HealthCare Radius, September 2018 by Itp India

WPP license no. MR/TECH/WPP-76/North/2018 License to post without prepayment Postal Registration No. MCN/242/2018-2020. Published on 27th of every previous month. Posting date: 30th &31st of every previous month. Posted at Patrika Channel Sorting Office, Mumbai-400001. Registered with Registrar of Newspapers under RNI No. MAHENG/2012/46040

Aligning business and healthcare in India

Total number of pages 48

SEPTEMBER 2018 Vol 6 • Issue 12 • `50

INFRASTRUCTURE TURN DOWN NOISE LEVELS

OPINION

ORGAN TRANSPLANTATION

WE ARE ALL LIGHT LIGHTING HAS TO CREATE AN ENVIRONMENT THAT IS VISUALLY SATISFYING AS WELL AS EMOTIONALLY COMPATIBLE

Published by ITP Media (India)

For more information, please visit: www.philips.co.in/healthcare/resources/landing/epiq/cardiology or call 1800-419-8844 (Toll Free)

Contents 18 26

30 COVER STORY Lighting has to create an environment that is visually satisfying as well as emotionally compatible.

BULLETIN 10 This month's important news

TECHNOLOGY 36 Innovations in imaging is one of

updates.

the most important advancements to revolutionise modern medicine.

INSIGHT 26 Technology helps to protect the integrity of the normal brain tissue.

COMMENT 30 It is in the interest of private

INFRASTRUCTURE 40 Noise reduction programme requires careful assessment of the geographical, physical, and operational environment.

facilities to work for improved quality of care at rural facilities.

OPINION 44 Since the THOA was passed,

OPERATIONS 33 Factors that ensure a pleasant

there was a decrease in the number of foreign nationals travelling to India seeking transplant surgeries.

and satisfied hospital stay.

SEPTEMBER 2018 | HEALTHCARE RADIUS

EDITOR'S NOTE

Lighting: An integral part of design

SEPTEMBER 2018 • VOL 6 • ISSUE 12

ITP MEDIA (INDIA) PVT. LTD Notan Plaza, 3rd floor, 898 Turner Road Bandra (West), Mumbai – 400050. India

Hospitals are the most complex buildings when it comes to design and choosing the right lighting can prove to be a daunting task. The main objective of hospital lighting is to usher in daylight scenarios, enhance wellbeing of patients and improve performance of staff. But it’s easier said than done as the lighting needs of the occupants are varied and even conflicting. Choosing the right lighting is a key element of interior design, given that it is not just an illumination, but a factor that contributes to patients’ recovery. Good lighting should simulate natural daylight to support patients' sleep, mood, and recovery and should blend into the architecture like an inherent piece of the design. An atmosphere of harmonious lighting eases the visitor, calming his nerves, while making the surroundings appear friendlier. A well lit drop off zone and entrance helps in easy location while welcoming the visitor with cheerfulness. In the cover story, industry experts have enlightened us on lighting requirements for various areas of a hospital. Read the article to find out how the healthcare industry is moving towards dynamic lighting and away from point sources of light to an aggregate system.

Rita Dutta Editor rita.dutta@itp.com

T +91 22 6154 6000

Managing director: S Saikumar Group publishing director: Bibhor Srivastava

Editorial Editor: Rita Dutta T +91 9980 588199 rita.dutta@itp.com

ADVERTISING Director: Sanjay Bhan T +91 9845 722377 sanjay.bhan@itp.com

STUDIO Head of design: Milind Patil Senior designer: Vinod Shinde Contributor: Sanjay Bandre

PRODUCTION Deputy production manager: Ramesh Kumar

CIRCULATION Distribution manager: James D’Souza T +91 22 6154 6006 james.dsouza@itp.com

Cover Image: Nayati Medicity, Gurugram The publishers regret that they cannot accept liability for error or omissions contained in this publication, however caused. The opinions and views contained in this publication are not necessarily those of the publishers. Readers are advised to seek specialist advice before acting on information contained in this publication, which is provided for general use and may not be appropriate for the readers’ particular circumstances. The ownership of trademarks is acknowledged. No part of this publication or any part of the contents thereof may be reproduced, stored in a retrieval system or transmitted in any form without the permission of the publishers in writing. An exemption is hereby granted for extracts used for the purpose of fair review.

Printed and Published by Sai Kumar Shanmugam, Flat no 903, Building 47, NRI Colony, Phase – 2, Part -1, Sector 54, 56, 58, Nerul, Navi Mumbai 400706, on behalf of ITP Media (India) Pvt. Ltd, printed at Indigo Press India Pvt. Ltd., Plot No. 1C / 716, Off Dadoji Konddeo Cross Road, Between Sussex and Retiwala Ind. Estate, Byculla (East), Mumbai-400 027, India and published at ITP Media (India) Pvt. Ltd, Notan Plaza, 3rd floor, 898 Turner Road, Bandra (West), Mumbai – 400050. India

Editor: Rita Dutta

WRITE TO THE EDITOR Please address your letters to: The Editor, Healthcare Radius, Notan Plaza Third Floor, 898 Turner Road, Bandra West, Mumbai - 400050. India or email rita.dutta@itp.com. Please provide your full name and address, stating clearly if you do not wish us to print them.

SEPTEMBER 2018 | HEALTHCARE RADIUS

A DV I S OR Y B O A R D OUR EDITORIAL BOARD HOLDS UP A MIRROR TO THE HEALTHCARE INDUSTRY, HELPING US UNDERSCORE THE KEY TRENDS AND DEVELOPMENTS OF THE INDUSTRY

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

AJAY GUPTA Executive Director, KGD Architecture

DR GIRDHAR J GYANI Director general, Association of Healthcare Providers

DR RAVINDRA KARANJEKAR CEO, Jupiter Hospitals

DR G BAKTHAVATHSALAM DR MK KHANDUJA

Chairman, KG Hospital & Post Graduate Medical Institute

Chairman, BSR Healthcare

Subscription form

DR GUSTAD B DAVER Medical director, Sir HN Hospital

BRIGADIER JOE CURIAN Healthcare Consultant

DR DURU SHAH Director, Gynaecworld

DR NC BORAH Chairman, GNRC

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

DR SANJEEV SINGH Medical superintendent, Amrita Institute of Medical Science

Duration

You Pay

1 year (12 issues)

Rs1000/-

Please use BOLD / CAPITAL LETTERS ONLY Mr/Ms: _______________________________________________________________________________________________ (First name) (Middle name) (Last name) Designation ____________________________________________________________________________________________ Company ______________________________________________________________________________________________ Address1 ______________________________________________________________________________________________ Address2 ______________________________________________________________________________________________ Address3 ______________________________________________________________________________________________ City: ___________________________________Pin code: __________________State: ________________________________ Tel: ______________________________Fax: ______________________Mobile:_____________________________________ Email: _________________________________________________________________________________________________ Cheque/DD No. _____________________ Dated______________ Favouring ITP Media (India) Pvt. Ltd Drawn on __________________________________________________________________________________________Bank Please use bold & capital letters only l The mode of payment should be cheque/demand draft favouring ‘ITP Media (India) Pvt. Ltd’ Please write your name and address on the back of the cheque/demand draft l Orders once placed will not be terminated or transferred l Please allow a minimum of 4 weeks to process the order. Subscribe to HEALTHCARE RADIUS by completing the form and sending it to: Subscription Department ITP Media (India) Pvt. Ltd, Turner Road, 898 Notan Plaza, 3rd Floor, Bandra (W), Mumbai-400 050. For further queries write to: james.dsouza@itp.com | Tel:+91 22 6154 6006/6000 l l

SEPTEMBER 2018 | HEALTHCARE RADIUS

BULLETIN

Siemens Healthineers opens manufacturing facility in India

The new facility is spread across 3,150 square meters.

Peter Koerte, President – Point-of-Care Diagnostics, Siemens Healthineers, recently inaugurated a new diagnostics manufacturing facility at Vadodara, Gujarat. The new state-of-the-art facility is spread across 31,50 square meters, and is equipped with benchmarked manufacturing facility and globally renowned processes and systems for the Indian healthcare industry. As a part of skill development initiative, the facility also serves as centre of excellence for training in laboratory diagnostics, point-of-care testing and diagnostic imaging, across South Asia region. The future ready site has a fully-functional PLM Lab set

up for product development and validation. The manufacturing unit comprises two product lines namely Urine strips; Autopak Biochemistry Reagent and Reagent Grade Water Aqualab. From being pioneers in diagnostic manufacturing, Siemens Healthineers has maintained a high level of quality and reliability in diagnostics operations for over 40 years in India, and has been consistently tracking changes in consumer demands and met majority of consumer requirements in time. Peter Koerte, President, Point-of-Care Diagnostics, Siemens Healthineers, stated, “With chronic diseases on rise, demand for fast, convenient testing is higher than ever. Increasing focus on healthcare infrastructure and effective use of Point-of-Care Testing will enable reduced expenditures and ensure quick turnaround for critical illnesses and chronic diseases. We are committed for consistent quality product supply from the facility and to work towards innovations in Point-of-Care Testing.” Amit Sinha, Head Diagnostics, Siemens Healthineers, India, said, “With a well-equipped R&D centre for Product Lifecycle Management for diagnostics products, the manufacturing unit at Vadodara is helping us derive better outcomes and improved patient care solutions.”

Nayati Medicity, Mathura receives NABH Nayati Medicity, Mathura, the flagship hospital of Nayati Healthcare, has received the prestigious accreditation from the National Accreditation Board for Hospitals and Healthcare Providers (NABH), the highest recognition for providing quality patient care and safety. With this, Nayati Medicity has become the first hospital in the region to receive this certification. NABH recognises hospitals for fulfilling high standards in delivering quality healthcare to its patients. The accreditation recognises the fact that the hospital meets strict standards of quality and safety set by the esteemed body. Niira Radia, Chairperson, Nayati Healthcare, said, “It brings a great sense of fulfillment and happiness that within two and half years of starting its operations, Nayati Medicity has become one of the most sought after healthcare institutions, in terms of high quality patient care, bringing in the world’s best infrastructure and clinical expertise.”

SEPTEMBER 2018 | HEALTHCARE RADIUS

J Mitra launches iQuant J Mitra has launched India’s first portable diagnostic solution - the iQuant immunoassay analyser in the Indian market. Launched in collaboration with IIT Madras’ HTIC (Healthcare Technology Innovation Centre), this portable is a state-of-the-art Fluorescence Immunoassay Analyser for quantitative and qualitative determination of blood test parameter – that includes TSH (Thyroid Stimulating Hormone), T3 (Triiodo thyronine), T4 (Thyroxin), Vitamin D, Dengue NS1 Antigen, Dengue IgM, Dengue IgG and HbA1c test. Beta-testing for the product had been going on for the eight months and has generated tremendous positive response and demand.

BULLETIN

Asia’s 1st clinical school for stereotactic radiotherapy tion oncologists and physicists to offer better patient-centric treatment protocols. As this is the first-ofits-kind training centre in Asia, Kokilaben Dhirubhai Ambani Hospital will also host medical professionals from across Asia who wish to be a part of the training. The aim of establishing this centre is to provide quality healthcare, which was previously KDAH will host medical professionals from across Asia, as a part of available only in the West, across India and the training. other Asian countries. With the onset of a growing number of casThe Varian Training Centre for Radiaes related to cancer, Varian Technologies, tion Technologists involves case-based in collaboration with Kokilaben Dhirubhai learning with expert clinicians from Ambani Hospital, has started offering Asia’s some of the leading cancer centres in the first Stereotactic Radio Surgery and Stereo- country. The present programme is detactic Radiotherapy Clinical School. While signed to fortify the abilities of already arming established medical practitioners trained candidates who are familiar with with cutting-edge technology management radiotherapy, but not competent with training, the course will also enable radiastate-of-the-art technologies.

Apollo Hospitals Navi Mumbai opens OP centre Apollo Hospitals Navi Mumbai inaugurated an all new Out Patient Centre (OPD) at its facility. The new OPD will offer specialty consultations, follow-ups and other OPD services. The centre was inaugurated by Dr N Ramaswami, Commissioner of the Navi Mumbai Municipal Corporation. Commenting on the occasion, he said, “This facility should benefit the people of Vashi and surrounding areas for special-

ist consultations.” Dr Narendra Trivedi, CEO, Apollo Hospitals Navi Mumbai, said, “There has been a growth in the population in Navi Mumbai. In order to meet the growing need, Apollo Hospitals has launched the new Out-Patient Centre at Vashi, which is easily accessible for patients across Vashi and surrounding areas. Our specialists will now be available for consultation and second opinions at this facility.”

SEPTEMBER 2018 | HEALTHCARE RADIUS

Health Ministry signs MoU with Ministry of Tribal Affairs JP Nadda, Union Minister of Health and Family Welfare, and Jual Oram, Union Minister of Tribal Affairs, recently presided over an MoU signing ceremony between Ministry of Health and Ministry of Tribal Affairs for working in a cooperative partnership to improve the health and wellbeing of students in tribal schools. At the function, the Expert Committee on Tribal Health also submitted its detailed report with findings and recommendations jointly to Nadda and Oram. “In line with our Government’s commitment to universal health coverage with priority accorded to the health needs of those who require it the most, our endeavor is to ensure that health concerns of the tribal population are met holistically,” said Nadda.

a i d n I n i t n i r p t o o f r Ou ed on Publish 6-2018 74 pages 46/201 400001 12 ber of MCN/1 num ISSUE n No. ce, MumbaiTotal E9• • `50 istratio Offi VOLUM MUMBAI • tal Reg l Sorting 2018 nt Pos nne AUGUST payme Patrika Cha pre t RY ST t withou Posted at IN DU TIO N e to posry months 387 UC ens TR Lic eve G/2008/33 18 CO NS 4th of RTH/20 TH E 77/NO date: 3rd & I No. MAHEN FO R E PPNC CH/W ting under RN LL IGE s MR/TE nth. Pos IN IN TE NLINE. nse no. vious mo Newspaper ES S WEEKO BU SIN WPP liceevery pre istrar of UCTION TS & ONSTR 30th of red with Reg OJ EC WWW.C IS, PR Registe ALYS

EEK W N O I T UC CONSTR NE WS

20 018-20 101/2 00001 MCN/ n No. ce, Mumbai-4 istratio tal Regel Sor ting Offi nt Pos payme rika Chann hout preted at Pat wit t pos nth Pos mo 411 ense to 18 Lic th of every/2009/33 10 TH/20 /NOR e: 9th & . MAHENG dat PP-79 I No CH/W Posting under RN rs MR/TE month nse no. of every Newspape WPP liceed on 5thRegistrar of Publish red with Registe

of number Total

HED PUBLIS

Total

es of pag ` 50 ber 18 | ST 20

num

GU 20 1 | AU 018-20 ue 08 N/99/2 ai-40000Vol. 10 | Iss n No. MCOffice, Mumb istratio tal Reg l Sorting ment Pos Channe t prepayted at Patrika t withou to pos ry months Pos8 nse 8 Lice 6th of eve 009/3341 th/201 & 82/Nor date: 5th No. MAHENG/2 ting RNI CH/WPPnth. Pos s under MR/TE nse no. every mo spaper WPP liceed on 3rd of istrar of New Publish red with Reg Registe

84 pages

| Vol 10

5 Issue

BY ITP

0 18 | `5 st 20 | Augu

(INDIA) MEDIA

-RISES D • HIGH EERE ENGIN • PRE- DINGS BUIL

NTS PRESE

ight for and ins ation Inspir

, AN

rs signe or de d interi ects an archit

SITER SEE

m uminiu ural al Struct t sturdy ye Light

.com dioindia igitalstu www.d

mes en it co ks. tute whg landmar t en in p, is as e Grouns and buildof developm ips. sh s Prestig CMD, inent locatio vel aspectZs and town , ck SE om Raza to no Irfan oosing pr ered him ch parks, to ch ct has ve hotels, te il, in ta st This in such as re

ALL M S E H T TE TO BIG SALU

tion innova m and ia) ia (Ind idealis ITP Med ed by iration, Publish ing insp lebrat felicitations ce of dition sions and tra e us th inued tations, disc 18 cont en rum 20 rough pres th sign Fo en De The iG

G SETTIANGENDA TH E A CLO

SER

THE K AT LOO

d by ITP Publishe

CES SUC

RIE S STO

INDU S OF

STRY

PIO

. 8-2020 Office, 42/201 ting MCN/2Channel Sor n No. istratio at Patrika ted tal Reg nt Pos month. Pos payme us hout pre ry previo /46040 post wit st of eve HENG/2012 to &31 MA nse h e: 30t 18 Lice RNI No. orth/20. Posting datpers under P-76/N CH/WP vious monthar of Newspa MR/TE pre istr nse no. of every with Reg WPP liceed on 27th Registered Publishai-400001. Mumb

ng Aligni

d ess an busin

in care health

Total

(India) Media

FAR Y SO E N R JOU THE

IS DIGITAL OF EROS NT ON GH, CEO STME N LULLA SIN LLION INVE WI RISHIKA THE $50 MI LP EROS NOW NT HE CONFIDE SHOWS WILL ALLS L EB ORIGINA TTLE FOR EY T BA THE OT

• Vol 6

48 pages

om india.c otelier www.h

URE L FEAT SPECIA NGES

LITY

QUA KAIZEN ATION OF APPLIC N OPINDIIOCARE OF MO IMPACT

India

70 PAGES TOTAL 8 | `50 201 | AUGUST

RING FACTU MANU CENTRES TECH EDGE

S RING L BEA RY O STRIA INDU NEW TERRIT

TECH

INTO

18 st 20 Augu • `50 11 Issue

UE 8

E 8 | ISS

VOLUM

-2020 0 /2018 00001 8 | `5 N/98 st 201 No. MCce, Mumbai-4 ation 7 |Augu Issue Registr ting Offi e 10 | Postal nnel Sor ment Cha Volum t prepay at Patrika t withous Posted nth 8 e to pos Licens of every mo 09/3464 018 /20 7th h/2 /Nort date: 6th & . MAHENG PP-73 I No CH/W Posting under RN rs MR/TE month. nse no. of every Newspape WPP liceed on 4thRegistrar of Publish red with Registe

S NEER

of number Total

pages

019 2017-2 00001 N/154/ ai-4 n No. MCOffice, Mumb istratio tal Reg l Sorting ment Pos Channe t prepay at Patrika t withou Posted to pos ry months nse 59 eve Lice 8 of 011/379 th/201 & 8th 74/Nor date: 7th No. MAHENG/2 ting RNI CH/WPPnth. Pos s under MR/TE nse no. every mo spaper WPP liceed on 5th of istrar of New Publish red with Reg Registe

ALLE TECH CH

BATE STRY DE ADS INDUGS T HR HE AMON

FULL STEAMD! AHEA PRESEN

INDIA, O, MD,TATION, IR RA SUDH TRANSPORMPANY’S RDIER HIS CO SING A BOMBA ATES ON LE IN INFU ERN OD Y. OR M RO AB EL ARRING M IN NE ST MOMENTU RAIL JOUR OUS WED RENE A’S AMBITI INDI Published

SIGN

MI D

RUL

TALE D N U O R A TURNA

D LLEGE AN ICAL CO STAINABLE SU JALI MED , GEETANHOSPITAL SELF OR CT RE D 0-BE IVE DI , EXECUTAKING THE 1,15 ARWAL M ANKIT AGEPS TOWARDS L, ON ST ITA nth. 810. SP 013/52 HO vious mo

ry pre MAHENG/2 h of eve on 25t under RNI No. lished s 019 Pub of Newspaper r 2017-2 N/265/ with Registra No. MC red istration 01. Registe tal Reg 000 ment Posce, Mumbai-4 prepay Offi out ting post withChannel Sor nse to 18 Lice ted at Patrika orth/20 Pos P-75/N s month. viou CH/WP MR/TE of every pre th nse no. WPP licedate: 29th &30 Posting

d by ITP

Publishe

Media

sful succes

and spaces ercial comm

t emen manag facilities

Volum

ISE G PREM TIN THE CO-CREA OF

SION, S, OFES CT THE PR ARCHITE T S OF ABLE R AT CN INDIA NE LIVER G IN RE DE GING PART EVOLVIN E ME IS URE ND TH , MANA BEYO VARK AR CHITECT ING AR DA GO HOW CHAN PREM LIGHT ON S SHED

Issue e5|

) (India Media

IONAL’S TERNATNIOR IOTT IN SE MARR L WANG, OF GLOBAL MICHAE ENT HEAD PACIFIC IN CONT N FOR ASIA T HOW OU DESIG , SPELLS TELS IS REGION TURE OF HO THE FU REDEFINED BEING

ia) dia (Ind ITP Me

R U O Y R E D OR W O N Y P O C

today’s re for furnitu ; Office kspace g wor t AV changin efficien king ating gr te In co-wor ? Does s; offices em syst itional al pages 56 Tot ge trad | `50 2018 challen gust

(India)

to guide finitive The de

ed by Publish

by ITP

12 | Au

Publish

dia ITP Me ed by

(India)

For subscriptions, please contact: James Dsouza Tel: 022-61546006 Email:james.dsouza@itp.com

BULLETIN

Brains introduces technology to ease spine surgery Bengaluru-based Brains Hospital has recently acquired the cutting-edge mobile fluroscopy machine - Ziehm Hybrid RFD 3D HE Intraoperative Imaging System. Brains is the first hospital in India to house this high-end equipment used for spine surgery that gives 100 percent accuracy and 3D Imaging. This highly mobile apparatus offers surgeons three dimensional imaging with exceptional clarity, helping them achieve pin-point precision with never-before confidence and speed. At Brains, surgeons pair the Ziehm with another first-in-India technology, the Stryker navigation system NAV3i, a computer-assisted, navigation guidance suite that gives real-time feedback about the position, direction and progress of surgery, aided by in-built pre-programmed and planned safety checks. This mobile apparatus offers surgeons 3-D imaging with exceptional clarity. Deployed together, these two systems have helped doctors achieve perfection in spinal surgery and invasiveness and muscle dissection without disturbing reduce the chances of errors to near zero. Dr Venkatathe joints, ligaments and other supportive elements. ramana NK, Founder & Chief Neurosurgeon, Brains They also greatly enhance the possibility of using miniHospital, said, “These technologies enable our surgeons mally invasive surgery for fixing unstable spines percutato operate with extremely small incisions with minimal neously, using key holes.”

OMRON step-up after sales service expanse

IIT Mandi ties up with RxDataScience Inc

OMRON Healthcare India, the leader in digital blood pressure monitoring segment, has announced the opening of 48 pickup centres in addition to seven existing authorised after-sales service centres across tier-1 and 2 cities. This strategic move denotes company’s efforts to deepen its reach and connect with the endcustomers via strengthening its after sales service infrastructure. OMRON Pickup Centres present walk-in facilities for customers for all of their repair needs and provide the first-level check of product and allow the customers the convenience to get the same picked up after the repair at the nearest service centre, thus saving them the hassles of visiting the pharmacies or retailers (from which they had bought the products) and a centralised interface for speedy resolution of their service needs. Kazunori Tokura, Managing Director, OMRON Healthcare India, said, “OMRON aims to add on value to the whole customer journey by bringing not only the products but also the services closer to them.”

Indian Institute of Technology Mandi has tied up with RxDataScience Inc, a leading healthcare manufacturer in the US, to create a portal documentation Artificial Intelligence and Machine Learning Research in the pharmaceutical sector. Further, IIT Mandi team is also planning to work closely with RxDataScience Inc, to apply deep-learning methods and cognitive algorithms for discovering patterns among patient journeys and social ties among physicians. This is part of a long-term collaboration focused on performing machinelearning on healthcare datasets concerning patients and physicians and developing novel web-based visualisations.

SEPTEMBER 2018 | HEALTHCARE RADIUS

Haven't you liked us on

Facebook yet ?

Indiaâ&#x20AC;&#x2122;s pemier healthcare B2B magazine

BULLETIN

Acinetobacter baumannii- The Superbug research A new virulence mannii can resist the factor (combat action of all the prevastrategy/antidote) lent antibiotics and has been detersuch infections are mined in multidrug often fatal. The introresistant nosoduction of new drugs comial pathogen has rather slowed Acinetobacter down and on top of baumannii, as per that, the bacterium’s Prof Ranjana Pathaability to develop nia, Associate Prof, resistance rapidly, Department of Biodefeats the overall tech, IIT Roorkee. purpose of having new Acinetobacter baudrugs. It is pertinent mannii is one of the to identify novel drug most prevalent bactargets to increase teria responsible These bacteria are not airborne, but can spread through direct contact our arsenal against this for neonatal sepsis pathogen.” with surfaces, objects, or the skin. in India. These The Acinetobacter bacteria are not airborne, but can spread through direct superbug can cause diseases such as pneumonia and contact with surfaces, objects, or the skin of people that meningitis. Multidrug-resistant Acinetobacter infections are contaminated with A baumannii. have an extremely high crude mortality rate and occur Professor Pathania, said, “Clinical strains of A baumost frequently in severely ill patients.

Gleneagles Hospitals announces emergency campaign

Dr RM Anjana awarded

Gleneagles Hospitals India has announced the launch of one of its kind unique emergency campaign titled ‘I Am Emergency Ready’. The objective of this initiative is to minimise the risk factor during medical emergencies by training citizens to administer immediate care and ensure a correct first-response treatment to a victim until specialised medical help arrives. This initiative will be executed across four metropolitan cities such as Mumbai, Chennai, Bengaluru and Hyderabad at Gleneagles facilities which comprises nine hospitals of Gleneagles Global Hospitals and Continental Hospitals. Through this drive, Gleneagles Hospitals would conduct BLS training for individuals, corporates, everyday people like auto drivers/ roadside vendors and many, schools, social workers, security guards and many. At the end of the training, a certificate and an emergency toolkit will be presented to the qualified participants. Dr Ajay Bakshi, CEO -India, Parkway Pantai, said, “Our larger objective is to spread awareness regarding the importance of emergency assistance during the initial critical minutes and help India establish as an emergency ready nation.”

Dr RM Anjana, Managing Director and Senior Diabetologist of Dr Mohan’s Diabetes Specialties Centre and Vice President of Madras Diabetes Research Foundation has been awarded the Keshavdev JPEF Award for ‘Young researcher in diabetes in India’. Governor of Kerala, P Sathasivam, has presented the award in the presence of the Tourism Minister of Kerala, Kadakampally Surendran on the occasion of the two-day convention organised by the DrJothydev and Jothydev’s Diabetes and Research Centre at Thiruvananthapuram. This is one of the highest honours for young diabetologists and is given to the best conducted original research in India.

SEPTEMBER 2018 | HEALTHCARE RADIUS

BULLETIN

Group CEO, AOI & Citizens Hospitals

r Jagprag Singh Gujral, former Group COO, Global Hospitals, has taken over as Group CEO of AOI and Hyderabad’s Citizens Hospitals. A doctor with an MBA from Indian School of Business, Hyderabad, Dr Gujral has more than 18 years of experience in the healthcare sector, with a strong focus on corporate strategy, management consulting and operations.

Prior to Global, Dr Gujral was the Executive Director of investment banking at Anand Rathi Advisors, where he was instrumental in building a successful healthcare investment banking and advisory practice. He has replaced Dr Lloyd Nazareth, who moved up as Executive Director of Asian Healthcare Holdings, the investment platform set up by TPG Growth to invest in India.

CIO, HCG

adhavi Kanumoory has taken charge as CIO of Bengaluru’s HCG Enterprises Limited- .the largest cancer care network in India,. She is an Electrical & Electronics Engineer from National Institute of Engineering, Mysore -1992 batch and has an extensive IT domain experience of over 20 years. She has worked with GE for over 17 years including seven years

with various leadership positions. She brings extremely strong strategic capabilities to HCG, adding long-term value. She was working as Senior Director- Commercial Excellence IT at GE Healthcare, where she was responsible for strategic direction and organisational leadership for the Commercial Excellence IT Delivery and Operations.

CEO, Milann

udhir Bahl has assumed charge as CEO of Bengaluru’s Milann- the Fertility Center. Sudhir is an MBA in International Business from IIFT and comes with 25 years of experience with a thorough understanding of healthcare ecosystem in India and global markets like MENA and South East Asia. In his earlier assignments, Sudhir has worked in

leadership roles with GE Healthcare, Apollo Hospitals, Nova Day Surgery & Irene Health Care. His last assignment was as an entrepreneur in Singapore and Dubai - LifeForce Capital – an innovative and specialised healthcare platform focused on investing in growth-stage companies.

CHRO, Apollo Hospitals

riharsha Achar, Executive Director and CPO, Apollo Munich, has assumed charge as the new CHRO of Apollo Hospitals. He has replaced Karunakar T, who joined Abu Dhabi’s VPS Healthcare as Group CHRO. Sriharsha has worked as CHRO with NamevKarma, as Director-HR with Xchanging Technologies India Private Limited, Director

HR with America Online Pvt Ltd and First Ring India Pvt Ltd and Max Bupa Health Insurance. Harsha is a professionally qualified and experienced HR specialist with extensive knowledge and skills in training and development, recruitment and selection, career counseling, communication and performance management,

HEALTHCARE RADIUS | SEPTEMBER 2018

COVER STORY

SEPTEMBER 2018 | HEALTHCARE RADIUS

COVER STORY

We Are All Light Lighting has to create an environment that is visually satisfying as well as emotionally compatible BY RITA DUTTA

ighting design is an important aspect of providing the necessary comfort and healing in a healthcare space. The lighting has to create an environment that is visually satisfying as well as ‘emotionally compatible’. In addition to clinical areas, non-clinical and public areas also need optimised lighting solutions. Says Siddharth Puri, Director- Architecture, WARD FOUR, "The effect of lighting, natural and artificial, on human psychology in terms of being able to affect both mood, productivity and perceptions, is well known. In a scenario when people and those around them are at their most vulnerable in a hospital setting, the role of lighting is greatly enhanced." Research indicates the deep link between lighting and well-being. One such significant research paper “The impact of light on outcomes in healthcare settings”, Anjali Joseph (the Center for Health Design, 2006) outlines that “light impacts human health and performance by enabling performance of visual tasks, controlling the body’s Circadian system, affecting mood and perception, and by enabling critical chemical reactions in the body.”

Sumandeep Singh Associate, HKS India

1. The effects of daylight and artificial lighting have an overarching impact on the wellbeing of all the inhabitants of a hospital. The project picture is of Kuwait Children Hospital.

HEALTHCARE RADIUS | SEPTEMBER 2018

COVER STORY

Siddharth Puri DirectorArchitecture WARD FOUR

2. In lobbies, warm lighting is considered to mellow down the frantic emotions of families and caretakers. Picture is of American Oncology Institute, Nagpur.

Daylight and artificial lighting The effects of daylight and artificial lighting has an undeniable impact on the wellbeing of all the inhabitants of a hospital – the most fragile, the patients and those rendering care to them – staff and family members. Says Manu Malhotra, Director, RSMS Architects, “We design the lighting of building, using the combination of daylight entering through window and skylight and electric light sources. It is extremely critical to balance the light intensity, as too much light can also be discomforting. At the same time, lack of natural light can make patient feel unsafe and claustrophobic.” He adds that one must try to create a great first impression with a welcoming ambience of entrance area as it can set the tone of entire patient and visitor experience. The use of attractive and adequate lighting in entrance area plays a major role in creating a welcoming and user friendly environment. Light sensitivity is an aspect that cannot be ignored while design, as it can frequently lead to general agitation, migraines or even seizures in patients with neurological disorders among patient population. It can also hinder exercise or social interaction. The

SEPTEMBER 2018 | HEALTHCARE RADIUS

most fragile of patient population - neonates, the elderly and those with neurological conditions struggle with light sensitivity. "For the very premature babies, intense and continuous bright light can cause impaired growth of eye sight among neonates. This applies not only to babies born before the 32nd week of gestation who are especially at risk because their pupillary light reflex has not yet developed, but to all premature babies, says Puri. For the elderly, especially those struggling with Parkinsons, Dementia and Alzheimer’s, perception of depth is greatly affected. Poor lighting can lead to falls which in turn leads to second level complications among the elderly. One key challenge is lighting need of all occupants in a hospital are very different and sometimes even conflicting. Many 24x7 areas add even more significance to the lighting design. One can’t treat clinical lighting similar to other spaces like offices and restaurants. In an emergency department or operating room, every second counts, and even the smallest details can be matter of life and death. The practice that is consistent worldwide is the preference for warmer temperatures

COVER STORY

in the 3,000 - 3,500K range and movement away from troffers in these spaces. "The diagnostic areas including surgery and the critical care areas have their own very specific lighting requirement in which both natural and artificial light is very carefully modulated," says Puri. LIGHTING UP VARIOUS AREAS A) Reception and Lobby Lobbies no longer simply serve to guide patients from a parking garage or drop-off area into the hospital. Instead, hospitals are taking a cue from hospitality and are utilising lobbies to create a positive first impression. “Plenty of natural light should be used especially if we can have access to North or South Orientation; in other orientations this has to be modulated and controlled. The designer has to find balance between visibility, heat gain and natural light,” says Puri. In artificial lighting, the trend is for warmer mood lighting with a combination of recessed can lights and decorative fixtures. "In most of our recent projects, we have moved away from troffers which earlier were a standard choice," says he. Reception areas, since they are used for work should incorporate under-cabinet lights for the paper-work and none of the lighting fixtures, should cause an in-face glare. A comfortable lux level must be maintained for reading and writing activities. Says Sumandeep Singh, Associate, HKS India, “In lobbies, where there is a need to provide a feeling of warmth and panic-reduction, warm lighting is considered to mellow down the frantic emotions of families and care-takers. Maximising access to natural light mixed with appropriate incandescent lighting would uplift the ambience of these spaces.” Global standards based on what is followed in the US, and referred to as the RP29-16, recommend two lighting levels for the entrance of a general lobby, instead of one one light level for daytime and one for night time. “These two lighting levels are designed to better accommodate the eye’s natural

3 ability to adapt from bright and sunny outdoor conditions to more muted indoor illumination levels,” says Puri. In outpatient waiting areas, where waiting times can sometimes be long, day lighting should be maximised, as it is healthier than artificial lighting. Accent lighting can be used effectively for purposes of way-finding in waiting zones. B) Nurse stations Nurse stations are heavy work areas for nurses and should be brightly lit with cool coloured light. "Inside a nurse station there are zones for reading imaging films, blood glucose monitoring and even CCTV observation zones which must be enabled with optimum lighting levels," says Singh. Work area task lighting with 4000 colour temperature and about 300-400 lumens, similar to an office space, is recommended for nursing station space, say experts. . C) ICU ICUs are crucial areas for lighting design in a hospital. "Daylight should be maximised, and if not possible, then artificial lighting must follow the natural ‘Circadian Rhythm’, patterns and lighting levels. This has been proven to have positive effects on the healing processes,” says Singh. Surgical style ceil-

3. One needs to design the lighting of building using combination of daylight entering through window and skylight and electric light sources. Picture is of Nayati Medicity, Gurugram.

HEALTHCARE RADIUS | SEPTEMBER 2018

COVER STORY

4 ing mounted lights must be provided over the patient bed for detailed examination. These are usually fitted with LED fixtures these days. Ideally, ICU should be designed for variable lighting – ambient, glare free light for the comfort for patients (allowing the patients to sleep) and for physical examination by physicians and nurses at 6,500K.

4. Diagnostic areas like MRI and CT rooms have very specific lighting design. Project picture is of HCG Cancer Hospital, Nagpur.

D) Consultation rooms Consultation rooms are areas where the physician and surgeons meet and examine patients. In consultation rooms, there is general lighting which is ceiling can-lights or LED 2x2 panels, over the exam bed is an exam light or in some cases a portable light on a stand is used for specific exams like gynaecology, etc. Dental and ENT consult rooms have lights built into the Dental chairs and ENT consoles respectively, whereas the Eye exam rooms have specific lux level lighting for the consult rooms. “Warmer lights in the doctors consult area with dimmers and a desired 300-400 lumens especially in the area around the

SEPTEMBER 2018 | HEALTHCARE RADIUS

doctors table is recommended. A 6,500K light over the patient area is recommended,” says Puri. E) OTs Operation theatres must have the lighting levels specific to the kind of procedure being performed. The laminar flow ceiling on top of the surgical table provides for HVAC ducts as well as soft lighting panels that are used for general illumination. Specific exam lights, two sets should be provided at patient centre position in the ceiling. There are disinfectant UV lights that are used to cleanse all surfaces in the OT room. F) In patient rooms In patient rooms are generally areas where natural light is maximised, as for any other area where patient is housed for a prolonged period of time. “Circadian lighting is again a solution which must be explored for IP rooms. There is nothing better than daylight for IP rooms,” says Singh. In an ideal world the larger percentage of lighting especially during the day should

COVER STORY

be through daylighting and the rooms should ideally face north or south in order to mitigate the heat gain associated with natural light. In terms of artificial lights, it is found that many use dimmable recessed fixtures in the 3,500-4,500K range for the major part of the room especially the care giver side and to provide the ambient light. Controllable mood lighting associated with the patient headwall or footwall is provided, basis the design and budget. However, the trend is to move away from this as it seems a little superfluous and clients seem to be trending towards simplified headwall/footwall designs. Often, there is one 6,500K troffer directly over the patient which provide white light for diagnostics. "However, care has to be taken in placement of this light for it to provide uniform workable illumination in the patient area while not serving as a source of glare directly into the patient’s eye. A night lamp closer to the floor level for minimal lighting during night time is recommended for safety," says Puri. G) Diagnostic areas Diagnostic areas like MRI and CT rooms have very specific lighting design as the patient is lying down and looking at the ceiling. These days back-lit illuminated panels with artwork are used to keep the patient anxiety levels low. LED screens are being adopted to play soothing videos while the procedure goes on. This is of interest to patients and provided momentary relief. The general lighting in diagnostic rooms must have dimmable controls. H) Corridors and passages In corridors and passages, the lighting must assist in illuminating the path clearly and cool lighting is preferred. An important aspect of lighting design in passages is wayfinding and signage. Lighting design must compliment the signage, so that it’s easier to manoeuvre the path.

Current trends Energy codes continue to become more rigorous, further requiring the elimination of wasted energy and more efficient system designs. The use of LEDs for general ambient lighting, task lighting, accent lighting and almost every other type of lighting has multiplied leading to substantial changes across the lighting industry. While LED lighting and lighting controls have become increasingly more efficient, lighting technology now plays a role that is central to safety and comfort of the occupant and even helping with sleep patterns by addressing circadian rhythms. Night lighting is also an emerging trend. “At night, healthcare facilities are silent and still, with little or no activity or movement on the premises. To a visitor or patient who is already burdened with illness or injury, such an atmosphere might prove to be scary or psychologically intimidating. Well designed lighting can help ease the stress of the visitor in such a situation by providing clear and well-lit pathways, with the lighting aiding the visitor in way finding in conjunction with signage,” says Malhotra. At night, artificial lighting must follow specific use in the hospital. In the exterior,

Manu Malhotra Director, RSMS Architects

5. There is nothing better than daylight for IP rooms. Project picture of double room at Nayati Medicity.

HEALTHCARE RADIUS | SEPTEMBER 2018

COVER STORY

and mood lighting. “Festive seasons like religious and national holidays may also be celebrated by customised lighting. Taking a step further, one can attempt to integrate the system into the façade and external lighting of building. Integrating this intelligently into the system allows the ease of maintenance and control,” says Malhotra.

6. Warmer lights in the doctors consult area with dimmers and a desired 300400 lumens is recommended. Project picture is of Columbia Asia, Sarjapura Road, Bengaluru.

however, building illumination is a must, clearly demarcating the emergency access using RED lighting. Wayfinding at night assumes a greater significance and must assist to reduce panic. A soft façade illumination provides a reassuring feeling to the patient and family. The night lighting strategy should ensure corridors should stay well lit with ample fixtures on UPS in case of power outage and critical egress should ideally have a higher ambient than even day time. In external areas, one must prefer to go for lighting as per requirement, instead of conventional high wattage and bright pole mounted lights. “One must ensure well lit pathways with lighted signage, aiding the users in way finding. Also, one must try to place parking lots and other similar areas away from the main building while ensuring the security of the space,” says Malhotra. Another important source of light comes from signage systems that are often added as afterthoughts to building façade. “We prefer to design signage system which are not lit during the day and come to life in night and merge into overall lighting scheme,” says Malhotra. Experts also recommend improving patient experience through the use of festive

SEPTEMBER 2018 | HEALTHCARE RADIUS

Tunable and Circadian lighting In the years to come, experts predict that lighting design will be based increasingly around energy efficiency in hospitals. From a healing and comfort perspective, tunable and Circadian lighting will become more widely used for critical areas like ICUs and High Dependency Units. Lighting-based disinfectants will gain traction particularly in the Ultra violetrays based disinfection units, say experts. Lighting will be controlled based on occupancy and use IoT and data. “Dynamic façade lighting will also gain more acceptance in healthcare but with a scientific use to it. The lighting controls will become more stringent and energy effectual,” says Singh. Also, dynamic lighting will become widely used not just in healthcare but also at workplace and homes. The use of electric lighting and electronic devices with bright screens — from smart phones to tablets, laptops to big-screen TVs at night expose us to blue light at the wrong times, which exacerbates circadian disruption. LEDs and knowledge of lighting's role for circadian health can help put us back on track, or at least closer to it, for improved health and well being, point out analysts. And the industry is expected to move away from point sources of light to an aggregate system where multiple sources are embedded or even painted on the walls and ceiling which will allow greater flexibility in design of spaces and reduce project timelines as lighting design and fixture selection is taken out of the normative project process and becomes a parallel exercise that can be modified at any stage.

EVENT

Healthcare technology conference CAHOTECH 2018 is being held on 29th September, 2018

he Consortium of Accredited Healthcare Organisations (CAHO) is a not-for-profit society that was formed to fulfill the need for a common platform to facilitate communication amongst the accredited HCOs, share best practices, and provide benchmarking, while promoting and continuously improving the quality and safety of healthcare services provided by the HCOs across India, in collaboration with all stakeholders. CAHOTECH- The annual International healthcare technology conference, provides a suite of technology based solutions to give maximum efficiency to its member hospi-

tals. CAHOTECH 2018, the 3rd International Healthcare Technology Conference of Consortium of Accredited Healthcare Organisations, is being held on 29th September, 2018 at Bengaluru. The theme of the conference is 'Adaptable Future Technologies for Indian Hospitals.' CAHOTECH is a platform for healthcare organisations and technology industry to share and utilise combined experience, to guide themselves continuously towards more efficient practices utilizsng technological development. The first CAHOTECH was launched at ITC Kakatiya, Hyderabad on 17th Sep, 2016.

INSIGHT

Advancements in brain tumour surgery 1. The brain is posed for variety of tumours including malignancy.

Technology helps to protect and preserve the integrity of normal brain tissue, screen and preserve normal blood vessel BY DR NK VENKATARAMANA

SEPTEMBER 2018 | HEALTHCARE RADIUS

INSIGHT

rain tumours are the most difficult tumours in the body causing significant disability, morbidity as well as death. Brain tumours can occur from the brain in the foetus all the way to old age. The incidence of brain tumours is gradually increasing year by year and this could be possibly due to awareness and detection. The brain is posed for variety of tumours including malignancy. According to a study, the prevalence of brain tumour cases stands at 8.2 cases for every 1 lakh population in the world. In this, 15-20 per cent of the brain tumour cases occur in children. In children after blood malignancy, brain tumour is the second major form of malignancy. Brain tumours arising from the neuron, blood vessels, nerves and nerve sheaths starting with skull bones, pituitary glands, pineal glands are termed as primary brain tumour. Some of them are benign, but a good number of tumours are malignant. In addition, brains can also have metastatic tumours starting from the breast, lungs, pancreas, kidney, intestine, etc. This isnâ&#x20AC;&#x2122;t all, brain tumours can also affect the spinal cord and the vertebral column. Younger the child, more malignant are the tumours. The tumours are more even in the foetus, sometimes called the congenital brain tumour. In children, the brain tumours are more commonly found in the posterior part, whereas in adult the tumours are mostly located in the deep brain. These tumours primarily increase intra-cranial pressure (pressure effects) causing headache, vomiting, and secondly it leads to compression effects causing focal neurological defects, dysfunction of the nerves, brain or the spinal cord and thirdly, it causes general problems like convulsions, psychological issues, pain, etc. Clinical examination and imaging are the major form of diagnosis when it comes to the brain tumour. MRI is the gold standard in identifying the tumours which are less than a centimetre lesion, its location, size,

vascularity, effect on the surrounding area and MR tractography can provide information about the white matter tracts and the MR spectroscopy can give a gross idea about the tumour and the degree of malignancy. The gold standard of treatment for brain tumour remains the surgery followed by radio therapy and chemotherapy if the tumours are malignant. Meanwhile, a variety of supportive therapies are now being tried to compliment the primary therapy. However, the exact etiology or the cause of the brain tumour is still not clear. A variety of genetics, environmental, toxins, exposure to radiation, drugs have been incriminated. Going ahead, the development of molecular biology of tumours might throw light about the exact causative factor in the future. When we go back to the history, it has been found that the first brain tumour surgery was performed in England by Richmond Bradley. Yesteryears have witnessed a series of problem due to lack of imaging, illumination, infection control and surgical instrumentation. Due to this many brain tumour surgeries were difficult to perform as some of the areas were not accessible, making the total removal of the tumour difficult. In addition, the surgery was associated with significant morbidity. Over the last three decades, there has

2. MRI is the gold standard in identifying the tumours which are less than a centimetre lesion.

HEALTHCARE RADIUS | SEPTEMBER 2018

INSIGHT

3. Computerassisted surgery helps the surgeon to approach the tumour through a small scale.

been a significant development, the technology adoption has made the brain tumour surgery as one of the most successful field with very good outcome. Imaging today will give all the relevant information to the surgeon about the tumour and the surrounding brain structure, blood vessels and 3D orientation. The operating microscope has helped the illumination and the magnification in such a way that the tumour from all location of the brain can now be operated upon. Every neural structure can be visualised clearly so that it can be protected and preserved during the surgery. The high speed drill has created rapid access to the brain, thus reducing the duration of the surgery as well as the bleeding. The bipolar diathermy has contributed to the precise control of the bleeding. The understanding and comprehension of the anatomy of the brain has paved the way for specialised approaches to the weaker areas through the safer zone like three sylvian feature, subarchnoid systems, trans-corpus callosum approach, trans-ventricular approach and trans-fulcul approaches minimizing the brain damage and the neurological effects.

SEPTEMBER 2018 | HEALTHCARE RADIUS

Making new strides and development in the field of brain tumour treatment, the self retaining retractive system have become sophisticated to create a clear scene for the surgeon. Similarly, the controlled suction can keep the operative field clean without any blood. The ultrasonic surgical aspirator is able to break the tumour into pieces and aspirate using the high-power ultrasound technology. This can facilitate rapid debulking of the tumour and at the same time preventing fraction to avoid the damage to the surrounding normal brain. The laser system sometimes can help to evaporate the tumours using laser energy. All these gadgets have helped in achieving the gross total removal of the tumour, irrespective of the location and type of the tumour. Secondly, the technology helps to protect and preserve the integrity of the normal brain tissue, screen and preserve the normal blood vessel that supplies the brain, selectively blocking the blood supply to the tumour, so that the Ischemic injury to the brain is prevented. We are able to preserve every single cranial nerve, thus reducing the morbidity significantly and also improving the function of the individual. Overall, all

INSIGHT

these factors can contribute in improving the quality of life after the surgery. With these great advancement, neuro surgery has become one of the finest branches of medicine that can lead to gratifying results with satisfactory outcome. The tumour fluorescence technology is able to provide better visualisation of the tumour tissue under the microscope. The colour difference will be able to differentiate the tumour tissue from the normal brain, helping the surgeon to remove selectively and totally the tumour tissuethereby preserving the normal brain. The endoscopic system has enhanced the visibility and accessibility of deep-seated tumours. With the advent of endoscopy and endoscopic micro-instruments, neurosurgery became the key-hole surgery as well as minimally invasive surgery. Good number of tumours located in the intraventricular space can be removed using the endoscope through key-hole approaches. This has minimal retraction of the brain and greater visualisation and endoscopic assisted surgery is a great compliment to the micro-surgery in order to visualise the blind corners and achieve total removal. Intra-operative MRI is a real time imaging technology that can help the surgeon to achieve complete removal of the tumour as well as get the real time verification of the complete mess of the surgery. Computer-assisted surgery or navigation surgery is another great advancement which will helps the surgeon to approach the tumour through a small scale and in real time verify the location, trajectory and the progress of the surgery. We can also plan the approach through the safer areas of the brain and navigate oneself accordingly- avoiding injury to the important structure. All these can be pre-determined, pre-planned, previous day using specialised computer software and execute the plan effectively. Stereotactic surgery is yet another additional specialised area. This allows the ac-

4 cess to deep seated tumours in a minimally invasive way in order to access, obtain biopsy and also treat some of the tumours. This stereotactic technique is also used to provide targeted therapy like targeted radiotherapy, targeted chemotherapy and targeted cell therapy as well as implantation of drug delivery devices. In addition to this, a variety of other supportive therapies are also being researched. These include cell therapy, immune therapy, gene therapy, targeted drug delivery through nano-technology and MR-guided radio frequency ablation. The angiography and endovascular intervention sometimes helps to identify the vascularity of the tumour as well as to reduce the vascularity by tumour embolisation and provide selective intra-vascular drug delivery. The future holds a lot of promises in the field of molecular biology, drug delivery by modulating the blood brain barrier, targeted therapy, and drug discovery. The optics thus contributes to a different operating system where one will be able to see the tumour and the cell activity using specialised devices. Now the goal of research is towards early identification of tumour, non-invasive method of monitoring and the targeted therapy in order to attack tumour selectively without causing any cell damage.

Dr NK Venkataramana is Founder & Chief Neurosurgeon, Brains Hospital, Bengaluru.

4. With the advent of endoscopy and endoscopic microinstruments, neurosurgery became the key-hole surgery as well as minimally invasive surgery.

HEALTHCARE RADIUS | SEPTEMBER 2018

COMMENT

Mentoring in rural India It is in the interest of private facilities to work towards improved quality of care at rural facilities BY PIYUSH MEHRA

T 1. The status of training of medical staff in the country continues to be poor.

he National Health Protection Scheme (NHPS), launched by the central Government, is being referred to as the world’s largest health insurance plan. The plan envisages covering 10 crore poor and vulnerable families which amounts to approximately 50 crore beneficiaries. The coverage amount has been set at Rs 5 lakh per family per year for secondary and tertiary care hospitalisation. This amount is significantly higher than the cover provided by other central or state Government schemes. Over a period, the scheme is expected to subsume the existing

SEPTEMBER 2018 | HEALTHCARE RADIUS

central scheme, Rashtriya Swasthya Bima Yojana (RSBY), as well as many state insurance schemes. India’s poor health outcomes are welldocumented. A UNICEF report released this year named India as the 12th worst country for new-borns among 53 lower-middle income countries. The country’s neonatal mortality rate (child deaths in first 28 days, per 1,000 live births) of 25.4 puts it behind smaller neighbours like Sri Lanka, Bangladesh and Nepal. A major determinant of neonatal survival is coverage and quality of rural health facili-

COMMENT

ties, as India continues to live in its villages. According to the latest Union census, 68.8% of India’s citizens live in rural areas. India has a well-designed system on paper – tiers of health facilities from large tertiary facilities and advanced research institutes down to Community Health Centres (CHCs) and Primary Health Centres (PHCs). Consider CHCs and PHCs. Each PHC serves a population of around 20,000 in tribal / hilly areas, and 30,000 in the plains. It is typically the first point at which a villager can avail a doctor’s services. PHCs were conceived to improve delivery of maternal and child health services, promote family planning and perform basic diagnosis, treatment and referrals. Each PHC is expected to have a doctor and 14 other staff. The next level, the CHC, is ideally a 30-bed institution providing specialist care in medicine, obstetrics and gynaecology, surgery and paediatrics as per the Indian Public Health Standards (IPHS). It serves a population of 80,000 to 120,000. Each CHC is expected to have four doctors and 21 other staff. According to the Rural Health Statistics (RHS) 2017, only 3,303 of 25,650 (12.9 percent) PHCs and 912 of 5,624 (16.2 percent) of CHCs meet IPHS norms for infrastructure. PHCs and CHCs are plagued by two types of issues: a) infrastructure related and b) human

resources related. As per RHS 2017, over 60 percent of PHCs don’t function on a 24*7 basis. Around 63 percent of them do not have an operation theatre. If there is an emergency, people have to approach a distant CHC or private facility. And 44.5 percent of India’s 5624 CHCs do not have a functional X-Ray machine while 16 percent do not have a new born care centre. In several facilities, labour rooms are not organised as per the Government guidelines. Essential equipment is often missing and supplies are not made available on time. Issues here refer to staffing (availability of requisite number of staff), and knowledge and skills of available staff. In the five-year period from 2010-2015, 52 percent of births were in public health facilities. This represents an increase from 18 percent between 2000 and 2005. Yet, according to RHS 2017, 24.39 percent of 33,968 sanctioned doctor posts in PHCs are vacant. The situation is even more stark in states like UP where less than half of the sanctioned posts have been filled. It is a similar, if not worse, story in CHCs- 52.85 percent of 3,103 sanctioned obstetrician / gynaecologist (ob-gyn) posts are vacant. In UP, 78 percent of 524 sanctioned ob-gyn posts are vacant. 68 percent of 11,910 sanctioned specialist posts (surgeons, ob-

2. In Rajasthan, as a part of the Akshada programme, the Antara Foundation has deployed nurse mentors.

HEALTHCARE RADIUS | SEPTEMBER 2018

COMMENT

3 gyns, physicians, paediatricians) have not been filled. Increased burden is putting pressure on rural health facilities and compelling staff to shoulder more responsibility. The staff lack the knowledge and skills to handle case load and complications. Status of training of medical staff in the country continues to be poor. Instruction is theoretical and administered in conditions that fail to replicate real-world challenges.

3. The proper functioning of PHCs and CHCs makes economic sense.

he word 'mentor' has ancient origins, first appearing in Homer’s Odyssey. The corporate sector is increasingly adopting the idea of mentoring to nurture future leaders. A mentor’s role goes beyond helping a mentee improve his/her knowledge and skills. Mentors can advise mentees on their context and the channels that may be used to obtain resources necessary to carry out their work. Inadequacy of infrastructure, human resources and training in rural medical facilities indicates a case for mentoring. In UP, the India Health Action Trust (IHAT) has deployed nurse mentors to work at district hospitals, CHCs and PHCs. They work with nurses at delivery points to facilitate self-assessment exercises, prepare action plans, identify training needs and provide on-site mentoring. In Rajasthan, as a part of the Akshada programme, the Antara Foundation has deployed nurse mentors to work with nurses in facilities where a large num-

SEPTEMBER 2018 | HEALTHCARE RADIUS

ber of deliveries take place. They adopt a scientific and empathetic approach to training, to ensure that nurses are best-equipped to deliveries and related issues. Finally, proper functioning of PHCs and CHCs makes economic sense. According to the National Health Accounts, 2014-15, India’s per-capita out of pocket expenditure on health is Rs 2394. This is over 62.5% of total health expenditure. Better quality of care in rural health facilities would drive more people to use public health facilities and reduce out-of-pocket expenditure. People can easily access quality healthcare and save on transportation. This also makes economic sense forsuperspeciality private hospitals. They are often expected to deploy resources to handle cases that ought to be handled at lower-level facilities. Often, such expenditure on care and documentation is not viable. Better rural public health facilities will enable these hospitals to focus their resources on specialist tertiary care. Better and timely diagnostics at PHCs and CHCs would also enable more effective handling of cases. Thus, it is in the interest of private facilities to work towards improved quality of care at rural health facilities. This can take various forms. They could work with the Government to upgrade quality of infrastructure, equipment and diagnostic facilities. Resources could be deployed to operate diagnostic and other equipment for a small price. Practitioners could participate in the Government’s initiatives such as the Pradhan Mantri Surakshit Matritva Abhiyaan campaign. Collaboration with organisations mentoring staff in rural facilities could help address the skill gap as well. These actions make sense as the public health system needs all the help it can get.

Piyush Mehra is the Chief Executive Officer of the Antara Foundation. Karthik Ram, senior associate with the Antara Foundation, has also contributed to the article.

OPERATIONS

The pillars of a hospital Doctors, nurses, administrators and support staff ensure a pleasant and satisfied hospital stay BY DR J SIVAKUMARAN

eing in the service industry, hospitals depend largely on people to be successfully run. To earn satisfied patients and attendants, hospitals depend on doctors, nurses, technicians, support staff, administrative and management staff. All are equally responsible and they have to play their respective roles to deliver quality care. In other industries, automation is possible to a large extent and manpower could be reduced substantially. But in hospitals, though limited automation is possible, reduction of manpower is not possible to the expected level.

To have precision accuracy of surgery, robotic can help. But no way can we reduce the manpower requirement for the surgery. Robot cannot do surgery by itself, unless the doctor spends time to give various instructions till the surgery is over. In spite of investing in infrastructure, technology and equipment, if competent work force is not set then the investment would be in vain. Hence in a hospital environment, people are most important at various levels. Patients are the main focus of attention for healthcare providers. Right from the reception to discharge, the hospital func-

1. A good working environment will motivate doctors to do more.

HEALTHCARE RADIUS | SEPTEMBER 2018

OPERATIONS

2. Nurses spend more time than doctors with the patients.

tions are supposed to be patient centric and all requirements of the patients need to be met. In the absence of technical knowledge about patient care, patient and attendants judge a hospital with tangibles like ambiance, interior, clean environment, neatly dressed healthcare staff, waiting time, transparent billing, soft skills of the staff, response time from the staff, harmless food facilities, banking facilities, etc. So, it is not sufficient to keep just the patient satisfied, but also essential to keep the patient attendants satisfied as well. This is because the attendants influence patients while choosing a healthcare facility. Customer Relationship Management needs to be modified to Customer Relatives

Doctors attract patients Doctors are heroes for any hospital, as patients mainly chose the hospital for the doctor. The fate of a hospitalâ&#x20AC;&#x2122;s top line and bottom line mostly depend on the type of doctors available and their satisfaction level. A good working environment will energise doctors to do more. Any incentive model for their extra efforts will contribute more to the hospital. Technological upgradation and bringing newer technologies will make them proud to work in the hospital and they feel better among peers of other hospitals. Making doctors as a part of major decision in the department and equipment procurement activities will make them feel as a part of the management. Allowing them freedom on clinical practices and supporting them during any professional crisis will ensure their loyalty to the hospital. They will become an agent of change when their suggestions and views are respected and implemented within the framework of the hospital. Required manpower support needs to be provided to doctors to share their work load to create better results. And supporting them during crisis situations like medico legal complications is important. Nurses: The backbone of a hospital Nurses spend more time than doctors with the patients. The behaviour, soft skills and technical knowledge can change the perception of the patients towards the hospital. According to surveys with patients who survived after decades of treatment,

Management to improve the satisfaction level. If the non-technical aspects are up to the satisfaction of a patient, he will become a marketing tool for referring more patients among his/her circle. Within the limitations of the hospital policies, taking care of the patient and ensuring satisfaction is much more effective than is given. The cost of generating a new customer is costlier than retaining the old customer.

SEPTEMBER 2018 | HEALTHCARE RADIUS

OPERATIONS

most patients remembered the name of the nurses more than the doctor who treated. Nurses take care of various technical and non-technical needs of patients. Nurses slog the full day and win confidence of the patients and reassure them about quality of care. The decision of revisiting a hospital is not only depends on the patientsâ&#x20AC;&#x2122; comfort with doctors but also the quality of nursing care in that hospital. Nurses are also accountable for stocks, billing and proper documentation. However, due to shortage of nurses they are over loaded with work. Workers: Core to Patient Satisfaction Health workers are essential to increase the satisfaction level of patients during their stay in hospitals. Customers for hospitals are not healthy and they often find it difficult to move from one place to another and even to the wash rooms. Health workers extend their service to meet the needs of patients from time to time. The staff try their best to keep the hospital premises spic and span. Waste segregation and safe handling is a challenge faced by hospitals. They segregate the waste as per the guidelines and handle them without harming themselves and others. Their tolerance and patience is appreciable and worth any compensation. They help patients transport from one place to another safely. They take care of patient right from entry to exit point. Role of administrators Though administrators are not directly responsible for revenue generation, they are the custodian of a hospital. Right from establishing various protocols, policies and procedures, administrators struggle to run a hospital effortlessly. Right from admission to discharge, patients pass through various touch points. Administrators ensure seamless flow of systems for patients and ensure ease and comfort at each point. Problems from patients,

3 attendants, doctors, employees, regulating authorities, bankers, stakeholders, others are all handled and managed by the administrators on a day-to-day basis. They draw out various strategies and plan to run the hospital cost effectively and optimally.

ttracting best talent to the hospital is one of the foremost challenge faced by any hospital. Only less than 20 per cent of the available manpower is employable and willing to do their job of own. Balance work force need to be trained and their talent is to be leveraged for better utilisation. Hospitals need to invest time and money in training and upgrading their skills on these employees to get the expected results. But even if anybody spends on these, retention is not guaranteed. With reduced manpower strength, getting quality output is a challenge for hospitals. With possible automation, proper training and engaging employees in retention activities will address the challenges to some extent.

Dr J.Sivakumaran is Chief Operating Officer, KMCH, Coimbatore.

3. Robot cannot do surgery by itself, unless the doctor spends time to give various instructions till the surgery is over.

HEALTHCARE RADIUS | SEPTEMBER 2018

TECHNOLOGY

The shadowy world of radiology Innovations in imaging is one of the most important advancements to revolutionise modern medicine BY DR RAJAT BHARGAVA

1. MRI is nonionizing and safe for all ages.

t was seemingly a routine day for me in my radiology department with several scans piled up for reporting. But my flow was being regularly interrupted with a stream of clinical colleagues who wanted to see the scans of their patients. Each one wanting to know the various possible diagnoses that we had to offer for the patients. It was in the midst of this, that my surgeon colleague barged in and wondered if one of his young patients in the Emergency Room with a history of minor injury by a bicycle accident, would need a CT scan. He said that based on relatively innocuous preliminary findings, they were considering to discharge the patient, but for the fact that there was a niggling abdomen pain, he is going to order a CT scan. He also added for a good measure that the chances of finding something on the scan are low. At 6 pm, it was my phone call which interrupted the surgeon as he was driving back home. With an urgency in my tone, I told him that the CT scan of his young patient shows a complete pancreatic tear

SEPTEMBER 2018 | HEALTHCARE RADIUS

1 with bleeding and would warrant an urgent surgery. â&#x20AC;&#x153;Are you sure?â&#x20AC;? was his immediate incredulous reaction. It is after some years of practice and managing many emergencies successfully that surgeons start believing in the advice of their colleagues from radiology. We were steadfast in our finding, hence the patient was promptly wheeled to the OR. Soon enough, the findings were confirmed and the bleeding pancreas were repaired. Danger averted, the patient went home healthy in a few days leaving everybody with a satisfied smile. This is the success story that a radiologist remembers and craves for, because not only did he diagnose an emergency condition when nobody was suspecting it, he also helped in the treatment plan which finally led to saving a life. This also exemplifies why modern diagnostics have become so important in today's clinical care. Imaging technology often comes to the aid of clinicians in confirming their suspicion and also occasionally throwing up completely unsuspected diagnoses. It is not an overstatement

TECHNOLOGY

to say that ‘innovations in imaging medicine is one of the most important advancement that has revolutionised modern medicine, and enabled more effective and efficient care that has saved countless lives’. Radiology scans allow doctors to peep inside people bodies virtually, and diagnose tumours and diseases as small as few millimeters. This early diagnoses of diseases like cancers leads to less invasive treatment procedures and markedly improves the treatment outcomes. From the point of more efficient and cost effective medicine, scans have virtually eliminated exploratory surgeries, reduced unnecessary hospital admissions and often shortened hospital stays. The various tools of imaging available to radiologists include the humble X-ray, Sonography, CT Scans, MRI Scans, Catheter Angiographies and PET Scans. While X-rays continue to be the cost effective, and widely available imaging tool to look at lungs, bones etc., sonography occupies a stellar position in imaging the foetuses. With sonograms, one can assess the development of the foetus and also diagnose developmental anomalies. Sonography also is the first imaging tool to look inside the abdomen and other soft body parts. The advantage being, it’s non-ionizing nature and also wide availability. The cross sectional modalities like CT, MRI and PET have revolutionised the diagnostic care, enabling high resolution and precise imaging to diagnose the smallest of tumours. Multi-slice CT scanners have become so fast that the entire body can be covered in a matter of 10 seconds. The most modern CT scanners even allow imaging of beating heart with exquisite anatomy of the coronary arteries and pick up small plaques that may cause a heart attack in the future. MRI places the patient in a magnetic field and small radiofrequency pulses are sent to patients, body and the resulting changes in the hydrogen protons of the body are read and the images are generated. MRI is also non-ionizing and safe for all ages. The mod-

2 ern scanners have evolved into a stronger 3Tesla strength with wider bore sizes and less noise for patient comfort. PET scanners are molecular imaging tools which take help of tumour metabolism to diagnose cancers. A radiologist not only reports the scans but discusses the findings with the clinicians, often guides the surgeon on the pathological anatomy, enabling them to take decisions on the approach to surgery. Through interaction with the radiologist, the surgeon prepares himself on what difficulties he is going to encounter even before opening up the patient. In the modern medicine oblivious to the patients, the treatment plan for the patient is often made in the radiologists's room. The radiologist thus plays a role of consultant to the other consultants of the hospital. Radiologists these days are not just content with diagnosing diseases, a modern intervention radiologist is using catheters and tubes for treating emergencies like a bleeding aneurysm or blocking blood supply of tumours. They often open up arteries by placing stents and obtain tissue pieces from deep inside for biopsies. Radiology has been around for over a century since Wilhelm Rontgen first discovered the strange new phenomenon he called “X-rays,” It has been evolving ever since and changing the way medicine is practiced.

Dr Rajat Bhargava is HOD-Radiology with Fortis Hospital, Mulund.

2. With sonograms, one can assess the development of the foetus and diagnose developmental anomalies.

HEALTHCARE RADIUS | SEPTEMBER 2018

INNOVATION

New-age education tool Simulation-based training has been standardised in various high-risk professions BY COL M RAJ GOPAL

H 1. Simulationbased medical education also provides a safe learning environment for repeated practice of meta-cognitive and psychomotor skills.

ealthcare and medical education faces an ethical impasse on using patients as practicing tools as it is bound by an obligation to provide optimal treatment while ensuring patient safety. To this end, the latest concept of simulation plays a crucial role in acclimatising healthcare professionals with all required skills in performing the most complicated procedures without risking patient safety. Simulation-based training has been standardised in various high-risk professions such as aviation, military and nuclear power to assure safety and curtail risk. Modern healthcare also seeks such competency-based instruction. Simulation-based

SEPTEMBER 2018 | HEALTHCARE RADIUS

medical education not only helps in error management, training for risky procedures and assessing competencies but also provides a safe learning environment for repeated practice of meta-cognitive and psycho-motor skills. Benefits of Simulation-based Education Improving patient care: Patient safety is a global health issue globally, and it is estimated that medical errors result in approximately 1.2 million deaths, every year. The World Health Organisation has published a report suggesting that harm from medical care poses a substantial burden in terms of morbidity and mortality on people around the world.

INNOVATION

2 The methodology of simulation education has gained widespread recognition within the field of healthcare as a powerful tool for reinforcing clinical knowledge, improving team communication, and teaching decision-making skills. Simulation is an educational methodology, not a technology. Simulation can be used not only to teach clinical skills, but also teamwork and communication. It can also be used to standardise training, meet evidence-based guidelines, and target specific goals. There is a shift in mindset from what simulation can do to how simulation can be best used to improve patient care. Opportunity to practice: One of the biggest challenges for improving patient safety is the opportunity to practice. Clinical placement opportunities, especially within nurse education, are becoming increasingly limited as the demand for healthcare workers increases due to aging populations. Not only is the opportunity for practice essential, but also the ability to practice safely without putting the patients at risk. Simulation-based training allows students,

physicians, nurses, and other healthcare providers to integrate cognitive learning with hands-on skills practice without risk to patients. Reducing medical errors and improving patient safety are essential elements of patient care, but not the only ones. Providing optimal patient care also includes uncovering latent safety threats, facilitating teamwork and communication, and ensuring professional competency is not only maintained but improved. Healthcare training has traditionally relied on a â&#x20AC;&#x153;see one, do oneâ&#x20AC;? approach to teaching. Teaching in this context focuses on imparting knowledge. Simulation-based training makes that knowledge comes alive- alive in a setting designed to imitate real clinical encounters and life-like experiences where clinicians can refine their individual and team skills without posing risk to real patients.

Col M Raj Gopal is Chief Operating Officer at CARE Institute of Health Sciences (CIHS).

2. There is a shift in mindset from what simulation can do to how simulation can be best used to improve patient care.

HEALTHCARE RADIUS | SEPTEMBER 2018

INFRASTRUCTURE

Turn down the noise Noise reduction programme requires careful assessment of the geographical, physical, and operational environment BY SUJAYANTI DASGUPTA

1. The average background noise in hospitals should not exceed 30 A weighted decibels (dB[A]).

he cacophony of alarms, conversations coupled with the noise from a bedside dialysis machine, may feel normal to most serving in an ICU unit. The highly stressful environment the caregivers are a part of may lead to subconsciously underplaying the effects of increased levels of noise and the well-being of the caregivers as well as the patients in these environments. Several research pa-

SEPTEMBER 2018 | HEALTHCARE RADIUS

pers like Xie H, Kang J, Mills GH â&#x20AC;&#x2DC;Clinical review: The impact of noise on patientsâ&#x20AC;&#x2122; point out sleep and the effectiveness of noise reduction strategies in ICUs. Yet, discussions pertaining to design and operational interventions that minimise noise in an ICU environment that support the most fragile of all patient population remain sidelined. The World Health Organisation (WHO) recommends that the average background

INFRASTRUCTURE

noise in hospitals should not exceed 30 A weighted decibels (dB[A]), and that peaks during the night-time should be less than 40 dB(A), but hospitals world over consistently exceed these values significantly. While there are many valid arguments that these recommended values are hard to achieve in an ICU setting, it is worth using it as a benchmark to measure against. Impact of noise in ICU Between increasing levels of life saving and life supporting devices, the ICU environment has gotten noisier over the years. The correlation between presence of noise and lack of wellbeing of patients and staff alike has been recorded anecdotally as well as through organised studies the world over. This is manifested firmly in compromised physiological as well as psychological parameters of the inhabitants of an ICU. Some of the most common and notable effects of noise in an ICU are as follows: Sleep deprivation: One of the major consequences of heightened noise levels for patients in ICUs is sleep disruption which in turn leads to sleep deprivation and interrupted circadian rhythms. Conversations have revealed that patients remembered sounds associated with the ICU staff, other patients or equipment. For a patient population that is most fragile, this lack of sleep for extended periods of time contributes to a further weakened immune system, psychological imbalances, neurologic changes, and decreased tolerance to pain. Additionally, sleep deprivation may also lead to respiratory muscle dysfunction causing weaning difficulties from mechanical ventilation. Delirium or ICU psychosis: Sleep disturbance, especially in the elderly post surgical patients, is a factor in the development of delirium. Critical care patients that have been sedated are especially prone to delirium, as their normal circadian pattern is greatly affected by lack of sleep. It

is well-documented in studies like 'Sleep in the surgical ICU: continuous polygraphic recording of sleep in nine patients receiving postoperative care'. The study 'Aurell J, Elmqvist D, Br Med J (Clin Res Ed). 1985 Apr 6; 290(6474):1029-32' states that because of interrupted sleep, patients may develop hallucinations, dissociation disorders which may be interpreted as hallucinations or as REM sleep behavioural disorders. These episodes promote delusional memories, which in turn increase the likelihood of post-traumatic stress disorder leading to longer ALOS. Stress for caregivers: Exposure to consistently high levels of sound is an additional source of stress with the caregiver as well. Increased levels of heart rate and blood pressure due to consistent exposure to noise has a long-term impact on the wellbeing and productivity of caregivers who are already working in a stressful environment by the very definition of their job profile. This can also lead to challenges in patient safety with respect to medication error, error in reading vitals, etc when a nurse is not completely alert and focussed because of the noise around him/her.

2. One of the major consequences of heightened noise levels for patients in ICUs is sleep disruption.

HEALTHCARE RADIUS | SEPTEMBER 2018

INFRASTRUCTURE

3. One of the major causes of noise in the ICU is equipment handling and alarms.

Sources of noise Sound levels in ICUs have risen significantly as a result of innovative and sophisticated equipment that assist the caregiver team monitor and provide care for ICU patients. However, the increased use of life saving and supporting devices have also led to increased levels of noise in the ICU environment. One of the major causes of noise in the ICU is equipment handling and alarms. Speech or talking in many different forms is also a major noise generating factor. The study also demonstrates that shift change, and handover tends to be one of the noisiest after visiting hours in an ICU. Another systematic review of 29 studies in the US related to ICU noise also found that the major sources of noise in the ICU were conversations, equipment alarms, caregiver activities (such as handwashing and opening equipment), telephones, pagers, televisions, closing doors, and falling objects. The sources of noise, therefore, seem to be universal. What magnifies the problem in some parts of the world, including India, are the open bays for ICU patients which allow for little to no auditory privacy.

SEPTEMBER 2018 | HEALTHCARE RADIUS

Noise mitigation The use of a noise reduction programme requires careful assessment of the geographical, physical, and operational environment. A series of behavioural changes along with operational and design changes may result in a quieter and a more restorative environment that is the need of the hour. Some of the strategies that might be worth considering are: • Designing for individual enclosed bays with partial bifold glass doors that allow for auditory isolation without compromising visual connection. • Design smaller units of 6-8 in clusters with shared support as opposed to the large open bay system that is currently practiced. • Decentralisation of ICU nurse stations that minimise noise generated from conversations. • Design and locate noise generating support areas like clean storage, handwashing sink, dirty utility off the main path of ICU bays to buffer some of the inevitable noise. • Installation of sound absorption ceilings along with dampers in the HVAC system.

INFRASTRUCTURE

4 • Designing walls between bays or a cluster of bays that go up to the plenum will help mitigate movement of sound from one bay to another. • Employing dimmable lighting during ‘restorative periods’ in the day allows for a visual cue towards a quieter environment. • Installing sound monitors that offer a visual cue to staff about decibel levels within the unit will also go a long way in serving as a visual reminder to maintain a quieter environment. • Minimise bedside conversation between nurse, physician and family members. Design for a room within the unit for private conversations with family members or staff. • Minimising volumes of monitors and using visual alarms at the nurse station • Allow for ‘white noise’ to dull ambient noise generated from conversations and rhythmic sounds of monitors. It is needless to say that consistent levels of noise around us are an annoyance at

best and severely disruptive at worst. Therefore, noise reduction is a daunting task in the ICU environment, but it’s imperative to do so for the well-being of staff and patients alike. There are opportunities to develop technology and test remote alarm options, including systems that can be connected to headsets for staff, or use of visual light bars with only critical alarms using sound for notification. Additionally, the design, configuration and built quality will go a great distance in mitigating sound in an ICU setting. However, it is important to note that any noise reduction programme will see a higher degree of success only if it has the buy-in and support of the staff that man these sensitive environments.

Sujayanti Dasgupta is Co-Founder, K Ward Four.

4. Noise reduction is a daunting task in the ICU environment, but it’s imperative to do so for the wellbeing of staff and patients alike.

HEALTHCARE RADIUS | SEPTEMBER 2018

OPINION

Tackling illegal organ transplant The current laws are strong enough to curb the practice but its implementation is far from satisfactory BY DR SURESH RAGHAVAIAH

1. This shortage of organs had led to large-scale organ trafficking in the past.

rgan transplantation has been recognised as an effective therapy for patients with organ failure. However, the number of patients suffering from vital organ failure keeps increasing every year. For example, In India alone, according to the available statistics, more than 2,00,000 are suffering from kidney failure and are in need of kidney transplant. Unfortunately, out of which only 6,000 transplants are performed. These numbers clearly display the disparity in the number of organs required versus the number of organs available for transplant. This shortage of organs had led to large-scale organ trafficking in the past and brought the illegal organ trade in India to international focus. The Transplantation of Human Organs act (THOA)(1994) and its subsequent amendments were passed in order to regulate organ transplant and one of the main focus of the act was to define “who could donate”.

SEPTEMBER 2018 | HEALTHCARE RADIUS

Although initially only first degree relatives could be a potential donor, subsequent amendments allowed for second degree relatives (grandparents, aunts, uncles and cousins) to be included as potential a donors. It also allows the donor who is not related to the potential recipient to donate if it can be proven that it is being “done by reason of affection or attachment towards the recipient”. The donation can only proceed after approval from the “Appropriate Authority” which will include participants from both the hospital and the state. According to the WHO, India was known as the “Organ Exporting Country” where organs from poor Indian donors were routinely transplanted to patients from other wealthy countries for monetary compensation. These surgeries were often carried out in unregulated medical centres, not licensed to carry out organ transplant surgeries. The THOA also stipulated who could perform organ retrieval and transplantation surgery

OPINION

and where it could be done. It also ruled that if any hospital or a person was found to be violating these norms, they could be liable for suspension and criminal prosecution including imprisonment. Since the THOA was passed, there was a decrease in the number of foreign nationals travelling to India seeking transplant surgeries. There was a further decrease in the illegal trade of organs and transplant tourism during 2006-07. It was due to serious resolution by the different countries which led to signing of the “Declaration of Istanbul” in 2008 with the signatories agreeing to take measures to protect the poorest and vulnerable groups from transplant tourism. This also protected the sale of tissues and organs, including attention to the wider problem of international trafficking in human tissues and organs”. According to the WHO, the “underground organ market is still existent and resurging in India”. It has been estimated that around 2,000 Indians still sell their kidney every year. The middle-men who arrange these surgeries have come up with ingenious ways to circumvent the legal process of the THOA. The simplest is falsification of the legal paper work to prove close relationship between the recipient and the donor (where none actually exists). This is most often done in connivance with the personnel responsible for issuance and verification of the various legal documents required. Recent cases of illegal transplants also suggest involvement of the hospital authorities and the assistants of the medical personnel. In other instances, ‘transplant marriages’ are conducted where the recipient shows proof of marriage to the donor and once the transplant is completed, divorces the donor. In addition, the clause in the THOA where unrelated donation is allowed on grounds of “by reason of affection or attachment towards the recipient” is often misused. It is very easy for the donor to develop sudden affection towards the recipient once a monetary reward is expected.

2 The reason this illegal trade continues is due to the lack of strong legislative and enforcing mechanism. The current laws are strong enough to curb the practice but its implementation is far from satisfactory. Although the state Medical Councils have been granted suo-moto powers to investigate, it is rarely evoked. Corruption in the enforcement agencies combined with a largely illiterate, poor and gullible population allows the practices to go on unchecked. As long as there is such a discrepancy in the 'demand and supply' of organs, and as long as transplant trade continues to be profitable, it is unlikely that we will be able to abolish this completely. One option is to increase awareness about cadaveric donation. Once the supply of organs become adequate, the profitability factor decreases and this will help control the practice of trading. Stricter legislation is not enough, we also need to work on a stronger enforcement mechanism to discourage this unscrupulous practice.

Dr Suresh Raghavaia is Consultant, HPB & Multi Organ Transplantation, BGS Gleneagles Global Hospitals, Bengaluru.

2. 'Transplant marriages' are conducted where the recipient shows proof of marriage to the donor and once the transplant is completed, divorces the donor.

HEALTHCARE RADIUS | SEPTEMBER 2018

CONSUMER CONNECT

Step towards NABH Dr Kishor Pujari, CEO, Geetanjali Medical College and Hospital, speaks about the efforts to get the NABH accreditation

GMCH is the first large medical college and hospital to get full NABH accreditation in Rajasthan.

eetanjali Medical College and Hospital (GMCH) is 1,150 bed multi-super-specialty hospital and a part of Geetanjali University situated in Udaipur. This institute has been established in 2007 and in past 10 years, it has served the population from south Rajasthan. Being a teaching hospital, it emphasised on volume of patients coming majorly from lower middle class and poor class strata so far till 2016. We deployed various strategies to transform this large teaching hospital to self-sustained, quality oriented, upgraded healthcare facility where high quality clinical care is given comparable to any corporate hospital. After careful implementation and intense work up, GMCH has achieved NABH full accreditation on 11th March 2018. GMCH decided to establish an ecosystem of highest possible clinical quality care and determined to get NABH full accreditation, soon after I took charge two years back. With this resolve, we started preparing for NABH process. We began by founding the quality department and hiring manpower for it. We appointed Sukanta Das, who had worked with me while in Apollo Group, to head the department. Our first challenge was to prepare the large infrastructure like this hospital where my clientele was mix population with majority (70%) coming from rural and tribal area who don’t understand much of the hospital policies and protocols. The second challenge was to prepare the large workforce of doctors and nurses and allied staff for organised and standardised clinical care under NABH. This workforce was working here for last decade in academic environment and entirely for different

SEPTEMBER 2018 | HEALTHCARE RADIUS

ecosystem where main focus was to attend large crowd of patients and treat them and teach MBBS and PG students. Third was the modification of the hospital infrastructure as per the NABH guidelines. Fourth was to convince the medical and nursing workforce for the additional burden of documentation, clinical protocols, pathways etc. We developed a strategy deployed to overcome the hurdles. We recruited few key talent in the area of operations, nursing, stores and inventory management, laundry and CSSD, security and maintenance and billing and mixed with old talent and created a new task force for the NABH. With regular meetings and education, we aligned the core team towards NABH objectives, requirements. Team building and team work measures were implemented across the all functions. ‘Train the trainer programme’ was implemented across various functions for various clinical and nursing NABH protocols, disaster management protocols, fire and safety protocols, 5S programmes. The quality department along with medical, nursing admin team and HR team created a momentum in entire organisation for the implementation of NABH guidelines. Through continuous efforts by all departments, we moved successfully from stage from preparation phase to pre-assessment stage to final NABH assessment stages with required compliances. Thus, we became the first large medical college and hospital to get full NABH accreditation in the state of Rajasthan and one of few of other teaching hospitals in India. It’s rare achievement for us because only 525 hospitals till now out of over 40,000 hospitals across India have NABH accreditation.