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INDIA’S FOREMOST HEALTHCARE PUBLICATION VOL. 6 NO.9 PAGES 112
September 2012 ` 50
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Healthcare INSIGHT INTO THE BUSINESS OF HEALTHCARE
VOL 6. NO 9, SEPTEMBER, 2012
Chairman of the Board Viveck Goenka
Market
Radiology
Editor Viveka Roychowdhury* Assistant Editor Neelam M Kachhap (Bangalore) Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Delhi Shalini Gupta MARKETING
‘India is one of our key markets’ - Mirna Bassil, Marketing Manager, Emerging Markets, Carestream Health.... ............52
Deputy General Manager Harit Mohanty Senior Manager Tushar Kanchan Assistant Manager Kunal Gaurav
Knowledge
PRODUCTION General Manager B R Tipnis Production Manager Bhadresh Valia
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Asst. Manager - Scheduling & Coordination Arvind Mane
Nova Medical on an expansion mode ..................................20
Photo Editor
Apollo’s march to progress ..................................................20
Sandeep Patil
One more step towards National Commission for Human DESIGN
Resources for Health (NCHRH) ............................................22
Asst Art Director Surajit Patro
Trivitron Healthcare gets Asia’s Best Employer Brand Award 22
Chief Designer
Philips and Celsion get US FDA clearance to commence phase II
Pravin Temble Senior Graphic Designer
study of ThermoDox and MR-guided HIFU in bone cancer ....23
Eliminating healthcare associated infections ..............71
Rushikesh Konka Layout Rajesh Jadhav CIRCULATION
North India Special Batra Hospital & Medical Research Centre ................36
Strategy
Circulation Team Mohan Varadkar
SPS Apollo Hospitals ........37
Express Healthcare
Sir Ganga Ram Hospital (SGRH)..............................39
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Editorial
Miles to go.......... before achieving Universal Healthcare Coverage
India's GDP may have marginally perked up to 5.5 per cent in Q1FY13 but as a CARE Ratings analysis shows, this is still a poor show, compared to eight per cent for the same period last fiscal
I
t is not news that the healthcare sector in India needs a major revamp. Unfortunately, this is turning out to be a debate between the Planning Commission and the Ministry of Health, with the main bone of contention being the extent of the role of the private sector. Take for instance the roll out of Universal Health Coverage (UHC). The Minister of State for Health and Family Welfare Sudip Bandyopadhyay has avowed at the recently concluded 30th Meeting of Ministers of Health, in Yogyakarta, Indonesia, that there will be special focus on key areas in healthcare during the 12th Five Year Plan to accelerate the pace of attainment of Universal Health Care in India. The Indian government is even reportedly considering a new law, aimed at making Right-to-Healthcare (RTH) a reality, to provide affordable and quality healthcare for all. But no one seems to agree on the exact roadmap towards these goals. Health activists from organisations like the Jan Swasthya Abhiyan are wary of too much dependence on the private sector. They point out that the recently released draft chapter on health in the 12th Five Year Plan document has raised doubts on the Planning Commission's promise to consider the recommendations of the High Level Expert Group (HLEG) report, chaired by Dr Srinath Reddy. The recently concluded FICCI Heal 2012 conference in Delhi, saw the release of yet another report full of suggestions on what should be the roadmap to achieve UHC. FICCI and Ernst & Young's study titled “Universal health cover for India: Demystifying financing needs� at FICCI Heal 2012, maps out a demand model for healthcare and estimates that UHC in India can be achieved over a period of 10 years with Government health expenditure gradually increasing to 3.7 per cent and further to 4.5 per cent of the GDP. In a Utopian world, this would be achievable but unfortunately, reality bites. India's GDP may have marginally perked up to 5.5 per cent in Q1FY13 but as a CARE Ratings analysis shows, this is still a poor show, compared to eight per cent for the same period last fiscal. The fear is that a further dip in GDP will also lower the chances of fund allocation, with the Government possibly re-allocating health funds to other fronts. But financing will not a problem if there is political will. Given that policy decisions will be dictated with the 2014 elections in mind, experts urge that the government looks at UHC not just as a health cover but a holistic approach to health, sparking a mindset change to prevention and healthier living practices. One solution to these uncertainties is better coordination and trust between the public sector, which has the bulk of infrastructure and the private sector, which has plenty of expertise. If the two sides can build partnerships for public purpose (Dr Srinath Reddy's definition of PPPs), India can achieve these goals faster. There is no doubt that healthy citizens make a productive workforce while an ailing population is a liability and will only add to the disease burden. Whatever the contours of the UHC, we need to move fast. Viveka Roychowdhury viveka.r@expressindia.com
8
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Letters QUOTE UNQUOTE "HIV infections have declined by 56 per cent during the last decade from 2.7 lakh in 2000 to 1.2 lakh in 2009 in our country. This has been possible due to political support at the highest levels to the various interventions under National AIDS Control Programme, including from Parliamentarians and elected leaders at the State and local levels and cooperation received from NGOs, civil society etc." Health and Family Welfare Minister, Ghulam Nabi Azad at an international HIV vaccine symposium in New Delhi
Very informative and enjoyable read Dr Sanjeev Sood, Enjoyed reading your very informative article. If it is not too late it would be nice if the Planning Commission vs MoH debate on including private sector in reforming healthcare can be added. Dr Thanga Prabhu Indian Association for Medical Informatics
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SEPTEMBER 2012
UPFRONT
Market
Right-to-healthcare (RTH) will soon become a reality
Good design is a key component to increase the efficiency of the device
M Neelam Kachhap Bangalore
Shyam Sunder B K, Chief Designer Tata Elxsi on the opportunities for diagnostic and preventive devices
T
he Indian government is considering a new law to provide affordable and quality healthcare for all. “Like RTI and RTE have brought about a sea change in our life, rightto-healthcare (RTH) will also revolutionise healthcare in India,” said Dr Devi Shetty, Chairman, Narayana Hrudayalaya. Talking to the media at the announcement press conference of the 3rd Edition of Healthex International
Page 14
Hospital Build & Infrastructure India 2012 (HBII) HBII aims to serve as a meeting ground for everyone with stakes in the Indian hospital infrastructure sector
Page 24
RTH will provide access to healthcare with dignity to the unregulated workers and poor
2012 on August 14, Dr Shetty, said that RTH will become a reality in one or two years. This law when enforced will not only encourage the government to spend more on healthcare but will also make the poor participate in healthcare delivery. Currently, the government spends 1.1 per cent of GDP on healthcare and 75 per cent of the healthcare spending in India is out-of-pocket. India will be the first country to disassociate healthcare from affluence and show the world that quality healthcare can be provided at much lower price than the current costs. RTH will also provide access to healthcare with dignity to the unregulated workers and poor. Shetty said, “Initial response to RTH have been phenomenal and encouraging. The proposed law is being applauded by both the ruling and the opposition parties.” mneelam.kachhap@expressindia.com
SEPTEMBER 2012
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11
M|A|R|K|E|T elhi, officially the National Capital Territory of Delhi (NCT), has witnessed explosive growth in population and economy during the past decade. The NCT and its urban region has been given the special status of National Capital Region (NCR) under the Indian constitution’s 69th amendment act of 1991. There are nearly 22.2 million residents in the greater NCR urban area, which includes the neighbouring cities of Baghpat, Gurgaon, Sonepat, Faridabad, Ghaziabad, Noida and Greater Noida along with other smaller nearby towns. Incidentally, the infrastructure and service segments have also grown in this region but not proportionate to the growing population, thus putting additional pressure on already stretched resources, with healthcare being one of them.
D
Healthcare overview Healthcare services in NCR is provided by both government and private players. Govt of National Capital Territory of Delhi, local bodies i.e. MCD, NDMC and Delhi Cantonment Board, Ministry of Health and Family Welfare through its network of hospitals and other specialised institutions, Ministry of Railways, Ministry of Defence, Ministry of Labour and various Central Govt undertak-
The last decade has seen an un-precedented healthcare activity in Delhi Charu Sehgal SENIOR DIRECTOR, CONSULTING – STRATEGY & OPERATIONS DELOITTE TOUCHE TOHMATSU INDIA
ings. Within the private sector, Delhi has good presence of non-profit organisations and charitable institutions in providing free health services or services at subsidised rates to the poor. Along with these non-profit organisations and NGOs, private sector super speciality hospitals are also functioning and getting patients referred from the hospitals based in different parts of the country and also from other countries. Out of total number of 883 medical institutions in Delhi, 752 are in private sector and 131 institutions are in government/public sector. The total number of hospital beds in these institutions are 42698 which includes 24484 beds in
The focus is on high-end technology solutions with improved health outcomes Faisal Siddiqui
Solution lies in the creation of a health network based on an asset light model Rajiv Tewari
Carryout of selective healthcare segment as standalone chain is a new trend Shravan Talwar
VICE PRESIDENT, HEALTHCARE, TECHNOPAK ADVISORS
DIRECTOR, HEALTH & WELLNESS, ROCKLAND HOSPITAL
CEO, MOOLCHAND MEDCITY, NEW DELHI
government/public sector institutions and 18214 beds in private sector institutions. With these hospital beds the bed population ratio is 2.55 beds per thousand population in 2011.
Healthcare spending The state has constantly allocated more than seven per cent of the Plan outlay to the health sector and has utilised more than 80 per cent of the outlay. The commitment of the government to improve the healthcare services may be seen from the fact that as compared to plan expenditure of Rs 862 crore under health sector in 2007-08, the plan outlay for the year 2011-12 has been enhanced to Rs 1821.10 crore.
This plan outlay for health sector accounts for 12.8 per cent of the total approved plan outlay for the year 2011-12.
Changing healthcare delivery In the past 10 years, DelhiNCR, has seen remarkable growth in terms of healthcare infrastructure. “With fast economic growth and rapid urbanisation near Delhi-NCR areas, there has been a huge transition in hospitals infrastructure with key factors responsible such as shifting demographics, changes in morbidity pattern with growing degenerative and lifestyle diseases, affordable quality healthcare and increasing penetration of health insurance,”
A comparative picture of some of the key demographic indices is as follows S. No.
Demographic indices
Delhi
India
1
Decennial Population as per Census-2001
47.02%
21.54%
Census-2011
20.96%
17.64%
2.
Crude Birth Rate SRS –2008 year
18.4
22.8
3.
Crude Death Rate SRS –2008 year
4.8
7.4
4.
Infant Mortality Rate SRS -2009 year
33
50
5.
Sex Ratio [Census 2001]
821
933
[Census 2011]
866
940
[Census 2001]
868
927
[Census 2011]
866
914
7.
Neo-natal Mortality Rate -2008
20
35
8.
Institutional Delivery 2009
75.6
28.3
9.
Anti-natal Care – 2008 (in lakh)
3.38
232.48
10.
Immunization Coverage – 2008 (%)
83.2 (ICMR)
43.5
6.
12
Growth
Rate
Child Sex Ratio
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says Shravan Talwar, CEO, Moolchand Medcity, New Delhi. In the last decade, hospitals not only grew in numbers but also in size; from stand alone hospitals to health cities everything grew around Delhi. “The last decade has seen an un-precedented healthcare activity in Delhi with the boundary of the healthcare capital extending to regions outside Delhi to Gurgaon and Noida. Corporate chains like Max, Fortis, Apollo setting up tertiary care hospitals, emergence of large standalone health cities, high-end hospitals like Medanta Medicity, Artemis and emergence of specialised centres in eye care, skin, IVF, birthing centres and day care surgery centres have metamorphosed Delhi-NCR into a healthcare hub,” adds Charu Sehgal, Senior Director, Consulting – Strategy & Operations, Deloitte Touche Tohmatsu India. The change was not limited to increasing hospitals but also change in technology and treatment. “Hospitals are becoming more and more technology driven. The focus is on high-end technology solutions with improved health outcomes. For example, now with Fematosecond Laser, Cataract surgery has become significantly automated and blade free, ensuring greater safety and accuracy. Robotic surgery is also picking up in India,” explains Faisal Siddiqui, VP, Healthcare, Technopak Advisors.
New trends This changing competitive landscape has kicked-off a slew of new trends, to keep the hospitals ahead of competition. “Spurred by the activity from the new players even the older hospitals like Moolchand and Gangaram are expanding and reinventing,” says Sehgal. “Concept of hospotel SEPTEMBER 2012
M|A|R|K|E|T
Future plans of Delhi Government
T
he ratio between government and private sector hospital beds was 57:43. With the same ratio of govt and private sector hospital beds, 8152 new beds are required to be added in govt hospitals and 6150 beds by private sector hospitals during 12th Five Year Plan. To achieve the projected target of 14302 new beds during 12th Five Year Plan both by government and private sector hospitals, Delhi Development Authority will have to allocate adequate and suitable sites both for these hospitals, failing which it will be difficult to add the proposed number of new beds by 2017. At the same time higher FAR also need to be allowed to hospital buildings to promote new institutions. With the expansion of health care institutions, the need for doctors and trained para medical manpower has increased
(hospital + hospitality) is gaining momentum with newer facilities being constructed keeping in mind not just high-end medical facilities but also patient comfort, convenience and safety,” she adds. New formats of healthcare delivery is also seen emerging in the past few years. “Carryout of selective healthcare segment as standalone chain is a new trend,” informs Talwar. “The new formats include day-care surgery centres, stand-alone dialysis units, ophthalmology units, birthing units, dental units and primary healthcare clinics,” adds Siddiqui. “The current patient mix does not match with the huge investments made in land, building, equipment, manpower and operational costs. Solution lies in the creation of a health network based on an asset light model connecting the primary, secondary and tertiary health care providers to generate volumes with the right patient mix at all stages of treatment,” opines Rajiv Tewari, Director, Health & Wellness, Rockland Hospital.
manifold. The adequate number of para medical training institutions specially for radiology, operation theatre technicians courses need to be set up during 12th Five Year Plan. Three new medical colleges will be started. DGHS Cadre recruitment will be made to fill up all the vacant posts of doctors. With the growing population of senior citizens, all public and private hospitals may set up Geriatric Clinics. Delhi Government Hospital Services will be improved with the target for 50 per cent hospitals to get the accreditation from NABH. NAT Testing in blood banks, registration of all clinical establishments, strengthening of diagnostic facilities with PPP approach will improve the quality of health care services.
benchmark their performance against the best in industry; nationally as well as globally,” states Siddiqui. “Focus on quality certification and accreditation is an emerging trend,” agrees Sehgal.
Changing investor outlook Healthcare is one of India’s largest sectors, in terms of revenue and employment, and the sector is expanding rapidly. Today, continued on page 19
DEALERS WANTED
Focus on quality Quality service at reasonable cost is the need of the hour yet it seems not many hospitals focus on quality. “Several large hospitals have come up in Delhi but the problem of delivery of quality services at reasonable costs has not been resolved,” laments Tewari. Today, with the rise in competition among hospitals quality service has become a key differentiator between a good hospital and a better hospital. “More and more hospitals are measuring performance and analysing their clinical, operational and financial dashboards. They are now more open to ideas and take initiative to
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M|A|R|K|E|T 30 MINUTE INTERVIEW
Good design is a key component to increase the efficiency of the device Shyam Sunder B K CHIEF DESIGNER - TATA ELXSI
R
aelene Kambli quizzes Shyam Sunder B K, Chief Designer - Tata Elxsi on the opportunities in the Indian market for diagnostic and preventive devices
Which factors act as catalysts for some of our lifestyle related diseases? We live in a convenient world these days. From food, to clothing to entertainment, everything today has become a one-stop shop.With convenience being the driving force, from banking, to shopping to ticket booking, every facility is now available online, rendering any form of physical activity almost unnecessary. All you need to do is click a button and all products or services you may possibly require would be delivered at your doorstep. The ‘anytime, anywhere’ availability has fuelled a sedentary lifestyle. A short walk to the nearby grocery store has now been replaced by a quick home delivery service. Add to that, stress-induced drinking and smoking. This, coupled with the stressful lives that we lead today and a poor diet, has led to the increase of several lifestyle-related diseases like obesity, heart diseases, cholesterol, diabetes, stroke, depression etc. These diseases have exponentially increased as countries become more industrialised and people live longer. The occurrence of lifestylerelated diseases have become so frequent that WHO has identified India as a country which will have most of the lifestyle disorders in the near future.
Kindly elaborate on your statement that though there is a need for efficient and cost-effective products, yet there is also a stigma attached to using certain devices in public as it creates an unhealthy impression about the user. Lifestyle-related diseases are now the leading cause of death worldwide, killing 36 million people a year. Almost every second person you meet is a victim of some lifestyle-related disease. Hence, people’s dependency on medicines and products that help to manage and keep these diseases at bay have increased exponentially. Research reports indicate that 68 per cent of the working
14
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women in India suffer from various lifestyle related diseases and as a result a large chunk of one’s income goes in the upkeep of the medical expenses involved. But, if you take some of the diagnostic and preventive devices, like an inhaler or a glucometer, they are actually quite expensive. Moreover, they are very functional in nature and hence it makes the deficiency in the user very obvious. Users today have become very discerning about using such products in public as it prevents them from leading a normal life. The other aspect of these products is the performance levels which are fairly low due to the way the devices have been developed. It also needs to be immediately addressed.
According to you, what is a good design device? Good design is a key component for increasing the efficiency as well as acceptability of the device. Any device that leverages the benefits of the latest technology available, and combines that with simplicity and ease of use, is tasteful and has an aesthetic appeal is an ideal design.The product should also cater to the core requirement with minimal effort. Moreover, the device should function accurately and consistently and at the same time should be ergonomic and minimalistic.
What designs will suit the needs of Indian population? When designing for the Indian markets one needs to keep in mind the socio-economic nature of the market. However, the Internet and the phone revolution in India has created a highly aware consumer population.Thus, there is a need to design products that not only maintain world class standards but also are priced appropriately, keeping in mind the purchasing power of the target population for the product.
What design opportunities exist while making products for the Indian middle class? India’s emerging middle class presents a huge opportunity in the Indian market scenario. This emerging urban middle class has a large amount of money at their disposal of www.expresshealthcare.in
which a large chunk is spent on their lifestyle needs.This emerging middle class also has extensive exposure to the products and services available around the globe and hence will not settle for anything less than the best. However, this group does not have the affordability to purchase or sustain the products at international prices. Moreover, the emerging middle class, in its attempt to make more money, is caught in a very stressful life where they are simultaneously pressed for time. Hence, any product that is designed keeping international aesthetic sensibilities and design philosophies in mind, that has minimum investment in terms of time and effort and yet functions consistently well and is affordable, is an instant hit with this segment. Tata Elxsi has designed various cost effective and efficient medical devices like glucose monitors, breath inhalers, accelerometers, other monitoring devices, that has helped patients to keep diseases in check, without having to regularly visit the doctor or get medical tests done.
What strategies should Indian manufacturers adopt to make the most out of these opportunities? In order to make most of these opportunities that presents itself, with the growth of the emerging middle class segment in the country, Indian companies need to be able to design and package their products well. This segment of the population is very aware of the products they invest in and are not easily taken in by marketing tactics. They are known to do proper research before making any purchasing decisions. Multi-functionality, time effectiveness and convenience that the product allows for are some of the major forces that help the consumers in making their purchasing decisions.Thus one of the major strategies the companies need to adopt is to design their products well, so that they are convenient, useful and affordable at the same time.
spaces is still a stigma. This challenge drives designers to make them trendy and intuitive to use. For example: a hearing aid made to look like a jewellery, a wearable body monitoring device made to look like a wrist/band watch and not a device that will make them conscious. A typical dry powder inhaler no more looks like a transparent chamber but a large whistle, that delivers drug but it is aesthetically treated, influenced by electronics and technology, usability as well as compliance has been thought of which still addresses the fact of on-go delivery system but not making it to look obvious. The devices, moreover, will become compact and easy to use. There will also be niche devices created to address a specific ailment and ensure that it is eliminated faster and effectively.
What is Tata Elxsi’s contribution in this space? We are an ISO 13485 qualified company for designing medical products. Tata Elxsi has built a set of new products including our own IPs in the medical device domain spread across drug delivery devices, surgical devices, hospital equipment etc. We are proactively identifying opportunities for new product introduction and trying to indigenise expensive devices and products that caters to specific Indian needs.
What is Tata Elxsi’s way of dealing with challenges that come across while designing products for Indian consumers? This is one of the major challenges, which Tata Elxsi addresses through product innovation, thus consistently designing products which cater to two of the major demands of the Indian consumer by bringing forth the latest technology at affordable prices.
What are the company’s future plans in this space?
What will be the future trends in designing lifestyle related healthcare products?
We feel that there are several opportunities in the space - diagnostic, drug delivery and monitoring where we will address affordability and accessibility needs of the customer. We would also work on products specifically for the Indian and emerging markets.
Using the devices in public
raelene.kambli@expressindia.com
SEPTEMBER 2012
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M|A|R|K|E|T continued from page 13 investors look at great opportunities in the healthcare sector. With rising health insurance, soaring medical tourism and added advantage of IT technologies like telemedicine potential in this segment is enormous. “Healthcare industry in India has a huge demand-supply gap. Ageing population, rising disposable income, increased health insurance penetration along with growing urbanisation and increasing life style related diseases have been the key growth drivers. Establishing India as a hub for medical value travel has given a bigger platform to this industry. All this is very encouraging for entrepreneurs and nonhealthcare business houses to venture into this space. The advantage is that such houses do not hesitate in implementing innovative care model and hence they assist in identifying new formats to serve the population,” opines Siddiqui. “Healthcare is seen as being relatively immune to recessionary conditions. The constantly increasing demand for healthcare services due to rising disposable income, increase in life style diseases, improving insurance penetration have all led to a keen interest in this sector, The increasing interest of private equity players has also helped the emergence of innovative partnerships in this sector. Non-traditional businesses not just in Delhi but countrywide are entering or evaluating an entry into the healthcare sector. Some of these new players are looking for alternate models (day care surgery centres, asset light models, partnering with experienced healthcare players etc.) to establish themselves in the sector. Overall, it is a positive step for the development of the sector,” adds Sehgal. All this may seem very encouraging but new entrants to healthcare should be aware of the risks. “Healthcare is viewed as an attractive segment and new players are entering into it. However, they are likely to face significant challenges on multiple issues like historic low return on capital on healthcare despite of high-capital investment and complexity of business,” alerts Talwar. “Not everyone finds the going that easy as SEPTEMBER 2012
running healthcare operations is a highly complex activity. Healthcare also needs patience as financial returns take time to accrue. New players have to be mindful of both financial and operational challenges when they evaluate the sector,” advices Sehgal.
Looking forward The future of healthcare delivery in Delhi-NCR looks bright with many efforts from both public and private play-
ers. Where as the public sector is engaged in capacity building the private sector is looking at innovative methods to increase patient footfall and profits. The combined effort is bound to take Delhi-NCR to new heights in healthcare delivery. “In the coming years, we will see a great out-of-the-box thinking by the strategists in the field of healthcare which will change the whole scenario of healthcare delivery,”
feels Talwar. “Consolidation of hospitals will accelerate; additional areas of specialty player (eg IVF) will emerge; institutionalisation of quality accreditations (eg NABH) will happen, as without theses accreditations, providers will get lower prices and we will see the opening of specialised second opinion centres,” he adds. “The increased supply in big towns and the ensuing competition will also lead to the need for the healthcare
players using innovative marketing and customer relationship management techniques. Once the customers have choice, the providers will need to differentiate their offerings. There will be increasing partnerships between the various playersinsurance companies, pharma companies. medical device players, ICT players,” opines Sehgal. mneelam.kachhap@expressindia.com
A U TO M ATI C
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D O O RS
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Company watch
Super Religare Laboratories is now ‘SRL Diagnostics’
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uper Religare Laboratories (SRL) has been re-christened as ‘SRL Limited’ with a identity of ‘SRL Diagnostics.’ SRL is a leading diagnostic network and the company enjoys a formidable presence in India as well as a strong presence globally. After becoming a subsidiary business of Fortis Healthcare, SRL elected to give itself a new identity. The company has also rebranded itself and as SRL becomes ‘SRL Limited’, all the diagnostics centres will be branded as ‘SRL Diagnostics.’ It has also introduced a new logo and colour which showcase the core strengths of SRL. As a note from the company explains, the microscope signifies precision and is a critical instrument in science and clinical research. SRL embraces blue for its stability, reassurance, optimism, friendly and innate strength. Red, the colour of the life-giving blood has a strong symbolism as life, energy and vitality. Green is SRL’s underlying promise towards world class healthcare and the promise of healing. Speaking on the occasion, Dr Sanjeev K Chaudhry, now the Managing Director (former CEO), SRL said, “The new identity is symbolic of a new thrust, a second takeoff we shall witness at SRL”. “The new logo will allow people to recognise and understand the core competencies of SRL in a better way. Considering the growth potential of the healthcare sector that India is bound to witness, the need to have a brand that can stand as an independent entity was strongly felt. With the change in the name of the company, we thought it apt to unveil our new logo which truly reflects our present reality,” added Sanjeev Vashishta, CEO, of SRL. EH News Bureau
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ROBOTICS UPDATE
Asian Heart Institute performs first robotic cardiac surgery in Western India The Asian Robotic Surgery Institute has already successfully completed more than 75 robot-assisted surgeries in various specialties like urology, nephrology and gynaecology sian Heart Institute recently conducted the first robot assisted cardiac surgery in Mumbai and western India. The da Vinci Si robotic surgical system with simulator at the institute is the latest third generation robot and the first of its kind in India. The institute has already successfully completed more than 75 robot assisted surgeries. The team at the Asian Robotic Surgery Institute is led by Dr Ramakanta Panda, Vice Chairman and MD and Chief Consultant: Cardiovascular Thoracic Surgery, Asian Heart
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Institute. The surgery was led and performed by Dr Sudhir Srivastava, Chairman and MD, of International Centre for Robotic Surgery. Dr Srivastava is one of the world’s leading surgeons in robotic cardiothoracic surgery and is credited to have performed more than 1,300 robotic cardiac surgeries. Speaking on the procedure, Dr Panda said, “As opposed to traditional open heart surgery, robot assisted surgery is minimally invasive. This is beneficial since it means smaller cuts (incisions) of one or two cen-
timetres only as compared to conventional surgery (10-12 inches), lesser pain and trauma, lesser blood loss, faster recovery time and lesser scars. In fact we were able to send the patient home in a couple of days. The procedure becomes less daunting for old and young alike.” Dr Sudhir Srivastava, said “Open heart surgeries require the chest to be opened to access the heart which leads to a long recovery time, blood loss, trauma and increased risk of infection and leaves a lifelong ugly scar and patients are weary
of getting it done. But through robotic assistance, we managed to reach the area through just four finger tip sized incisions. One can see just tiny incision marks from outside which will disappear with time. He is able to walk around and even return to his daily routine work within 48 hours of the surgery.” Robotic cardiac surgery can be performed for congenital heart defects, bypass surgeries, valve repair and replacement and heart tumours. EH News Bureau
EXPANSION
Nova Medical on an expansion mode Gets PE investment worth Rs 300 crore from Goldman Sachs and New Enterprise Associates (NEA) ova Specialty Surgery has embarked on a major expansion spree and intends to expand its footprints across India. Suresh Soni, Chairman and CEO, Nova Medical Centres spoke to Express Healthcare correspondent Lakshmipriya Nair, and informed, “We plan to establish 8-10 centres in cities across India including cities like Jaipur, Kolkata, Chennai, Ahmedabad in a time span of 10-12 months. Plans are afoot to set up another 8-10 centres in the
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next year as well.” Nova’s expansion plans got a boost in the form of Rs 300 crore PE investment that has come in from investment banking firm Goldman Sachs and venture capital firm New Enterprise Associates (NEA). This investment would help Nova’s expansion plans and diversify its business of speciality surgery and fertility business. While Rs 220 crore would be offered by Goldman Sachs, NEA will contribute rest of the amount. “This landmark invest-
ment from Goldman Sachs and NEA will accelerate the expansion of Nova’s footprint across the country both organically as well as through acquisitions. This will ultimately better serve India’s healthcare delivery services industry, surgeons and, most importantly, patients,” informed Soni through a company release which also revealed that Ankur Sahu, Co-Head of private equity in Asia at Goldman Sachs and Harsh Nanda, Executive Director at Goldman Sachs,
will join the Board of Nova. On being quizzed by the Express Healthcare correspondent on any more such investment deals in the offing, Soni replied that Nova is not looking for any more investments at the moment. The healthcare has become very attractive for PE funding and so far $521 million has been raised through 16 deals until June this year. This deal adds to this number and reiterates this growing trend. EH News Bureau
EXPANSION
Apollo’s march to progress Buoyed by strong revenue growth Apollo Group looks to conquer new grounds Raelene Kambli EH News Bureau pollo Hospital group has had a buoyant consolidated revenue growth of 21.8 per cent at Rs 8813 million as per its revenue results in the Q1FY 13. The results also reveal that Apollo’s earnings before interest, taxes, depreciation, and amortization (EBITDA) went up by 24 per cent at Rs 1480 million and the consolidated PAT went up by 44.2 per cent at Rs 787 million. The compa-
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ny has consistently expanded by 20 per cent over the last few years without over-leveraging its balance sheet as per the results. Additionally, Apollo Hospital’s FY13 results show volume growth across all ‘Centres of Excellence’. The company’s Hyderabad hospital has been re-accredited by the JCI while the Group’s REACH hospitals initiative received recognition at the recent G20 Summit in Mexico. With such remarkable revenue results, Apollo www.expresshealthcare.in
Hospitals has set forth on an expansion path. The group will establish a 200-bedded hospital in Chennai, a 100bedded ortho-spine centre at Bangalore, another 200-bedded hospital at Vellore in Andhra Pradesh and a REACH hospital in Trichy. The time frame set for the establishments of these hospitals is between four to six months informed Krishnan Akhileswaran, Group CFO, Apollo Hospitals. The group will increase its pan India presence by adding
around 3,000 beds in the next three years. Moreover, plans are to establish hospitals at Indore and Patna as well. The company is also looking out for strategic partnerships to expand their business in Africa, the Middle East, Asia and the neighbouring countries. “Our strategy for business outside India is currently not focussed on active investment model but we are looking out for operation management positions,” added Krishnan. raelene.kambli@expressindia.com SEPTEMBER 2012
M|A|R|K|E|T
Appointment
Roche Diagnostics appoints new CMD for India and South Asia
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oche Diagnostics has appointed Lance Little as the Chairman and MD of Roche Diagnostics India and South Asia. In his new role, Little will oversee operations in the Indian subregion which includes the neighbouring markets of Sri Lanka, Bangladesh, Bhutan and Nepal. He joins the India operations from New Zealand where he served as the MD of Roche Diagnostics New Zealand. Speaking of his recent appointment Little said, “India is a dynamic and evolving market with expanding healthcare needs and quality requirements. Roche Diagnostics, with a decade-long experience in the market, is wellpositioned to meet those needs and I am thrilled about the opportunity to lead the next evolution of our business in India.” As the India and South Asia head, Little will be responsible for the overall business which includes centralised diagnostics, a mainstay of diagnostics labs and hospitals, molecular diagnostics, tissue diagnostics, applied science, and near patient testing. Little’s primary areas of focus will be on supporting India’s healthcare expansion by providing hospitals and labs across the country with quality diagnostic products, services and solutions that meet their diverse needs. A Roche Diagnostics veteran, Little has witnessed the revolution of diagnostics from a largely manual process to a highly automated system. “For the past decade, Roche Diagnostics India has been at the forefront of the automation revolution that is helping labs of all sizes in India improve their testing efficiency, eliminate potential risk of human error and ensure quality control of test results,” said Little. “As India’s healthcare needs continue to evolve and expand, Roche’s diagnostics technologies will continue to grow with it and provide innovative solutions to meet market needs.” EH News Bureau
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GOVERNMENT INITIATIVE
One more step towards National Commission for Human Resources for Health (NCHRH) It would be a regulatory body for medical education and allied health sciences he government has proposed to set up the National Commission for Human Resources for Health (NCHRH) under the Ministry of Health & Family Welfare as an overarching regulatory body for medical education and allied health sciences with a dual purpose
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of reforming the current regulatory framework and enhancing the supply of skilled manpower in the health sector. The NCHRH Bill has been introduced in the Rajya Sabha on December 22, 2011, which was referred to the Department-related Parliame-
ntary Standing Committee on Health & Family Welfare for examination. The Commission would subsume all the existing councils regulating the education in medicine and allied sciences viz., Medical Council of India, Dental Council of India, Nursing Council of India and
Pharmacy Council of India and replace them with corresponding new Councils. This information was given by the Union Minister of Health & Family Welfare Ghulam Nabi Azad in a written reply in the Rajya Sabha on August 14. EH News Bureau
AWARDS & ACCOLADES
Trivitron Healthcare gets Asia’s Best Employer Brand Award The company bagged the award for ‘Innovation in retention strategy’ and became the first medical technology company in Asia to win this award in the healthcare sector rivitron Healthcare was conferred with the Asia’s Best Employer Brand Awards 2012 for Innovation in Retention Strategy at the official award ceremony held in Singapore recently. The prestigious award was hosted by the Employer Branding Institute, World HRD Congress and Stars of the Industry Group. Amongst several other renowned brands, Trivitron
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has bagged the prestigious award for demonstrating excellence in building its brand and identity. Trivitron is Asia’s first medical technology company to win this award in the healthcare sector. “Trivitron is pleased to be recognised as a top ‘employee brand’ amongst diverse business segments and industries especially in healthcare, which is one of the fastest
growing competitive and quality-focused industry sector,” quotes Chandra Ganjoo – General Manager Human Resources, Trivitron Group of Companies. Trivitron, in its next growth phase will be focusing on global brand building, people, process and products. Hence, the next growth phase of the company will focus on skill development and mentorship initiatives.
Trivitron also aims to leverage the manufacturing revenues from 35 per cent to 80 per cent to establish and enhance ‘Brand Trivitron’ in emerging markets, global manufacturing and innovation presence. Trivitron is an Indian MNC offering end-to-end solutions ranging from distribution to manufacturing and innovation in medical technology. EH News Bureau
EDUCATION
Harvard School of Public Health introduces online course on clinical research nder the recent collaboration between Harvard University and MIT called EdX, a new introductory course on clinical research has been introduced at the Harvard School of Public Health. The course is known as Quantitative Methods in Clinical and Public Health Research. Dr Swati Piramal, Vice Chairperson of Piramal
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Group, who was recently elected on the Harvard Board of Overseers was instrumental in bringing this course. The course will be offered online by Harvard School of Public Health to students in India and around the world beginning in October 2012. The Quantitative Methods in Clinical and Public Health Research course is an online
adaptation of material from the Harvard School of Public Health’s classes in epidemiology and biostatistics and will be taught by Harvard School of Public Health professors Earl Francis Cook and Marcello Pagano. The course will be available to anyone in the world with an Internet connection, without any rigorous admis-
sions process. According to Piramal, an alumna of Harvard School of Public Health, a course like this is a great opportunity for physicians in India. “One of the big shortages we have in Indian science is the lack of research curriculum in our medical training.” EH News Bureau
ACCREDITATION
PD Hinduja College of Nursing goes for NAAC accreditation The College of Nursing was also recently awarded the ISO 9002 certification D Hinduja College of Nursing, Mumbai will add another feather to its cap soon, after getting accredited by the National Assessment and Accreditation Council (NAAC). The college, within a span of six years, upgraded to College of Nursing under Maharashtra
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University of Health Sciences, Nashik from School of Nursing. NAAC is an autonomous body that assesses and accredits institutions of higher education in India. Jaya Kuruvilla, Principal, College of Nursing informed, “Accreditation from NAAC is a three part process consisting www.expresshealthcare.in
of the preparation and submission of a self-study report by the unit of assessment. Once completed and published, an on-site visit of the peer team for validation of the self-study report is done with recommendations of the assessment. Lastly, the final decision is made by the
Executive Committee of the NAAC.” The NAAC Peer team will be visiting the College of Nursing from August 9-11, 2012. The present move is yet another effort to improve quality of nursing education. EH News Bureau SEPTEMBER 2012
M|A|R|K|E|T RESEARCH
Philips and Celsion get US FDA clearance to commence phase II study of ThermoDox and MR-guided HIFU in bone cancer It is being touted as a non-invasive next generation approach with great potential in oncology oyal Philips Electronics and Celsion Corporation have received the US Food and Drug Administration (FDA) clearance to initiate a clinical study supporting a joint development programme for Celsion’s ThermoDox combined with Philips’ Sonalleve MR-HIFU (MRguided high intensity focused ultrasound) technology for the palliation of painful metastases to the bone caused by lung, prostate or breast cancers. The companies expect to initiate a phase II study in this indication in the second half of 2012. ThermoDox combined with MR-HIFU will be investigated for pain palliation in patients with bone metastasis. Cancer progresses to the bone in a majority of patients with late-stage breast, prostate or lung cancer, with estimates of between 300,000 to 500,000 cases annually in the US. Patients may experience excruciating and unrelenting pain, often treated with opiate drugs and NSAIDs (non-steroidal anti-inflammatory drugs) with only modest benefit. External beam radiation therapy is effective in palliating painful bone metastasis, but is limited by accumulating toxic effects to normal organs. Philips’ MR-HIFU system has the potential to precisely and non-invasively target lesions with acoustic energy, creating sufficient heat to activate ThermoDox and preferentially release high concentrations of doxorubicin in the targeted treatment area. Celsion is developing the combination of ThermoDox and MR-HIFU through a joint research agreement with Philips Healthcare, a division of Royal Philips Electronics. “The combination of Philips’ MR-HIFU system, a high-precision, heat-based therapy, and ThermoDox, a heat-triggered oncolytic agent, holds great potential in that it gives us the ability to combine non-invasive thermal treatment with local delivery of high concentrations of potent, wellcharacterised anti-cancer drugs directly in a target area,” said Falko Busse, VP
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and GM, MR Therapy for Philips Healthcare. This multi-modality approach could be transformative for the treatment of a number of cancers. “Celsion is excited to
evaluate ThermoDox in combination with MR-HIFU as a next generation, non-invasive treatment for a variety of cancers; a logical step to expand ThermoDox’s great potential in oncology. FDA’s clearance
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to clinically study the combination of ThermoDox and MR-HIFU is a cornerstone of this joint Celsion/Philips effort,” said Michael H Tardugno, Celsion’s President and CEO. “Philips brings
tremendous resources to this development pathway for ThermoDox, optimising its role in cutting edge medicine,” he added. EH News Bureau
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M|A|R|K|E|T PRE EVENT
Hospital Build & Infrastructure India 2012 (HBII) Hospital Build & Infrastructure India 2012 (HBII) aims to serve as an excellent meeting ground for everyone who has a stake in the Indian healthcare and hospital infrastructure sector
he healthcare infrastructure expenditure in India is expected to touch $14.2 billion by 2013. The last few years have seen massive investment and expansion in the healthcare industry within India. As investment in India's healthcare infrastructure continues to rise, Hospital Build & Infrastructure India 2012 (HBII) is bound to become a milestone in the tireless journey to update, upgrade and fine tune global strategy in the field of healthcare infrastructure. The 3 rd International HBII 2012 is scheduled for the December, 14 – 16, 2012 at Mumbai’s business hub, Bombay Exhibition Centre (BEC). HBII is setting new standards within the industry as a premier regional event with an international appeal, attracting exhibitors, visitors and delegates from across the globe. It is India’s only focussed international exhibition and congress dedicated to help the healthcare community to build a sustainable and profitable hospital infrastructure and healthcare industry development. The 3rd edition aims to be bigger and better tahn ever and and will strive to leave a perceptible impression over 4,000+ focussed industry visitors, more than 100 exhibitors from 15 countries, covering 6,000 sq m of exhibition floor space, as well as more than 400 con-
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Participants of HBII’s earlier editions checking out the stalls in the exhibition area
ference delegates. Investors, planners, builders, contractors, architects and designers will get to meet senior managers and commissioners of PSUs and private healthcare facilities in India. An exhaustive range of products, solutions and services across all areas of hospital investment, planning, designing, building, operating, managing and refurbishing will be showcased and highlighted at the event. HBII will also host the first ‘Hospital Build Healthcare Awards’ an exclusive three-day healthcare conference and will launchthe flagship session
Delegates attending a session at the conference of an earlier edition of HBII
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www.expresshealthcare.in
Product demonstrations at HBII
on ‘Leaders in Healthcare’ where the top dignitaries of the hospital and healthcare industry are expected to attend. Knowledge partners for the conference, HOSMAC, have zeroed in on conferences topics like Hospital Build & Design, Quality Care and few other industry related topics. The event will also feature international pavilion, product demonstration area, B2B meetings and various other attractions. Major participants at HBII include Draeger India, Tata Motors, Tahpi, Portalp International, Alvo, Modular Concepts, Responsive Inds, Hospaccx India systems, Medica Synergie, Zebra Technologies, Bioni Paints India, Sio Vasundhara, CR Medisystems, RR-Eubiq and many others. HBII 2012 has already
started receiving a good response from the industry and most of its stall space has been sold already. It also has the support from various industry associations, Canadian Ontario government’s support and a strong speaker line up for the conference. HBII will provide a unique gateway to new business opportunities and partnerships in and across the complete spectrum of healthcare facilities in India - from investment to maintenance. Over a short period of time, it has become India’s leading strategic gathering which attracts the best in the Indian healthcare industry and delegates from all across the globe. It is a must for everyone who has a stake in the Indian healthcare and hospital infrastructure sector. SEPTEMBER 2012
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M|A|R|K|E|T PRE EVENT
VCCircle Healthcare Investment Summit 2012 VCCircle Healthcare Investment Summit 2012 to offer an opportunity to meet India's next generation healthcare entrepreneurs and investors lated to be held on September 11, at ITC Grand Central, Mumbai VCCircle Healthcare Investment Summit would focus on the emerging investment opportunities in Indian healthcare. The VCCircle Healthcare Investment Summit 2012- IV
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acterised by a near absence of accessible and affordable quality health services for a larger part of its population. Multi speciality hospital chains are now expanding their boundaries to the under-penetrated regions of the country. Single speciality healthcare is attracting a
The Summit will touch upon the most critical issues confronted by the healthcare industry in India and try to unmask newer avenues of growth edition is expected to attract 200+ industry participants including top healthcare entrepreneurs, in addition to partners/CEOs of leading private equity and venture capital funds. India’s healthcare system is paradoxical - on one hand, it boasts of ‘best in class’ healthcare delivery and on the other, it is char-
lot of investor attention with the emerging business models. The Summit will touch upon the most critical issues confronted by the healthcare industry in India and try to unmask newer avenues of growth to go forward with along with identifying the emerging investment themes prevailing in the sector.
The agenda for the event is as follows:
Agenda Keynote address: Reinventing healthcare delivery in India Panel I: Investing in Indian healthcare - Past experiences and lessons for the future Entrepreneur story I A private equity funded entrepreneur will make a 30-minute presentation on: ● The company’s early days and business model ● Significant milestones ● Growth path and projections ● How it raised private equity funding and scaled Panel II: Multispeciality tertiary care – What is the road ahead? Entrepreneur Story II A private equity funded entrepreneur will make a
30-minute presentation on: ● The company’s early days and business model ● Significant milestones ● Growth path and projections ● How it raised private equity funding and scaled Panel III: Single Speciality – Emerging business models Panel IV: Delivering patient centric healthcare VCCircle Lounge Interaction with India's topmost PE investors at a special structured session, VCCircle Lounge. This is session is limited to select 10 companies and 10 investors. Cocktail and networking To book your seat for the event or for more details, contact: Kanika Suneja Tel no: 0120-4171111 Email: register@vccircle.com
PRE EVENT
Nursing Leadership Programme The nursing leadership programme organised by DY Patil University's Department of Business Management ( DYPDBM) will focus on improving the management skills of nurses in the area of their practice and thus promises to be very useful for both hospitals and individuals admashree Dr DY Patil University's Department of Business Management (DYPDBM) is organising a management development programme (MDP) for nurses and its first module focussing on Nursing Leadership is slated to be held on October 6, 2012. The rationale behind the nursing leadership programme is that a great nurse manager is an acknowledged leader; an advocate for her patients, staff, and hospital; a powerful agent for change; a respected member of the nursing administrative team; and a good fiscal manager. It's not easy to balance the competing demands of patients, families, visitors, physicians, unit staff, and personnel from other departments, but an effec-
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tive nurse manager is flexible and organised enough to address everyone's needs in a systematic way. Being a successful nurse manager requires a combination of empathy, good organisational and leadership abilities and strong communication skills. The training programme aims to improve the management skills of nurses in the area of their practice. The objectives of the programme are to: ● To enhance management skills ● To learn various aspects of leadership ● To develop better relationship building with management and peer group Key benefits to be accrued from the event are For organisations: www.expresshealthcare.in
● ● ● ●
Development of personnel Compliance with standards of care Collaboration among departments Improved patient care
For individuals: To improve managerial skills which fall under three categories ● Technical - ability to perform a specialised task involving a particular method or process ● Interpersonal motivation and communication management ● Conceptual - ability to see the organisation as a whole, to recognise complex and dynamic issues, examine the factors that influence these problems and resolve such situations The DYPDBM’s MDP
programmes are an intitiative that helps business executives to explore new frontiers of knowledge, sharpen their tools and help their organisations to grow. They also enable organisations to improve productivity and process efficiency, enhance communications and teamwork, improve human performance and morale, retain talent and resources, reduce cost and waste, anticipate workforce and technology changes and stay competitive. Contact details: Asst Professors: Dr Sippy/ Dr Shital Mob nos: 9987090768/ 8692899799 respectively. Emails: drnitin5683@gmail.com, shitalshinde07@gmail.com SEPTEMBER 2012
LONG-LASTING QUALITY. MINIMISED ERRORS. ELEVATED EFFICIENCY. EXTENDED PATIENT SAFETY. ZEBRA HC100™ DIRECT THERMAL PRINTER — EASY-TO-USE, RELIABLE & HIGHLY COST-EFFICIENT. With Zebra’s new durable, easy-to-scan all-in-one HC100 patient ID solution, now you can enhance critical workflows throughout every department of your government healthcare organisation. Accelerate patient admissions by producing more secure, longer-lasting antimicrobial-coated wristbands on-demand — easily, quickly and conveniently. Enhance productivity and minimise errors in medical record labelling with this reliable and easy-to-use direct thermal printer that automatically detects the wristband size, calibrates — and prints. Ensure your delivery of unrivalled patient safety with Zebra HC100 — the reliable and cost-efficient solution for all your patient ID printing needs. Key Benefits: • Easy-to-use and load for optimum user efficiency • Automatically detects wristband size and calibrates settings for optimal print quality • Lower maintenance costs with longer-lasting wristbands with bar codes and text that remain readable For more information about HC100 printer, please, visit www.zebra.com/hc100 For further enquiries, please email SGMarcom@zebra.com Zebra Technologies India Pvt Ltd Boomerang A202 Near Chandivali Studio Main Chandivali Farm Road Main Andheri E Mumbai 400072 T: 022 67275555 ©2012 ZIH Corp. All rights reserved.
M|A|R|K|E|T PRE EVENT
Healthex International 2012 Healthex International 2012 aims to serve as an ideal platform for non industry people to network with healthcare professionals, witness the newest innovations in healthcare technology and interact with company ambassadors face-to-face in order to learn and explore new developments angalore International Exhibition Services (BIES) brings the 3rd edition of Healthex International; scheduled to held from September 7 to 9, 2012 at the Bangalore International Exhibition Centre (BIEC), Tumkur Road. Healthex International 2012 is an international exhibition which will feature a complete range of equipment, materials, services, processes, systems, components, consumables etc that find wide use in medical surgeries, hospitals, clinics, and diagnostic centres across the world. Healthex International 2012 is a business-to-business platform dedicated towards knowledge sharing and brings together the industry experts from major government and private institutions and offers them an opportunity to both develop and maintain business relationships. During the three days of the exhibition one can even witness a unique concurrent conference and exhibition - Dentacon 2012, a forum on innovative trends and practices in the dental industry. Healthex International 2012 will discuss and tackle challenges that are continuously demanding innovative,
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affordable, accessible, quality equipment and technology in the healthcare industry. Healthex International 2012 aims at addressing the growing population concern, increase in lifestyle related diseases, availability of cost -
Indian medical industry whilst maintaining and bringing in advanced technology and product that are in-sync with global standards. Dr Devi Shetty, Founder and Chairman, Narayana Hrudayalaya Hospitals and
Healthex International 2012 is a B2B platform dedicated towards knowledge sharing. It brings the industry experts together and offers them an opportunity to both develop and maintain business relationships effective treatments and the preference of treatments from private hospitals through various seminars and workshops scheduled. The conference primarily focusses on the public - private partnerships (PPP) for quality healthcare setup, demand for more hospitals including the tier 2 and tier 3 cities, deficit in number of hospital beds, trained manpower and the need for better infrastructure. Healthex International 2012 is an effort to foresee the future of the
Chairman, Healthex International 2012 giving an outlook for the Indian medical industry said, "The market for tertiary care is expected to grow exponentially due to the rise in complex ailments such as heart diseases and cancer. India’s changing demographics and the increasing incidence of non-communicable and lifestyle-related diseases is expected to trigger the need for more tertiary care. Regardless of today's global shifts, it is clearly recognised
that trade exhibitions are still of prime importance to the economy - and in some cases they are even more important than ever before." Key highlights of the exhibition: ● Best brains in the Indian Healthcare industry like Dr Devi Shetty (Chairman of Narayana Hrudayalaya Hospitals) and others from GE, SIEMENS, ROCHE, 3M, L&T, Global Hospitals will be coming together in this exhibition with an aim to scale India on the global healthcare industry map ● Concurrent Event: Dentacon 2012 International serves a smorgasbord of lectures, demonstrations, playstations, product information kiosks, trade displays, and panel discussion to cater to the entire team. ● CEO’s roundtable on “Innovative Solutions for Affordable Healthcare” which would bring in a perspective on the best available solutions and practices to make healthcare affordable ● Major institutions and associations such as National Accreditation
Board for Hospitals and Healthcare Providers (NABH), Academy of Hospital Administration (AHA) and Private Hospitals and Nursing Homes Association Bangalore (PHANA) have partnered with this exhibition and they are holding workshops, seminars which makes it the first exhibition to have support from such medical associations ● Best brains from across the industry will debate on the need for modern ICUs, recent trends in clinical biochemistry, cardiology, radiology, oncology, new surgical technology and techniques, role and importance of robotic radio surgery in cancer care delivery and the increased need to spread the awareness and importance of green hospitals in India. ● Spread across 6500 sq m, the exhibition will be a host to national and international exhibitors. Besides the leading multinational companies in the sector in India, there will be ample scope for establishing profitable business relationship and an opportunity to interact with others in the.
POST EVENT
EyeAdvance Congress 2012 IXth Congress of the International Academy for Advances in Ophthalmology was a successful event which was attended by 3000 ophthalmic surgeons from all over India and the neighbouring countries he IXth Congress of the International Academy for Advances in Ophthalmology was recently concluded in Mumbai under the Chairmanship of Prof Dr Keiki R Mehta, the Surgical Chief and Medical Director of the Mehta International Eye Institute in Colaba, Mumbai. The Congress was inaugurated by K Shankaranarayanan, the Governor of Maharashtra, with Vice Admiral DK Joshi, Flag Officer Commanding-inChief, Western Naval Command as the chief guest. The EyeAdvance Congress, held biannually, has now become an impor-
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tant ophthalmic conference for learning new and advanced techniques. It was attended by over 3000 ophthalmic surgeons from all over India and the neighbouring countries. This is one of the largest international congresses in India in which 31 distinguished foreign professors from 20 countries, running from Australia to US and from Japan to Argentina, participated. The speakers at the congress focussed on ● Advances in stem cells which will permit restoration of vision even in retinal blind patients with
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macular degeneration and night blindness, retinitis pigmentosa. Retinal implants for severely damaged retinal cases, which is still experimental but hope is now around the corner Newer techniques of cataract surgery: utilising advanced new lasers permitting better faster vision for far and near Laser applications: to reduce spectacle powers removal corneal irregularities and control lazy eyes Advanced glaucoma treatment: utilising special shunts and valves where even uncontrolled www.expresshealthcare.in
Dr Keiki R Mehta, Chairman of International Academy for Advances in Ophthalmology, EyeAdvance 2012 presents K Shankaranarayanan the Governor of Maharashtra a plaque, at the inaugration ceremony of EyeAdvance 2012 glaucoma can now be treated successfully and a
modicum restored.
of
vision
SEPTEMBER 2012
M|A|R|K|E|T POST EVENT
MEDICALL 2012, Chennai: An event to remember MEDICALL 2012, Chennai lived up to the successes achieved by its predecessors and has also managed to set up a precedent for future MEDICALL expos, thereby giving credence to its reputation as India’s premier medical equipment expo and the first real “supermarket” for hospital equipment and supplies eld at Chennai Trade Centre from August 36, 2012; MEDICALL in its ninth edition attracted visitors from the entire spectrum of the healthcare industry. Doctors, equipment manufacturers, service providers, hospital owners, healthcare administrators, marketing professionals, healthcare consultants all were a part of this four-day event. Organised by Medexpert, this year too MEDICALL had its share of interesting segments and sessions which captured the interest and elicited the admiration of the delegates and participants. Some that definitely need a word of mention are as follows
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companies like RD Plast, Schiller India, Forbo Flooring Systems, Philips, Tanita India, Allengers, Premier, Shuter, Godrej Interio, Fuji
Film India, etc were some of the exhibitors.
A networking platform With the representatives
of the entire healthcare spectrum present at MEDICALL 2012, Chennai; the event also served as a very good networking platform. Hospital
owners, doctors, medical directors and purchase heads, in addition to producers, dealers and suppliers were all present at the event.
GMP From Concept to Commissioning… And everything in Between !!!
Interesting seminars The seminars that were organised at MEDICALL 2012 covered an eclectic range of topics pertinent to the healthcare industry. Experts spoke on like branding of hospitals, expansion of a family-owned hospital into a healthcare chain, healthcare financing, healthcare infrastructure models etc and answered any queries that the audience put to them. Many from the audience were seen sharing their own experiences as well and seeking the experts' advice for the same. One of the most interesting ones was the Presidential Address by Dr Devi Shetty, the eminent cardiologist. Though he couldn't be present in person, the session was conducted through a live video conference wherein he spoke on India's Healthcare Vision 2020, affordable healthcare, and how to ensure 'healthcare for all'.
Excellent exhibition The exhibitions at MEDICALL have always been noteworthy. This year was no exception. MEDICALL 2012, Chennai had hosted a huge exhibition where both national and international healthcare players had put up their stalls to showcase their latest and best offerings. Hospital flooring, avant-garde equipment used in hospitals, modular OTs, telemedicine technologies, diagnostic tools, surgical instruments et al were part of the exhibition. Renowned SEPTEMBER 2012
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Exhibitors Speak “We are here to sell our products. We want to find distributors in the Indian market.” - Asel Moldobaeva, Export Manager, ACTO GmBH We hope that MEDICALL would bring us the creme-dela-creme of the industry. Exhihibiting at MEDICALL is also a brand-building activity for us. - Stuti Soni, Marketing Coordinator, Forbo Flooring India “It (MEDICALL) is working very well for us. We have had some good leads. It is a single platform for everything in healthcare and the scope of the event has widened over the years.” - Dr Vijay PV, Associate Consultant, Medica Synergie We launched in the Indian market last year, we are here to get an outlay of this market. It's only been a day, let's see how it works out. - Manoj Dharman, MD, Modular Concepts
Words of Wisdom
The MEDICALL Team : Yogita Panchal, Dr S Manivannan and S Sundararajan
“Investing in technology does not make a great hospital, investing in the right people, right resources is the key” “Great companies are not created by a single strategy or one innovation, it needs several pushes to grow” - Dr S Manivannan, Joint MD, Kauvery Hospital & Organiser of MEDICALL 2012 “The economy of the 21st century will be driven by the healthcare industry.... 75 per cent of Fortune 500 companies are directly or indirectly related to healthcare” “We are the largest producers of doctors, nurses, medical technicians and drug makers. Indian healthcare has a huge capacity to create jobs and thus drive the economy” “We don't need more technology or magic pills, we need a mechanism to deliver what is available to people who are deprived of it” - Dr Devi Shetty, Chairman, Narayan Hrudayalaya Group of Hospitals
MEDICALL Innovation awards recognised healthcare players for their innovatiions
The innovative fashion show at MEDICALL proved that creativity has no bounds It gave the visitors an opportunity to interact with people pertinent to their business.
Healthcare Innovation Awards The 'Healthcare Innovation Awards' was one of the most important segments at MEDICALL 2012, Chennai. It was a very successful attempt to acknowledge innovators in healthcare across three categories i.e. Healthcare Delivery, Medical Equipment, IT & Diagnostics and CSR Initiatives. It received
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“While planning for a hospital, lot of times pre-operative expenses are not taken into consideration” “It is necessary to have a contingency plan for additional funds. Plan for the negative fund-flow as well” “Determine your revenue model according to the specialties you are looking at. Leverage on brand value and expertise of your strategic partners to overcome operational inefficiencies” - Abhishek Singh, Director-Healthcare, Crisil over 65 entries of which three winners were chosen from each category to receive Bronze, Silver and Gold awards for their innovative contributions. The jury who chose the winners comprised of Prof VI Mathan, Retired Director, CMC, Vellore and Professor of Medicine and Gastroenterology, Dr B Krishnamurthy, Head Of Department, Quality Management Services, Baby Memorial Hospital, Kozhikode and Visiting Consultant, ICU Kauvery Hospital, Chennai, Anuradha Ramachandran Investment Director, Omidyar Network, Abhishek Singh, Director – Healthcare, CRISIL and CA Ravikumar P, Managing Director, Bio Vedas Consultancy.
Unique fashion show Glorious models walking the ramp in their designer attires are a common sight
but what about a fashion show on hospital garments? Yes, one of MEDICALL 2012, Chennai's highlights was the innovative fashion show on hospital garments which very effectively demonstrated that white, green and blue do not have to be the only colours suited for hospitals. The well cut attires in soothing shades of sea green, lavender, beige etc, designed for surgeons, front desk staff, therapists, anaesthetists, nurses, attendants, technicians, housekeeping staff and of course the patients, were very well appreciated and admired by the audience. It was indeed one-of-its kind and thoroughly enjoyable. Thus, all in all MEDICALL 2012, Chennai turned out to a very well organised event and the visitors would definitely have had several learnings to take home with them. SEPTEMBER 2012
“EXPHEX1”
M|A|R|K|E|T POST EVENT
AIMA Healthcare Conference 2012 The theme this time was 'Innovative and sustainable healthcare management: Strategies for Growth'
Preetha Reddy, Conference Chairperson, delivering the inaugral address at AIMA he second installment of healthcare conference, organised by All India Management Association (AIMA), was held on August 7, 2012 at Bangalore. The theme this time was 'Innovative and sustainable healthcare management: Strategies for Growth'. The conference, which was attended by over 180 delegates across the healthcare continuum, was inaugurated by Preetha Reddy, Conference Chairperson, MD, Apollo Hospitals and VP, AIMA in the presence of EV Ramana Reddy, Secretary to Government Health and Family Welfare, Government of Karnataka. K Jairaj, Former Additional Chief Secretary, Government of Karnataka & Past President AIMA and Rekha Sethi, Director General, All India Management Association were also present at the inaugural session. Speaking at the inaugural session Preetha Reddy said, “With this conference we aim to ignite the minds of the healthcare providers to go beyond their traditional boundaries and the thought process in the healthcare delivery. The challenges are large and the danger of not tackling the menace of the disease burdened in the country innovatively will have a far reaching and disastrous consequences.”
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Following this EV Ramana Reddy talked about challenges faced by the public sector in delivering healthcare. “Healthcare in itself is very complex and to make it sustainable for 1.2 billion Indians is a huge challenge. We are fighting with the diseases of both developed countries – lifestyle diseases like cancer, diabetes, hypertension and underdeveloped countries like malnutrition, tuberculosis and other communicable diseases. To make healthcare management sustainable, we need to have a holistic approach. We need to have convergence with the departments managing sanitation, nutrition and drinking water,” he said. The conference began with first plenary session on 'Innovative and Sustainable Healthcare Management –Opportunities and Challenges'. It brought together various segments across the healthcare spectrum - including providers, payers, pharmaceuticals, and diagnostics – to discuss the state of play of the sector and how they have fared in making the most of the opportunities available. The panelists included Kewal Handa, Managing Director, Pfizer India & Past President, AIMA; Dilip Jose, Zonal Director Fortis Healthcare Ltd; Rajen Padukone, CEO & www.expresshealthcare.in
MD, Manipal Health Enterprises and Shreeraj Deshpande Head - Health Insurance Future Generali India Insurance. “India is strong in information technology but the challenge lies in how to provide this, in larger access and coverage in the healthcare sector. There is a great opportunity in healthcare segment. Infrastructure investment is required in doctors, hospitals, nurses and paramedics. Insurance sector needs to be scaled up to meet the insurance needs of the larger population,” reiterated Handa. New ideas and innovations have been implemented across all segments of healthcare - providers, payers, pharmaceuticals, and diagnostics – driving improvements in quality, affordability, and accessibility for millions of Indians. Jose said, “Healthcare space in India has grown rapidly in the last decade. However there is tremendous disparity in both availability and affordability. The challenge lies in how to address these issues. It is essential to have sustainable growth and innovative solutions keeping in mind the Indian context. The second session focused on learning from India’s biggest and best in class case studies in healthcare delivery and the strategies these leaders have adopted in bringing
about large-scale change. The session explored the improvisation and customisation that were adopted to meet local demands and plug gaps in the Indian healthcare system. The eminent panellists were Charu Sehgal, Senior Director & Lead – Life Sciences & Healthcare Consulting Deloitte; Sangita Reddy, Executive Director – Operations Apollo Hospitals; Ashwin Naik, Founder and CEO, Vaatsalya and Sanjay Kakkar, Chairman Jai Medica. The session focused on learning from India’s biggest and best in class case studies in healthcare delivery. It focused on the strategies that these leaders have adopted in bringing about large-scale change. The session explored the improvisation and customisation that were adopted to meet local demands and plug gaps in the Indian healthcare system. Discussions debated on the scalability and sustainability of these innovations, including techniques that worked and those that can be improved upon for the future. In his speech Kakkar, stated, “India is witnessing an epidemic of heart diseases with about three million deaths per year and with approximately 12 per cent of the population affected. Indians have a higher genetic predisposition to heart disease, affecting people at younger age with greater severity and higher mortality than the West. In India we need to improve on the current routine tests done to identify heart attack.’’ The last plenary session on “Sustainable Innovations and Leveraging Technology” witnessed various speakers discuss how innovations across a spectrum of complementary areas such as technology, payment schemes, and diagnostics have played and continue to play a pivotal role in pushing the goal of sustainable healthcare growth in India. The panelists included in this session were Vishal Gupta, Vice President, Global Healthcare Solutions, CISCO; Sreenath AV, Vice President Business Solutions Division, Wipro Limited; Munesh Makhija, Chief Technology Officer, GE Healthcare India and Zeena Johar, President, IKP Centre for Tech.in Public Health. SEPTEMBER 2012
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M|A|R|K|E|T
EVENTS UPDATE HospINVentory 2012, Chennai Date: September 5, 2012
healthcare consultants
charge, infection control managers, B Sc nursing graduates and nurses with more than one year of experience
Contact: Mob: 09717074228 Email: kanika@vccircle.com/ register@vccircle.com
Contact: Dr Nitin Sippy Asst Professor & Course Coordinator, (Health & Hospital Management) Padmashree Dr. D. Y. Patil University Mob no: 99870 90768
Venue: Hotel Marina Towers, Chennai Organiser: AMEN, Bangalore, India Participant profile: Hospital/healthcare promoters, CEOs/COOs, administrators/managers, executives, hospital operations managers, inventory managers, stores managers/incharge, healthcare management students Last date to register: August 15, 2012 Contact: Email: hospinventory@gmail.com/ amen.paniel@gmail.com Phone: 09035189824/25
3rd Healthex 2012 International Date: September 7-9, 2012 Venue: Bangalore International Exhibition Centre Participant profile: Professionals from various verticals of the healthcare sector Contact: Suresh Babu P Entry Plaza, BIEC, 10th Mile, Tumkur Road, Madavara Post, Bangalore-562 123 Mob: +91 80 6583 3234, Mob: +91 99729 29976 Fax: +91 80 6624 6661 Email: suresh@bies.co.in Web: www.bies.co.in
HospiArch 2012, Kochi
3rd International Hospital Build & Infrastructure India
Date: September 29, 2012 Venue: Hotel Presidency, Kochi
Date: December 14-16, 2012 Organiser: AMEN & Hospaccx India Systems, Bangalore, India Participant profile: Hospital/healthcare promoters, CEOs/COOs, administrators/managers, executives, healthcare mgmt. consultants, designers and architects, healthcare management students Contact: Email: hospiarch2012@gmail.com/ amen.paniel@gmail.com Phone: 09035189824/25 Web: www.amen-hospiarch2012.blogspot.in
Management Development Programme (MDP) for Nurses Date: October 6, 2012 Venue: Dept of Business Management, Padmashree Dr DY Patil University, Sector 4, CBD Belapur, Navi Mumbai. Organiser: Padmashree Dr DY Patil University
Venue: Bombay Exhibition Centre, Mumbai Organiser: Informa Exhibitions India Participant profile: CEOs, chairman, managing directors, general managers, chief operating officers; presidents; owners; medical directors, executive directors; vice presidents; operating directors; department heads; chief financial officers; ministry of health; quality management; engineering consultants; advisors; project managers/ directors, strategists healthcare investment funds, architects; engineers (electrical, civil, mechanical); interior designers; construction managers and contractors; project managers; hospital planners and designers; hospital managers and administrators, logistic managers; facility managers, patient safety officers; building administration officer Contact: Sujoy Gomes, Exhibition Manager Phone: +91 22 4048 1705 Mob: 91 9920 288 808 Email: sujoy.gomes@informa.com
Participant profile: Nursing head, nursing supervisor, floor in
To tie up with VCCircle Healthcare Investment Summit 2012IV edition, Mumbai Date: September 11, 2012 Venue: Hotel ITC Grand Central,Mumbai Organiser: VCCircle, India Participant profile: Hospital/Healthcare company promoters, CEOs/COOs, Hospital operations managers, doctors, healthcare professionals, investors, bankers and
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for Media Partnerships Contact tushar.kanchan@expressindia.com
www.expresshealthcare.in
SEPTEMBER 2012
Batra Hospital & Medical Research Centre Batra Hospital has positioned itself as the one stop cutting-edge multispecialty destination with pioneering work in the field of oncology amongst others
A L BATRA
President, Batra Hospital & Medical Research Centre
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atra Hospital & Medical Research Centre, set up in 1987 under the umbrella of Ch. Aishi Ram Batra Charitable trust, has been one of the most important landmarks in the delivery of healthcare in Delhi. It has been the torch bearer in bringing oncology to the private sector. Over the years it has progressed, bringing in the latest and the most modern medical care in critical and life threatening areas like cancer, cardiology and cardiac surgery, orthopaedics, nephrology, neurology and neurosurgery and plastic and reconstructive surgery. Highly trained doctors, nurses and technical staff carefully selected from all over the world and a dynamic leadership has always enabled it to bring world-class medical care within the reach of the common man and paved the way for multi-super-specialty hospitals in India. Today, the hospital offers tertiary level care in 42 specialties with an infrastructure comprising of 495 beds, wellequipped operation theatres, 112 ICU beds, 24x7 emergency facilities backed with ambulance services for patient evacuation and transportation, ‘state-of-the-art’ diagnostic laboratories and comprehensive rehabilitation facilities. The faculty at Batra Hospital & Medical Research Centre is of international repute. It has decades of clinical research and academic experience having links with medical fraternity across continents, providing a synergy in healthcare. The management has laid great emphasis on creating a customer-based environment with pro-active and system driven procedures keeping the patient foremost. This is in line with the continuing ethos of the hospital to combine the best medical care with passion and compassion, essential to the healing process. Batra Cancer Centre was the first private healthcare setup to offer radiation facility in Delhi way back in 1987 and has evolved to become one of the best private cancer setups with all modern facilities. The centre is fully equipped with linear acceler-
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ators, IMRT, 3D CRT, rapid arc, brachytherapy and CT simulator. It has recently installed Image Guided Radio Therapy (IGRT) to provide the latest treatment in cancer care. Batra Gastrosciences Centre provides comprehensive services in gastroenterology that include hepatology, surgical gastroenterology, paediatric gastroenterology, pancreatiobiliary and GI oncology. Batra Heart Centre has well-equipped ultra-modern cardiac surgery theatres capable of dealing with all kinds of patients, from neonates to the geriatric population. Trans oesophageal echocardiography and other intensive monitoring equipment help in intensive constant monitoring in the postoperative CTVS ICU. A 64-slice CT scan machine is available constantly for comprehensive evaluation of heart, kidneys, lungs, brain, coronaries, peripheral blood vessels and all other organs of the body The Department of Nephrology is well equipped with 14 machines in haemodialysis unit including two machines dedicated for hepatitis patients with isolation and barrier nursing and two machines for critically ill patients on haemodialysis/continuous Renal Replacement Therapy (CRRT). 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 in patients with nearly irreversible kidney ailments. Supported by two operation theaters, the transplant surgery unit is geared to deal with all emergencies. ‘Laparoscopic harvesting’ of donor kidney has further minimised the discomfort to the donors. All the super specialties are delivering services at the cutting edge. Arthroscopies and joint replacements in orthopaedics; advanced laparoscopic techniques and bariatric surgery in minimal www.expresshealthcare.in
access surgery; brachial plexus surgery, replantation, post- oncosurgery reconstruction and microsurgery in plastic surgery; hair transplant and other cosmetic procedures in aesthetic surgery are some of the routine surgeries performed in the hospital. Batra Hospital, established on firm tenets of quality and affordability, constantly strives for a patientcentric approach, evidencebased treatment and outcome-oriented healing system. Seamless operation theatres, hepa—filters in airconditioning, laser-guided surgeries and computerassisted procedures ensure results and outcome at par with the best centres abroad. This has made the hospital a popular destination among patients from other Asian and African countries. Following its core philosophy of valuing human life above all, Batra Hospital continuously strives to provide newer standards of medicare with human touch. Its no wonder then, that today, the name Batra Hospital is synonymous with care.
Mission To continuously engage in upgrading its comprehensive multi-specialty healthcare delivery system through quality intervention, involvement of all functionaries and excellent leadership.
Vision To be the leader in the area of quality healthcare
and commit to provide efficient, effective, timely and user-friendly healthcare to its patients, through best medicare practices in a clean, healthy and rejuvenating environment. Quality objectives: ● Best quality patient care ● Judicious use of drugs and appropriate interventions ● Compliance with the highest standard of medical ethics ● Continued skills upgradation and keeping abreast of latest developments ● To carry out all processes right the first time, on time and every time Quality values: Care, compassion and courtesy ● Community health provider: patient centric care with value for money across all sections of society ● Timely intervention ● Effectiveness: Sharing knowledge and best practices ● Efficiency: Never-ending improvements ● Maintenance of highest standard of hygiene and cleanliness ●
Centres of excellence Batra Cancer Centre Batra Gastrosciences Centre ● Batra Heart Centre ● Batra Joint Replacement Centre ● Batra Neurosciences Centre ● ●
SEPTEMBER 2012
SPS Apollo Hospital SPS Apollo Hospitals has emerged as a leading healthcare player in North India by offering quality service to patients at affordable costs
oncology, vascular and endovascular surgery etc have also been added. The
diagnostic and laboratory services have been boosted with the addition of interven-
tional radiology and mycology services. During the recent past, SPS Apollo Hospital also
became one of North India’s first centres to offer neuro intervention services.
he mission of Satguru Partap Singh (SPS) Apollo Hospital is 'To bring excellence in healthcare within the reach of every individual’. We are committed to the health and well being of humanity.' In the seven years since its inception in 2005, the hospital has been setting standards in North India. SPS Apollo Hospitals has built a strong and profound goodwill and an unwavering image in healthcare sector. It has also witnessed phenomenal growth YoY in terms of patient numbers (both OP and IP) and revenue. Commencing operations in 2005, SPS Apollo reached its breakeven in the year 2007. Revenues since inception have risen by approximately 20 per cent every year and both EBITDA and net profits margins have been handsome. In terms of patient volumes, SPS Apollo has grown by over 25 per cent each year.
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Growth areas SPS Apollo Hospitals is broadening its purview of excellence by adding new specialties and looks forward to be the foremost name in healthcare in North India. SPS Apollo Hospitals added another feather in its cap by launching The Apollo Transplant Institute at Ludhiana and making the world’s largest and most trusted programme in solid organ transplantation accessible to the people of this region. SPS Apollo has commenced kidney transplants in the first phase. Various superspecialised services like paediatric neurology, paediatric haematology, SEPTEMBER 2012
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Patient outcomes Quality at SPS Apollo is a way of life and is driven passionately by the top management. The certainty of positive patient outcomes is the responsibility of the Quality Assurance (QA) department the hospital has developed more than 200 quality indicators which are continuously monitored. An infection prevention committee is also formed to offer quality care to patients. Regular extensive Infection Prevention Committee meetings are also conducted to commit to quality patient care.
New projects SPS Apollo Hospital’s main aim has always been to reach out to cities of Punjab and provide them with qualitative healthcare at affordable prices. To contribute to the mission, the hospital is expanding and further strengthening its existing Centers of Excellence. SPS Apollo Hospitals has a Centre of Excellence for cardiac sciences, neuro sciences, orthopedics and joint replacements, gastro sciences, advanced paediatrics and emergency services. SPS Apollo Hospitals is also starting a dedicated 100bedded Mother and Child Care Hospital and IVF Centre in Ludhiana to reach out to and commit to the health and well being of mother and child. The Apollo Transplant Institutes shall also be expanding its purview by starting liver transplants. A Cancer Treatment and Research Centre is also in the pipeline.
Achievements and accolades The year 2011 has been a year of accolades and recognitions for SPS Apollo Hospitals. The list of the accomplishments is exhaustive but the major achievements in the past year have been: 1. Launch of new specialties and services—Renal Transplant Programme, Vascular Surgery, Paediatric Neurology, Paediatric Oncology, Interventional Radiology and Mycology 2. Being rated as the best commercial building of Punjab for energy conservation practices by Punjab Energy Development Agency 3. Academic recognition of
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clinical excellence and enhancing the excellence of various associates through academic courses 4. Addition of new facilitiesInstallation of 128 slice CT Scan and BMD DEXA Scan 5. Launch of Tele Radiology for the convenient usage by the consultants 6. Branding and marketing excellence through various activities like launch of Stroke Awareness Club, State level Gastroenterology CME
Competitive advantage The competitive advantage of SPS Apollo Hospitals is the quality of healthcare services that it offers at affordable rates. SPS Apollo Hospitals also boasts of an infection free environment which further adds to the quality patient care in the hospital. The cost effectiveness always ensures that world class healthcare is assessable to all the people in North India. The 'We Care' Programme aims at generating a confidence among the patients that the decision to come to SPS Apollo was right. The in-house programme aims to make patients feel comfortable and ensures that their needs are attended to in the best possible way. Hence, its quality and commitment towards patient care in a cost effective way gives SPS Apollo Hospitals an advantage over its competitors.
Great workplace In a healthy, high performing work place behavwww.expresshealthcare.in
iours are guided by people centric values and supported by human resource practices. SPS Apollo Hospitals has been named as the workplace that follows best HR practices by following this policy and showcasing the practices mentioned below ● Creating congenial and fair work environment ● Focus on professional development ● Creating a sense of pride, security and belongingness ● Safe, secure and clean environment ● Employee and family engagement activities
Energy efficiency @ SPS Apollo The Punjab Energy Development Agency rated SPS Apollo Hospitals as the best commercial building in Punjab for energy conservation practices. Following are the initiatives taken by the hospital for energy conservation this year. 1. Electronic ballast chokes are used in lighting fixtures. 2. Building management system and variable frequency drives for heating, ventilation and air conditioning system. 3. The Power Factor is maintained as one and the balance load is maintained on all the three phases. 4. Timers in different areas for controlling timings of light. 5. Solar system for water heating (15000LPD). 6. Energy management system to keep an eye on the consumption in various areas to avoid wastage.
Disaster management at SPS Apollo Disasters in hospital environment are when number of patients and/or severity of illness or injury are such that normal emergency department operations are no longer possible. The disasters may be internal or external. Internal disasters are situations where in normal functioning of the hospital is disrupted due to accident within the facility such as fire, quake or explosion. There may be a need for extra care personnel to care for patients or even their possible evacuation. For example, in case of fire, RACE i.e. R – Rescue, A – Alarm, C – Confine and E – Extinguish/Exit system is followed. External disasters are when resources are mobilised to meet the situation of excessive causalities. On announcement of an external disaster, all available doctors, nursing staff, GDAs with wheel chair and stretchers move to the emergency. The causalities are classified as red – very serious, yellow – serious, green – lightly injured and black – dead. While the dead are moved to the mortuary, the others are treated accordingly. The hospital also informs the media and the public. All these steps for disaster management are taken at SPS Apollo Hospitals. At the time of joining, every associate undergoes induction regarding the various steps for disaster management. Also these trainings are repeated on regular basis to keep the associates abreast with the newer techniques of disaster management. SEPTEMBER 2012
Sir Ganga Ram Hospital (SGRH) Sir Ganga Ram Hospital ensures that every individual recuperates with a sense of gratitude
great institution to towering heights comparable to the best in the world like the
Mayo Clinic, Cleaveland Clinic and Harvard School of Medicine. Thus, I believe
with this vision SGRH could become the Mecca of tertiary healthcare.�
Centre of excellence SGRH of-the-art
houses stateequipment,
DR DS RANA Chairman, Sir Ganga Ram Hospital
ir Ganga Ram Hospital (SGRH) is a 675-bed multi-speciality hospital in Rajinder Nagar, Delhi. It was founded in 1921 at Lahore by Sir Ganga Ram, a civil engineer and leading philanthropist. After partition in 1947, the present hospital was established in New Delhi. The foundation was laid in April 1951 by Jawahar Lal Nehru, the then Prime Minister of India and was inaugurated by him on April 13, 1954. This hospital is a unique hospital in the nongovernment sector, as it works on the not-for-profit concept where richer people contribute to the treatment of patients from the economically weaker sections of society. It provides patient-friendly, doctorfriendly and employeefriendly environment with sense of belonging. Standing tall as one of the leading community hospitals in the private sector, SGRH has been serving as a tertiary care referral centre with no financial assistance from the government or other external agencies, as all development activities of the hospital are financed from internal resources. Says Dr DS Rana, Chairman, Board of Management, SGRH, “My vision will be to take this
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SEPTEMBER 2012
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laboratories and research facilities for performing cutting-edge procedures and research and development to be among the best health centres, nationally as well as internationally. Some of the Centres of Excellence at SGRH are critical care and emergency medicine, Institute for Child Health (with state of the art neonatology services), Institute of Renal Sciences (nephrology, urology and kidney transplantation), Institute of Minimal Access, metabolic and bariatric surgery, gastroenterology, surgical gastroenterlogy and liver transplantation, neurosciences
(medical, surgical and spinal surgery), cardiology and cardiac surgery, cosmetic and plastic surgery, clinical haematology and bone marrow transplantation, joint replacement, ENT and cochlear implantation, ophthalmology, peripheral vascular and endo-vascular surgery, medical genetics, and in-vitro fertilisation. The Department of Nephrology has been elevated to the level of 'Institution of Renal Sciences'. This development will be followed by further improvement in all the services related to nephrology, urology and kidney transplantation by
inducting more talent and providing adequate physical infrastructure equipped with
Government of India. It plans to promote cadaver kidney transplant programme and
there are plans to promote research in the field of kidney transplantation.
Accolades
modern technology. The hospital is an integral part of National Organ Transplant Programme of
work towards making the kidney transplant programme affordable and available to the society at large. Also,
SGRH has been is accredited by the National Accreditation Board for Hospitals and Healthcare Providers (NABH—2009), National Accreditation Board for Testing and Calibration Laboratories (NABL—ISO 15189: 2007), Quality Management Systems as per ISO 9001: 2008, Environment Management Systems (EMS) as per ISO 14001: 2004 and Occupational Health and Safety Management Systems as per OHSAS 18001: 2007.
Academy of Hospital Administration [AHA] With several programmes for healthcare professionals, AHA has an important role to play in transforming the sector in India for the better, especially in North India
SUR CAPT N A KHAN VSM Retired, Executive Director AHA
cademy of Hospital Administration [AHA] is a professional body of qualified hospital administrators. It is a 'not for profit' organisation, established on February 16, 1987 under the Society Registration Act 1860. AHA celebrates its Silver Jubilee Year in 2012. AHA is also registered by National Accreditation Board for Education and Training [NABET], QCI Government of India as a Consultant Organisation. The academy, based in a modern state-of-the-art building in Noida, has a wide span of membership of around 1300 members across the country and abroad.
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Mission “Developing and maintaining quality training, consultancy and research activities in health and hospital system through active
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involvement of health care organisers and providers, to attain a leading role in continuously improving the performance of health care system in the country”.
Short-term programmes
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Programme
No. of Days
Management Development Programme [MDP] for senior or mid-level MO’s.
6-12 Days
Management Development Programme [MDP] for senior or mid-level Nursing Staff and non Medical Administrative Staff
6 Days
Orientation Programme on Quality Management and Accreditation of Health Care Organisation [QM&AHO] for Senior Health Staff [Top level].
6 Days
Orientation programme on QM&AHO for Senior and mid level MOs both [Clinical and Administrators]
6-12 Days
Quality Managementnt Programme for Senior Nursing Staff
6 Days
Orientation Programme on Health and Law
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Objectives Its main objectives are to impart training to medical, nursing and para medical personnel in healthcare services by organising long and short-term management development programme [MDP], In addition, we provide consultancy services to hospitals to facilitate efficient functioning through development of NABH Standards and carry out medico administrative research.
Strengths ●
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Academy of Hospital Administration has the distinction of training medical officers across the country right from the day of its inception. It has a dedicated group of members who are
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fully committed to the cause of imparting professional and scientific management training to doctors, nurses and paramedical staff across the country. The main strength of AHA is its faculty which has a wide range of on ground experience of working and holding important appointments and posts in various Governmental, Public sector, NGOs and Corporate Health sectors. AHA has its own training infrastructure and a bench of experienced and professionally-qualified instructors in the field of health and hospital management and is thus not dependent on other institutions for the conduct of their programmes. AHA had successfully run a PG diploma course in hospital and health management for over a decade and a large number of qualified personnel of this course are now holding prestigious appointments both in governmental and private organisations. AHA had successfully conducted training programme for UPHSDP/OHSDP/KHSDRP a world bank-sponsored programme and now has the requisite expertise and experience to conduct the same programme at higher levels SEPTEMBER 2012
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of skills and competence development. AHA published its biannual journal in the field of hospital and health administration and circulated to its members free of cost.
AHA Programmes Long-term programmes ● MBA ( Hosp Management)—One year—Distance learning (for PG Diploma Holders in Hosp Mgt. or equivalent from recognised university/Institute authorised by UGC/AICTE/DEC). ● PG Diploma (PGDBMHMGT)—One year— Distance learning for Fresh MBBS/BDS/AYUSH/Nu rsing and other graduates of any stream with three years administrative experience in hospitals. ● MBA (Hospital Management)-Two years- Regular classroom programme (for graduates of any stream). Fresh MBBS/BDS/AYUSH/Nu rsing and other graduates of any stream with three years administrative experience in hospitals can opt for distance learning mode.
Achievements of AHA ●
It has trained more than 450 healthcare professionals through distance learning programme for post graduate diploma in Hospital and Health Management [PGDHHM] approved by DGHS, Govt of India.
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It has trained more than 4,300 healthcare professionals through distance learning programme for Post Graduate Diploma in Hospital and Health Management [PGDHHM] in collaboration with Indira Gandhi National Open University
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[IGNOU] 2000 to 2004. Trained more than 500 medical officers through short-term Management Development Programmes [6-12 days], of UPHSDP/ OHSDP/UAHSDP etc. sponsored by World Bank Projects. AHA has trained
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approximately 700 healthcare professionals in QM&AHO Programme as on date In addition it has trained 400 candidates from all over the country from various public and private organisations/hospitals/institutions etc.
Real washing power
Admissions: [Every year March and September] MBA HMGT programmeAuthorised By UGC Recognised Punjab Technical University (PTU) Quality Management Programmes ● Six months Distance Learning Programme for PG Certificate in Quality Management and Accreditation of Health Care Organisation [QM&AHO]. With two contact programmes seven days duration each. ● One month Distance Learning Programme for PG Certificate in Quality Management in Allopathic Clinics [QMAC] – with two-day contact programme weekend [Saturday and Sunday]
Admissions: [Every year January and September]
SEPTEMBER 2012
Non-stop washing, 24 hours a day, 7 days per week: the Modular Rack Type dishwasher from Electrolux, with its unique Ideal Wash System (IWS), guarantees the highest performances in every area of the dishwasher and perfect hygiene on every washed item.
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Rotary International With an array of blood banks, eye care centres and others, Rotary International is poised towards a humanitarian approach of delivering healthcare to the masses
otary International is the largest service organisation of the world serving the needy and less fortunate sections of society. It is providing humanitarian service, encouraging high ethical standards in all vocations and helping to promote goodwill and peace worldwide. We take this opportunity to introduce our humanitarian activities. Rotary Blood Bank located Tughlakabad institutional area, New Delhi is a significant achievement of Rotary Clubs in District 3010. Since its inception in 2002, the blood bank has dispensed 4,40,000 units of blood/components to those in need to life threatening situation. It is a major public service initiative of Rotary Clubs and is sustained by clubs through organising blood donation camps. The Blood Bank can provide safe blood to people in need, since Rotary Clubs demonstrate a strong commitment to this activity by organising blood donation camps regularly. All donors are entitled to one unit of blood without any processing charge on the basis of a card issued to them. Besides, all Below Poverty Line (BPL) patients, Thalassemic and
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HIV patients are entitled to receive blood without any processing charge. Considering the inadequate availability of high quality blood for people in life-threatening conditions, Rotary International has set up a voluntary blood bank to serve a population of over 15 million people in Noida, NCR of Delhi. Eye Care Centre: The top floor of the blood bank building, houses a world class eye care centre to provide cataract and other surgeries for poor patients and on certain designated days for those who can afford to pay. This eye care centre has the best equipment and an equally well equipped operation theatre with top surgeons from Apollo and Max Hospitals to provide eye care treatment to those in need. Clubs and members are encouraged to donate ` 3000 per surgery for cataract operation on poor patients. Clubs are also requested to organise eye check up camps in slum areas and nearby villages where the Eye Care Centre team would go and identify patients needing cataract surgeries. Dr BRA Institute Rotary Cancer Hospital is one of www.expresshealthcare.in
the few centres in the country to have established haematopoietic stem cell bone marrow transplant programme, where more than 250 transplants have been performed. In collaboration with dept. of CTVS, stem cell transplant programme has been extended to treat myocardial ischemia as well. The medical oncology department has established modern techniques utilising FISH and polymerase chain reaction (PCR) to prognosticate cancer patients. Also, innovative research by this department has demonstrated the liberation of haematopoietic cytokines from foetal liver, with the potential to treat aplastic anaemia. The department has researched into our ancient wisdom and discovered that a combination of yoga, pranayam, meditation and sudarshan kriya (a rhythmic breathing process) induces positive changes in the brain. These processes enhance antioxidant defence and immune functions of the body, and thus may prevent onset and/or progression of cancer. Preventive oncology programmes to bring awareness about cancer masses have been initiated, alongwith a
screening programme for early cancer detection. Over 10,000 people have been screened so far. The Rotary Viklang Kendra, a unit of Rotary Delhi Central Charitable Trust sponsored by Rotary Club of Delhi central has been established mainly to"alleviate the suffering of the handicapped and the ailing humanity 'to live a life of dignity and honour'. Our main objective to defeat disability are: To rehabilitate the disabled and help the crawling polio disabled walk. To rehabilitate the needy poor, senior citizen with physio and occupational therapies and help them lead a normal life. It is also working towards imparting vocational guidance and arranging proper placements to serve the poor and disabled for their social and economic development. Rotary's humanitarian efforts in the elimination of polio have come a long way since the inauguration of a workshop in 1988 by HL Kapur, the then Lt Governor of Delhi, for manufacturing artificial limbs and providing them free of cost to the disabled. It began in the primary school building at Chitragupta Road under the auspices of Rotary Delhi Central Charitable Trust sponsored by Rotary Club of Delhi Central. SEPTEMBER 2012
Rockland Hospital Since its inception in 2004, Rockland Hospital has taken great strides to progress and has established itself as a major private sector healthcare player in North India
ockland Hospital was launched in 2004 with a plan to create five hospitals by 2020. Execution of the plan has been so efficient that the Rockland Group now plans to have five hospitals by 2015, a full five years ahead of the initial plan. Rockland Dwarka has already been launched. Manesar Hospital will be operational from October 2012 and Rockland Qutab 2 in Delhi will be ready for launch by the end of this year. Land for Noida Hospital has already been acquired and the current plan is to launch it by 2015.
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Rockland medical corridor
RAJESH SRIVASTAVA
Chairman & MD, Rockland Hospital
Rockland Hospital, in the last one year, has moved forward from a single hospital to the creation of a Medical Corridor. Rockland Medical Corridor will have super specialities in several areas like cancer (oncology), cardiology, neurology, orthopaedics, obstetrics, gynaecology, bariatric surgery and other general surgeries with state-of-the-art equipment. The length and width of the corridor will allow doctors located in the entire Delhi-NCR region to be effectively tapped. The patients coming to Delhi would also find it easier to choose the hospitals best linked to their state. By 2015 the Rockland Group will have 1300 beds including two 65-bedded assisted living centres with full backing of all the super specialities.
Assisted living centres
Rockland Qutab
Rockland will focus on the special needs of those who need assisted living facilities due to disabilities of various kinds or due to old age. A difficult gynaec case may force other family members to take long leave, children of old parents living abroad have to run back if their parents fall ill or there could be a physically challenged person in the house who needs special attention. While all the Rockland Hospital units have trained personnel to handle the needs of such patients, exclusive, independent, assisted living facilities have been planned for Manesar and
Noida. These will be housed in an independent Wellness Centre with a club-like environment comprising a swimming pool on top, alternative therapies, indoor games, yoga, spa and multi-cuisine restaurant facilities. A Wellness Centre with 65 rooms at Manesar is almost ready to be launched in the next few months. The Wellness Club members will be allowed free stay up to a week for health check ups or any other needs they may have. They will have access to pick-up and drop facilities from their homes in the event of any medical need by simply calling Team Rockland.
Rockland Dwarka
Medi tourism International patients have special needs as they need complete diagnosis before starting from their country and need a complete package for travel assistance, stay for the attendants, translators and special food needs. The Rockland Group has roped in its hospitality team managing the Rockland hotels to give a combo package to reduce the costs and solve all the other challenges connected during their stay in India. Rockland has combined the medical services with travel and tourism services for medi-tourism. Several delegations from the multinational companies located in the Manesar region have already visited the upcoming hospital in Manesar and are keen to tie up for exclusive arrangements for their employees. These requests include allowing their doctors to collaborate with the Indian doctors from their home country through an IT interface, having the food of their choice, rooms designed to suit their needs and staff that understands their culture and language.
Patient outcome From a ortho, onco and gastro focussed hospital the Rockland Group now has a mix of several specialities which has changed the patient mix to a great extent. Patients requiring neurology, ENT, eye, obstetrics and gynaecology, cosmetic surgery, GI surgery, nephrology and cardiology services are increasing consistently due to the addition of new doctors and additional facilities in these areas.
Green initiatives
Rockland Medical Corridor
SEPTEMBER 2012
Rockland Hospital has been awarded the Gold Grading for its commitment towards conservation of the environment and making a green building. Rockland Hospital has a green approach to all its projects. Particular attention is given to water supply, sewage collection and disposal, solid waste generation www.expresshealthcare.in
and disposal, power system, landscaping and green belt development. A baseline study is done of the region where the hospital is built to establish existing environmental status of the area including topography, drainage pattern, water environment, geology, climate, transport system, land use, flora and fauna, socio-economic and human resources, health, etc. An Environmental Impact Assessment (EIA) is conducted and on the basis of this assessment an Environmental Management Plan (EMP) is developed. Rockland Hospitals have water harvesting as well as drip irrigation systems installed in all its projects to ensure water conservation. The hospitals use energy efficient lighting and ventilation. The building orientation is energy efficient. The towers have been oriented to face directions through which minimum heat is gained. The basic design approach shuts out excess heat with roof overhangs, trees and landscaping. Interfacing of the HIS with the entire management andoperational systems to ensure minimum use of paper in the hospitals. All day-to-day communication is on email. Reports are online for the doctors and patients with minimum use of hard copies and even digital images.
NABH certification Rockland is a NABH certified hospital so it has a comprehensive disaster management system in place with all the training protocols. Hospital is fully equipped with fire alarms, fire extinguishers and fire exit plans. There is a fully equipped emergency department to handle earthquake and other natural disasters as well. Thus, Rockland Hospital has established itself as a very strong player in the Indian healthcare scenario with patients coming across the country and abroad as well. EXPRESS HEALTHCARE
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Pushpanjali Crosslay Hospital With a strong focus on quality, PCH is a unique hospital that employs doctors as 'partners'
hospital has prepared a welldefined disaster management plan, which elaborates the sequence of actions to be taken and the roles and responsibilities of concerned personnel. To maintain a state of preparedness, the plan is practiced and tested in a simulated condition twice a year.
A greener tomorrow
ushpanjali Crosslay Hospital (PCH) is dedicated to its mission of providing patient care that is innovative, compassionate, efficient quality driven and cost effective. The hospital has grown from a bed strength of 100 in September 2008 to 300 in 2012. PCH constantly endeavours to provide patients with any healthcare needs a patient may have—and thus works continuously to add new amenities and services to make this possible.
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Serving more patients better PCH has also witnessed a sharp increase in the total number of OPD cases in the year 2011-12, with over 1,00,000 cases as compared to 66,558 in 2010–11 and 30,393 OPD cases in the year 2009-2010. The IPD cases in 2011-2012 rose to over 12,000 as compared to 10,262 in 2010–2012 and 4,984 in the year 2009-2010. Analysis of the extensive database of patient feedback collected systematically from all patient touch points indicates a rising quality of care, especially in the departments of nursing, housekeeping and dietetics. Translation of the feedback to efficient service delivery is achieved by regular meetings with management and department heads followed by staff training.
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Forging into newer areas The new facilities added in the last one year are IVF, renal transplant facility, suicide prevention clinic and comprehensive diabetic clinic. Around 300 patients have been treated in the department of IVF with a success rate of 70 per cent. The department of nephrology and dialysis saw a huge growth in the number of dialysis carried out from around 3,700 in 2010-11 to more than 10,000 in 2011-12. The hospital also conducted its first renal transplant recently. In the suicide prevention clinic, volunteers and members of the community are trained to understand people who may be exhibiting such tendencies. Three workshops have already been conducted.
Improving quality, upgrading manpower With quality of care as its priority, constant efforts are made to improve standards. In the recent past, a new initiative called 'Quality circles' has been introduced, under which the hospital has undertaken diverse projects like reduced use of paper—a contribution towards environment conservation. Quality circles to improve patient satisfaction have also been started. The hospital has also established ties with the Health Ministry of Gambia to enhance the medical and surgical capacities of www.expresshealthcare.in
their doctors and also send its doctors to perform difficult surgeries for the needy. Collaboration with educational institutes to run courses on hospital administration, to address the increasing demand of superior administrators is also a focus area. The hospital has successfully passed NABH surveillance and received NABL certification for its laboratory. It has also received DNB approval for departments of paediatrics, anaesthesia, internal medicine and radiotherapy and is now authorised to provide hands-ontraining to doctors in the stated departments.
Different from the rest PCH is a hospital with a difference. It follows the concept of being a cooperative corporate where more than 100 doctors are equity partners. The hospital is led by a team of doctors who intrinsically understand the needs of maintaining patient-care standards for better treatment outcome. The hospital believes in extending the advantages of all systems of m e d i c i n e — A l l o p a t h y, Homeopathy and Ayurveda to patients. As a part of its corporate social responsibility, the hospital employs physically challenged people in many backend departments such as housekeeping and console; and also as acupressure specialists. The
PCH is a 'green hospital', with CNG-fired generators, and heat recovery system for AC plants. Not only does it reduce environmental pollution but grid electricity consumption too, thereby assisting the city maintain its total consumption. Water harvesting is being carried out since July 2010, where water is reused after treating in the Sewage Treatment Plant (STP). The Effluent Treatment Plant (ETP) added in September 2011 has further enhanced operations in this regard. Water from various hospital areas is discharged in STP after treatment in ETP and is then used for gardening and washing/mopping purposes. PCH has a web-based robust hospital information system and PACS which offers timely and convenient access to 'electronic' images, reports and other information from one PC to another anywhere in the hospital. Reducing and reusing paper at points where printed material is mandatory has led to a 25 per cent reduction in paper consumption in the last three months.
The hospital believes in ●
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Providing leadership through commitment and role modelling Adhering to a people centered management system Training and mentoring work team Encouraging an open channel of communication with the management Communicating work expectations and goals Treating all employees with honesty, respect and dignity Following plans and policies very strictly SEPTEMBER 2012
Sri Balaji Action Medical Institute Driven by a vision to provide affordable yet best medical care, Sri Balaji Action Medical Institute has also taken up the challenge to build up the talent pool
measured against a number of indices. There are a number of indicators monitored, with the number of follow-up visits on one end of the spectrum and clinical outcome on the other. The hospital boasts a higher number of follow-up visits thus confirming that the earlier experience of the patient was satisfactory. The clinical outcome is measured in terms of increase in level of care and reduction in complications. Hospital associated infections are closely monitored and quick CAPA on reported cases done. Patient safety as well as staff safety is critically kept under control.
Energy efficient and paperless ri Balaji Action Medical Institute was inaugurated on April 10, 2005 by Bhairo Singh Shekhawat, the then Vice-President of India. The hospital started with 100-inpatient beds and OPDs. Today it has 300 beds at about 85 per cent occupancy with an OPD count of 2,27,656 (2011-12). Run by a trust under the bigger umbrella of Action Group of Industries, the hospital believes in evidence-based clinical practices driven by process and protocol and received NABH accreditation in October 2011. The labs are NABL reaccreditated. Super-specialties like cardiology, cardiac surgeries, neurology, neurosurgery, nephrology, urology, gastroenterology, GI surgery, medical and surgical oncology, interventional radiology, paediatric surgery, plastic surgery and rheumatology along with the basic disciplines of medicine, surgery, orthopaedics, obstetric gynaecology, paediatrics ,ophthalmology, ENT, dermatology, psychiatry and dental services are offered under one roof. To support these disciplines, 24-hour emergency services, blood bank, radiology, lab, pharmacy and physiotherapy are available. Apart from this, nursing staff and students are provided with fully air-conditioned hostel facilities.
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DR (PROF) D P SARASWAT
CEO Action Group of Hospitals
SEPTEMBER 2012
World class care at affordable price As a part of its corporate social responsibility (CSR), patients from middle and lower social economic strata are given world class medical care at affordable rates while ensuring high standards in terms of service quality. Out of the 22,211 patients admitted in 2011-12, 1646 were from the economically weaker section. Upgrading to a tertiary level hospital from a secondary level has contributed to enlarging the catchment area with patients from neighbouring states of Delhi also availing services here.
Towards a multi-specialty hospital Three clinics, namely joint replacement and sports injuries clinic, breast specialty clinic and diabetes clinic were set up last year. Two new modular OTs along with state-of-the-art technology of OR-1 were commissioned and a new paediatric high dependency unit opened to provide step down services to patients. A bariatric clinic to carry out bariatric surgery and an operation theatre alongwith other in-house support system is almost ready. Storage and quick retrieval of images through PACS is also in the offing. Besides enlargement of the existing services and upgradation of the equipment used is also undertaken e.g. new www.expresshealthcare.in
Cath Lab IGS -520 for cardiology and neurology departments is being procured. The existing 15 machine dialysis unit is being enhanced to double its number to help commence renal transplants in the future. One more linear accelerator is likely to be procured after seeing the utilisation of existing Rapidarc Clinicix Varian.
Creating a talent pool The training of surgeons, anaesthetists, nurses and para medical staff is one of the priority areas. Ginnidevi Action School of Nursing has taken its first batch of 30 students for three and a half years General Nursing and Midwifery course under the banner of Indian Nursing Council. This shall address the challenge of nurses' shortage in this geography. DNB training in anaesthesia, family medicine and internal medicine alongwith a twoyear full-time Post Graduate Diploma in Clinical Cardiology course under the banner of Indira Gandhi National Open University is also being conducted in the department of cardiology. A two-year full-time Fellowship in Critical Care Medicine under Indo-Australian Critical Care Association is also carried out.
Delivering highter patient outcomes The patient outcome in any healthcare organisation is
Solar water heater and LED lights are installed to save electrical energy. Pneumatic chutes are used to transfer samples and patient records etc which reduces use of lifts by staff. Provisions for rain water harvesting are in place. Green environment is maintained around the hospitals and insulated glass used in windows to reduce the air conditioner requirement. Hospital kitchen provides only vegetarian food and used water recycled in ACH. A good HMIS system is in place which facilitates online sharing of data and online handling of complaints and suggestions. All indents, returns and day-to-day maintenance are done online. Networking of all computers within the hospital is done to facilitate communication and information sharing amongst the staff, which minimises the use of papers.
Prepared for disasters Disaster management plan of the hospital is in place and regularly updated. Emergency response team is available round the clock. Evacuation plans are displayed in all areas. Staff is trained to deal with emergency codes so that each staff member is aware of his/her role during a disaster. Mock drills are conducted regularly to check the adequacy of plan and corrective actions are taken immediately. EXPRESS HEALTHCARE
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Radiology ‘India is one of our key markets’ Mirna Bassil, Marketing Manager, Emerging Markets - Middle East, Africa, Greater Russia, Turkey, India, French Overseas, Carestream Health
Page 52 MAIN STORY
Teleradiology in today’s world Dr Harsha C Chadaga, Senior Consultant and Head of Radiology Operations at Columbia Asia Hospitals, Bangalore, outlines the relevance and need for teleradiology in healthcare and elaborates on the challenges that need to be tackled to facilitate its further growth
DR HARSHA C CHADAGA
Senior Consultant and Head of Radiology Operations, Columbia Asia Hospitals, Bangalore
wenty five-year-old Avinash is hit by a lorry as he rides home on his motorcycle on a poorly lit road one evening. He is rushed to a local nursing home where a CT scan is performed. In 15 minutes, a team of radiologists report the presence of internal bleeding confirming the medical officer’s diagnosis of head injury. Avinash is rushed into surgery, and a potential fatality is averted. This sounds like any one of hundreds of road accidents that occur daily in India. So why does it merit any further discussion?
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The differentiator? What differentiates this incident is that Avinash’s accident occurred in a small town in Nagaland which can only be reached by road. A qualified radiologist would have to travel 24 hours to reach here. The 15 minute turnaround time between taking a CT scan and obtaining a report was possible because a team of radiologists from Bangalore was available, able to obtain the scan and send back the report, all within a time span that makes the difference between life and death.
Boon for small town dwellers This is the new world of teleradiology. This technique of imaging has allowed healthcare providers to harness technology to provide quick, high-quality and widely accessible specialist care. Let’s go back to Avinash’s story for a moment. Isn’t it unusual that a remote nurs-
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discuss cases with reporting radiologist.
the
Factors limiting growth of teleradiology
ing home in Nagaland should have access to a CT scanner but not to a qualified radiologist? Unfortunately, the answer is no. Over the past few years, investments in Indian healthcare have grown rapidly, with the result that hospitals and diagnostic centres have mushroomed across the country. The bottleneck now has moved to manpower: recruiting and retaining a radiologist is increasingly challenging, even in the metros. By utilising the expertise of specialists, wherever they may be, teleradiology provides a means of overcoming this bottleneck.
Overcoming geographical boundaries Today, over 70 per cent of clinical decisions are made on the basis of diagnostics like radiology and laboratory results. Further, medical science is evolving rapidly and developments like the 256slice CT and 3T MRI produce images that can be interpreted only by highly qualified specialists. Teleradiology allows patients to overcome the constraints of geography to access the benefit of this www.expresshealthcare.in
small pool of specialists. The other great benefit of teleradiology is in providing 24 X 7 coverage. This is one of the main reasons why 75 per cent of American hospitals contract with at least one teleradiology company, which helps them distribute the load and ensure radiologist availability throughout the clock. This in turn allows the rationalisation of escalating healthcare costs by optimising radiologist productivity, better utilising expensive CT and MRI systems and contributing to the development of imaging science by knowledge sharing. Technology developments have facilitated teleradiology in several ways. The progress made in 3G networks, mobility devices and broadband connectivity has facilitated the quick transfer and seamless integration of radiology images across geographic locations. Teleradiology has been built on the foundation of technology like PACS and video conferencing facilities which helped overcome the fundamental limitation of the radiologist not being able to view previous images and the inability to directly
Several factors have prevented teleradiology from growing as fast as requirements suggest. Primary among these is the ambiguity in the legal system which results in unclear liability sharing between different stakeholders and hence an unwillingness to take risk. The lack of awareness and discomfort with technology among hospitals and physicians has also constrained growth. Further, it is currently often considered acceptable for non-specialists to read and report on complex radiology images. Nevertheless, as the healthcare system evolves, both patient communities and insurers will increasingly insist that reports be read by a qualified radiologist. The other limitation in teleradiology adoption by hospitals has been the requirement for an onsite radiologist to perform ultrasound scans. The growing demand-supply gap will inevitably result in the development of sonologists, trained ultrasound specialists who represent a qualified alternative to an onsite radiologist. This is a trend that countries across the world have witnessed in response to radiologist scarcity and it is only a matter of time before it reaches India. The growing demand, the acute shortage of radiologists, the complexity of the specialty and the enabling technology will continue to be growth drivers and ensure that teleradiology is here to stay. SEPTEMBER 2012
R|A|D|I|O|L|O|G|Y INTERVIEW
‘India is one of our key markets’ Mirna Bassil MARKETING MANAGER, EMERGING MARKETS - MIDDLE EAST, AFRICA, GREATER RUSSIA, TURKEY, INDIA, FRENCH OVERSEAS, CARESTREAM HEALTH
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f the field of radiology has made rapid strides, the contribution of Carestream Health, which has been actively involved for more than 100 years in the evolution of X-ray imaging technology, has to be noted in giving a major thrust to the radiology domain. Driven by the vision of providing innovative solutions to customers, Carestream Health has been at the forefront of providing a broad portfolio of conventional and digital X-ray systems as well as medical IT systems for healthcare professional worldwide. Ever since Carestream Health set foot into the Indian market in 1991, the company has made significant contributions towards the development of medical imaging market by introducing innovative and state-of-the-art products and solutions.
Mirna Bassil, Marketing Manager, Emerging Markets—Middle East, Africa, Greater Russia, Turkey, India, French Overseas, Carestream Health speaks to Express Healthcare about the company's perspective on the Indian radiology market and its plans for India. Associated with Carestream Health for more than a decade, Bassil has indepth knowledge of the Indian radiology market and its customers. Excerpts:
How important is the Indian radiology market for Carestream? How has Carestream Health been faring in this market? India is one of the key markets for us. Ever since we forayed into the Indian market in 1991 we have always strived to make our latest technologies promptly available to the Indian customers. We have introduced a slew of innovative X-ray imaging solutions in the Indian market and have developed a strong and loyal customer base.
With which products did you enter the Indian market?
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When we entered the market, medical imaging was almost synonymous with analog x-ray system and film. X-ray imaging was reliant on x-ray films being developed in dark rooms with the help of chemicals.That was the starting point. We were the first to introduce laser imaging technology for Xray film printing, which was a step towards the digital technol-
tion with India’s most known luminaries in the field.
When you compare the Indian market with the rest of the world, where would you rank the Indian radiology market? Indian radiologists in general are very technology oriented and very knowledgeable. The Indian radiology
Indian radiologists, in general are very technology oriented and very knowledgeable. The Indian radiology market is ready to adopt new innovations and is advancing rapidly ogy in imaging. With the laser film technology, customers can do away with dark room and hassle of developing film with chemicals. So it’s just laser printing. This is one of our innovations that we brought to the industry. More recently, we’re proud to have also been pioneers in digital imaging technology, with our launch of the world’s first cassette-sized wireless digital radiography detector.
You have been associated with the Indian market for a long time now. What can you tell us about your experience with this market? Yes, my association with Carestream Health is a decade old and since the last five years, I support India for various marketing initiatives. India’s radiology professionals are very keen on image quality and are very knowledgeable in their field. We are very proud to have had the chance over the years to be close to the Indian radiology professionals cooperating with them on bringing to India the latest technologies, which help them improve both image quality and patient care. We are especially proud of our educational programmes and activities, which we continue to implement in India in cooperawww.expresshealthcare.in
market is ready to adopt new innovations and is advancing rapidly.
Indian experts believe that innovation does not happen in India, it is adopted from the West. So, what is your perspective on this line of thought? I feel is that the response to new technologies and products is quiet encouraging among the customers in India. Indian radiologists are open to learning and adopting new technologies. They regularly attend trade shows and congresses in the world in order to remain up-todate on the latest technology advancements. Many Indian radiologists make it a point to attend RSNA, which is the biggest radiology show in the world. At RSNA, Indian radiologists are seen keen on understanding the new developments in the field. So, my perspective is that Indian radiologists are always looking forward to learning new things that they want to embrace and adopt.
Coming back to Carestream's operations in India, what marketing strategies did you adopt when you entered the Indian market in 1991? How did you make your presence felt? Our effort is to stay as
close as possible to the customers. We have direct presence in India with our own sales and service teams covering all the states of India. We have also a network of over 150 channel partners across India serving thousands of customers. With the passage of time, we are adding more feet on the ground. We bring all newly introduced X-ray imaging products to India without any time lag. Customer’s success and satisfaction are the centre of our focus always.
How do you focus on territories and products? We try to be as close as possible to the end users, be it through personal connections or by way of our channel partners. We try to be present at various shows and conferences. We are well known in India for our various educational activities that we conduct for our customers to contribute towards the growth of the industry. We had an educational magazine that we are revamping this year. Also, we regularly conduct Digital Radiography seminars across India to share advanced radiology imaging techniques and solutions with our customers as well as organise training programs for radiographers.
Indian hospitals are price sensitive and often talk about budget constraint when they have to update technology. Is it difficult to market your DR products in such a market? At Carestream, we understand the requirement of the customer and based on this, we develop our products. Going for a full room DR may be a costly proposition for many Indian customers, which is why we came up with a retrofit solution, Carestream DRX1 System. Keeping existing set up with the help of the retrofit solution, one can upgrade to DR at just one third the cost of full room DR. Afterwards, the customer can step by step SEPTEMBER 2012
R|A|D|I|O|L|O|G|Y upgrade to full-room DR as and when he wishes to.Through this DRX technology, we offer flexibility of transforming the existing analogue X-ray room into a DR within a day.
Do you think that Indian hospitals and imaging centers are really prepared to embrace digital radiology? Yes, they are. We can gauge their interest when we meet them at radiology events in India, the US and Europe, which they attend to understand the significance and usage of latest technologies. That many hospitals are now going film-less also reflects the fact that doctors are keen on adopting new technologies. Our latest digital imaging solutions have already been adopted by many sites in India and we are very excited by the response we have had so far for our digital solutions.
You must have come down to India with a special purpose. So is there a new project that you are working on?
bar up with respect to what a customer should expect from a DR mobile system. We are positive that the Indian radiologists would appreciate it as
We have always strived to make our latest technologies promptly available to the Indian customers. We have introduced a slew of innovative X-ray imaging solutions in the Indian market We always have projects in the pipeline and it’s always a pleasure for me to be here. We have a new product that we want to launch soon. It’s our DR mobile system, part of the DRX family. This is a revolutionary DR mobile system, which is why we call it the DRX Revolution. It’s different from what we know of mobile systems and really raises the
ment in many parts of the world, most recently in China and Saudi Arabia. We have a slew of mobile solutions, one of them being our CR mobile, the CR-Vita system. We are capable of linking rural diagnostic centres with main city hospitals. We are running successful projects with our CR and PACS solutions in Saudi Arabia and China. And hopefully, we shall implement something similar in India as well when and as needed, because we have the experience.
much as our other products.
Some PPP models have been created to make radiology and imaging available to the rural sector. Is Carestream willing to explore such an opportunity? Yes, we are very keen on PPPs. Carestream Health has always focused on rural develop-
What are your plans for the Indian radiology market? As India is one of our key markets and Indian radiologists are technology-savvy, we will continue to introduce new technologies and products in India, which answer our customers’ needs for image quality, productivity and better patient care.
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Hospital Infra Healing healthcare environments
Lighting the way of healing environments Raghunanda SA, Founder and Principle Architect, Synergic Designs, Bangalore explains the importance of lighting in a healthcare
Meeta Ruparel, Director, AUM MEDITEC gives an insight into hospital and healthcare design concepts that enable healing healthcare pathways
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MAIN STORY
Rooting for healing interiors I As the demand for quality healthcare services increases, the demand for good hospital architecture and interiors also rises concurrently. Raelene Kambli profiles how evidence-based design approach in hospitals can make for happier and healthier patients
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magine visiting a hospital setting that is notable for its classic serenity and elegance. As you enter the gate of this institute, you will find broad tree-lined roads crisscrossing the campus area and lush tropical vegetation forming a green canopy that shelters the hospital building. A few steps further, series of illuminated vertical masts, characterise the entry into the hospital. The lobby incorporates playful naturethemed motifs, such as mobile sculptures depicting colourful pictures of flowers and birds. An amazing 30 feet high waterfall tower at the left corner of the reception area captures your eye as water cascades over its shiplapped panels to create a stunning water wall feature. As you walk around various departments within the hospital, you will find well-furnished rooms with big windows that allow natural light and fresh air to breeze in as well as open spaces which give ample scope for free movement. Plants at every corner creates a refreshing feel. Every detail, from the artwork on the walls to the furnishing inside every room compliment each other perfectly. Wondering if this is a fairy tale description of a hospital or a reality? Can hospitals also look and feel impressive? Of course yes! Hospitals these days are harmoniously designed to be a safe and comfortable place for their patient, visitors and medical staff. But this was not the case some years ago. Traditionally, hospitals were known to be noisy and cluttered. They were passive reflections of institutional designs that gave little regard to the potentially detrimental effects that these environ-
Kohinoor lobby ments have on the patient's physical or emotional wellbeing. But today it is different. Today, hospitals not only focus on advanced medical knowhow (also known as evidence-based medicine), but reflect the realities of modern-day healthcare whose prime goal is to deliver care keeping the patient first. Thanks to the introduction of creative interior decorators in the Indian hospital infrastructure segment, who are responsible for transforming the look and feel within hospitals. Talking about healthcare delivery in modern times, it is a known fact that hospital interiors have a strong impact on a patient's health. According to experts around the world the right kind of elements incorporated in the interiors can help fasten the recovery process of a patient.“Healing and recovery are holistic processes and can be aided substantially by the right setting,” claims Ram Raheja, Director, S Raheja Realty. To define interiors that create a healing environment, one can say that these designs support health and well-being. Additionally, these designs help in improving a patient’s outlook on care and ultimately increase patient satisfacwww.expresshealthcare.in
tion. It can also streamline workflow and eliminate the opportunity for medical errors. This is one reason why hospital administrators are now-a-days trying to evolve their hospital designs beyond their infamously sterile décor towards creating an healing environment. Ratan Jalan, Founder and Principal Consultant, Medium Healthcare Consulting is of the opinion that not only hospitals but even architects and interior designers for hospitals are now focussing on creating a healing environment for patients. He, refers to an hospital project he had worked on in the past saying,“While I was the President at Asian Health Services, possibly India’s first hospital architecture firm, we had released an ad to recruit architects with a headline, 'We need architects who can help patients recover faster.'”
the registration and throughout their treatment time. In reality, designing healthcare environments is a complex discipline. Apart from patient experiences these designs are drawn on the basis of biology, chemistry, patientoutcomes research, psychology, physiology and the list continues. Meeta Ruparel, Director, AUM MEDITEC, listing down some of the pre-requisites for creating such designs says, “There are many factors that need to be kept in mind while preparing a design. To name a few: vision of the project, strategic design concept (exterior and interior), facility / services aimed to be provided, equipment requirements that are proposed to be installed, safety criteria, patient and staff comfort, efficiency, mandatory standards / regulations applicable, environmental factors, land properties (type of land), demography studies, etc., and let us not forget the budget allotted, because the cost of interiors has a wide scale continuum between cost and aesthetics. This needs to be balanced in synchrony with the management's or the project vision.” She strongly recommends the use of environmental research before preparing the design. This would enable an appropriate design in harmony with the prevailing environment system.
Creating a design that heals
The right elements
Designing a healing environment within a hospital is more than just wrapping a pretty facade on a building or decorating the lobby. It’s the orchestration of every moment that a patient experiences, right from the point of arrival into the hospital, to
After understanding the pre-requisites for designing a healing environment, let us move on to elements that are helpful in optimising physical, mental, emotional and spiritual healing for the individual needs of patients coming from a variety of SEPTEMBER 2012
H|O|S|P|I|T|A|L|I|N|F|R|A background and culture.“Use of cheerful colours, textures, patterns on the walls, artwork, signages, etc., contribute to faster recovery of a patient,” avers, Girish Deshpande, Architect, Focusz Designs.” While designing a hospital emphasis is given to ample natural light and view to all patient rooms and other areas to foster wellness,” he adds. These elements play an important role in developing a surrounding that will reduce stress and engage the senses in therapeutic ways.
Bringing in some natural light John Saladino, a famous interior designer from Rome, once said, “In my view, no space without natural light is worthy of human occupation.” A candid statement indeed. Natural light beyond its aesthetic appeal, reduces eyestrain, increases productivity and reduces excess consumption of electricity. Making good use of natural light cuts the need for artificial lighting and helps provide a feeling of well-being among patients, visitor and medical staff. It also lifts spirits and makes spaces appear larger. Jalan adds, “Full spectrum light has been shown to reduce depression, even in cases of deep depression. Just to give an example, the role of sunlight, which is a crucial element in the design process, is rarely appreciated. Florence Nightingale, in her famous book Notes on Nursing, has devoted almost an entire chapter to sunlight. Similarly, the choice of colours and even paintings can do miracles.”
Adding colour Colours are said to be nature's healing element. They have the tendency to elicit certain emotions, moods and physical feeling. Using appropriate colours in waiting areas, examination rooms, ICUs or other patient private rooms will not only enhance the look of the hospital but will also help patients recover faster. Shades of blue, green, grey, yellow and lavender are mostly recommended by interior designer to create a soothing appeal. Nevertheless, choosing colours also depends on the departments and facilities provided within the hospital.
Experiencing nature Plants bring in a sophisticated and a natural feel to the hospital décor. Citing an SEPTEMBER 2012
example on how adding plants can help in creating an healing effect, Raheja refers to the Hinduja Healthcare hospital in Mumbai that he has recently designed. He says, “The rooms of the hospital overlook an expanse of green and we have included a terrace garden for fresh air and a lounge with a healthy café. From the minute a patient checks in to the moment he or she checks out, we have created a luxurious yet uncomplicated restful space for them to heal.” Further, he believes that adding the green element create a therapeutic aura. Other elements such as the right kind of flooring, artworks, signages, furnishing etc., also facilitate in enhancing the ambiance within the hospital.
Reception area of Hinduja Healthcare
The trend today With more and more hospitals in India adding natural elements into their hospital décor, experts find this phenomenon to be one kind of health reform wherein hospitals are transforming themselves into healthcare centres of excellence. In the quest to create a healing environment, some hospitals in India are going green. The green building concept in India was initiated in 2007 by Indian Green Building Council (IGBC). The concept of green architecture primarily centres around creating an ecofriendly environment as well as reducing carbon footprints. While creating such design, architects and interior designers implement a range of energy efficient measures to reduce energy consumption, decrease greenhouse gas emissions and improve the quality of patient care. Moreover, as the green building concept focusses more on structural applications, hospitals and designers felt to need to add aesthetics that could breathe in the feel good factor inside the hospital. Speaking of what Indian hospitals look for, Deshpande informs, “Modern designs focus on surfaces that can be cleaned easily and do not harbour contaminates. The main concerns for hospital designs are functionality, cleaning abilities and infection control.” In order to overcome the functional and safety challenges that hospitals and interior designers undergo, the concept of evidence-based designs has been introduced in recent times. This concept focuses on efficiencies and thus helps reduce operational www.expresshealthcare.in
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Kohinoor private rooms expenses.” Evidence-based design is a field of study that emphasises the importance of using credible data in order to influence the design process. The approach has become popular in healthcare architecture in an effort to improve patient and staff well-being, patient healing process, stress reduction and safety. Evidence-based design borrows terminology and ideas from several disciplines including environmental psychology, architecture, neuroscience and behavioural economics,” defines Deshpande. Elaborating further Raheja says, “One can define it as a wide range of functional aspects, with personal human experience as the primary objective. We’ve researched behaviour and
habitual patterns of patients and thus created different zones for comfort and relaxation within what have earlier been seen as impersonal and unimpressive public spaces. Symphony and harmony of detail-oriented practical realities with aesthetics is of essence to evidencebased interiors.” But does evidence-based design help in creating a healing environment? Telling us why it is important to opt for evidence-based concept while creating a healing environment, Jalan explains, “Internationally, evidence-based design is emerging as an important philosophy. Research has shown that evidence based interiors form an integral part of any hospital setting. For instance, many patients complain about noise in EXPRESS HEALTHCARE
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H|O|S|P|I|T|A|L|I|N|F|R|A hospital. In fact, in the US, it forms a part of the government required Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) survey questionnaire ‘How often was the area around your room quiet at night?’ A well thought through hospital interior design that uses the right technology and materials could help to reduce this problem. The same is applicable to other design elements. For instance, it is a common knowledge that sunlight contributes to healing.” Evidence-based interiors research has also said that these designs can lower stress levels (glucocorticoids) for both patients and staff. The correlation between stress levels and clinical error has been extensively documented and so design elements which decrease staff stress levels would clearly aid in providing quality care. “Design aspects which have been demonstrated as reducing stress include colours, ambient light and even fragrances. The choice of colours - including the patterns, shades and brightness—impacts far more than the sense of sight. Soothing arrangements like those seen in Japanese rock gardens,
The Hinduja Healthcare Case Study
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induja Healthcare, Mumbai has adopted the concept of evidence-based design. Ram Raheja, Director, S Raheja Realty briefly explains the making of this hospital.
The concept Our core objective was to blend two diverse programmes, healthcare and hospitality, into one. This was a challenge, which we embraced as a opportunity to create a state-of-theart , one of its kind project. It took us approximately three years to complete this project.
The challenges This project had several challenges, some were programmatic but a major one was the site constraints. Working within a dense urban fabric in an infamously chaotic metropolis has its ups and downs. The success of this project should be given to collaborative effort.
widely hailed for their role in positively influencing mood. Lavender, for instance, is a well known sleep aid,” Jalan adds. Interestingly, this concept also enables hospitals to reduce capital expenditure. “There are several ways it does, but these can also vary project to project. The right amount of research helps in the functional requirements of the hospital. Data analysis, R&D and programming as per the same, are most important parts in healthcare design. This will make the project truly functionally efficient and not just esthetically wonderful,” informs Raheja.
The design process The design process experimented vertical and diagonal sequencing of medical programmes and ancillary services within the context. As a hospital, we had to continuously maintain a balance between crisp efficiency and relaxation, public and private spaces, isolation and inclusion. We’ve worked consciously towards creating a modern and aesthetic space for convalescence at Hinduja Healthcare. As light and texture are essential in transforming a space, the finest organic fibres and plush surfaces have been combined with the use of light and shadow through perforations and curtain wall systems to ensure peace and tranquility. We’ve incorporated extensive use of white and beige in the interiors to create warmth for the patients and visitors. also called Zen gardens, are great examples of the intentional use of light and colour. The Ryoan -ji Temple in north of Kyoto is perhaps the
most famous instance. Full spectrum light has been shown to reduce depression, even in cases of deep depression. Some fragrances are
Scope for the future Looking at the developments in the hospital infrastructure space in the past decade, one can say that the segment has grown by leaps and bounds. Experts predicts that the sector will still continue to grow. Besides this, as evidence-based design increasingly gains popularity among Indian hospitals, architects and designers will continue to add new concepts that help embellishing environments inside hospitals. raelene.kambli@expressindia.com
INSIGHT
Lighting the way of healing environments Raghunanda SA, Founder and Principal Architect, Synergic Designs, Bangalore explains the importance of lighting in a healthcare set up and outlines how it can be put to best possible use for enhancing the environment in hospitals
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functional for the staff. Most importantly, good lighting gives a sense of safety for all people in the hospital. Getting controlled natural light into the hospital is the best form of lighting. In India, it is important to study the best orientation from solar point of view, such that the building should receive the maximum during the winter and minimum in summer. Architectural designs and elements play a very important role in controlling excess light from the outside and inducing light as a concept for wellbeing. In the long run, the hospital benefits from good lighting designs.
ood lighting is necessary for all buildings, irrespective of location and building type. In hospitals, lighting plays a very important role satisfying the needs of personnel involved. Typically in healthcare designs, to understand the needs, it’s important for an architect to wear multiple hats, those of a patient, the medical staff, the visitor, the doctors, and the administrator staff. Understanding their work and emotions helps the architect to develop the design to suit their function and requirement. Lighting helps the hospital environment in creating an ambience of well-being for the patients. It gives a sense of privacy, an identity, and helps in social contact. For the visitor, lighting gives them information, a good sense of orientation, and good hospitality. For the assisting the staff, be it medical or administrative, it helps in performing their duties. It helps them to communicate; it is more
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Giving direction Orientation and guidance is extremely important, especially for patients and visitors. “Opening up” the institution makes the hospital a 24 hours public space. This is achieved by exposing waiting areas and main corridors in the general public areas open to the outside through glass walls or large window www.expresshealthcare.in
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H|O|S|P|I|T|A|L|I|N|F|R|A openings. This design aspect lets the outside light in and provides view which help people feel secure and not disoriented. An important aspect in letting in outside light is to reduce glare. Excessive contrast or abrupt and large changes in brightness produces the effect of glare. When glare is there it reduces the efficiency of vision, and small changes and details cannot be perceived. An example of glare is when the view of the outside bright sky through a window or skylight is perceived with the surrounding room light is dim and comparatively dark. Change in direction of corridors or change in levels affected by glare is definitely an area for accidents. Architecturally glare can be addressed by shielding the direct light by louvers, changing the external form with hoods, a “jaali window or jaali wall”, verandahs, covered balconies, large overhangs, cross lighting the surroundings to a comparable level, and many more design elements. A gradual transition of brightness from one portion to the other within the field of vision always avoids or minimises the glare effect.
Planning lighting pattern Careful planning of brightness and colour pattern, within working areas and surroundings, help in drawing attention to the task or function of the room. The detail is seen quickly and accurately. Aspects that require to be considered here is the task itself, the immediate back ground of the task, and the general surroundings of walls, ceiling, floor, equipment, and furnishings. In patient room the choice should be given to create individual lighting moods according to the moods and situation. The design should adapt flexibility. Lighting should change the ambience of a patient room to make it suitable for different purposes. It should be bright functional light for an examination environment and have a warm and pleasant atmosphere in which the patient can enjoy a relaxing conversation with visitors Hospitals are high-intensity, 24/7 working environments. The staff must be able to communicate with patients while concentrating on demanding tasks and making critical decisions under pressure at all times of the day and night. How well a hospital performs, and how it is perceived by the staff, is SEPTEMBER 2012
directly related to their motivation and sense of wellbeing. In functional areas, be it the intense work atmosphere in the OTs, or the ICUs, or the diagnostic areas, etc., the main work takes place over the whole utilisation area of the room. The illumination needs to be reasonably uniform and specific over the main work space. Task brightness should be appropriate to the function that it is catering for. The brightness to the other parts of the room should be planned to give proper emphasis to visual comfort and interest. The rhythm of light and darkness also synchronises the biological clocks. Two characteristics of light that strongly influence how they feel, both physiologically and psychologically, are its intensity and color (e.g., “cool” or “warm”). Having the ability to adapt the environment to their personal preferences also increases their motivation and improves their sense of comfort and satisfaction. In short, a flexible lighting design in functional works is a must.
The ambience Today, many hospitals already offer hotel-style facilities for people receiving outpatient care and for family members of inpatients. Buildings of this kind require a very different atmosphere than that found in the hospitals of the past. It is important for hospitals to prepare for this new range of patients and services. By embracing the coming changes in the healthcare industry, hospitals can attract a wider public— and benefit from the associated revenue streams. They will also build an atmosphere of confidence and trust, demonstrating that they not only take the needs of their www.expresshealthcare.in
patients seriously, they also support family and friends as partners in the healing process. Lighting designs that is integrated into the architecture can create an appealing, emotionally uplifting atmosphere. It is important to grade the ambience within the building to allow adequate time for adaption when passing from one area to another area. This is important to avoid accidents and give that sense of belonging. Example - A spacious entry hall with bright light and colorful light accents communicates an important message to visitors. Entry halls need to have windows arranged to the outside to give adequate natural lighting to the immediate entrance. Windows help in creating levels of gradation of light from a very bright outside to the inside. This architectural design detail communicates to the people – You are welcome. In a nutshell lighting in hospitals should cater to the following aspects. Patient areas - These are patient rooms, recreational areas. The key issues are to make the hospital less intimidating, create personalised space and Safety. This can be achieved by easy controlled light and no direct lighting. Indirect lighting where the source of light is covered is preferred. Public areas—Lobbies, corridors, cafeteria, waiting rooms. The key issues are giving orientation and safety, inviting interiors for the visitors and patients, giving brand experience. This is achieved by contour lighting and colour solutions. Openings to the outside is a very good idea.
Exterior and entrance Facades, parking areas, entryway. The hospital needs to be the landmark, a building to be remembered. The key issues are visibility, creating a brand image and orientation and safety. Striking façade lighting, functional area lighting for parking is some of the solutions. Imaging and treatment areas - Operating rooms, MRI and CT rooms and diagnostic rooms. These purely functional areas require optimal working environment, efficient turn-over rates, (this helps in generating good business for the hospital) and motivate the staff for improved performance. Good task lighting solutions with low glare designs help in achieving good lighting designs. Staff areas - Nurse stations, laboratories, examination rooms. These support service areas too require optimal working environment. A feeling of well being helps in motivating the staff with better performances. Lighting helps communicate the hospital’s healthcare mission to the outside world while also increasing the facility’s operating efficiency. Architectural outdoor lighting is one of the most powerful ways to turn the building into a prominent landmark, a living symbol of care and hospitality. Indoors, smart lighting management systems can allow substantial savings on energy costs. Intelligent and good lighting design details, develops highly durable, energyefficient lighting systems that reduce total cost of ownership and minimise environmental impact. EXPRESS HEALTHCARE
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H|O|S|P|I|T|A|L|I|N|F|R|A INSIGHT
Healing healthcare environments Meeta Ruparel, Director, AUM MEDITEC gives an insight into hospital and healthcare design concepts that enable healing healthcare pathways
iseases can manifest in many combinations of the mind and body (spiritually, psychologically, physically, etc) and we must utilise all possible therapeutic means in order to achieve and sustain stability. However, as a healthcare service the caregiver generally tends to focus more on "cures" than on "healing". “Cures” specifically treat a state of physical, psychological, and emotional being of an individual, whereas; “Healing” addresses not just the disease but the whole individual. Globally, it is a widely accepted belief that clinical treatment is more effective when the whole individual is treated; body, mind and spirit.
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The brain —body communication To keep things organised in a body, brain communication is very important. To create harmony throughout our physical-energy system, the brain uses whatever resources available. What we need to understand is how the brain can stimulate a communication system that has shut down from an overload of stress (physical stress, environmental stress, emotional stress, chemical stress). Let us consider an analogy here of the circuit trip
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switches. Once there is an overload, the circuit breaks, to restart the system, someone has to turn the switch on or the circuit will not restart. Similarly, once the brain and body communication breaks someone or something has to trigger the brain to communicate with the body again. These triggers are the five senses (sight, sound, smell, touch and taste). These senses are the information carriers for the brain that are further disintegrated into signals by the brain to stimulate healing. The brain keeps mobilising the body energy in the direction of healing therefore it is very important to switch on the brain circuit. There is energy all around us in different forms we need to tap the right energy for the right communication of the brain to heal the body. Energy stimulates the senses. Light/nature/colour is energy (sense of sight); music/voice is energy (sense of sound); aroma is energy (sense of smell); tender care is energy (sense of touch); nutrition is energy (sense of taste). Evidences for use of such energy and its efficacy for healing exist in age old therapies being practiced worldwide; to name a few: aroma therapy, hydrotherapy, colour laser therapy, oil massage www.expresshealthcare.in
therapy, magnetic therapy, sound therapy, etc.
Healing environment “Healing Environment” is a concept built just on this belief. However the application methodology has a slight modification with a perception to address the five senses. “Healing Environment” orients a holistic approach to healing care. The evident question here is; what is the modification? Is this another equipment use? The answer is No and Yes! I mean it is not any special equipment that induces “Healing Environment” it is a concept that needs to be designed specific to the care/service being delivered in the area into consideration. There maybe a bit of technology in use, but not any high capital equipment. Healing environments are best achieved when it is built into the interior designs of the hospital along with a bit of orientation training of its benefits to the staff. Value addition would be training on communication skills and behavior attitude trainings of the staff directly in contact with the patients.
Healing hospital interiors Now, let us understand how the concept of healing
environment can be integrated into hospital interior designs. Hospitals are generally having limited natural light and natural air. To acquire infection control and dust free environments, the hospitals are generally having closed doors and windows. Environment in terms of temperature and humidity is controlled with HVAC, air curtains, etc and adequate luminance is taken care of with high wattage lights. These lights not only consume a lot of energy but also generate heat. It is therefore recommended to follow certain Green systems, to encourage more natural light and air in the building, wherever possible.
Interior colours It has been known for ages that color plays an instrumental role in setting up a particular mood or state of mind. All respond to color environment, in some way. Some colors are soothing and tendering warmth and some stimulate the body and inhibit relaxation and sleep. Some colors inspire emotions and some influence moods, depressions, etc. There is a deep science of colors and its effects on mind and body. Till date we see hospital interiors in monotonous white / off white / creamy SEPTEMBER 2012
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15 points to know before creating a healing healthcare environment in hospitals: 1. This is neither a fad nor any superstition. 2. It sounds glamorous but it is an effective aesthetic design element. 3. It is not equipment nor is it just an infrastructural fixture; it is a design complemented with the behavior and attitudes of the care givers. 4. The healing environment design concept is best implemented with a culture that believes in healing rather than just cure and by those healthcare givers who religiously practice the art of care. 5. A holistic design solution that addresses the five senses is advised, however it is not necessary that all need to be taken into consideration in one design. A design solution may have any one element or a combination of two or more elements (for e.g. only sound / light or a combination) 6. It is preferred to implement this concept at the design stage itself; however one can implement Healing Healthcare Environment design solutions in even in an existing set-up, in major sections of a hospital; with negligent or rather nil renovations or shades with blue/green linen. It does not require a second look at such a room to relate it to as a hospital room. My debate is; why such self created gloom in an ambience that is supposed to cure and render care? We talk of five star looks in hospitals these days; but this look is limited only to the main entrance lobby; beyond which; is a thought to ponder on.
Interior sound Ambient noise in a hospital can result in disturbed and deprived sleep, reduced productivity and lower performance levels by staff, errors like patient falls, etc. In a hospital the sources of noise are many and the decibel is high. To recognise a few; the staff voices, voices of visitors and other occupants in the wards, alarm systems, the paging systems, trolley noise, clutter of utensils/bed pans, medical equipments beeping, etc. With all the emergencies and rush in a hospital, high decibel noise is bound to exist. The hospital has not only human noise but also technology noise. Noise is one of the dynamic components of hospital environment and not under much management control. Question here is; why should any decibel level of noise be accepted in a hospital? Is noise control an activity solely of acoustic management or can it be managed by some other engineering? This is where the design SEPTEMBER 2012
damage to property (Unless it requires paneling and some construction work) 7. Healing Healthcare Environment is a holistic approach to healthcare delivery process and has a remarkable impact on the recovery duration and wellness state of being. 8. Researches have been conducted (evidence based) and many are being globally conducted on various aspects of holistic healing and its efficacy. 9. This article is just to throw light on Healing Healthcare Environments and does not discuss the scientific details of implementation of any methodology. 10.To create and integrate healing environments in a hospital design one must have thorough knowledge of the science of the elements supporting healing environments that I discussed above. 11.Half knowledge can have no impact or an adverse impact, for e.g. certain colors and music give a sedative effect and some increase the energy levels and subsequently blood pressure, so it should not happen that a person with high blood pressure is in such an ambience and vice versa
aspect comes in. The design and system needs to be such that the hospital noise is controlled at an acceptable decibel and further neutralised or balanced with external induction of soothing sound. Such sound introduction not only reduces anxiety amongst patients but also reduces stress amongst the staff; thereby encouraging relaxed atmosphere for care and treatments and increased comfort levels amongst all. Every organ and system in the body has its own pattern of rhythm (Pulse, cycle) and responds to sound vibrations, impacting the physical, psychological and emotional being. Healing sounds concentrates on the ability of sound and music to create vibration energies that encourage healing and initiate transformation. Many a research suggests use of healing sound to enable relaxation which further influences lowered blood pressure, stabilising heart rate and respiratory rate, to minimise pain, reduce complications of surgical procedures, etc. In some cases, healing harmonics can be utilised as medicine, but in all situations it can definitely be used as a pleasant value addition to any form of treatment environment.
Interior aroma The typical odour of antiseptic/spirit which is so often used in hospitals is not unfamiliar. Any such odour even www.expresshealthcare.in
for depression cases. 12. There is no harm to consult an expert for a good and effective design. 13.The conceptual design changes / integration are not expensive and are indigenously available, you do not require to import any stuff. 14.The design solutions can be availed at affordable costs. 15. It gives me immense pleasure and pride to recognise my design team at AUM MEDITEC as one of the trend starters and pioneers in India, providing Healing Healthcare Environment solutions right from hospital interior designs with colour / visual concepts, noise and sound control designs to simulated healing environments. Our design team researches and continuously innovates on design solutions that are creative as well as compatible with the patient and staff safety, hospital infection control requirements, efficiency, efficacy and the quality of care delivery process and operational requirements and which do not contradict or hamper the hospital accreditation systems and requirements.
outside a hospital reminds an individual of a hospital or a healthcare clinic. Apart from this smell there is a mix of other gases, sterilising solutions that add to the odour of a hospital. Again we may not be able to reduce use of these important materials and solvents in a hospital but we can control the odor with an adjunction of some aroma. Aroma therapy is not new. It is applied with use of therapeutic essential oils and methods of applications to the skin. However it needs to be well learnt before practiced. I am not discussing the science of aroma therapy; I am suggesting an innovative use of this science in a different form, by adding a well studied combination of flavors in the environment to control the odor and provide a comfortable environment that exhale odors that remind a person of a state of being with natural ambience and not a certain state of sickness.
Nutrition to taste In today’s rapidly changing and challenging healthcare environment, leaders are challenged to focus on aspects that yield quality in both patient care and business performance. Other than the doctor’s expertise and the nurse’s care the food is one of the criteria that people remember about their stay at the hospital; hence dietary service plays a very significant role in satis-
fying the patients. Healthy food is important in the treatment of the patient and is a part of patient’s total care. Bland food, tasteless meals is a frequent complaint observed by hospital patients at large. It is an ongoing challenge for every hospital nutritionist to achieve a balance between nutrition and taste in the meals for the not so happy taste buds in a hospital setup. The dietary team must continue innovating interesting tastes along with the nutritional content to serve and satisfy the patients.
Care: The touch, compassion, smile and healing process: Last but not the least, in fact the most important energy that a hospital is required to vibe for effective healing and faster recovery of a patient is care. Care that is accompanied with good clinical knowledge, compassion for the ailing and a cheerful smile that would energise the whole environment. A small verse for all the healthcare givers that continue to serve responsibly and cheerfully always, no matter what stress they may be in… “With an eternal pace and a smiling flair, They dexterously work in the curing lair… Rendering the healing touch and tender care, Harmonising wisdom and compassion so rare…” EXPRESS HEALTHCARE
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‘Our vision is to be the choice of customers for healthcare interiors’ AI Buvaneshwar, GM & BUSINESS HEAD, GODREJ INTERIO, GODREJ & BOYCE
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I Buvaneshwar, GM and Business Head, Godrej Interio, Godrej & Boyce shares his views with Express Healthcare on the changing face hospital interiors, creating a healing environment and Godrej Interio's offerings for the healthcare sector.
What is the role of interiors in faster recovery of patients? How much importance is given to this element while designing a hospital? Human experiences are dynamic between environmental elements and individual perceptions. Interior designers have inherently and intuitively known this, and drawn inferences of the impact of designing decisions on the quality of human experiences.This principle at a broad level could be considered applicable to healthcare facility settings as a natural extension of the same principle at work in workspaces and homes. However, moving to the next level, there is today significant scientific evidence, demonstrating correlations between the environmental design of healthcare facilities and the impact of design decisions on patient outcomes. Additionally, the healthcare environment is not just a home for patients, but also a workspace for the caregivers, and part of an integrated healthcare organisation with specialised needs. In India, where the healthcare sector faces a demandsupply gap and the demand for quality healthcare is by far exceeding its availability, hospitals had been under pressure to maximise their coverage of the population, and depth of their facilities in treatment of different disease profiles. With funding for healthcare projects being limited, the planning of a hospital had historically been done with higher priority given to decisions directly impacting the treatment of patients, and ‘leftover’ budgets allocated to interiors: these constraints may often in the past, have led to a superficial, ad-hoc approach towards hospital interior design. Even with the last two decades of corporatisation and privatisation of this sector, the pressure on operat-
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ing profitably may have caused well-designed interiors to be viewed as ‘frills’ in the overall scheme of a hospital project’s construction and functioning. However, as the sector matures and evolves, it is encouraging to view that there is a growing understanding of the importance of interiors in hospital design, and accordingly the entry of specialised consultants to handle this critical aspect correctly. Hospital interiors are being increasingly viewed as they should be, not as an expense, but as an investment which pays off in terms of in improved patient outcomes, better occupational health for caregivers, and positive indicators for the entire healthcare organisation. If we progress beyond a general understanding, to
principles should be used continuously throughout the schematic design phase to test alignment between developing design solutions and the goal of the hospital. Additionally, in larger context of the overall project, the follwing factors also need to be considered. Complexity of implementation: The phasing requirements for the project; if there are any pre-scheduled projects that need to be completed first, and in case of an operational hospital, the potential impact to critical care and emergency power supply, whether departments need to be moved temporarily. Long-term flexibility: Does the concept allow potential for long-term space and service expansion, upgradability of technology equipment and
Hospital interiors are being increasingly viewed as they should be: not as an expense, but as an investment the next level of research, we will be able to apply these design principles, to translate research findings into physical healthcare environments which benefit patients, caregivers and hospitals alike.
How can a hospital go about choosing the right interior design? The term ‘right’ interior design is individual for every project as each project is different. In view of the hospital’s profile and specialities, whether it is a greenfield project, a refurbishment or an expansion, the key guiding principles that need to be considered are the patient profile, the operational workflows, and as described above, the people, systems, environment and implementation. Determining which concept is the best fit for the project can be difficult. Testing each concept against the guiding principles provides a consistent evaluation method that determines to what extent the planning and design concept addresses the original project’s goals. The guiding www.expresshealthcare.in
systems, potential for reassigning the space with minimal architectural changes. Project costs: The estimated project construction costs, whether a set-off is possible between construction and operational costs. Operational costs: If the concept necessitates additional staffing or equipment resources, the maintenance requirements. Schedule timeline: whether the concept will be consistent with allowing the project to be completed in the desired time line. Essentially the right way is to define the goal of the hospital in terms of specific outcomes and performance parameters, identify the design elements which will link to these result areas through research, and implement the concepts consistently with the overall goal of the project.
What are the latest trends in hospital interiors? We witness an increasing awareness in both the clients and the designers, in terms of their exposure to international
trends, as well as the evolving needs of the Indian healthcare sector. Progressing beyond viewing hospital interiors as pleasant healing environments in abstract subjective terms, they are gradually adopting a more scientific approach, directing interior design decisions to specific patient outcomes. The focus on enhancing patient safety has grown stronger. The impact of the correct lighting, ergonomically designed patient furniture, and hygiene-enhancing finishes is gaining recognition. Crevice minimising designs are gaining acceptance. We are working on a project with Copper International to explore advantages of bacteriostatic finishes at touch-points in hospital environments. General wards are slowly giving way to dual/single occupancy rooms, recognising the need for patient privacy and seclusion in helping the patient feel in control of their environment, as well as in reducing the risk of cross-infections. Ceiling pendants are the trend. These take equipment and storage off the floor, facilitating hygiene. Modular OTs are also gaining acceptance, with the higher standards of hygiene and flexibility they promise. Additionally, clinical workspaces in hospitals, like nurse stations and diagnostic laboratories are being ergonomically designed, with consideration being given to caregiver occupational health and impact of the workspace on caregiver performance. Green building is also a new trend wherein energyefficient buildings made from the right balance of concepts and materials are sought to not just optimise energy costs but also to be environmentally responsible.
What kind of interior help in creating a healing environment? The term “healing environment” is used broadly throughout the design field to describe a place that both physically and culturally supports health, healing, and wellbeing. ● A place to heal the mind, body, and soul. ● A place where respect and SEPTEMBER 2012
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dignity are woven into everything A place where life, death, illness, and healing define the moments and the building supports these situations
Basic components of a healing environment are: ● Air quality ● Thermal comfort ● Privacy ● Light and illumination ● Views of nature ● Visual serenity for those who are very ill ● Visual stimulation for those who are recuperating ● Access to nature ● Positive distraction ● Access to social support ● Options and choice (control) ● Elimination of environmental stressors such as nose, glare, and poor air quality
How important is it for hospitals to opt for evidence-based interior designs? Healthcare environments are the settings in which the systems, people and processes are activated, to deliver the healthcare treatment and service. In the short term, with immediate concerns being availability of quality healthcare to the masses, it may be tempting for hospitals to ignore the healthcare environment and interior design as a whole, as also the role of evidence-based design (EBD). However, if healthcare facilities and their infrastructure is aimed to be sustainable into the long term future, the positive role of EBD based interior design cannot be ignored. With increasing number of hospitals and choices available to patients, hospitals will be compelled to offer higher standards of healthcare and evaluate their own performance in terms of patient satisfaction. Hospitals will also be required to match higher standards of accountability and responsibility, linked to specific patient outcomes. Additionally, with manpower costs on the rise, healthcare being a manpower intensive industry, hospitals will need to look at improving staff outcomes, inorder to attract and retain manpower. Lastly, with healthcare also being a technology intensive industry, the speed at which technology evolves will necessitate the right healthcare settings which are flexible to keep pace with technology. Overall, to make a healthcare facility sustainable into the future, EBD based interiors SEPTEMBER 2012
are an integral part of the planning process.
Could you highlight Godrej Interio’s specialised product offerings for healthcare environments? Godrej’s specialised offerings cover the entire range of hospital furniture from examination couches, ward beds, patient room furniture, ICU beds and accessories including mattresses. Ergonomic patient beds designed to offer maximum safety to users along with reduced effort levels for operation and maintenance. While the safety to the patient is assured through fulfillment of stringent FDA Safety Requirements the reduction in bed operating effort helps reduce fatigue levels of the staff helping them to be more productive and efficient at work place. In the long run it helps staff to remain healthy.
The hospital furniture has to satisfy the expectations of patients, doctors, attendants, maintenance staff and other stake holders which are at times very challenging covering aspects such as safety to patients, comfort, mobility and ability to withstand long duty cycles without failures. The furniture design must make cleaning easy for better infection control. The type of material used must be Bacteriostatic resistant and Environment supporting. Must help in therapeutic procedures by co-ordinating well with other medical equipment and devices used.
How do you assist hospitals in planning and designing their interiors? What approach do you adopt? Godrej Interio has developed sufficient in-house expertise in designing interiors and execution of work places. Working with various partners
Godrej’s specialised offerings cover the entire range of hospital furniture from examination couches, ward beds, patient room furniture, ICU beds and accessories including mattresses Strikingly contemporary and aesthetically appealing healthcare beds from Godrej Interio with intelligent choice of material besides offering a soothing effect to the already agonised patient and stressed out staff and visitors, offer long lasting differentiated look to the hospital which break the monotony of hospital furniture which remained almost the same for many decades in India. The most critical requirements are safety, comfort, mobility, fail safe, is the single most important expected to support the patient be it while they are safely all the time during their stay in the hospital and integrate well with other Medical devices during clinical and therapeutic protocol.
What are the challenges and special needs of hospitals in terms of hospital furniture? The current hospital furniture especially the bed plays a major role in determining the quality of treatment resulting in complete and quick patient recovery which are the most critical requirements of any hospital. www.expresshealthcare.in
and specialists, Godrej Interio is currently in a position to design hospital facilities factoring requirements of leading accreditation standards
What specialised medical furniture is Godrej Interio offering today? Godrej in India as the exclusive distributor of Europe’s leading brand LINET, brings high-end, technology embedded motorised ICU beds. These beds use patented column technology for attaining multi axis bed easily using hand controls. These beds due to their sleek construction design are easy to clean helping in infection control and are technology embedded motorised ICU beds which can be pre programmed to attain any posture needed at pre determined time and intervals. They can monitor the critical parameters of patients occupying the bed constantly and send alerts automatically to the medical attendant via Wi-Fi about patient’s clinical emergency situation in advance. These beds allow medical attendants to be fully vigilant
about the status of the patient even while operating from a remote location on more important.
Many hospital are going the green way, could you emphasise how Godrej Interio assists hospitals in achieving this related to their interior design and planning? Godrej is a pioneer in Indian in bringing and developing Green Technology by working closely with USGBC, IGBC and CII. We have a dedicated inhouse cell offering consultancy in LEED Certification for commercial facilities. Godrej is involved in design, implementation, assessment and validation of more than half of all the Buildings awarded LEED Certifications so far in India.
How does Godrej Interio address the impact of furniture products on the environment and patient safety? What aspects do you consider related to design and manufacturing process? At Godrej Interio, green concept is given prime importance in all our business operations. Starting from product conceptualisation to manufacturing, design and disposal green requirements are complied with. We have taken initiatives in India to launch green guard rated furniture to enable commercial facilities comply with green certification requirements. Not only the products, even our manufacturing processes are green certification compliant and we are the first in India to obtain Gold Level in BIFMA certification for our newly launched office furniture. We intend bringing all our furniture offerings under green guard certification in a phased manner. These green products control VOC emission levels which are a critical requirement in helping healthy indoor work environment. Choice of material in manufacturing, packing and distribution are environmental friendly thereby respecting sustainability requirements.
Please share with us the vision that you hold for Godrej Interio to emerge as a specialist healthcare interior planning company? At Godrej Interio, our vision is to be the choice of customers for healthcare interiors which we wish to attain by transforming lives of our clients at work place and residence. EXPRESS HEALTHCARE
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Strategy Private equity– A new engine for growth in healthcare Economic slowdown in the recent years have brought investors including PE closer to the healthcare sector as it has comparatively lesser business risk. Ketul Patel and Vivek Yadav from Spectra Management Consulting give an insight Page 64 MAIN STORY
Good health on a platter Boutique hospitals are a rising phenomenon in the Indian healthcare sector. Raelene Kambli finds that the trend is backed by booming medical tourism, growing number of private players and increasing preference for private treatment by patients and examines the ramifications of this concept which is also known as 'concierge medical practice'
Privacy, comfort and comprehensive care are the basic principals followed in a boutique hospital Dr Dilpreet Brar REGIONAL DIRECTOR FORTIS HEALTHCARE
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oday, healthcare delivery within hospitals has gone beyond treating medical conditions. Hospitals now go out of the way to offer private rooms, catered meals, and round-the-clock private nurses. But healthcare delivery is taken to the next level by a unique fusion of clinical expertise, personally tailored medical services and brilliant hospitality with the concept of ‘concierge medical practice’ also called as ‘boutique healthcare’. With a look and feel of an five star hotel and its focus confined to few specialities, boutique hospitals cater to quality conscious affluent patients. By design, these hospitals have less number of bed strength in order to provide the requisite atmosphere to its patrons. “Privacy, comfort and comprehensive care are the basic principals followed in a boutique hospital,” states Dr Dilpreet Brar, Regional Director – Fortis Healthcare. She further informs that boutique hospitals are manned by best in class doctors and supporting staff that provide exceptional care in a highly relaxing ambiance. Amenities provided by these hospitals include: ● Restful, peaceful atmos-
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Keeping in view the economic concern, the concept creates a two-tiered system Rekha Dubey COO ADITYA BIRLA MEMORIAL HOSPITAL
Super delux room at Beams Hospital
phere for recuperating patients ● All private suites have spacious bathroom and in-room family area ● Large, spacious waiting rooms with multiple flat screen TVs ● Patients' rooms are on one side of a floor to maintain their privacy ● Room service everyday— patients can order their own meals ● Patient entertainment centres in each room intended to enhance communication, education and entertainment options ● Wireless communications and Internet access Elaborating further on the concept, Rekha Dubey, COO, Aditya Birla Memorial Hospital, explains, “It’s a concierge medical practice with a higher level of service. Functionally, the concierges would welcome patients to the hospital, orient them with their amenities, and walk them to the room, where the patients would be introduced to their personal nurse, who would take the time to discuss the stay and schedule the facial in between MRI and physical therapy.” With such luxurious amenities provided www.expresshealthcare.in
by boutique hospitals, certainly patients will be willing to pay for such hotel-like services, she feels. Dubey also points out that boutique healthcare centres bring in the wellness factor while providing medical care. She says, “Typically, worldwide such centres are focused on wellness and lifestyle, cosmetology, cosmetic surgery, delivery, rehabilitation and dental care. Some of the typical procedures carried out at such centres are laser treatments, botox treatment, acne treatment, acupuncture, tummy tuck, liposuction, facelift, weight loss, stress management, smile makeovers, dental implants, laser dentistry, silicone prosthesis etc.” Talking about the high tech medical technology and infrastructure in these hospitals, Baldev Raj, Country Head, RG Stone Hospital states, “Technology-wise boutique hospitals have all the required state-of-the-art healthcare technologies such as fully digital systems with electronic medical records, real-time access to patient results, radiology imaging systems that provide transcribed reports, telemetry monitoring in all patient rooms, easy reg-
istration, digital surveillance and many more.” The concept of boutique healthcare originated in the US owing to the increasing demand for personalised medical care. Though the concept gained popularity in a short span of time; later a report published in the New York Times revealed that the concept did not gain sustainability as it created a “twotiered” system in the US that exacerbated disparities in healthcare access. Nevertheless, when applied in Asia, the concept blossomed well and countries like the UAE, Singapore, Malaysia and Thailand became well-known destinations for boutique hospitals. The reasons for its success in Asia were the growing demand for speciality institutes that cater to the elite class as well as the growth of medical tourism in this part of the world. India, of late, has joined the race.
The new wave in India India is said to be emerging as a preferred healthcare destination for patients across the globe. Besides this demand for personalised care in India has also increased SEPTEMBER 2012
S|T|R|A|T|E|G|Y over the years. This makes the concept quite workable in the Indian context. Currently, the country has around 6-8 well-known boutique hospitals across the country. Though the trend began with single speciality centres like Beams Hospital, Cradle by Apollo and La Femme by Fortis that focussed on mother and child care services, the concept is slowly being applied to other healthcare specialities as well, thus, giving rise to the concept of multi-speciality boutique hospitals in India. Neeraj Lal, Senior Vice President, Shalby Hospitals, citing an example of this transition says, “Beams Hospital, Mumbai the first boutique hospital in India was founded in 1994 with a focus on gynaecology and obstetrics. This phenomenon also helped in evolving the OBG sector which today holds a market share of about 13 per cent of the total healthcare industry in India. On the other hand, we have Hinduja Healthcare Surgical, Khar, Mumbai a well established group hospital which started of with a 103-bedded multispeciality boutique hospital early this year.” The transition from a single speciality to multi-speciality has not only evolved the boutique hospital concept in India, but also given hospitals the scope to think out of the box. The concierge medical practice is a new booming concept which is attracting big corporate companies to invest in it, opines Lal. On the same lines, Dr Prakash Khubchandani, MD, Khubchandani Healthcare says, “The emerging trend is to set up more compact, higher throughput healthcare facilities which focus on a limited number of synergistic clinical domains. These not
only translate to higher patient satisfaction and more effective clinical outcomes, but the operational efficiencies which can be built into such a model also result in lower overheads, more specialised manpower and higher operating margins.” The boutique hospital concept eliminates the anxiety factor of a patient by introducing the system of surgical packages. This includes the pre-operative, intra-operative, and post-operative surgical services. Patients choose packages that suits their pocket and payment is done before or after the entire procedure. Surgical packages reducing excess billing work and helps in reducing billing errors. This, also enables the hospital to get cost settlements done more easily. Furthermore, what attracts private players to invest in boutique hospitals, is that this concept allows them to expand their range of services.
Market watch Currently, the boutique hospital sector in India is witnessing a surge of activity. Beams, Apollo’s Cradle Hospital, Fortis La Femme, Hinduja Healthcare, Nova Medical Centres are few of the major players in this segment who are making it to the top. Other players like Lokmanya Hospital, a orthopedic boutique hospital, Diva Hospitals in Gujarat and Jupiter Lifeline are also slowly making their mark within the sector. On the other hand, Krimson Healthcare who will be soon entering the boutique healthcare space over the next 12-18 months has plans to launch a number of super-speciality boutique facilities in Mumbai, all focussing on the premium market segments across different clinical specialities like
Delivery suite at Hinduja Surgical Centre in Khar
oncology, orthopaedics and aesthetics. Apart from this, there some private players who are exploring opportunities to start up buotique hospitals in Goa, Kerala and Gujarat. Analysing the current trend in the market, Khubchandani is of the opinion that speciality wise, a few brands have taken the lead in this field; but given the growth potential of the country we can expect more entrants over the next three to five years.
A concept for the metros However, as the concept of boutique healthcare is meant to provide luxurious service, it is certain that the corporates will be eyeing the metros rather than venturing into the Tier-II and Tier-III cities. “Majority of the elite population reside in the metros and regularly spend on luxury goods and services. They also don’t mind paying a premium in return for the 'feel good' factor that boutique set-ups offer. Therefore, boutique healthcare models are and will be concentrated in such cities,” says Dubey. “Mumbai, Delhi, Bangalore, Chennai, Hyderabad, Chennai are the major target areas for boutique hospitals,” updates Atul Kunwar, Director, Beams Hospitals. Also, it is important to note that setting up a boutique hospital needs a lot of top end infrastructure facilities and resources which will be best available in the metros.
Money matters
The emerging trend is to set up more compact, higher throughput healthcare facilities which focus on a limited number of synergistic clinical domains Dr Prakash Khubchandani
Technology wise boutique hospitals have all the required state-of-the-art healthcare technologies such as fully digital systems with electronic medical records Baldev Raj
MANAGING DIRECTOR KHUBCHANDANI HEALTHCARE
COUNTRY HEAD RG STONE HOSPITAL
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are lower, area requirements are lower and return on investments are faster. He goes on to say, “Broadly, the ticket size per investment is smaller as the units themselves are usually less than a 100-bedded facility. In addition, the equipment required is more focussed and the specialised man power allow for a faster setup. One would typically see shorter gestation times at a project level, usually three to four years instead of the current 7-10 years for a larger multispeciality project”.
Establishing a luxurious set-up is not a cake walk. Experts feel that the total investment in a boutique hospital is high in comparison to other hospitals. According to Brar, a boutique hospital may spend around Rs 60-80 lakh per bed. Moreover, the total investment depends mainly on the number of beds within the hospital. However, Khubchandani has a different viewpoint on this. He believes that investments in boutique hospitals www.expresshealthcare.in
Stumbling blocks Strategically and financially, the concept of boutique healthcare seems to be quite impressive for all stakeholders. The model is likely to have robust demand, but at the same time it also has certain road blocks that could crimp its growth. Khubchandani points out that the primary concern would be a slowdown of activity which can be financially difficult to bear through due to the single vertical nature of the model. Additionally, if a brand fall into the category of becoming known for one particular speciality of service offering, then brand perception may prove a challenge and your credibility as a specialist in one domain could hinder you when it comes to expansion or diversification. Kunwar, feels that the challenges associated with the poor coverage of health insurance in our country is detrimental to the growth of this sector. Dubey on the other hand speaks of the medico-legal issues that boutique hospitals may have to battle with. “High-end patients demand, high level of care and they also have access to legal resources. Slightest lacunae in treatment can lead to medico-legal cases with much higher settlements. So these hospitals have to be JCI/NABH certified with medico-legal experts on board,” she appeals. All these are functional challenges that can be over-
come over a period of time. But, the biggest worry is that like in the US, this concept can create a two-tiered system in India also wherein the "haves" get special service and the "have nots" don't. Maybe yes or maybe no! This thought has received mixed reactions from experts. “Keeping in view the economic concern, the concept creates a two-tiered system. On one hand the customer is willing to pay for boutique services to make it worthwhile for hospitals to offer them and on the other hand catering to affluent patients will diminish the quality of care for those unable to pay more, ” states Dubey. Lal assumes that this concept may create a multitiered system. He claims that it would divide the population into groups, with elite class people preferring boutique hospital services where as the other classes would have to seek services from the corporate or smaller hospitals. Keeping in mind the economic concerns, we shouldn't forget the fact that boutique hospital are designed to serve the top-notch people of the society. “If one were to assume that all boutique hospitals are aimed at the premium market segment, then yes you could argue that this creates a two-tiered system. The ground reality however, is quite the opposite. Brands are focussing on different aspect like technology, interiors, hospitality serivces etc depending on their strategy and their pricing reflects this. We are also witnessing the emergence of a new game changer in the Indian healthcare landscape, as health insurance penetration grows at a phenomenal pace. With these coverage firms tying up with boutique healthcare centres, there will be something for everyone in this segment”, expresses Khubchandani.
In the years to come ... With increasing disposable incomes and growing demand for ‘branded’ healthcare there seems to be a lot of scope for boutique hospitals to thrive. However, there are few questions that still go unanswered. But will this concept flourish in India without creating a healthcare divide? Will this concept work for or against India's dream of universal healthcare? And what more would these players do to stay ahead in the race? Only time will reaveal the answers to these questions. raelene.kambli@expressindia.com
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S|T|R|A|T|E|G|Y OPINION
Private equity – A new engine for growth in healthcare Economic slowdown in the recent years have brought investors including PE closer to the healthcare sector as it has comparatively lesser business risk. Ketul Patel and Vivek Yadav from Spectra Management Consulting give an insight
ealthcare is one of the most underserved sector in India. Currently, only 0.9 bed per 1,000 population is available against the global average of five beds per thousand. This is such a huge gulf between the supply and demand that we need to spend close to $50 billion every year for the next 10 years to make up this healthcare infrastructure deficit. Due to burgeoning fiscal deficit, the government is not in a position to earmark funds for healthcare and thus, majority of investments are happening in the private sector. Broader Indian healthcare sector, consisting of hospitals, clinics, diagnostics, pharma and medical devices, is growing at 16 per cent CAGR and poised to grow with a double digit rate in the next decade. A confluence of strong demographic and economic enablers is driving this fast-paced growth and would continue to do so in the coming time. This booming healthcare industry is attracting wide interest from private equity (PE) players and they are pouring a lot of money into it. As per Venture Intelligence database, in the healthcare space 18 deals worth $581 million are already done in the first half of 2012 against 22 deals worth $207 million and even average ticket size has risen more than three times to $31 million in a year. There is a widespread belief that the healthcare sector is recession proof and the last five years of slowdown in economy has brought investors including PE closer to the healthcare sector as it has a comparatively lesser business risk, and thus
H
●
Most Favored Sector by PE in 2012 0
3
6
9
12
Healthcare FMCG Agri-buisness Education Life Sciences E-Com Restaurants Cleantech Mobile VAS Retail Hotels Micro-finance
Source: Venture Intelligence
investors are using healthcare to diversify their portfolio. As per the survey conducted by Venture Intelligence of top PE fund managers, healthcare is the most favoured sector for investments by fair margin in 2012. The frenetic PE/VC activity in healthcare space over the last couple of years reinforces the attractiveness of this sector for global and domestic investors, and slew of investments have been made by PE players across various levels of the healthcare delivery value chain. PE investments in healthcare and life sciences industry this year is 31 per cent of total PE deal value across 16 investments, which is 16 per cent of PE investment volume across sectors. Lack of momentum in the stock market has turned promoters to the PE investments in fund their expansion plans. Three of the six big ticket investment (> $100 million) were made in hospitals and clinics segment, thus showing immense interest by PE. As per the survey conducted by Venture Intelligence of top PE
fund managers, the healthcare sector is the most favoured for investments by fair margin in 2012.
Private equity investment process PE funds are always on the lookout for companies which can give them high returns during investment horizon and spend considerable amount of time evaluating them. As shown, there are different stages involved in this evaluation process and less than five per cent of companies go to the level of non-binding offer (NBOs) and finally measly one per cent receives funding. Success of such investments depends upon the careful selection of firm which has a potential to grow fast, is scalable, and has a strong management team. Following are some the parameters used by PEs for selecting investee companies: ● Executable growth plan ● Healthy financial indicators ● Sustainable and scalable business model
MEGA HEALTHCARE PE Deals - 2012
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Company
Sector
Amount ( Mn USD)
PE Investors
CARE Hospitals
Multi-Specialty
110
Advent International
DM Healthcare
Multi-Specialty
100
Olympus Capital
Vasan Eye Care
Eye Care
100
Singapore GIC
Specialty Hospital
Super Specialty
77
Halcyon
Super Religare
Pathology
66
IFC, NYLIM
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USP – Differentiated value proposition. ● Sizable market opportunity ● Management Team - A team that is prepared to learn and adapt as they progress ● Available exit options in future PE’s expected return also depends partly on the sector in which the portfolio company operates. Investment in companies operating in high beta industries like IT/ITES, E-Commerce, annualised return may be in the range of 40–45 per cent but healthcare being a defensive sector, expectations are lower. The rate of return at the time of exit is also governed by many systemic and un-controllable factors like global financial crisis of 2008-09 which narrowed down the exit opportunities and returns of all firms. Life span of a fund is around 10 years and in this time fund manager has to perform four tasks – finding target company, invest, hold, and exit in the same chronological order. So, on an average PEs remain invested for a period of five to six years that is the timeframe for them to make a transformational impact to the organisation to earn unusual returns. Understanding the dynamics of PE funding in healthcare is of utmost importance before making a foray. Value creation takes longer in healthcare, but once created, it is sustainable. So, while PE firms in other sector can exist within four to five years, in healthcare, the PE firms need to wait for six to eight years to get the right value for money. PE firms also need to conduct a proper legal, operational and commercial due diligence, which includes checking capabilities of the management team, financial performance over the years, taxation and auditing of the company before going ahead with the investment.
PE investment themes in healthcare delivery Tertiary care hospital chains Big hospitals chains like SEPTEMBER 2012
S|T|R|A|T|E|G|Y single-specialty focused, and such models focusing on specialties like eye-care, oncology, dental, kidney care, women care etc are PE friendly models as they do not require high capex like that of tertiary care hospitals, break even within 24 months and exit is possible in a much shorter time frame. The exit period for PE funds is the main differentiator for single specialty chains like Cloudnine, Nrivate Eephrolife, Vasan eyecare. Scalability is another factor which makes this single specialty attractive to PE.
PE investments in Healthcare 1686 USD Mn
51 41 34
36 26
700
601
581 300
2007
2008
2009
2010
319
16
2011
H1-2012
Apollo, Max, Manipal have received funding for PE at some stage. In September 2007, Apax Partners invested $104 million in Apollo Hospitals for a stake of 11 per cent. Similarly, Manipal and Max Healthcare had been recipient of PE funding from IDFC and Warburg Pincus respectively. Lately, interest of PE in large stand-alone tertiary care format has waned to some extent due to fundamental constraints like big ticket size investment requirement, long gestation period to get unusual returns and saturation of demand in upscale urban consumer segment which are being catered by these chains.
Affordable healthcare In the last decade, most corporate healthcare models were developed with metro markets in mind and most of the capacity addition has happened at high-end price points. Thus, there is a severe dearth of quality healthcare infrastructure in Tier-II and Tier-III cities and companies like Care Hospitals and Vatsalya Healthcare are tapping on this business opportunity by coming up with innovative models to bring down the cost structure. This sector
Tertiary care hospital chains Company
Year
Amount (in Mn USD)
PE Investors
Global Hospitals
2007
116
Samsara Capital
Apollo Hospitals
2007
104
Apax Partners
Narayana Hrudayalaya
2008
108
JP Morgan
Max Healthacre
2009
115
Goldman Sachs
Seven Hills Hospital
2009
72
JP Morgan
Vikram Hospitals
2008
24
I-Ven Medicare
Manipal Hospitals
2006
20
IDFC PE
Sterling Hospitals
2006
16
Actis
Rockland Hospitals
2008
12
IFC
PE investments made in hospitals in Tier-II and Tier-III cities Company
Year
Amount ( in Mn USD)
PE Investors
Care Hospitals
2012
110
Advent Intl’
2007
22.8
Ashmore
Glocal Healthcare
2011
3.36
Sequoia Capital & Elevar Equity
Vatsalya Healthcare
2011
10
Aquarius Fund
2010
4.5
SeedFund, Oasis fund
2005
3.0
Aavishakaar India, SeedFund
BSR Hospitals
2010
10
Aureos Capital
Jeevanthi Healthcare
2011
2
Seed Fund
SEPTEMBER 2012
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has caught the attention of PE investors and has seen slew of investments – Advent International has invested in Care Hospitals while Vatsalya Healthcare has till now raised a total of $17.5 million in PE capital since inception. These low capital intensive model suits the requirements of financial investors with respect to gestation period and risk-return profile. Day Care De-centralised healthcare delivery models are the flavour of the season among PE investors and day care is one such de-centralised model which has seen lot of PE/VC activity in recent times. Day care delivery model has lower initial investment requirements, shorter payback periods, and a wider geographic reach, all of which minimises the inherent business risk. As per estimates, 70 per cent of the surgeries can be performed in a day care format; wherein the patient is not required to stay in a hospital overnight. Day care format has been hugely successful in the US and other developed markets and the same format is being tried to be replicated in India by players like Nova Medical Centre. Nova, itself being a brain child of GTI LLC, a New Yorkbased PE fund, opened its first centre at Koramangala, Bangalore in May 2009, and is seen as a leader in the daycare format. One year later, another PE firm, NEA also invested $16 million in Nova Medical Centre. Beams Hospital having day care centres dedicated for Minimally Access Surgery (MAS) in Mumbai and Bangalore, have received funding from Ambit Pragma Ventures. Single Specialty There are a number of healthcare players which are
Advantages of PE for healthcare players PE provides much needed capital required for testing innovative but risky healthcare business models. PE has given a new avenue to entrepreneurs to try and come up with the new models which can meet healthcare requirements of masses and also support their entrepreneurial ambitious aspirations. Apart from providing much needed equity funds, the role of PE investors now includes helping companies to become more professional, inculcating higher corporate governance standards, helping in installation of more resilient systems and processes to enhance operational performance, assisting in raising new rounds of capital and providing access to their own business networks. PE investors also at times play a role in helping companies bring in senior management personnel at key operational level to manage growth. This comprehensive approach is often called as PE plus approach. Hospitals also get benefit from the global linkages of the PE funds, sourcing of good clinical talent from abroad and maintaining the financial discipline, especially in the initial phases of when cash flow is a constraint. Investment in a hospital by PE investor is in a sense an acknowledgement of the company’s strong value proposition and confidence reposed on the entrepreneur’s ability. A hospital funded by a PE investor can get comparatively easy terms from banks for debt and even get second round of equity funding very easily. The relationship between entrepreneur and private equity investor is successful only if there is a cultural synergy between two and it is often observed that investee companies resist the suggestion made by PE firms. This is more often when there is no distinction EXPRESS HEALTHCARE
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PE investments made in the single specialty space in last few years Company
Year
Segment
Amount ( in Mn USD)
PE Investors
Vasan Eye Care
2012
Eye Care
100
Singapore GIC
HCG
2006
Oncology
10.8
IDFC
2008
20
Premji Invest
2009
6.85
Milestone
2009
6
Evolvence
Kidney Care
25
Da Vita, NEA
Nephrolife Nephroplus
2009
Kidney care
NA
Bessemer
EyeQ Hospital
2009
Eye Care
NA
Helion, Nexus, song
Centre for Sight
2010
Eye Care
10
Matrix Partners
Alliance Medicorp
JV between Apollo and GSK Velu ( founder & MD of Trivitron)
Medfort Hospitals
NA
Diabetes, eye care
13.3
ePlanet, TVS Shriram
Cloud Nine
2011
Woman Care
9
Matrix Partners
between management and promoters of a hospital. Type of EXIT for PE Funds: ● Secondary Sale ( to financial Investor) ● Open Mkt. ● IPO ● M&A (Sale to Strategic Investor) ● Buy back Open market The most common type of exit in India is the open market sale. Open market exits accounted for nearly 38 per cent of total PE exit volume over the period January 2005September 2011. This can be attributed to the fact that once a company is listed on a stock exchange, it is fairly easy for a PE investor to sell off in one shot or dribble its stake, depending on the liquidity in the company’s stock. IPO It
is
a
traditionally
preferred route of exit by a PE fund as it gives the maximum valuation to the PE’s stake in a hospital but on the flip side successful IPO is heavily dependent upon the favourable market conditions. Further, an IPO involves considerable transaction costs and can go from 6 to 7 per cent for a small IPO (<Rs 100 crore). It also involves careful planning and the process may take a few months to a year and drastic changes in market may warrant abandonment or withholding of listing process. Additionally, PE investors rarely get complete exit from company in an IPO as public investors perceive this as lack of confidence by current investors in company and put downward pressure on the valuation. The other than two healthcare chains, Apollo and Fortis, there are few other single facility
Comparison table between healthcare investment themes Feature
Day Care/ Single Specialty /Affordable
Stand-alone Tertiary care
Scalability of Model
Highly scalable
Scalable
Geographical Diversification
Yes
No
Capital Requirement
Low to Medium
High
ROCE
66
Medium
Low to Medium
Payback
Medium( 4 – 5 yrs)
Long ( upward 8 yrs)
Risk of business failure
Medium
Low
Predictability of cash flows
Medium
High
IRR
High
Medium
Ideal PE Partner
Growth Fund
Infrastructure Fund
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healthcare players like Kovai Medical Centre, Regency Hospital which are listed. But going forward, there may be listing of few other bigger names in healthcare. Secondary sale Under secondary sale, PE investors may sell their stake to some other PE investors. PE firms investment horizon is five to six years and to stick to this timeline, one investor may sell its stake to other PE player, who is ready to take exposure in a healthcare asset. These PE to PE deals are largely driven by the need to exit investments and not valuation. In addition to buying existing stake, new PE player may also infuse fresh funds into the company. In this year itself, the broader healthcare sector has seen at least three such deals of exit through secondary sale – a) IDFC has acquired I-Ven Medicare’s stake in Punebased Sahyadri Hospital b) Goldman has acquired 6.7 per cent stake of Max India from Warburg Pincus b) TA associates have bought 15 per cent stake of Dr Lal Pathlabs from Sequoia Capital Strategic sale/merger Merger of a firm also with other comparable or leading player in the industry provide gateway for possible exit to PE firms. Unlike financial investors like PE firms, these strategic investors have an appetite for longer period stay in ventures, and thus they don’t mind paying premium in valuations as they know that extra price paid can be recovered by un-lock-
ing of merger synergies over a period of time. Further, this type of sale provides a payment in cash and clean and complete exit for PE players. However, company promoters or management may resist takeover by competitors as it may dilute their independence in company matters. In the healthcare sector, big brands have been acquisitive, thus stake sale to strategic investors is going to be the main exit route for PE players. Buyback PE investors could agree to exit by selling their stake to the management or promoters at mutually agreed price. This buy back is to be made pro-rata to all the stake holders which some time acts as a deterrent for complete exit to PE investors. This mode of exit is not very conventional and least preferred by PE players as it does not offer attractive valuation, and is executed if they feel that enterprise has not gained significantly in value and there is no prospect of an alternative exit but the company has generated sufficient profit to fund the buy-back. Promoters cite the rationale for buyback as a way of maintaining control over the enterprise and uncertainty in the IPO market. Obliviously, PE investors use this as a last resort as they do not get them very good valuation for their stake. Max India (parent company of Max Healthcare) brought back 16.7 per cent stake from Warburg Pincus for Rs 140 crore in 2011. Warburg Pincus had invested Rs 140 crore For 23 per cent stake in 2004. Spectra Management Consultancy (SMCPL) is a business consulting and internal audit firm specialising in providing solutions in risk management, compliance and governance. It operates through its office at Pune and serve a client base across the globe with stateof-the-art office infrastructure and work environment. The firm meet business needs of clients by bringing the professional and analytical skills to an assignment, which we have developed, through the academic background, internal training, continuing professional education and engagement experience of our consultants. (The authors can be reached at ketul.patel@smcpl.co.in and vivek.yadav@smcpl.co.in) SEPTEMBER 2012