST GAUDIUM, DELHI

experience. Family spaces include a children's play area, a lounge, a nourishment area, lactation rooms, and family sleep rooms with shower facilities.

Nursing homes In the 80s, maternity centers were in abundance in India. "Conventionally in India, birthing services have been delivered in neighborhood nursing homes, largely owned by senior gynecologists in the city/town and who have been associated with the family for generations," explains Rajen Padukone, MD & CEO, Manipal Health Enterprises. Be it Nirmala Nursing Home, Chennai; Sevanjali Hospital & Maternity Home in Indore;

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Shubham Maternity hospital, Nagpur or Suma Maternity Hospital at Vizag all have the same success story to tell. But some have realised the merits of changing with the demanding times and have re-branded themselves, creating a much more 'polished version' of their earlier self. Like, Pune's Oyster & Pearl Hospital was created of Shree Clinic, a renowned maternity hospital of the late Dr HN Phadnis.

maternity suits, Neonatal clinic and Neonatal ICU. Neonatal clinic equipped with 24 hour foetal monitoring system, ultrasound machines, Neonatal Intensive Care Unit (NICU), incubators are mandatory for any maternity centre to provide quality healthcare, adds Dr Krishnan. Visibility, accessibility, privacy, noise reduction, and lighting are all critical elements in the design of these birthing centres. The inclusion of family and living-in of the caretaker/father are critical design considerations, as is noise transfer from the corridor to patient rooms. Inside rooms, sophisticated colour palettes, delicate patterns, and spatial configurations provide soothing environment for the mother. Elsewhere in the centre spalike surroundings—soothing natural materials, maximisation of daylight, and the tranquility of waterscape—all taking a cue from the verdant setting enhance the birthing

With the interstate migration of the working class, young expectant couples found it difficult to choose the right place for their first birthing event. Plus, the foreign returned working class knew what to expect. This led to multi-speciality chains first trying to accommodate these demanding customers in luxury birthing suits and later launching stand-alone luxury birthing centres. The prominent among those are the The Cradle by the Apollo

AND

IVF

EXPERT,

hospital group and Le Femme from Fortis Hospitals. Specialised birthing centres exist in most cities in India today. For instance, a city like Bangalore has a number of stand-alone birthing centres like Cloudnine, Lady Hospital, Cradle, The Nest etc., with most of the speciality hospitals like Manipal, BGS Global, Vydehi, Columbia Asia having a birthing ward at the hospital. However, a smaller city like Jaipur may have many nursing homes but only one luxury birthing centre called Cocoon. On the other side maternity hospitals like LifeSpring fill the void of high quality maternal and child healthcare at affordable rates for lowincome population. www.expresshealthcare.in

Market talk Birthing care is a lucrative market. With approximately 20 million births in a year, 10,000 per day, 400 per hour and 62 per minute, birthing offers an immense market opportunity. According to a report by McKinsey, the market for maternity care in India was around Rs 6,000 crore in 2009 which was expected to grow to Rs 11,000 crore by 2012. "Driven by rising disposable incomes and increased insurance penetration, boutique mother and child centres, with a unique and compelling value proposition are gaining wider acceptance in metros and urban areas and are likely to grow faster than the 15 per cent growth of general healthcare," says Padukone. In addition, the lower investment and lesser gestation period than conventional hospitals add to the attraction of stand-alone birthing centres as a good business idea. "With a relatively lower investment per bed and potentially higher average revenue per patient (significant price elasticity for differentiated service), the classical ROCE measure is likely to be higher and for these reasons, the business of standalone birthing centres appears to make good business sense," says Padukone. However, presenting a different theory, Dr Manika Khanna, Senior IVF expert & Gynecologist, Director, Gaudium, Delhi says, "Birthing centres make business sense only if the choice of location and gynaecologist is made correctly." Indeed, good gynaecologist is the main attraction in any birthing centre. The other reason for the success of birthing centres is the increased awareness of safe delivery options and increased medical insurance. With government efforts like the 'Janani Suraksha Yogna' and insurance schemes like Employees State Insurance Scheme (ESIS), Rashtriya Swasthya Bima Yojana (RSBY) and Central Government Health Scheme (CGHS) along with the state level schemes like Rajiv Arogyashri (Andhra Pradesh), Yeshasvini (Karnataka), Vajpayee Arogyashri (Karnataka), Chief Minister Kalaignar’s Scheme (Tamil Nadu-later relaunched as Chief Minister’s Comprehensive Health Insurance Scheme), RSBY Plus (Himachal Pradesh),

and the proposed Apka Swasthya Bima Yojana (Delhi) women are more empowered to spend on safe and happy delivery. While, there is a sizable population that can afford the high-end birthing services, still there is a larger growing market for the lowerincome group that demands an inexpensive but quality birthing service. Besides 15 per cent of in-patient spend is on maternity services, providing a huge play for these caregivers. Lifespring Hospitals Hyderabad, caters to this population.

In future Birthing centres are gaining popularity but they will not replace nursing homes, maternity hospitals or regular maternity wards of specialty hospitals. They do have their set of advantages but may also have some disadvantages. While they provide homelike ambiance along with compassionate staff members, they lack expertise to handle complicated pregnancies. "The drawbacks are that medical and surgical high risk patients, who require a multi disciplinary approach cannot be treated easily at (such) centres," says Dr khanna. Agreeing Padukone says, "While these birthing centres can handle most routine /normal delivery cases, where there is a concern is in their ability to handle complex/high risk cases. For example, children born pre-term, congenital defects etc. In the initial stages of a centre, till volumes stabilise, such centres may find it difficult to engage a full-fledged neonatologist. The absence of a full time resource can at times prove to be a constraint.” "Maybe the time is ripe for strong healthcare brands to enter into this space—by establishing such centres within tertiary care hospitals with a distinct identity, differentiated ambiance and service experience–leading to healthy combination of pampered care coupled (with) patient delight and the ability to manage all potential risks," he adds. In future, this segment may see new players entering the market and changing its dynamics, but for now we can wait and watch as these birthing centres grow in India. mneelam.kachhap@expressindia.com

MARCH 2013

H|O|S|P|I|T|A|L|I|N|F|R|A INSIGHT

Quality improvement: The elixir for hospitals Suresh Lulla, Founder & MD of Qimpro Consultants elucidates on the need for quality improvement in hospitals, its advantages and opting for Lean Six Sigma to achieve it

ot long ago, the concept of quality simply meant the absence of defects from a manufactured physical good. In healthcare, quality tended to be limited to established standards for structure and process in clinical care. We now understand that this ‘limited quality’ or ‘little q’ view restricts our ability to satisfy our customers. To address this challenge, the Quality Council of India (QCI) took on the responsibility of expanding our approach to one of ‘total quality’ or ‘Big Q’ in all disciplines, including healthcare. More specifically, the National Accreditation Board for Hospitals and Healthcare Providers (NABH) was established as a constituent board of QCI. The NABH standards for hospitals provide a framework for quality assurance and quality improvement. The standards focus on patient safety and quality of patient care. Over and above, NABH accreditation provides assurance to the stakeholders that the hospital complies with statutory and regulatory requirements. All these measures are in the right direction. So why is it that we, as patients and customers, do not perceive the expected positive difference post-accreditation of a hospital? Quite simply, the emphasis is on quality assurance only. Not quality improvement. QCI was quick to realise this gap and appointed Qimpro as an implementation partner for a National Demonstration Project (NDP) to facilitate Lean Six Sigma (LSS) in nine NABH accredited hospitals in western and southern India.

LSS Projects The LSS Projects identified at the various hospitals addressed a wide spectrum of chronic problems in nonclinical processes. The selected projects directly impacted patient experience. Turn-around time for patient discharge: TurnAround Time (TAT) for Patient Discharge was the most popular problem in the NDP and as many as six hospitals had identified it as a project. The key drivers for MARCH 2013

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best suited the layout of the hospital. A printout of the layout, along with the patient’s route during the health check, was presented to the patient. This helped in saving idle time lost in searching papers, for the next test centre.

Key success factors ●

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this change were: ● Challenging the mindset against preparing discharge summary on the previous evening. ● Collaborative ownership between nursing and doctors for minimising the time taken to check and approve discharge summary. ● Collaborative ownership between nursing and accounts for minimising the time taken to prepare the final bill and intimate the same to the patient’s relative. Idle waiting time in OPD services: Idle waiting time in OPD was also a popular project in the NDP. The key drivers for reducing waiting time were: ● Streamlining the appointment process and encouraging more appointment patients. ● Improving the patient flow between the various laboratories through better coordination. ● Advance intimation to patients with special needs before they came for the appointment. Turn-around time for laboratory reports: Several hospitals opted for improving this process. The key drivers for reducing the TAT for lab reports were: ● Reducing wasteful effort of maintaining multiple entries for the same patient in multiple registers. ● Making radiologists accountable for releasing reports after a fixed number of images were completed. This also included www.expresshealthcare.in

a structured escalation process if reports were not released on time. Turn-around time for OT services and OT utilisation: Some hospitals selected TAT for OT services and OT utilisation for their LSS project. ● The main driver for change in this process was the reduction in the pre-surgery and post-surgery cycle times. ● Reduction in pre-surgery cycle time was achieved by pre-ponement of all activities related to surgical consents and financial approval to previous evening. ● Reduction in post-surgery cycle time was achieved by improving the efficiency of clearing the OT after completion of surgery. Turn-around time for ambulatory services: One hospital focused on ambulatory services. ● The key driver for reduction in TAT for ambulatory services was extensive training and sensitisation of the nursing and ambulatory staff regarding the criticality of their process. ● Also, mock drills were conducted by senior staff to demonstrate that shorter TAT was possible. Turn-around time for comprehensive health checks: Another hospital focused on comprehensive health checks. ● The key driver for reducing the TAT for comprehensive health check was the realignment of patient movement between the various test centres that

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The top management at the nine hospitals were personally involved in implementing the improvements for their LSS projects. The above led to the team members taking ownership of the projects. Implementing the change was seamless. The identified problems had high visibility. Hospital staff faced frequent patient dissatisfaction in these problems areas. The structured methodology for problem solving generated significant positive interest among the team members because they could visualise the distinct possibility of a practical solution at the end of their projects. Process mapping, facilitated collaboration amongst team members. Several commented that this was the first time they had actually stepped out of their silos and practically “seen” the complete end-to-end process.

Conclusion Make a habit of quality improvement. Challenge the standard!

About the author He is the Founder & MD of Qimpro Consultants; Founder & Director of BestPrax Club; and Chairman of the IMC Quality Awards Committee – IMC RBNQA; IMC Juran Medal. He is Regional Coordinator - Western India, Quality Council of India; and Director - Membership Retention and Engagement, Global Benchmarking Network. He is also a Member, Governing Board, Institute of Health Management Research EXPRESS HEALTHCARE

INTERVIEW

‘If you educate the girl and the mother, you are educating the family ... and an entire nation’

Dr Duru Shah, CHAIRPERSON, GYNAECWORLD

proficient gynaecologist and a benevolent woman, Dr Duru Shah has earned abundant goodwill for the work she has been doing. She has not only been the winner of several national and international awards for excellence in her field but also acted as the voice of the industry for promoting best practices. She has been a social crusader as well to uplift the health conditions for women and children living in the hinterlands of India. Her work is certainly admirable but what makes her more lovable is her humble nature and her unfailing determination to elevate the current conditions of women in India- be it health-wise or socially. Raelene Kambli in a tète-à-tète with the chrismatic doctor, finds out more about her experiences working for women and children in India and also on her plans for the year ahead

Excerpts... Dr Shah, you have been empowering women in India in many ways for a long time now. Tell us about your experiences through this journey? Which are the social ventures that you are associated with? Discrimination against women and girls remain the most prominent form of inequality in our country. Gender-based violence, economic discrimination, reproductive health inequities and harmful sociocultural practices are the various ways in which our women are suffering. What so many do not realise is that when you educate girls and young women on reproductive and sexual health, you are educating the mothers of tomorrow which will reap rich rewards in the future. It is a well known fact that if you educate the girl and the mother, you are educating the family and in the process, an entire nation.

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I have seen and met women from all strata of society both personally and professionally and the attitudes and mind sets towards women are no different. Whichever socio-economic class they come from. The only thing which is really obvious, is that when the woman is educated and self-sufficient financially, the attitude of men changes for the better towards that woman.

aegis of FOGSI.This project was undertaken to reduce the rate of women dying during childbirth which is very high in that region.

You stress on the importance of educating women in India and are actively involved in several education, health and exchange programmes. Please elaborate on these social ventures, especially the ‘Growing Up’ programme and the Adolescent Empowerment Project “Kishori”?

I think this can be done by way of: ● Education of the adolescent: to prevent unsafe abortions and transmission of HIV and other infectious diseases, availability of youth friendly services for young people where they can freely approach healthcare. ● Preventive healthcare for elderly to reduce disability. ● All vaccinations to be included in the National Programme. My passion has always been to focus on preventive health, especially in the young girls and women as they are the mothers of tomorrow. Currently, I am focusing my attention on combating sexual abuse, especially in young girls. Towards that end, more recently, I had partnered with the leading NGO, SNEHA and was part of their ground breaking 16-day campaign on gender violence issues, ‘Breaking the Silence on Violence'.

We have initiated many social programmes over the years such as ”Growing up” the urban adolescent empowerment project which educated approximately five million school going girls in India on adolescent reproductive and sexual health. Then we had 'Kishori' the urban slum and community-based adolescent empowerment programme in Dharavi. This programme aimed at empowering adolescent girls with health, knowledge and vocation – we adopted 2000 girls in Dharavi, the largest slum of Asia. The programme in Dharavi was done on the lines of the UNICEF education programme called ‘Life Skills’ and has been very effective here. Then we also had a rural maternal health programme 'Save the Mothers', that I had initiated and spearheaded when I was the President of Federation of Obstetric and Gynaecological Societies of India (FOGSI). There was also "Suprabha Ganga Yatra” (a five-year project) - rural women’s health programme, which was initiated on January 18, 2006, under the www.expresshealthcare.in

Apart from education, you also speak about increasing preventive healthcare. What are the strategies that India needs to adopt in order to prevent diseases especially among women? What is your vision in this regard?

Moving onto your achievements, doctor you became India’s first gynaecologist to receive the prestigious FIGO Distinguished Merit Award during the opening ceremony of the World Congress of the Obstetrics and Gynaecology. How do you feel? Appreciation always feels good, especially when it comes from the globally renowned FIGO - The International Federation Of Gynecology & Obstetrics. The FIGO Distinguished Merit Award means a lot, not only because it is

a global award, but more importantly because it recognises all the work I have done and my initiatives as President of FOGSI here in India, in improving women’s health especially in the preventive arena -- building awareness and educating our women on reproductive and sexual health, the importance of planned pregnancies, care in the pre pregnancy stage, during and post pregnancy, prevention of HIV and transmission to the new borns. All this adds up to my overall focus and ongoing efforts towards empowering women in our country because as they say, you educate the woman and you are educating the entire family, the nation when you look at it. These are the mothers of tomorrow's children.

And that really takes care of our future doesn’t it? As an Indian, I felt very proud to represent India on the world stage. As a woman, I felt elated to be recognised for my work in women’s healthcare.

What are your plans for this year? My plans for this year are to work on the area of :1. Sexual abuse – To improve the collection and recording of medical evidence which will assist in getting justice for the victim. 2. Menopausal health -- To bring menopausal health to the centre stage and to focus the attention of our policy makers on this key stage of a woman’s life.

Any special message for the women in the healthcare industry? You are the privileged women in our society and you should utilise your knowledge and expertise to its fullest capacity in creating a better healthcare environment for women in our country. raelene.kambli@expressindia.com MARCH 2013

L|I|F|E IN FOCUS

‘Women need to be more serious and proactive about their health’ Kanchan Naikawadi, DIRECTOR, INDUS HEALTH PLUS

health? How can they be tackled effectively?

anchan Naikawadi, Director, Indus Health Plus and a leading woman entrepreneur in healthcare talks about women entrepreneurs, healthcare scenario in India, improving the arena of women's health and Indus Health's strategies for the same, in conversation with Lakshmipriya Nair

As a renowned healthcare entrepreneur, how is the playing field for women entrepreneurs in this arena? It depends. I can speak from my experience and tell you my own story. It has been difficult for me to take up the venture and drive the initiative, not because I’m a woman, but because the whole idea of preventive health check-up was a new and radical concept, when we started out in 2000. Generally speaking, irrespective of being a man or a woman, hard work and perseverance are required to make any venture a success, and especially so if it is in healthcare.

What are the unique challenges that you faced as a woman entrepreneur? As an entrepreneur, the real challenge came from a certain section of the doctors who felt their livelihood would be at stake if people take to the idea of preventive healthcare. The ‘push’ factor as far as selling is concerned also met with resistance from people in general, as many were not open to the idea of proactively undergoing a medical check-up without the symptoms of any illness. We convinced the doctors by making them understand the fact that if people are more conscious about their health and take proactive measures in terms of a medical check-up, the likelihood of early detection of a certain class of diseases like cancers, heart diseases or diabetes, at an early stage would not only increase the chances of survival for the patient, it would give the doctors a meaningful chance to successfully treat them. With lifestyle diseases like cancers, heart diseases, diabetes, etc. the symptoms are not manifested until the damage is almost complete. Making ‘asymptomatic’ people understand this basic fact through interactive seminars with doctors, was something that brought about a shift in perspective and made them realise the importance of early detection and as a corollary, preventive medical check-ups.

How has Indus Health plus grown over the years and what are its goals for the current year? The last 12 years saw Indus grow in the state of Maharashtra and spread across its length and breadth. Today, the word Indus is synonymous with preventive healthcare. In the next ten years we aspire to have a pan Indian presence and MARCH 2013

make Indus a household name amongst every Indian. We have already taken bold steps in making that dream a reality. Indus is present in nine states which include Maharshtra, Goa, Karnataka, Gujarat, MP, UP, Harayana, Delhi & NCR, and Andhra Pradesh. We have recently forged tie-ups with Apollo Hospitals in Ahmedabad and Hyderabad, and Vikram Hospital in Bengaluru. We have already screened a population of 3.5 lakhs and have a modest ambition of reaching out to a million people in the next five years. We also wish to extend our reach from the present number of 29 cities to 50 cities in a couple of years.

What are the strategies planned to achieve the set targets? The strategy is simple. We will try and create more awareness on the fatal nature of lifestyle diseases to encourage and enlighten asymptomatic people about the life saving benefits of a preventive health check-up. We will also try to build new tie-ups with premium hospitals and diagnostic centres in cities we are yet to enter.

Moving on to healthcare in India, what are major issues in women's

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The responsibilities of a modern working woman far outweigh that of a man. As a mother she cares and nurtures her children, as a daughter or a daughter-in-law she cares for her parents and in-laws. As a wife she cares for her husband and the household chores, while as a professional she cares for the work. An involvement, both emotional and mental on so many fronts and at so many levels takes its toll on a woman’s health. Gynaecological disorders like endometriosis, infertility and menstrual disorders have been co-related to stress. Rise in medical conditions like polycystic ovaries and breast tumours, though not related, leads to stress and depression. Other physiological disorders include hormonal imbalance, high blood pressure, irregular heart rhythms, higher cholesterol levels, weakened immune system and damaged arteries leading to the development and progression of cardiovascular disease, especially coronary heart disease. Certain physical effects are also manifest in the form of frequent episodes of migraine, hair fall and obesity. In spite of being a pillar of strength and happiness for the whole family, a woman’s health more often than not receives the least priority. The apathy is encouraged by the woman herself in most cases as she places the well-being and good health of her family far ahead of her own. The change, therefore, has to take place in the mindset, especially that of women, more than anything else. With the increase of gender specific diseases, the necessity of a regular monitoring of women’s health is beneficial not only to her per se but to the whole family. A proactive role on the woman’s part to care for her own health is therefore the road ahead.

What are the services offered especially for women by Indus Health Plus? Are there any plans to augment it with any more additions? We do offer a special package for women. The package includes tests that can help in early detection of breast cancer and cervical cancer. Tests to detect problems in the heart, thyroid, liver, lung, and blood are also included.

What are your recommendations to improve healthcare delivery for women? Women need to be more serious and proactive about their health.

What is your message for other women entrepreneurs? Never stop believing in your dream. Work hard. You will make it. lakshmipriya.nair@expressindia.com

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L|I|F|E

People Dr Savitri Shrivastava receives PICS Achievement Award She becomes the first woman and the first Indian to receive this award

rofessor Savitri Shrivastava, Director, Paediatric & Congenital Heart Diseases Escorts Heart Institute and Research Centre New Delhi recently received the ‘Lifetime Achievement Award’ at the Annual PICS (Pediatric Interventional Cardiology Society) meeting held in Miami, Florida. She is the first Indian and the first woman as well to receive this prestigious award from the largest international society on paediatric interventional cardiology.

The award aims to encourage and recognise those who have contributed exceptionally to the field of interventional cardiology in congenital and structural heart diseases. The target audience at the symposium were paediatric cardiologists, cardiac surgeons, adult cardiologists, healthcare professionals with interest in the care of children and adults with structural heart diseases. Dr Shrivastava, a distinguished cardiologist, has received Lifetime Achievement Awards twice before for outstanding contribution to cardiology. She received these accolades from

Dr Shrivastava has received Lifetime Achievement Awards twice before for outstanding contribution to cardiology Dr APJ Abdul Kalam, President of India, in 2006 and Dr Pratibha Patil, President of

India in 2008. She is the Founder of Paediatric Cardiac Society of India and a pioneer in the country to perform balloon mitral valvotomy and other interventional procedures. The main focus of the symposium was on the latest interventional catheter strategies for congenital and structural heart disease in children and adults. Live case demonstrations were showcased from catheterisation laboratories from the eight centres around the world. There were special sessions which included debates on closure of all types of septal defects, percutaneous valve implantation and hybrid techniques.

Dr Sameer Ahmed Khan joins Rockland Hospitals as the CEO He will handle operational and P&L responsibility for the group

r Sameer Ahmed Khan has joined the Rockland Hospitals Group as its CEO. He will handle the operational and profit and loss (P&L) responsibility for the company and is expected to take Rockland Group of Hospitals to the next level of scaling up from 80 operational beds to over 800 beds. Dr Khan has over a decade of experience in managing

P&L, strategy, medical operations, projects, technology management, hospital planning, acquisition & mergers and clinical it in some of the large and respected healthcare organisations in the country. Before joining Rockland he has worked for Nova Medical Centres in the capacity of the CEO. He has also worked with Fortis and was part of the team which took Fortis from

being a single hospital to a 65 hospital chain. At the time of his leaving Fortis he was heading the department of Medical Operations and Strategy for the group. He has worked with the Apollo Hospital Group as well and was part of the start-up team which started and commissioned the first 10 clinics and planned the next phase of growth under the Apollo Clinic

brand in India. He has also spent considerable time with the Border Security Force as a practicing clinician. Dr Khan, with his hands on experience in process driven, large healthcare organisations, coupled with his strong operations, business acumen and leadership skills is expected to help Rockland to enhance its leadership position in the industry.

Dr Tamorish Kole: 2013 IVLP Program nominee from India ‘Emergency Preparedness and Crisis Management’ is the theme for IVLP this year

r Tamorish Kole, the President of Society for Emergency Medicine, India has been nominated for the latest recipient of the International Visitor Leadership Program (IVLP). The IVLP is the US Department of State’s major

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professional exchange programme that seeks to build mutual understanding between the US and other nations through carefully designed short-term visits to the US for current and emerging foreign leaders. These visits reflect the international visitors’ professional interests and support the foreign policy goals of the US. International visitors are the current or emerging leaders in government, politics, the media, education, the arts, business and other key fields. The theme of the programme this year is ‘Emergency Preparedness and Crisis Management’.This project, from June 3 – 21, 2013 is

designed for experts in emergency preparedness, crisis management, disaster relief, refugee assistance, and posttraumatic stress, working in government, medicine (physical and mental health), humanitarian assistance, faith-based organisations, and journalism. Meetings, site visits, emergency simulations, and hands-on activities will highlight US methods of preparing for, managing, and assisting victims of man-made and natural disasters, emergencies, and crises. In addition, the programme will explore the national and international coordination of responses in the aftermath of environmental emergencies.

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Given the theme, Dr Kole, the Head of Emergency Medicine of Max Healthcare, India and the Site Director of the Masters in Emergency Medicine (MEM) programme at his institution affiliated to The Ronald Reagan Institute of Emergency Medicine, George Washington University, Washington DC has been chosen for this programme. His subspeciality interest is Disaster Medicine and Mass Gathering Medical Care for which he serves as a core group member in Hospital Safety and Emergency Management Exercise Committee of National Disaster Management Authority of

India. He will visit universities and public and private agencies that research, design, plan, and implement local and worldwide preparedness programmes. Over 320 current and former heads of government and state and many other distinguished world leaders in the public and private sectors have participated in the International Visitor Leadership Program. Margaret Thatcher, Tony Blair, Juliya Gillard, Manmohan Singh, Indira Gandhi, Mahathir Mohamad, Hamid Karzai, Ranasinghe Premadasa, are some of other world leaders who were the recipients of this programme.

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Trade & Trends ‘My commitment towards the cause of touching lives through our services is renewed every day’

Ziqitza @ Medicall 2013

Sweta Mangal, CEO, Ziqitza Healthcare

Ziqitza Healthcare received a good response at Medicall 2013 which was held in Ahmedabad and garnered a lot of attention for their services

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Speak out with Ziqitza Health Care A An endeavour that appeals to the citizens to do their bit to improve the society

s a nation, we have always believed in a harmonious existence and a mutually beneficial environment leading to the growth of both individual and nation. Hence, whenever an act of hatred against a fellow citizen occurs or the secularity of the nation is threatened, it has led to a nationwide condemnation and ridicule by one and all. Today, we live in an era where due to widespread technology every Indian can voice his/her underlying opinion and make their concerns felt due to social media. Thus, these issues once dormant in one’s mind have found a channel and a very potent one at that. Though this is very essential as ‘Freedom of Speech’ is a fundamental right,

‘Speak Out’ is an initiative taken by Ziqitza Health Care which appeals to the citizens to do their bit to improve the society the same energy can also be channelised in general betterment and good of the society and it begins with us! The citizens of the nation! ‘Speak Out’ is an initiative taken by Ziqitza Health Care which appeals to the citizens to do their bit to improve the society. To be pro-active in every walk of life than depending on officials considering that it’s their job. Be it sparing a few moments from their busy schedule to help a needy they spot on the road to pointing out domestic vio-

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lence in their society and breaking the pattern (Remember the youth of tomorrow are the children of today. And they learn from us). The campaign takes another leap this February asking citizens to help Women’s Helpline by dialling 1298 and help in tackling atrocities against women. The number will be highlighted across the company’s social platforms and through a series of activities they tend to spread the message that help is only four digits away (1298). They also plan to run a hall of fame section recognising those citizens who have taken an initiative to point out atrocities against women and taken a stand to never let it happen again. Join them on this endeavour as they set out to do their bit. A start of a journey from being an unfazed onlooker to an aware, sensitive and an active citizen. MARCH 2013

T|R|A|D|E & T|R|E|N|D|S INTERVIEW

‘My commitment towards touching lives through our services is renewed every day’ Sweta Mangal, CEO, ZIQITZA HEALTHCARE

weta Mangal, CEO, Ziqitza Healthcare talks about her company, its endeavours, working for the betterment of women and their new endeavour ‘Speak Out’

Please tell us about your association with Ziqitza and your journey so far. I came back to India after pursuing higher education in the US, and started working in a corporate set up. In 2000, few personal experiences of my close friends Ravi and Shaffi made me realise the need and importance of a well-networked ambulance service in India. Along with my friends, I decided to work towards developing a strong EMS foundation in the country and laid the foundation of Ziqitza Health Care Limited (ZHL). ZHL journey has truly been rewarding and full of learning. Though we came across a lot of challenges and hurdles, it is those experiences that allowed us to reach the stature that we enjoy today. It seems like yesterday when we started our service with just two ambulances and today we are operating over 860 ambulances across the country and served over two million people. I am indeed filled with pride when I see that our dream of providing ambulance services to all, irrespective of income, is indeed creating a significant social impact across the globe. My commitment towards the cause of touching lives through our services is renewed every day when we lis-

ten to the wonderful stories of the lives we have touched and served. Apart from being a leading ambulance service provider, what are the other business initiatives that you have taken? I always dreamt of setting up world class education institution in Beawar, Rajasthan (native place). Mangal Newton School is the extension of my dream which has shaped the careers of many students. I am also the Trustee and Co-Founder of Life Supporters Institute of Health Sciences, which is the training arm of ZHL and has trained over 24 personnel across India. Tell us about Ziqitza’s initiatives that are focused on women. Being a woman entrepreneur myself I have always believed in the empowerment of women. In fact, at ZHL most of the senior management team comprises women performing most critical functions. Also in 2008, we took the lead to start the 1298 Women’s Helpline. Are you aware that a recent WHO document states that violence against women causes more death and disabilities in 15-44 age groups than cancer, malaria and traffic accidents? Mumbai has the highest percentage of victims. In response to the grave situation of violence against women in the city of Mumbai, the Women’s Helpline 1298, an initiative by Sheriff of Mumbai, Dr Indu Shahani

to help women who are facing violence or sexual harassment, was launched on January 28, 2008 with the assistance of leading women’s 75 NGOs in India. On calling 1298, from any mobile or landline, woman in distress are directed to relevant NGOs who provide counselling and assistance. The helpline has received over 30,000 calls since inception, where we have resolved calls related to violence and harassment. It makes me feel very proud to be of some assistance to women in Mumbai. What is the ‘Speak Out’ initiative by Ziqitza? ‘Speak Out’ is an initiative by ZHL which appeals to citizens to do their bit to improve the society in which we reside. To be pro-active in every walk of life rather than depending on officials, considering that it’s their job. The campaign took another leap this February asking citizens to help the Women’s Helpline by dialling 1298 and requesting them to help in tackling atrocities against women. We wish to spread the message that help is only four digits away (1298). Any special message for our readers on International Women’s Day? To live a happy life we need to tie it to the goal and not to people or things. The day we realise this thought stated by Albert Einstein the world will be a happy place to reside in.

Ziqitza@Medicall 2013 Ziqitza Healthcare received a good response at Medicall 2013 which was held in Ahmedabad and garnered a lot of attention for their services

MARCH 2013

excited to know about the company and showed interest in associating with them. Ziqitza claims that they got a platform to leave their traces in AhmedabadGujarat and they hope to associate with people in near future.

iqitza were the exhibitors at Medicall 2013 which majorly focused on healthcare industry and its trends. They showcased various training programmes for medical and non medical personnel to hone their skills. They also highlighted their major offering of ambulance outsourcing which is very beneficial for hospitals. Ziqitza received a spectacular response from the attendees and the visitors were

Contact: Ziqitza Healthcare AAA, CCSC Building 2nd Floor, C Wing, BKC, Bandra (E), Mumbai Tel: 022 26578845

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