Asian Hospital & Healthcare Management - Issue 48

I S S U E 48

2020

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Making health systems resilient and responsive

Associate Partner

Technology Deployment in Management of COVID-19 Infection

Viral Infections A modern Pandora’s box

FOREWORD

Virus outbreaks

Making health systems resilient and responsive “The failure to prepare could allow the next epidemic to be dramatically more devastating.� – Bill Gates, TED2015

Over the last decade, the planet has dealt with several virus outbreaks viz. H1N1 (Swine Flu), Middle East Respiratory Syndrome (MERS) and Ebola. These viruses turned out to be deadly with high fatality rates, but were probably not as devastating as the Spanish Flu. While the world, largely, has been free from the above-mentioned virus outbreaks, countries such as Congo are still dealing with Ebola as a national health emergency. And this year, mankind witnessed the deadliest of outbreaks in the form of COVID-19. As per the World Health Organization (WHO) records, the first set of cases were reported in Wuhan, China on 31st December 2019. Subsequently, China announced the disease to be novel corona virus, a respiratory syndrome closely related to the SARS 2002-03. Before long, the virus spread to nearly every country. So far, an estimated 3.8 million people have been affected and 270,000 patients are reported dead, and the numbers are increasing day by day.

Corona continues to spread and impact millions of people across the world, as countries find ways to tackle it. The rate at which the virus spread in China, Iran, Italy, Spain and the US shows how underprepared the world has been in addressing any pandemic. Germany and South Korea, on the other hand, showed the world that when testing is done on a large scale, chances of people with few or no symptoms are identified thus increasing the number of known cases. On the economic front, the virus severely impacted economies with most bearing the brunt of lockdowns. It may take some time to get a deeper insight into the impact on industries across the globe. The healthcare industry, however, is at the centre of the crisis.

When a virus outbreak occurs, it exposes gaps in the global healthcare infrastructure and capabilities to handle such crisis. On one hand, healthcare organisations are challenged to manage an overwhelming number of patients

with lack of facilities and necessary equipment.

At risk are millions of frontline health workers dedicated to serve the ever-increasing patients, and it is critical to safeguard the frontline staff physically and psychologically. On the other hand, social distancing and other measures have disrupted business continuity pushing out-patient visits and surgeries with exceptions for emergencies. Delay in returning to normalcy can impair the ability to manage their establishments.

In order for healthcare institutions to swiftly respond to a global health emergency there needs to be a strengthening of emergency management capabilities, improved technology adoption in patient management, and redesigning facilities to create dedicated space for isolation in case of a virus outbreak.

Better partnerships between governments and healthcare organisations could pave the way for building sustainable health infrastructure and disease surveillance systems. The solution to facing any epidemic is to anticipate potential outbreak, identify the evolution of disease and raise public awareness to contain and prevent loss of lives across the globe.

COVID-19 has shown us that developed countries are not immune to virus outbreak.

When public health services across countries are bolstered to respond to emergencies, the world becomes well-equipped to protect lives and minimise fatalities. The cover story of this issue showcases articles focused on dealing with health epidemics. They offer insights around technology deployment for managing infections, redesigning hospital emergency facilities, developing robust disaster management capabilities to containment of outbreaks through effective public health measures.

Prasanthi Sadhu

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CONTENTS HEALTHCARE MANAGEMENT

TECHNOLOGY, EQUIPMENT & DEVICES

08 Innovations in Healthcare Financing

56 Managing Medical Devices Failure Risk Improving health outcomes

Pradeep Kumar Ray and Yan Hanrunyu Centre For Entrepreneurship, University of Michigan-Shanghai Jiao Tong University Joint Institute

Sanjay Jha, Director, Colmed

14 How Conflict Between Medical Professionals Impacts Patients Nancy Michaels, President, NancyMichaels.com

20 Promoting Dignity in Care Role of management Rekha Elaswarapu, Lecturer (Health and Social care), University of Sunderland

26 Lean and Service Go hand-in-handi Gurrit K Sethi, Hospital COO, Care Hospitals

COVERSTORY MEDICAL SCIENCES 48 Emergency and Disaster Preparedness Significant drivers affecting emergency and hospital design Brinda Sengupta, Associate, HKS, Inc. Angela Lee, Managing Director, HKS Asia Pacific

51 Prevention of Infectious and Chronic Diseases An indispensable investment Md Moshiur Rahman, Associate Professor, Graduate School of Biomedical & Health Sciences, Hiroshima University Md Adnan Hasan Masud, Consultant, Haematology Department, Bangabandhu, Sheikh Mujib Medical University (BSMMU) Sajeda Chowdhury, Research Institute for Radiation Biology and Medicine, Hiroshima University

32 Technology Deployment in Management of COVID-19 Infection K Ganapathy, Director, Apollo Telemedicine Networking Foundation, Apollo Tele Health Services

40 Corona and India Gurrit K Sethi, Hospital COO, Care Hospitals

42 Viral Infections A modern Pandora’s box Sangita Reddy, Jt. Managing Director, Apollo Hospitals

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Prasanthi Sadhu

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Pradeep Kumar Ray Honorary Professor and Founder WHO Collaborating Centre on eHealth UNSW

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HEALTHCARE MANAGEMENT

INNOVATIONS IN HEALTHCARE FINANCING Declaration of health as a fundamental human right in World Health Organization’s (WHO) constitution of 1948 and the agenda of Health for All by Alma-Ata declaration of 1978 were instrumental behind Universal Health Coverage (UHC). However, according to WHO and World Bank, 400 million people around the world did not have essential healthcare services. Although the overall healthcare coverage is increasing (thanks to technologies, such mHealth and advances in drugs), the coverage gap between rich and poor is also increasing in developed and developing countries.

Countries are experimenting with schemes, such as low cost insurance to solve the problem. However, the success is limited and hence more innovative financing ideas are needed. This paper starts with a summary of our systematic survey of various healthcare financing options and summarizes three innovative approaches based on social business, crowdfunding and technology entrepreneurship.

Pradeep Kumar Ray Yan Hanrunyu Centre For Entrepreneurship, University of Michigan-Shanghai Jiao Tong University Joint Institute

U

niversal Health coverage (UHC) is the platform that seeks to overcome inequality in tackling the service provision gap and financial gap that populations face. The role of ICT to build the essential building blocks of UHC has been accepted, However, there are many areas that require further research and evaluation.

The use of ubiquitous technology such as mobile electronic devices to support medical or public health practice and health systems has been embraced as the new frontier of ICT that will improve efficiency and effectiveness of healthcare, especially for the majority of the world’s population that live

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in low and middle income countries. It has been predicted that by 2017 there will be ‘more mobile phones than people’ on the planet, and currently three-quarters of the world’s population have access to a mobile phone. “Mobile communication devices, in conjunction with Internet and social media, present opportunities to enhance disease prevention and management by extending health interventions beyond the reach of traditional care— an approach referred to as mHealth”. The World Health Organization (WHO) has announced that m-health has the ‘‘potential to transform the face of health service delivery across the globe”.

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1. Systematic survey

In view of the fact that UHC is now a part of the fundamental human right, it has been observed that healthcare should be seen as a holistic service that includes links to other services, such education, welfare and environment management. This led to the UN Sustainable Development Goals (SDGs).

The United Nations has recognised the need for a holistic approach of sustainable development where health, environment and social wellbeing are being targeted together through the new global SDGs. In the healthcare sector UHC is the platform that seeks to overcome inequality in tackling the service

provision gap and financial gap that populations face. Given the high importance of the financing strategies of UHC, a systematic literature survey was carried out on Financing of UHC by Pradeep Ray and his team in 20171. There are generally five 1. J. U. Palas, M. Asdhraf and P.Ray, Financing Universal Health Coverage: A Systematic Survey, The International Technology Management Review, Vol. 6 (2017), No. 4, 133-148

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primary methods of funding healthcare systems: • general taxation to the state, county or municipality • social health insurance • voluntary or private health insurance • out-of-pocket payments • donations to health charities In most countries, the financing of healthcare services features a mix of all five models, but the exact distribution varies across countries and over time within countries. In all countries and jurisdictions, there are many topics in the politics and evidence that can influence the decision of a government, private sector business or other group to adopt a specific health policy regarding the financing structure.

For example, social health insurance is where a nation's entire population is eligible for healthcare coverage, and this coverage and the services provided are regulated. In almost every jurisdiction with a government-funded healthcare system, a parallel private, and usually for-profit, system is allowed to operate. This is sometimes referred to as two-tier healthcare or universal healthcare.

For example, in Poland, the costs of health services borne by the National Health Fund

The use of ubiquitous technology such as mobile electronic devices to support medical or public health practice and health systems has been embraced as the new frontier of ICT that will improve efficiency and effectiveness of healthcare, especially for the majority of the world’s population that live in low and middle income countries.

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(financed by all citizens that pay health insurance contributions) in 2012 amounted to PLN60.8 billion (approximately US$20 billion). The right to health services in Poland is granted to 99.9 per cent of the population (also registered unemployed persons and their spouses).

1.1 Single-payer healthcare

Single-payer healthcare is a system in which the state, rather than private insurers, pays for all healthcare costs. Single-payer systems may contract for healthcare services from private organisations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom).

The actual funding of a ‘single payer’ system comes from all or a portion of the covered population. Although the fund holder is usually the state, some forms of single-payer use a mixed public-private system.

1.2 Publicly funded healthcare

This is a form of healthcare financing designed to meet the cost of all or most healthcare needs from a publicly managed fund (e.g., Medicare in Australia). Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it.

The fund may be a not-for-profit trust that pays out for healthcare according to common rules established by the members or by some other democratic form. In some countries, the fund is controlled directly by the government or by an agency of the government for the benefit of the entire population. That distinguishes it from other forms of private medical insurance, the rights of access to which are subject to contractual obligations between an insurer (or its sponsor) and an insurance company, which seeks to make

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a profit by managing the flow of funds between funders and providers of healthcare services.

When taxation is the primary means of financing healthcare and sometimes with compulsory insurance, all eligible people receive the same level of cover regardless of their financial circumstances or risk factors.

1.3 Two-tier healthcare

Two-tier healthcare is a situation that arises when a basic government-provided healthcare system provides basic, medical necessities while a secondary tier of care exists for those who can pay for additional, better quality or faster access.

Most countries have both publicly and privately funded healthcare, but the degree to which this creates a quality differential depends on the way the two systems are managed, funded, and regulated.

Some publicly funded universal healthcare systems deliver excellent service and the private system tends to be small and not highly differentiated. In other, typically poorer countries, the public health system is underfunded and over stretched, offering opportunities for private companies to deliver betterquality, albeit more expensive coverage.

disability, or accidental death and dismemberment".

The above summary provides the traditional financing methods of healthcare. Typically, many developing countries that inhabit the majority of the world population, use the two-tier healthcare in view of the limited resources in those countries. The basic needs are covered almost free by the government and the any specialised treatment is funded, mostly by for-profit private sector through health insurance.

UHC requires more innovative approaches and hence the following section discusses some emerging innovations in healthcare financing.

1.4 Health insurance

2. Innovations in UHC financing

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of healthcare and health system expenses, among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium, to ensure that money is available to pay for the healthcare benefits specified in the insurance agreement. The benefit is administered by a central organisation such as a private business, or not-for-profit entity. According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense,

2.1 Crowdfunding

A new innovation in China allows users to get up to CNY300,000 (US$42,457) in medical aid if they are diagnosed with one of 30 serious diseases like cancer, heart attack etc. by paying only about CNY30 (US$4.4) per year. Crowdfund medical aid is based on the philosophy of “one for all, all for one�. It is a new type of internet insurance platform that aims to help critically ill patients, who cannot bear high medical fees, by crowdfunding money from all of its users. These platforms evolved from their original function, namely as donation websites for patients.

Crowdfunded medical aid platforms first became popular in 2016. One company for example,

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Waterdrop Aid, has recruited 40 million users and provided about CNY100 million (about US$14 million) in medical aid to 720 users diagnosed with a serious disease in the last 2 years. This service is mainly popular with young people who were born during the 1980s and 1990s as well as residents of third or fourth-tier Chinese cities. More details are available at 2.

2.2 Social business

Social business for sustainable development was proposed by the Nobel laureate Professor Md. Yunus.

Just like in any business, investors can put their money in social businesses that do not provide any return to the investor, though the capital is protected.

The returns are reinvested in the business to help the disadvantaged population, such as the disabled, poor and the elderly. This has been developed with a view to maximise the benefits of donations from various sources (e.g., Corporate Social Responsibility funds) 2. Y. Shen, H. Wu and P. Ray, “Why is Crowdfunded Medical Aid so Popular and Successful in China?”, Asian Hospital and Healthcare Management (2018) Issue 41, pp 30-33, https://www.asianhhm.com/medical-sciences, last accessed October 11, 2018

that are single use funds whereas social business funds can reuse the social investments multiple times. More details on various forms of social business are available on this webpage . Although many NGOs have been showing increasing interest towards the adoption of the social business model (SBM) to minimise social problems sustainably, lack of conceptual clarity of the model limits the scope of its adoption in addressing social issues. This study identified five key aspects of social business, namely: business’s mission and outcomes, characteristics, operation, resource utilisation and environmental considerations. Based on these five key aspects one may like to infer that unlike other social interventions, the alignment of SBM is specific to empowerment of disadvantaged people leading to sustainable economic growth. The SBM relies on technology to bring down the cost of social services including healthcare. For example, the proliferation of mobile phones in developing countries, have raised the spectre of better access to quality healthcare in a cost-effective manner. This necessitates the innovative and entrepreneurial minds as discussed next3.

2.3 Role of Technology Entrepreneurship (e.g., m-Health)

Mobile phones are instrumental to socio-economic and healthcare development in many disadvantaged sections of the population. Entrepreneurs can now exploit mobile phone-based technologies to achieve the UHC goals that cannot be achieved just by government investment. The use of ubiquitous technology, such as mobile electronic devices can support medical or public health practice and health systems cost-effectively Also known as m-Health).

This has been embraced as the new frontier of ICT that will improve efficiency and effectiveness of healthcare, especially for the majority of the world’s population that live in low- and middle-income 3. Md Mahfuz Ashraf, Mohammed Abdur Razzaque, Siaw-Teng Liaw, Pradeep Kumar Ray, Md Rashadul Hasan, (2018) "Social business as an entrepreneurship model in emerging economy: Systematic review and case study", Management Decision, https://doi. org/10.1108/MD-04-2017-0343

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countries. The WHO has announced that m-health has the ‘potential to transform the face of health service delivery across the globe’. e-Health/tele-health/m-Health are now being used worldwide also for infection prevention of COVID-19. The Centre For Entrepreneurship (CFE) in UM-SJTU JI has been working on Technology Entrepreneurship for Sustainable Development (TESD) and has been leading a multi country initiative called mHealth for Belt and Road region (mHBR)4.

3. Conclusions

This paper has discussed the need for innovations in financing healthcare. It started with a systematic survey of financing healthcare that pointed towards the need for more innovations in financing healthcare. This was followed by brief discussions on three of the evolving financing innovations, namely Internetbased crowdfunding, SBMs, and technology entrepreneurship (e.g., mHealth) where entrepreneurs bring in funding from private sources based on potential increase in efficiency, quality and cost-effectiveness of healthcare. More such innovations are needed to support Universal Healthcare Coverage, especially in low-resource settings.

AUTHOR BIO

AUTHOR BIO

4. Soong-Chul Ro, Willy Jin Huang and Pradeep Ray, Advancing the Role of Entrepreneurship: Healthcare in Developing Countries, Asian Hospital and Healthcare Management (2019) Issue 44 (Feb 2019), https:// www.asianhhm.com/healthcare-management/advancing-role-of-entrepreneurship, last accessed October 9, 2019.

Pradeep Kumar Ray is the Founder Director of the Centre For Entrepreneurship (CFE) at the University of Michigan-Shanghai Jiao Tong University Joint Institute and is currently leading a major collaborative project called mHealth for Belt and Road Region involving eleven countries. He is the founder of the WHO Collaborating Centre on eHealth in the University of New South Wales (UNSW)-Australia (2013).

Hanrunyu Yan is now working on the international initiative called mHealth for Belt and Road Countries (mHBR) led by Prof Pradeep Ray at the Centre For Entrepreneurship (CFE), University of MichiganShanghai Jiao Tong University Joint Institute, China. Hanrunyu Yan holds a Bachelor’s degree in Electrical & Computer engineering from Shanghai Jiao Tong University and has two years’ experience in the field of finance in BNP Paribas China.

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HEALTHCARE MANAGEMENT

How Conflict Between Medical Professionals Impacts Patients Conflicts at the workplace cost organisations time, money and other resources. In healthcare, the cost to the patient when she witnesses disagreements between her medical team can be devastating. Not only does it cause undue stress on a patient, but it might also impact the importance of trust for patients and family members to have with their care team. Without this level of confidence between patient, nurse or physician, the safety and willingness to follow instructions, emotional well-being and ability to improve a patient’s outcome can be hampered.

Nancy Michaels, President, NancyMichaels.com

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I

n the United States, the total financial blow of dealing with workplace conflict is estimated to be at US$359 billion in paid hours or 2.8 hours per week for each involved employee. This is based on a May 2008 study commissioned by the CPP to analyse workers’ attitudes about conflict. 5,000 full-time employees in nine countries around Europe and the Americas were surveyed, including Belgium, Brazil, Denmark, France, Germany, Ireland, the Netherlands, the United Kingdom and the United States .

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in the ICU and the person who was monitoring my respirator, as I had a trachea.

Out of breath

I strongly believe that the same cost applies to the healthcare system, when patients witness conflicts between members of their medical team. Not only is this a source of undue stress for the patient and his / her family members, but it might cause their confidence towards their medical care team to deteriorate. Lack of trust can negatively affect the patient’s emotional well-being, his / her willingness to follow instructions, and eventually hamper the patient’s recovery.

It happened nearly 15 years ago, but I can still clearly remember what I saw, heard and felt, when I witnessed the conflict between my overnight nurse

The gentleman who was tasked to watch and regulate my oxygen intake had a brief discussion with my nurse Michelle. Though I didn’t clearly hear what they were talking about, I sensed the tension. It soon escalated into something more ‘serious’, when this care provider suddenly stormed out of the room, leaving my respirator unsupervised.

For two weeks, I had been comforted by the presence of a medical staff, watching my bedside monitor 24/7. Though my trusted night nurse Michelle was there, I immediately panicked after he left the room.

To this day, I remember how my anxiety built up into a full-blown panic attack. Machines were beeping, but I felt that I wasn’t taking in any oxygen (a feeling I had all the while being weaned off of the respirator, despite statements to the contrary) and I honestly feared that after surviving a liver transplant, brain surgery and two-month coma, that I would end up dying of suffocation. I was convinced that the absence of the person who was supposed to be making sure I was getting enough oxygen had put me in harm’s way.

Several medical staff suddenly bustled into my room. Michelle held my hand and tried to calm me down by encouraging me to think of the ocean or a beautiful place I wanted to visit when I was out of the hospital.

It took a few minutes, but it felt like forever before I was reassured. I only managed to calm down when someone else came to stand by my bedside and took over the position of the gentleman who walked out of my room.

Re-Admittance or emergency department?

Allow me to share an even more significant example than the one I just described.

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After six months of hospitalisation and rehabilitation, I was finally discharged and living with my parents, 60 miles from the hospital in Boston. I continued to be in and out of the hospital due to various reasons (high potassium, aspergillum in my lungs, inability to keep food down, etc.).

This eventful day started like many others I experienced during that time- I felt really sick and didn’t know why. I wanted to go to the hospital because I suspected that something would be found out there. My parents called the transplant unit at the hospital to check if there was a bed available. They told me to come in right away and they would have a room ready.

We drove the distance to the hospital and got to the transplant floor. One of my long-time nurses came to me and asked me to wait for the attending physician.

This doctor was not on my core team; however, he was familiar with my case as I had seen him on many of the rounds when I was on the transplant unit.

It was the fall season and there was a plastic pumpkin at the nurse’s station. I started feeling nauseous, grabbed the pumpkin, dumped the candies on the floor and proceeded to vomit into the plastic pumpkin container. The attending physician was doing his rounds when we arrived and a nurse went to inform him that I was there and very ill.

Instead of admitting me or seeing me personally to assess the situation, he insisted I go to the emergency department. I could tell the nurse was not pleased with his instructions. We went to the ED and waited for almost 12 hours before the doctor there admitted me to the floor I was already in earlier.

The following day, it was discovered that my body was rejecting my newly-transplanted liver.

My nurse insisted that I discuss my negative experience with my team of doctors. I believe that she also brought it to their attention because about one month after this day, we had a meeting with my medical team to describe what happened.

Thankfully, my team was extremely empathic

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A regular forum between key people in the hospital allows open and honest conversation between management, healthcare workers and colleagues, builds greater camaraderie, increases awareness of the challenges faced by one another and provides a venue to brainstorm on solutions and good ideas.

and understood my frustrations and agitation about being made to wait for hours, especially when my condition was more serious than anyone realised. I heard that the physician who refused to admit me had left the hospital soon after. I am not sure if my situation had anything to do with his departure, but it was clear to me that my core team was not pleased with how the attending physician managed the whole thing.

For the vast majority of my many days in the hospital, I was grateful and appreciative of the attentive care I received. Fortunately, conflicts I witnessed were few; but I know they exist. There are always power struggles within any organisation...

However, in the healthcare setting, the stakes are higher, given the life and death nature of medical emergencies.

Empathy as it relates to trust

Harvard researcher Paul J. Zak and author of The Trust Factor: The Science of Creating High Performance Companies, has spent two decades studying the neurological connection between organisational performance, leadership and trust.

In his article in the Harvard Business Research

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Journal, Zak explained the direct correlation between the level of trust a person feels and the amount of oxytocin a person's brain produces. His findings conclude that the levels of oxytocin significantly decrease when people feel stressed. He also found a direct link between oxytocin levels and empathy — a key factor when creating trust-based relationships and organisations. With high levels of oxytocin, higher levels of empathy occur, leading to a deeper connection and greater trust between the patient and medical practitioner.

I believe effective communication is the key in building stronger connections, eliminating conflict and increasing trust.

Although there is little to no research done on how conflicts among medical workers impacts the patients and their families, I know firsthand how disagreements of this nature affected me and have heard numerous similar experiences.

Namely, the issues of greatest concern to patients and family members include the following: Fear

The feeling of dread that not all members of the medical team are aware of all the details unique to the patient’s case and that they may not be communicating effectively, as a result of conflict.

Dr. Tom Lee stated in a TED talk that one of the common fears of a patient is that their medical team members are not communicating well, and therefore, may not be aware of what one department is doing and something could fall through the cracks. Even if there is no actual conflict witnessed by the patient, the perception that there is a lack of communication between medical practitioners in the team can lead to feelings of fear.

Fear is further intensified when actual conflicts exist, as patients and their families would tend

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to assume that there is NO communication or collaboration between the medical professionals working on their case.

Patient safety

The more that hostile communication between healthcare workers occurs in front of patients and their family members, the more that they feel that their health and safety are compromised. This leads to eroded trust, which leaves patients to doubt or question the information that is being shared with them. It may also impact a patient’s willingness to follow advice from his / her medical team, which can lead to greater problems and higher expenses.

A regular forum between key people in the hospital allows open and honest conversation between management, healthcare workers and colleagues, builds greater camaraderie, increases awareness of the challenges faced by one another and provides a venue to brainstorm on solutions and good ideas.

When effective communication is fostered and encouraged by hospital leadership, greater trust and respect develops among colleagues and conflicts will decrease.

Ultimately, honest and productive communication saves lives (and even billions of dollars for the hospital).

Recommendations

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In 2005, Nancy was the picture of success: a sought-after business speaker, the president of her own company, and a mother of three. Suddenly, Nancy found herself in a health crisis that would twice nearly end her life. Miraculously, her extensive rehab left her with no residuals; but, Nancy's life – and the message she wanted to bring to her audiences – were irrevocably changed. If you would like to learn more about Nancy's story (or illness and recovery) go to www.nancymichaels.com

AUTHOR BIO

It’s safe to say that conflict will always be present in a work setting.

Conflict exists among families, friends, as well as colleagues. The key to help resolve these conflicts lies in the management’s ability to acknowledge and manage conflict in a healthy way. It is a good idea for any organisation to establish a protocol for employees to air grievances and disagreements.

In the hospital setting, a group huddle at the start and end of a shift would allow each medical staff to share an update on what went well during the shift, what were the challenges encountered, and the action plans implemented (for possible continuity by the next shift).

This would provide real-time perspective for the oncoming workers and help alleviate the fear that patients experience during those transitions, as well.

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w w w. ha nna nd e si g nst ud i o. c om

Advertising in AHHM magazine will right away showcase your products to key decision makers in hospital and healthcare industry in Asia Pacific, the Middle East, Europe and USA. With a readership of more than 180,000 in these geographies, your products stand a better chance to recognized and trusted.

To book your ad now: Email: advertise@asianhhm.com Tel: +91 40 4961 4567 Fax +91 40 4961 4555

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HEALTHCARE MANAGEMENT

PROMOTING DIGNITY IN CARE ROLE OF MANAGEMENT Dignity in care is integral to providing person-centred care. Evidence suggests that when staff are treated with dignity, they will in turn treat service-users with dignity and respect. A blame free culture, robust leadership, good communication and a supportive environment are key ingredients for enabling staff to provide dignified care.

Rekha Elaswarapu, Lecturer (Health and Social care), University of Sunderland

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ongevity has been one of the greatest benefits of advances in medicine and better prevention strategies across the world.

Globally population of people over 65 years is increasing at a faster rate than any other population group. More and more people are living longer albeit with co-morbidities. This means that the need

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for health and care services for this group is rising rapidly and is set to continue in the future. Many older people live independently in their own homes or are cared for in a residential care facility. They often need frequent admissions and sometimes long stays in the hospitals due to their health conditions.

In all these settings they aspire to be treated with

HEALTHCARE MANAGEMENT

dignity and respect at all times. Healthcare professionals can play a key role in ensuring dignity and respect for older people. It is also important that staff are treated with dignity and respect who in turn will treat staff with the same approach. This paper looks at the concept of dignity, impact of undignified care and the role of management in enhancing dignity in a care setting.

KEY FACTS Between 2015 and 2050, the proportion of the world's population over 60 years will nearly double from 12 per cent to 22 per cent.

By 2020, the number of people aged 60 years and older will outnumber children younger than 5 years.

In 2050, 80 per cent of older people will be living in low- and middleincome countries.

The pace of population ageing is much faster than in the past.

All countries face major challenges to ensure that their health and social systems are ready to make the most of this demographic shift.

powerless and scared. This is even more significant for people who may be in vulnerable situations due to their disability, age or underlying clinical conditions. It is also very important for people at the end of their life. Being involved in the decisions relating to their care, able to express their care needs, their cultural preferences respected and access to appropriate pain relief are some of the aspirations of the care recipients. As mentioned before dignity means different things to different people and cuts across many areas of care as explained in the table below:

Source: World Health Organisation

Factors that affect dignity in care What is dignity?

Dignity is a complex term and means different things to different people based on their cultural background, values and attitudes. People often find it difficult to articulate what dignity means to them however, they do describe situations where their dignity was compromised. Dignity can be broadly described as below: Being treated with dignity is a human right and should be respected at all times. Compromise in dignity has a great impact on people at the receiving end. Anecdotal evidence suggests that people may feel ignored, worthless and insignificant embarrassed, humiliated, bullied and above all

KEY FACTS Respect for an individual including common courtesy, being addressed appropriately and not being rushed Privacy, including not being exposed physically and confidentiality of personal information Self-worth, self-esteem and identity including personal appearance, pleasant and comfortable environment Autonomy including freedom to make decisions based on informed choice and opportunity to be involved.

Source: Social Care Institute for Excellence, UK

Effective care planning is a crucial first step in providing dignified care. A well-documented and regularly updated care plan will enable continuity of care despite staff changes. Care providers should include the person receiving care in all matters relating to their care to ensure person-centred care in its true sense. Seeking informed consent and respecting their wishes is a key aspect of proving care with dignity.

Communication

Another important factor is how people are addressed. It has been noted that often older people are addressed in a manner that resembles ‘compassionate ageism’.

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HEALTHCARE MANAGEMENT

COMMUNICATION

CURE AND SUPPORT

PRIVACY

ENVIRONMENT

SAFETY

Being spoken about as If they were not there

Being left in soiled clothes

Being exposed in an embarrassing manner

Being Ina noisy environment at night retain lack of sleep

Lack of protection of personal property

Being addressed in an inappropriate manner

Not being Being appropriate food or help with eating and drinking

Being placed In a mixed sex accommodation

Having to use premises that are unclean and smelly (toilets and room)

Being subjected to abuse and violent behaviour

Not seeking their consent and/or not considering their wishes

Being left in pain

Personal details being discussed publicly Source: Healthcare Commission UK

Terms such as dear, sweetheart, or lovey may feel patronising and disrespectful to the age and lived experience of older people. Such actions continued for a long-term can impair communication between the care provider and the care recipient. It may even result in challenging behaviour due to the discomfort experienced by the person receiving care. Furthermore, such a situation could create a sense of being treated like children or incompetent and feel powerless due to indignity thus rendering them unable to be involved in their decisions. Care professionals should always be mindful of addressing people respectfully and ask the form of address that the care recipient may prefer.

Nutrition and hydration

Being able to eat and drink a meal that needs the cultural and clinical needs is integral to dignity in care. Care providers should aim to provide sufficient choice and also help with eating and drinking. Many clinical conditions such as arthritis, stroke, diabetes may mean people would have difficulty eating certain types of food or using the normal cutler. They may need adaptations and support during mealtimes.

People with dementia may need particular attention due to their cognitive impairment. Dehydration in older people is a key cause of urinary tract infections

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leading to delirium and subsequent hospital admissions which could be avoided by ensuring that people receiving care are encouraged and supported to drink fluids adequately.

Privacy

Many older people develop bowel and/or bladder incontinence with age and also due to physiological changes. They may also need support with toileting due to their frailty. However, it has been noted that they do not always receive this support resulting in accidents or are asked to wear nappies, both of which are inhumane and degrading. In addition when personal care is provided without regard to their privacy, it can be humiliating and embarrassing. Another aspect of privacy is confidentiality of information regarding the care details. Care professionals should be mindful of not discussing these publicly but also not sharing with others without the expressed consent of the person concerned (or their career in case they are not able to do so). It is important that privacy and dignity is maintained at all times.

Environment

Having a clean and comfortable environment aids in speedy recovery for people in care settings. It is fundamental to dignity in care that people are able

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to sleep well and protected from infections etc due to their compromised immunity. Regular cleaning schedules, using sanitisers, washing hands, and keeping the noise levels low can promote dignity for care recipients.

Safety

Feeling safe in any situation is a fundamental need for any individual as per Maslow’s hierarchy of needs.

In a care setting this would translate to not being physically, financially and emotionally abused or neglected as it can have detrimental effect on people’s mental health. As described above, lack of dignified care can be difficult for both care providers and care recipients and may cause significant challenges for the provision of care with dignity.

Role of managers in enhancing dignity in care

While no care professional sets out to provide

undignified care there are many factors that may result in inadvertent compromise in dignity in care. These factors range from individual behaviours to systemic issue as well the organisational culture. Managers have a significant role in promoting dignity in care.

Some of the key areas that are enabler of dignified care are discussed in the following sections.

Commitment and leadership

A very strong message and a culture of respecting individuals and their values and beliefs are essential for promoting dignity in care. A robust leadership and a clear message that compromising dignity will not be tolerated has a significant influence on the attitudes and behaviours in any organisation. Managers need to make dignity a high priority and lead by example.

Taking regular rounds of the care wards will provide a visible leadership and provides a model for their colleagues. It will also send a message that they are

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Competent staff

Staff are a key resource of any organisation and it is important that managers invest in their staff. It is very important that staff understand and respect the concept of dignity and practice the principles in every walk of their life. It needs to be ingrained in their mind to ensure that their attitudes and behaviours promote dignity at all times not only for people who they care but also for their colleagues. Evidence suggests that when staff are treated with dignity, they in turn treat people in their care with dignity and respect. It is also crucial that they have the right skills and competence (including cultural competence) to provide person-centred care. Lack of appropriate skills can result in unsafe and undignified care for the care recipients. It should be paramount in any care setting that staff are skilled and competent to do their jobs effectively.

Caring environment

An enabling working environment plays a major role in ensuring that staff feel positive about their role and duties. Clear protocols regarding care provision and sufficient resources can help staff to provide care with dignity. Inadequate staffing levels and lack of supportive equipment such as adapted cutlery, incontinence pads etc can put considerable amount

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of pressure on staff providing care at the front line.

Such situations can also cause staff to feel demoralised and low self-esteem.

Monitoring and learning systems

Continuous monitoring and learning from practice are important part of improving quality and dignity in a care environment. Managers should monitor staff behaviours and address any perceived bullying and harassment. Staff must experience dignity at work and should be supported with opportunities to develop and perform well. Learning from complaints and mistakes should be seen as a positive thing.

Robust reporting systems (both good and poor care experience) give managers an opportunity to implement a culture of quality and dignity in their organisation.

Conclusion

Dignity is a complex concept. Undignified care has a negative impact on the physical and mental health of the people receiving care. Expecting staff to deliver care with dignity when their dignity is not maintained is detrimental to the culture of any organisation.

Management has a crucial role in ensuring that staff are well supported to provide high quality dignified care for the people they care for. Dignity in care is everyone’s business and it should be fundamental to care provision in any care setting.

AUTHOR BIO

serious about their work and care about the people providing and receiving care. Evidence suggests that there is a clear link between staff engagement, care experience and financial savings. A task-oriented as opposed to people -oriented culture is detrimental as it promotes bullying and harassment which in turn causes high sickness rates and staff turnover. An open and transparent culture that promotes innovation enables staff to achieve positive outcomes and better experience for their care recipients. Staff should have opportunities to speak up and voice their concerns. Managers should treat such feedback as an opportunity to learn and improve practices.

Rekha Elaswarapu is a Lecturer in Health and Social care at the university of Sunderland in London, UK. With over 20 years of experience in health and social care policy and regulation in UK, her research interests include older people, nutrition, dignity, culture and leadership, patient and staff experience.

CliniQ

The future of connected healthcare CliniVantage Healthcare Technologies launched CliniQ, a unique smart care management system for better care delivery amidst COVID-19 Fears surrounding the spread of the pandemic COVID-19 have sparked increased engagement with the digital health world. The outbreak is an example of how a country like India needs to speed up the adoption of technology in order to address the needs of the masses. With delays in testing and lack of remote care support, it is hampering our ability to accurately monitor the spread of coronavirus. In the wake of the situation, CliniVantage Healthcare Technologies is swooping in with a seemingly practical solution for the entire healthcare ecosystem. Backed by artificial intelligence, CliniVantage offers a platform that connects healthcare providers and consumers to expedite the process of patient examination.

To address the need of proactive care, CliniVantage has launched CliniQ. Complete practice management with telemedicine features that encompasses a mobile application for patients and integration of smart IoT devices. The vision is to inspire futuristic healthcare that is accessible to all. The solution has been successful in revolutionising the synergy between patients and doctors by plugging intuitive technology to provide real-time care during COVID-19.

Currently what India needs is a quality healthcare system that is affordable and accessible to most of Indian citizens. With all the possible uncertainties we don’t have a clear picture of how to mitigate the spread of pandemics like COVID 19 in vulnerable populations. At present, technology is turning out to be our best bet for enabling early detection of the disease and supporting remote monitoring. The right use of technology will enable physicians to do realtime monitoring of the health data to accelerate the treatment in time with improved effectiveness.

Mr. Nilesh Jain, Co-Founder & Managing Director, CliniVantage Healthcare Technologies, said, “The idea behind the launch of CliniQ is to bridge the gap between people, physicians, and health systems, enabling everyone, especially symptomatic patients, to stay at home and communicate with physicians through virtual channels, helping to reduce the spread of the virus to mass populations and the medical staff on the frontlines. CliniQ helps practitioners to build, scale, and optimise their practice by providing service through virtual examination.”

India's healthcare system is inadequate to provide quality infrastructure and workforce to millions of its citizens is well known. CliniQ has unified all the roles of doctor’s practice so that they can provide advanced clinical care, and bypass various redundant tasks to seamlessly communicate, exchange medical records, and information. CliniQ plans to connect patients, physicians, and specialists on one platform in order to take the second opinion which is required for the right treatment.

Keeping the patient at the center, CliniQs telemedicine suite will transform the way healthcare stakeholders interact. The solution empowers the patients and enables him to make informed decisions related to his own health. Think management of records, ease of appointment booking, easy bill payments, notification at the time of emergency and access as well as renewals of the diagnostics orders & e-prescription.

The clinical data stored in the application can not only be shared between patients, physicians, and specialists but also provides an opportunity to take the second opinion for the right treatment.

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HEALTHCARE MANAGEMENT

Lean and Service Go hand-in-hand

If I were to define service as an efficient jugglery of to dos, with the right amount of resources and a great communication system, what would lean mean?

Gurrit K Sethi, Hospital COO, Care Hospitals

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ean is not mean. In fact, lean must mean an intended service, one with a well-defined service level to meet the expectations of any person, or for that matter, any process. A process is made to ensure the replication of a set of expected results. In fact, one can build up expectations for our brands and ensure that they are maintained by lean methods‌

HEALTHCARE MANAGEMENT

For example, when I board an Indigo flight, I expect it to fly on time largely. I also expect to board in a smooth, no nonsense way with a set precedent.

Airlines maintain a close to zero idle time for aircrafts in between landings and take offs. Over the years, they have been able to retain this image largely. If you examine closely, a lot many lean principles are in play right from staffing to the precinct operational aspects – cleaning, check-in queues, boarding passengers, in cabin services, etc. Over the years, the efficacy of this ‘way of operations’ has been maintained… largely. And this has also most surely reflected in the financials and the business sturdiness of the company.

My most favourite burger junction remains McDonald’s and for me it is the epitome of speed through the driveway, pay and pick the grub, all within minutes, and since I am lucky, mostly with smiling servers. I have experienced this across many geographies. Their India experience aside, the business model has shown great promise across other countries.

Etched in my memory is my visit to the Bumrungrad International Hospital in Thailand way back in 2007. A walkthrough of the hospital’s services, process functioning and the attention to every detail from the patient’s perspective is something I still marvel about. In India we are still far from that level of precision in service. Since the time I have been tracking them, they have consistently been awarded for consistent sigma metric excellence. One of the most shining example of service excellence and lean principles going hand-in-hand.

Closer home, we were able to up the patient satisfaction index by 10 per cent, reduce daily interdepartmental complaints by 30 per cent, upped the per bed earnings by 9 per cent, and increased contribution by 5 per cent as a proportionate impact of service improvements amongst others by introducing some lean factors in a hospital. All of this by simply focussing on removing obstacles faced by staff and patients. All the processes were

Lean methodologies can help keep the value chain gated from the fallacies of unhealthy bulges, keeping the objective in mind as well as keeping the chain itself healthy.

re-engineered with an eye to make things easy and quicker and one could see the perceptible difference when daily patient complaints started turning into appreciations for the team on ground. Slowly these appreciations turned to a perceptible difference in numbers as well. Since everything moved fuss free through system the patients went home earlier, the ALOS reduced, and the beds turned around faster, enabling a better throughput. And this has been a repeated experience. This was the effect when the treatment aspect wasn’t even touched — in fact, nor was the patient aspect. The target of the project was to make it an easier place to work and generate smiles amongst the staff.

The service stories compel one to wonder about the effects doctor schedules could have if they were to be made around patient scheduling. Most of the patient complaints are around the wait times – delayed appointments, delayed in-patient visits, delayed OTs, and of course delayed report results.

Most of these delays are linked to doctors’ schedules.

No one likes to wait, and definitely not when one is ill. What if the medical professionals followed their schedules as, in the legendary Dr. Eric Topol’s words ‘’the Patient will see you now”? In a hospital’s

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even time management? Or is it a typical case of too many cooks spoil the broth, or in fact not making the broth at all! The answer lies in lean. The right resources for the job with the right tools gets the work well done. Very often I have seen that problems occur not when the staff is less but much rather when there is more staff as there is enough idle time to spoil the rhythm of work.

Lean involves negating overheads — be those of wasted resources, or unwanted costs. Lean could also mean listening to the voice of the customer (internal and external) as well as innovation of newer ways of doing things. Of course, in hospital realms, especially where variability can be high, one needs to draw lines around certain limits, lower as well as upper. In the ongoing pandemic situations, there are hospitals witnessing both ends of the spectrum. There are those that are too empty and there are those that are too full. And both are painful for the stakeholders.

Service promises are a great way to reach out to patients who are the service consumers for healthcare service providers, who in turn are the service consumers for device and drug manufacturers, HIT and so on through the value chain. Lean methodologies can help keep the value chain gated from the fallacies of unhealthy bulges, keeping the objective in mind as well as keeping the chain itself healthy. But all this is a continuous effort of monitoring and upgrading.

Gurrit K Sethi Hospital Chief Operating Officer, Care Hospitals; Strategic Advisor for Global Health Services, Global Strategic Analysis, contributes to healthcare by helping providers build and better business efficiencies and concept development, also strives to contribute socially through the Swiss Foundation, Global Challenges Forum as Strategic Advisor, through conception of sustainable health initiatives. She started her career from the shop floor working her way up to lead and set up different healthcare businesses. In her words, her significant achievements have been in bringing to life different SMEs and SBUs signifying a change in the Indian healthcare scenarios, as the opportunity paved the way along the healthcare growth curve in the country. With over 18 years in healthcare under her belt, across different healthcare verticals, she has carried transformational changes in the projects she has led, four of those being early stage start-ups. Gurrit is an avid traveller and voracious reader of varied genres, attributes which she says, provide her with incisive insights about people and systems and what drives them.

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AUTHOR BIO

context, it is not that the doctors like to make their patients wait. On the contrary, the plethora of tasks that they manage calls for a lot of multi-tasking. If all these tasks were somehow to fit in like a big jigsaw puzzle, the remaining effect on a hospital’s patient satisfaction index as well as the balance sheet would be phenomenal.

Time management, protocolisation, communication and multi-tasking in multiple moving parts of any healthcare service calls for a lot of organisation. Ensuring that these work in tandem without dropping the ball reminds one of complex jugglery.

And so, these also become a critical aspect of the required training. More so for the doctors. Despite the academic nature of the profession itself, very few doctors have exposure to various management tools.

One will hear of a lot of training within a hospital but all of it is mostly on skill building. Of course, each of these skills are centred around the discipline of technique. But the softer aspects that would help them deal with many complex situations that entail resource management and even non-clinical aspects of patient management, more often that not, evades them.

Have you ever witnessed this? There are many team members assigned to do the same tasks. And, no one does them. Well, someone could have, but, no one did. Was it a lack of training, or protocol? Or was it a lack communication and understanding? Or

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Making health systems resilient and responsive

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Technology Deployment in Management of COVID-19 Infection Corona and India Viral Infections A modern Pandora’s box Emergency and Disaster Preparedness Significant drivers affecting emergency and hospital design Prevention of Infectious and Chronic Diseases An indispensable investment

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MEDICAL SCIENCES

TECHNOLOGY DEPLOYMENT IN MANAGEMENT OF COVID-19 INFECTION The COVID-19 infection, termed a pandemic by WHO, has as on 14th April, 2020 spread to more than 197 countries. Life is getting disrupted not primarily because of the mortality or morbidity caused by the virus but more as a consequence of the massive global measures already initiated to contain the rapid spread of the virus.

Global economy is taking a beating never seen before. Technology plays a critical role in the management of COVID-19 infection. This includes teleconsultations, promoting customised Health Literacy- the eWay, genome sequencing, drug development, interactive real time maps for monitoring and use of robots and drones1.

K Ganapathy, Director, Apollo Telemedicine Networking Foundation, Apollo Tele Health Services

Author doing a teleconsult in 2002

C

OVID-19, or the Corona Virus, has in a few weeks transformed life on this normally peaceful planet.

This exponential disruption is not primarily because of the mortality or morbidity of the virus itself, but is a consequence of the massive global measures sought to be taken, to contain the possible rapid spread of the virus. Response has to be almost in real 1, Also see Youtube presentation https://www.youtube.com/watch?v=7lm J6ByIoEY&feature=youtu.be Deployment of Telehealth in COVID19 containment March 18th 2020

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Author doing a teleconsult in 2002

CO VER STORE

The infographic given below describes the entire process of teleconsultation. www.asianhhm.com

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MEDICAL SCIENCES

time. Global economy itself is taking a beating never seen before. Is this just the beginning or is the worst over. What is the role of technology in management of COVID-19? Let us have a look 1. Relevance of telemedicine to Covid-19 pandemic situation

Telehealth can considerably increase access to specific care. Telemedicine can be useful to evaluate and reassure patients remotely, to help decide who needs to be seen in a hospital OP or ER. Diagnosing coronavirus-like illness (CLI) on a clinical basis can be confidently done virtually, without laboratory tests. Treatment monitoring and reviews can be done with the ‘patient’ self-quarantined at home. Care would be commensurate with acuity and nature of the symptoms. This helps with infection prevention and control. Elderly. or others with other increased susceptibility to CLI, run an additional risk of being susceptible to further illnesses in a hospital environment, Through telemedicine, if admission is deemed to be required, it can be made directly into an isolation ward bypassing the casualty. This simple step in itself would reduce risk of the virus spreading.

A major possible concern is the flooding of healthcare centres and hospitals for unnecessary examinations and reassurance. This would not only increase the risk faced by healthcare providers, but also reduce the quality of treatment required for those who do need it. In a potential pandemic setting, increased attention must be paid to the health of the healthcare providers (HCP). Tele evaluation enables even quarantined HCP’s to work from their own homes, significantly increasing their safety and bolstering the workforce to respond to a crisis. When patients are seen in their own homes, providers and health systems will be able to triage and screen many more patients than in face to face encounters.

Patients could also have other healthcare needs unrelated to coronavirus. Some will be afraid to go to a healthcare facility for fear of catching the

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epidemic. Telehealth could be the answer. Symptom trackers and chat bots is another promising area for virtual management of suspected coronavirus infection. These technologies allow algorithms to be created and continually modified as more is learnt.

Dedicated customised bots can even interact with patients, performing assessments, triage and provide ongoing support. The bots can escalate an interaction to a telehealth encounter or refer the patient for in-person care. It is simple to develop a user friendly customised even region-specific software. Detailed travel and exposure histories can be obtained Providers must know and understand their role in this as in any other healthcare crisis. They should be well informed and trained to follow national or World Health Organization (WHO) guidelines.

They should understand that telehealth is a powerful tool in fighting this outbreak. Telehealth virtual visits are typically sufficient to complete a robust initial assessment. This allows the provider to assign a risk category or make other diagnoses. Some patients may require additional care, as certain medical peripherals may not be available at home for serial monitoring.

A high-risk patient may need to be tested outside of home. Escalation of care may be required Reimbursement in a non governmental setting needs to be addressed. Ideally health insurance companies should reimburse teleconsultations. From an RoI (Return on Investment) perspective, it is in the interest of insurance companies to promote earlier diagnosis to prevent avoidable hospitalisation later.

One key advantage of telehealth is speed. Patients can access clinicians 24/7 without an appointment or physical trip to the doctor. Crisis management should include the Government of India and state governments unambiguously laying down clear rules for legalising teleconsults.

The US Congress last week legalised telehealth for coronavirus screening. The American Telemedicine Association has applauded the sanction of 500 million US$ exclusively for telehealth from the $8 billion

CO VER STORE

emergency funding legislation, to expand the toolkits of healthcare professionals working to combat the COVID-19 outbreak. This was possible only because of intensive lobbying by the ATA and the political will exhibited by Democrats and Republicans alike.

Will this followed in other countries?

Both the Center for Disease Control in the USA and WHO have recommended using telemedicine, to direct patients to the right site of care during the outbreak. This would also considerably minimise the use of personal protective equipment, such as gloves and masks, by healthcare providers. The economic benefit of this very doable procedure is staggering.

1. Clinical examination from a distance: Digital technology can make distance meaningless.

Geography today is history! The healthcare provider can virtually appear in all offices where there are video conferencing systems, PC’s and laptops.

Even an entry-level smart phone will suffice.

Sophisticated tele triage can be done. Detailed travel and exposure histories can be obtained.

Automated screening algorithms can be developed and local epidemiological information can be used to standardise screening and practice patterns across different providers in different geographies.

A reasonably adequate clinical examination can be done remotely. All that is required is dependable band width and good inexpensive video software.

Fever, cough and shortness of breath can all be evaluated from a distance. A bright torch at the

COVID 19 ILLUSTRATION OF TELE SCREENING

Remote fever measurement

Mother captures photo of ear and sends to Dr

Fig 1 Illustration of devices used for telescreening

Paramedic with patient Doctor sees throat clearly

Mother captures photo of throat and sends to Dr

Examination Cameras @ patient end. Images transmitted

ATNFŠ

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similar to what one sees with a traditional ultrasound in a radiology department (not relevant here just to let the reader know what is available in the market today). State-of-the-art medical care goes to where it is needed not vice versa . An ENT expert can peer into the ear and an ophthalmologist into the eye with the patient several thousand miles away. A computergenerated report with the doctor’s digital signature with annotated colour images can reach the patient’s smart phone with an ePrescription in a few minutes.

This transaction is stored in the cloud for perpetuity.

Telemedicine today cannot take a swab of the throat to collect a sample for scientific testing. However theoretically a robot can even do this in the not too distant future.

3. Artificial intelligence: Developing AI algorithms will help identify patterns using Big Data analysis.

This exponential disruption is not primarily because of the mortality or morbidity of the virus itself, but is a consequence of the massive global measures sought to be taken, to contain the possible rapid spread of the virus.

remote end can be used to illuminate the throat and nose of a suspected contact. This can clearly be seen by the healthcare provider wherever he/she is. Digital stethoscopes can transmit lung sounds and heart sounds. The audio file can even have a description 2. Promoting health literacy the eWay: Today in India, we hear of the sounds with a provisional an audio message preceded by a cough every time we make a telephone call. Similarly, a very short video can be sent to diagnosis which the clinician at a billion mobile phones. Promoting visually aided diseasethe other end can confirm. Blood specific health literacy will go a long way to create much needed pressure, pulse rate, respiratory rate, awareness. While WhatsApp no doubt has created awareness oxygen saturation, and temperature never before done in the history of humankind, it also gives can also be monitored remotely. room for spreading misinformation and disinformation. This Though not relevant in mass is leading to fear psychosis and avoidable panic. screening, if specifically indicated a patient friendly 6-lead, FDA-cleared, medical grade, bluetooth enabled pocket electrocardiogram (ECG) device can be used even without a paramedic. The automated diagnosis which comes along with the ECG tracing can be sent to a physician through an ordinary smart phone Similar 12 lead ECG will soon be available. A pocket ultrasound device can be attached to a smart phone to give real-time, Fig 2 Scientists working in a Corona Virus Lab ( Source-he Medical Futurist) high-resolution ultrasound images,

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CO VER STORE

This will help predict outbreaks before they actually occur. Meticulous follow up of every contact with an afflicted patient will help develop preventive and therapeutic measures.

4. A doctor in your pocket: Medical devices can be added on to a smart phone. Eventually a swab sample can be collected in a smart device and connected to a smart phone with optical scanning facilities. The COVID-19 pandemic will no doubt reduce the time taken from ‘bench to bed’.

5. Genome sequencing of the virus RNA was done within a record time of four weeks, whereas it took several months for sequencing the SARS virus. One is increasingly becoming painfully aware that in spite of uniform standards and protocols personalised medicine may be necessary for a specific individual.

Response to standard medication may depend on

8. Robots: Wuhan started using robots in quarantined wards immediately after the outbreak. Robots are now routinely used in many hospitals in China and in other countries. This certainly reduces risks of paramedics, nurses, and doctors catching the infection. A recent news in the media mentioned China opening a hospital entirely staffed by robots. The facility, dubbed the Smart Field Hospital, carried out basic

your genes. Genome sequencing may in the future address these concerns. Laboratories world wide are racing to make available a vaccine for the COVID19. Super computers and even quantum computing may be used.

6. Drug development: A cure for COVID-19 infection is required yesterday. In silico trials will be used. In these trials an individualised computer simulation is used in the development or regulatory evaluation of the medicinal product. While completely simulated clinical trials are not feasible with current technology and understanding of biology, its development would be expected to have major benefits over current long drawn clinical trials. ‘Virtual’ patients would be given a ‘virtual’ treatment, enabling observation through a computer simulation of how the drug performs and whether it produces the intended effect, without

screening tasks such as tracking temperature, heart rate and blood oxygen levels, with robots. Other robots tended to patients by bringing them food and drink, as well as medicine. Some robots put on a little dance to keep patients entertained. A team of researchers even successfully demonstrated a robot that can swab patients’ throats remotely, minimising contact for healthcare workers at the hospital.

Fig 3 Robot in an isolation ward Fig 4 Hospital with Robots

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inducing adverse effects. Such in silico clinical trials would significantly could help to reduce, refine, and partially replace real clinical trials for COVID-19 management. Nanoparticles could operate as precise drug delivery systems.

7. Interactive maps for monitoring: Data is instantaneously updated in real-time through online dashboards available globally. This is totally downloadable in the public domain. Organisations and governments have come together like never before. Tens of thousands of data scientists and scientists from every possible discipline are making use of futuristic technology to contain the Corona virus.

9. Drones can be deployed to drop essential supplies medical and

non-medical items to quarantined groups. Spain, Kuwait, and United Arab Emirates, drones equipped with loudspeakers have been telling roaming citizens to go back to their homes. Agricultural models have been modified to spray disinfectant on public areas, and drones have also transported medical and quarantine supplies to reduce people’s exposure to each other and reduce delivery time.

Fig 5 Drones broadcasting messages enforcing isolation

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Conclusion :

AUTHOR

BIO

Digital health is bringing about a real revolution, shifting the point-of-care to where it should have been all this time - the patient’s abode – not a hospital. Policymakers should provide incentives for healthcare facilities and physicians to use telemedicine and technology-enabled remote care in their normal healthcare practice. Awareness must be raised among patients about the benefits of telehealth. Technology acceptance as a behaviour modification strategy should be considered. Even in the USA 88 per cent of companies with 500 or more employees offered telemedicine as part of their health benefits last year. Only 9 per cent of eligible employees used it. Deploying TECHNOLOGY on a war footing is the only way we can contain

this pandemic. However, let us never ever forget that technology is a means to an end not an end by itself. Hitherto septuagenarians like me belonging to the BC era somehow felt that technology was developing solutions first and then searching for problems where they could be used. The COVID19 pandemic offers an urgent genuine reason why we should use technology not tomorrow not today but yesterday. Hopefully this global crisis will result in the right mix of deploying technology and TLC (Tender Loving Care) for the benefit of our fellow brethren Addendum: On March 25th 2020 the Ministry of Health Govt of India notified an amendment to the Medical Council of India Act. Telemedicine Practice Guidelines have been elaborated. The Prime Minister India has repeatedly exhorted Indian citizens to start using Telemedicine. The last 6 weeks have witnessed an unprecedented interest, growth and development of Telehealth in India. The Telemedicine Society of India has been given the mandate of sensitizing 500,000 doctors to the use of telehealth. Proof of concept trials have just started. Telehealth in India will now be divided into the BC and AC era ( Before Corona / After Corona) era!

K Ganapathy is Former Secretary and Past President of the Neurological Society of India a Telemedicine Society of India& the Indian Society for Stereotactic & Functional Neurosurgery.

He is Emeritus Professor @ the Tamilnadu Dr MGR Medical University India, a Visiting Professor Taipei Medical University & Member of WHO Roster of Experts on Digital Health

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CORONA AND INDIA

As the world watches us on how we deal with the COVID-19 crisis, there are learnings we can take from this experience and evolve our emergency tool box for creating a robust disaster management for such outbreaks. And of course there are lessons for each one of us on 'social re-learnings' that are much required. No doubt that these can also contribute to many parts of the world as well. Let’s put our best foot forward.

Gurrit K Sethi, Hospital COO, Care Hospitals

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uch as I would like to be talking / thinking about Corona the Beer, in the present tense it is Corona the Virus that is taking up much mind space. As we hear of the numbers swinging up, one sees, hears, and feels a sense of fear, anger on presence and absence of responsibility to the various causes as well as the spread of it.

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to counter such elements at a much earlier stage.

It indeed is spooky that somewhere, even though in fiction, we human beings did predict such happenings. When one watches movies like Virus, Contagion and others, one is definitely pushed to the edge of fear.

This needs to evolve into a compulsory awareness for many youngsters around the world on advantages and fallouts in their careers based on choices of professions they make, especially the personal dangers one might face with this and other infections. Also, based on these dangers, a more a thorough training regimen about how to navigate these situations needs to be created — for not only the doctors but also the other medical staff. Like when someone joins the defence forces, there is no doubt in the minds that one is being trained for war.

While Corona is dealt with iron hands, there are certain hygiene factors that we as a community need to adopt now and then stick to it. The country of yummy food and yoga needs to learn to adopt these healthy practices into daily living. And using Shoba De’s phrase, we ‘touchy feely’ Indians need to learn the art of ‘social distancing’ basically physical distancing. We need to learn to give physical space to each other especially at bus stands, railway stations, markets, lifts and all queues…something that will help us not only today but always.

Last but not the least, better civic sense is only expected from the educated lot – self acceptance, selfdeclaration and following of advisories.

Gurrit K Sethi Hospital Chief Operating Officer, Care Hospitals; Strategic Advisor for Global Health Services, Global Strategic Analysis, contributes to healthcare by helping providers build and better business efficiencies and concept development, also strives to contribute socially through the Swiss Foundation, Global Challenges Forum as Strategic Advisor, through conception of sustainable health initiatives. She started her career from the shop floor working her way up to lead and set up different healthcare businesses. In her words, her significant achievements have been in bringing to life different SMEs and SBUs signifying a change in the Indian healthcare scenarios, as the opportunity paved the way along the healthcare growth curve in the country. With over 18 years in healthcare under her belt, across different healthcare verticals, she has carried transformational changes in the projects she has led, four of those being early stage start-ups. Gurrit is an avid traveller and voracious reader of varied genres, attributes which she says, provide her with incisive insights about people and systems and what drives them.

AUTHOR BIO

A lot has been said and heard about symptoms and preventive methods. The government has done and continues to attempt a great job in spreading awareness on curtailing the tiny monster. Especially by way of compulsory to hear notices as part of a telecom campaign, or by stamping travellers, it has ensured that the message reaches one and all, however annoying they may find it to be. Being part of the healthcare ecosystem, I have witnessed the public and the private sector come together beautifully for preparedness. Prevention methods, appointment of nodal officers, preparation and ear marking of acute care beds, quarantine facilities, etc., happened in record time. All this along with the evacuation of our citizens is indeed applaudable.

Biological warfare or not, this is definitely not the end of the current episode, not only in India, but worldwide. Moreover, this is not going to be the last episode. All of the steps taken need to finally emerge and evolve into a well thought out doctrine for emergency / disaster control and management protocol. For action on field, as well as critical back end support of equipment and material availability.

There is also a need to stamp out economic opportunism in times of distress.

From what one has heard, this may not be a lethal virus in terms of fatalities. However, since this proceeds the other slightly more lethal ones like swine flu, Ebola, SARS etc., and all of these have come about repeatedly and then stayed, we do need to learn lessons on daily living but also preparedness

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VIRAL INFECTIONS A modern Pandora’s box The COVID-19 pandemic has brought the world to a near standstill. Understanding the disease and transmission dynamics, appropriate containment measures with surveillance, testing and treating the afflicted will aid in eliminating this threat. Enforcing preventive prohibitive measures will buy time for the healthcare system to cater for all affected victims.

Sangita Reddy, Jt. Managing Director, Apollo Hospitals

O

ver the past week, terms like "social distancing" and "self -quarantine" have become common parlance.

Apprehension is escalating about COVID-19 and mandates to cancel events, work from home, schools being closed, staying away from congregations and so on, have gained momentum. It is frightening for all, as families worry about loved ones around the world, brood about the economic impact on their lives and there is a growing sense of helplessness.

Alongside, there is a glimmer of positivity. As I started work on this article, three out of four coronavirus patients in Jaipur, in the northern state of Rajasthan were cured with a novel combination of medicines.

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A virus is an infectious agent, whose name originated from the Latin word meaning ‘simply fluid’ or ‘poison’. They are not true organisms because they lack the machinery and organisation of life form. Instead, they wholly depend on other living cells for their processes. As these viruses lack cellular structure and remained obligate parasites, they were thought to be primordial life forms, but recent cancer studies on proto-oncogenes strengthened the fact that viruses were simply rogue genetic material. The degraded DNA or RNA material, not repaired by cellular mechanisms, could have evolved to become viruses. Though the viruses depend on the host for metabolism and replication, they rapidly infect other cells and spread to different animal hosts despite containment measures. Hence the phenomenon of something spreading rapidly is aptly termed ‘viral’.

The viral genetic material mutates while replicating in the host cell which enables the viral infections to be unaffected by an immune response.

The host immune system learns from infection and produces antibodies against that particular offending pathogen. The response elicited against one particular strain of virus may not be efficient against another strain of a virus causing the same disease. This will become more significant in cases where the virus affecting humans have animals such as bats, pigs, wild birds as an intermediate host. In a scenario where the infection is simultaneously affecting different animal species, the human population will have little or no immunological protection against the new virus, which will result in a pandemic like COVID-19. The hypervariable genetic segments of the viruses resulting from mutations make synthesizing a vaccine for the recent SARS-CoV-2 is still a daunting task.

COVID-19

Coronavirus disease has been abbreviated as COVID-19 and the causative agents is a virus called

Public health measures from relatively innocuous techniques, such as disease surveillance and hygienic measures, to considerably more restrictive interventions, such as social distancing, travel restrictions, quarantine, and case isolation are warranted for containment.

severe acute respiratory syndrome coronavirus 2 abbreviated as SARS-CoV-2. This belongs to the coronavirus family identified in the 1960s, which has subtypes such as alpha, beta etc., among which the beta subtypes are further classified into four types. Mutations in viruses of the coronavirus family were responsible for two other major international outbreaks in modern history: the SARS outbreak of 2003 resulting in around 800 deaths and the MERS outbreak in 2013 that claimed about 900 lives. With the COVID-19 virus, it is believed to have mutated from bats which are animal hosts and passed on to pangolins which were intermediate hosts. Multiple mutations which are generally accepted as chance events occur in the virus that enabled them to affect humans and manifest as severe disease. My country, India, suffered a Nipah virus outbreak in 2018 which had a case fatality ratio of about 75 per cent claiming more than 495 lives. The mortality rate for SARS is about 10 per cent and for MERS remained at 34 per cent. So as compared to these, the mortality rate in COVID-19 has been considerably less, at about 3.4 per cent while the total number of cases is greater than 1,13,700.

However, another concerning factor leading to

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the rapid spread of SARS-CoV-2 is the infectivity of this virus which is in the range of 1.5 to 2.5.

Infectivity of an organism is the ability by which it can spread from one human host to the other, by way of transmission, which is measured as R0. For measles, the R0 is about 12-18; for chickenpox, it is about 6; and for the regular seasonal flu the R0 is about 1.5. While COVID-19 and flu have similar infectivity, the mortality rate of flu is significantly low at 0.02 per cent, and the lasting damage leading to hospitalisation is lower compared to COVID-19.

Furthermore, unlike envisaged earlier, the incubation period of COVID-19 is thought to be as long as 2-14 days compared to the 3-5 days observed in flu. This is vital to know because asymptomatic people can silently transmit the disease to others without even knowing. Among all infected people, 81 per cent will have the mild form of the disease while 14 per cent may suffer from severe forms requiring hospital admission with measures like O2 support, symptomatic relief etc and 5 per cent cases are severe forms which can progress to severe forms of pneumonia, needing ICU care with assisted mechanical ventilation. Critical cases include patients who suffer from respiratory failure, septic shock, and/or multiple organ dysfunction or failure. Severe cases include patients who suffer from shortness of breath, respiratory rate ≥ 30/minute, blood oxygen saturation ≤93 per cent, PaO2/FiO2 ratio <300,28, and/or lung infiltrates >50 per cent within 24–48 hours.

It is important to note that despite having low mortality rates, death among the elderly is significantly high, especially above the age of 80 years where the mortality rate is at 15 per cent. People with pre-existing medical conditions like diabetes, hypertension, heart diseases and lung illness are at a higher risk of suffering serious damage if they contract the disease.

Smokers can easily contract the disease and suffer more damage than non-smoking individuals. Above all, understanding the evolution of the disease is key

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to instituting containment and prevention strategies.

Testing identifies affected cases and gives objective data to incorporate countermeasures in controlling the spread and justification for containment measures such as isolation and quarantine.

Early counter measures intend at lowering the peaking of disease spread within the community, limiting the demand on the healthcare system. In epidemiological terms slowing the spread of an infectious agent is called “flattening the curve”, where the curve refers to the projected number of people who will contract COVID-19 over time. A steep curve signifies rapidly increasing numbers of people with the disease which can overwhelm the local health care system. With a flatter the curve, the same number of people inevitably get infected but the occurrence is spread over a longer time frame, not overloading the healthcare system beyond its capacity. This model, called the Drew Harris curve, named after the population health researcher, was seen working during the Spanish flu outbreak of

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1918. When comparing two cities in the U.S. — Philadelphia where the city officials ignored the early warning about the spread of the disease, and St. Louis, where the city officials quickly implemented social isolation strategies. Ultimately Philadelphia lost 16,000 of its inhabitants over St. Louis lost only about 2,000 people — one-eighth of the casualties of Philadelphia over the same span.

World Health Organization (WHO) describes the symptoms based on the 50 thousand plus laboratoryconfirmed cases of COVID-19, amongst whom fever and dry cough have been the most common symptoms. The third most common symptom is fatigue, and 1 in 5 patients experience shortness of breath. Around 3-5 per cent presented with diarrhoea, which can be risky in the elderly if not treated. While sharing a lot of common symptoms with flu, runny-nose is rarely seen in patients with coronavirus infection. On average, this disease can last up to 2 weeks in mild cases, while the same study suggests that it may take 4-6 weeks for severe cases to recover. Critical cases have a varied time of recovery depending on the individual’s health status.

Prevention strategies

Aggressive testing and disease identification, quarantine measures, deploying right equipment, and staff training are the chief measures in containing any pandemic. Given the lack of vaccination, the limited success of antiviral drugs and the availability of ventilators, non-pharmaceutical interventions are likely to dominate the public health response to a pandemic of this magnitude. Public health measures from relatively innocuous techniques, such as disease surveillance and hygienic measures, to considerably more restrictive interventions, such as social distancing, travel restrictions, quarantine, and case isolation are warranted for containment. The hope is that public health interventions, while incapable of completely stopping the transmission of the virus, will be able to slow the pandemic granting time to

the health care system to cater for all the patients.

Surveillance is necessary to quickly identify and respond to the COVID-19 as witnessed in South Korea. It had the largest prevalence in Asia other than China, where the incidence rate has been brought down to near zero. When comparing the trajectories of confirmed cases growing versus time, Singapore witnessed the lowest incidence thanks to the strict preventive and prohibitive measures. Surveillance thus comprises a crucial element of the early response to a forming pandemic. As these measures involve governments collecting sensitive health information from patients, travellers, migrants, and other vulnerable populations, surveillance also poses privacy risks.

Screening and testing while helping to limit the spread of the disease, can pose serious threats to a person’s privacy and bodily integrity. Ideally, public health officials should receive an individual’s informed consent before performing any medical tests, and education programmes can help convince many people to agree to voluntary testing. Hygienic measures to prevent the spread of respiratory infections include hand-washing, disinfection, the use of personal protective equipment (PPE) such as masks, gloves, gowns, and eye protection, and respiratory hygiene, such as the use of proper etiquette for coughs, sneezes, and spitting. The public must be informed of the need for hygienic measures as misinformation has been rampant during the past pandemics. The situation raises issues of distributive justice because ineffective or inaccurate communications have the greatest effects on marginalised members of society, as they are the least likely to have access to alternative credible sources of information. Healthcare professionals and organisations should focus on educating people with the right information and build a good public partnership as a way of achieving adherence. The information disseminated through public education campaigns should be accurate, clear, uncomplicated,

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The threat of COVID- 19 pandemic is real, but it is conquerable

A silver lining to the darkness shrouding our nation and the world is the news of doctors from Jaipur’s Government Hospital treating three confirmed patients successfully offers some great hope. Two of those patients were elderly with comorbid conditions which put them at a higher risk. But a novel drug therapy combination rendered them cured as their tests were negative for COIVD-19.

Standing together as a nation in these tough times and adhering to disciplined self and surrounding hygiene habits, putting our trust in our healthcare system to treat us and investing in preventive care for the future can make our resilient nation march past such tribulation.

AUTHOR BIO

not sensationalistic or alarming, and as reassuring as possible.

Our experience from other pandemics shows that one consistent response to epidemics has been to decrease social mixing and increase social distancing by means such as community restrictions and voluntary social separation which have been effective to an extent in limiting the spread and slowing the advance of the disease by local transmission.

Governments should explicitly define who has the power to order social distancing strategies and for what period as there is a worry that governments might use social distancing in a discriminatory fashion, scapegoating ethnic or religious minorities, or might deploy social distancing as a pretext to crack down on dissidents who assemble to protest.

Isolation and quarantine are two of the oldest disease-control methods in existence and they have been deployed during this COVID-19 pandemic.

While the terms “quarantine,” “isolation,” and “compulsory hospitalisation” are often used interchangeably, they are, in fact, distinct. The definition of quarantine is the restriction of the activities of asymptomatic persons who may potentially have been exposed to a communicable disease, during or immediately before the period of communicability, to prevent further chances of disease transmission. In contrast, isolation is the separation, for the entire period of communicability of the infecting agent, of known infected persons in such places and under such conditions as to prevent or limit the transmission of the infectious agent.

Quarantine and isolation can be accomplished by various means, including confining people to their own homes, restricting travel out of an affected area, and keeping people at a designated facility such as a hospital, exclusively equipped camp.

Pulling through a pandemic such as COVID-19 forces any society to face several difficult challenges, many of which transcend the issue of mere scientific effectiveness.

Sangita Reddy is the Joint Managing Director of the pioneering Apollo Hospitals Group, a proponent of integrated healthcare delivery. In addition to her operational responsibilities, Sangita led the group’s retail and primary healthcare endeavours.

An ardent champion advocating the benefits of a global delivery model through rural hospitals, outreach camps and telemedicine, Sangita is continuously engaged with the governments to deliver innovative health services harnessing digital platforms.

Every issue of AHHM magazine is a powerful dose of information and knowledge â&#x20AC;&#x201C; filled with original and undiluted content. Written by the best brains in hospital and healthcare industry, the magazine offers timely business insights and articles on cutting-edge technologies.

Subscribe now to get your doses regularly.

Email: subscriptions@asianhhm.com Tel: +91 40 4961 4567 Fax +91 40 4961 4555

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FOUR POWERFUL DOSES PER YEAR

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EMERGENCY AND DISASTER PREPAREDNESS Significant drivers affecting emergency and hospital design

Health Systems across the globe are challenged with the issues associated with pandemic events, including such as SARS, and the recent COVID-19. HKS has been at the forefront of emergency preparedness. The Macau Island Hospital and Changi General Hospital are being designed with several key elements that support the objectives for meeting emergency and disaster preparedness initiatives.

Brinda Sengupta, Associate, HKS, Inc. Angela Lee, Managing Director, HKS Asia Pacific

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he current outbreak of COVID-19 has given all countries a jolt and made them think about their healthcare facilities in a new light. Most countries are struggling with a lack of isolation wards and adequate decontamination facilities. It is the need of the hour for health professionals, operators, government departments to implement disaster preparedness within existing and new hospitals. While healthcare policy, governance, and operations will play a big role in planning and management, healthcare design professionals have a significant task of leading a radical shift in the design of hospitals.

Here we outline a few design strategies for hospital design to address disaster preparedness.

1. Allow compartmentalisation for isolation: For Macau Island Hospital, the emergency department

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(ED) was designed in a way so as to allow for a portion of the ED to be isolated for a mass casualty or contagious outbreak, while at the same time allowing for the main ED to remain operational.

The emergency department was designed to operate under normal circumstances with six key zones including a fever clinic, multiple floors with 23-hour emergency observation, level 1 trauma / resuscitation rooms, level 2 and 3 emergency room beds, level 4 and 5 fast track/triage area and dedicated computerised tomography (CT) and radiology imaging services.

2. Remodel existing emergency departments to be pandemic ready The remodelling the of emergency

department at Changi Hospital is still on going with the participation of EP team at an early stage.

The workflow of the pandemic is introduced and

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incorporated into medical planning with several key planning points to ensure the hospital the ability to respond to a pandemic event effectively within a short timeframe.

3. Plan for exterior expansion of ED: To ensure higher footfalls can be accommodated during an outbreak, it is imperative to create a larger department for pandemic readiness. In Macau Island Hospital, several design features are integral to allow for the expansion of exterior emergency drop-off area into a temporary triage area and separate decontamination area that allows for the treatment of potentially contagious or contaminated patients. Structural davit connections or permanent ceiling mounted tracks can be provided to accommodate temporary fabric partitions or curtains. Strategically located hose bibs with shower heads for decontamination of patients

Trench drains with dedicated plumbing diverted for decontamination 4. Ensure dedicated vertical circulation during an outbreak: In order to provide enough accommodations

for isolation of large patient populations during quarantine events, it was necessary to provide dedicated vertical circulation access to multiple levels of the facility. This access was coordinated to allow for the segregation of these isolated floors while also maintaining vertical circulation capabilities for the remainder of the hospital tower to allow for normal operations to continue during quarantine and pandemic events. The AGV Supply and Soiled Service Elevators will be temporarily quarantined for isolation of infectious patient movement from the ED to the isolated emergency observation floors on levels 8 and 9.

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5. Design of Isolation Room Suites: Isolation Patient Room Suites: In Queen Mary Hospital, Hong Kong, these

suites are areas where isolation patient rooms have been consolidated along a dedicated corridor with two entrances: one from the ward they are associated with and a secondary entrance from outside the ward.

This will allow utilisation of these room both as part of the department or as a free-standing infectious patient suite.

6. Devise a sound mechanical engineering strategy:

AUTHOR BIO

The physical design of isolation facilities needs to be complimented by a sound mechanical strategy.

This requires mechanical systems which have to be designed to allow for the compartmentalisation and isolation of several zones during seasonal flu season or potentially pandemic events.

While providing flexibility to convert patient care areas to negative pressure zones during mass quarantine or pandemic events is crucial, the solution must also be designed to conserve energy during normal use.

Areas programmed for quarantine isolation zoning are typically areas that are not fully exhausted during normal operation. Operating these areas with full exhaust during normal operation would increase the energy required to condition the necessary extra outside air. Using strategically placed dampers and direct digital controls energy can be conserved and the isolated areas can still be converted to negative pressure with minimal effort or disruption.

At the Macau Island Hospital, during normal operation the return air damper is open, the exhaust damper is closed, and the air handling unit is only bringing in the minimum amount of outside air required for the space. However, when the area 50

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is under isolation a command can be sent from the controls system to close the return air damper, open the exhaust air damper and also open the economiser damper in the air handling unit. When the damper positions are confirmed by the controls the exhaust fan starts, the area becomes active pressure and is isolated from spreading contamination to adjacent patient care areas.

During times of disaster, hospitals play an integral role within the health-care system by providing essential medical care to their communities. Without appropriate emergency planning, health systems can easily become overwhelmed in attempting to provide care during a critical event. It is time that hospital design and engineering professionals work together with healthcare operators, government officials and the community at large to be prepared for future disasters. Learning from International best practices and case studies would help create a shared knowledge platform on disaster preparedness which will help control outbreaks in the near future.

With 13 years of international design experience as an Architect and Urban Planner, Brinda Senguta has led teams across Asia, turning her clientsâ&#x20AC;&#x2122; visions into reality. Brinda believes the key to a successful project is great teamwork coupled with the pursuit of creativity and excellence at every step of the design process.

As regional managing director of HKS Asia Pacific, Angela Lee has had 26 years of architecture and medical planning experience for over 1.1 million square meters of healthcare projects worldwide.

She has been honoured and recognised by international institutes and publications such as AIA, Modern Healthcare, Health Facilities Management and Medical Construction and Design.

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Prevention of Infectious and Chronic Diseases An indispensable investment Evolving ecology, changing human behaviour, and shifting disease pattern, have created a growing burden of emerging and re-emerging infectious and chronic diseases. The worldâ&#x20AC;&#x2122;s most vulnerable populations continue fighting with this double whammy of diseases. It is important to understand disease epidemiology and act urgently for strengthening prevention and control measures.

Md Moshiur Rahman, Associate Professor, Graduate School of Biomedical & Health Sciences, Hiroshima University Md Adnan Hasan Masud, Consultant, Haematology Department, Bangabandhu, Sheikh Mujib Medical University (BSMMU) Sajeda Chowdhury, Research Institute for Radiation Biology and Medicine, Hiroshima University

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he world has developed an expanded global health system for the protection of known and unknown infectious disease threats and to promote human health. However, the system continues to be challenged by emerging and reemerging infectious disease threats. These threats vary in terms of severity and probability with the consequences for morbidity and mortality.

Recent outbreaks of a novel coronavirus (COVID19), Ebola, Zika, Dengue, Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and influenza have been raised concerns about whether the current global health system is ready to provide effective protection against the global threats. Several factors complicate the disease management as rapid population growth with weak health systems, urbanisation, globalisation, civil conflict, climate change, and the changing nature of pathogen transmission between human and animal populations. There is also the risk of human-originated outbreaks deriving from laboratory accidents or intentional biological attacks.

The world currently lacks the integrated system for managing and responding in an efficient and coordinated manner. This article explains the global

health challenges and rationale for the investment in preventing infectious and chronic diseases.

In December 2019, a group of patients with pneumonia were confirmed to be infected with COVID-19 in Wuhan, Hubei province, China.

Epidemiological evidence suggested as the virus obtained from these patients was highly similar to that identified in bats. We live in a world that is globally connected, in terms of the movement of people, goods, and food. As a consequence, the COVID-19 started spreading all over the world.

The outbreak was confirmed as a Public Health Emergency of International Concern on 30 January 2020. The situation analysis was released and considered scenarios for potential disruptions around the world. On 11 March 2020, the World Health Organization (WHO) announced that COVID-19 can be characterised as a global pandemic. In various regions around the world, the COVID-19 causes the fear and panic that resulted in social distancing, closing of schools, enterprises, commercial establishments, transportation, and public facilities, which disrupt economic and other social activities.

As of 27 April 2020, a confirmed 2,883,603 people have been infected with COVID-19 globally across www.asianhhm.com

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213 countries, areas or territories. Currently, there is no effective drug treatment or vaccine. It is essential to be strengthened for surveillance of the virus and drugs and vaccines to be developed against COVID19 infection within the earliest time. It is also important to conduct daily public-wide educational campaigns on precautionary measures against exposure to COVID-19, encouraging people to cancel traditional or avoidable gatherings to prevent the large-scale spread. The ongoing COVID-19 pandemic response requires rapid action from all societies and governments. Individuals need to adopt new preventive and control behaviours and as well societies need to implement new public health strategies. Today, the whole world realises the importance of life-saving risk communication and demanding evidence-based guidance to reduce the burden of COVID-19. A combination of public health measures are recommended as rapid identification, isolation and case management, contacts identification and follow up, infection prevention and control in health care settings, population awareness and limiting movement, and risk communication.

Until now, vaccines have been a core component of preventive measures and the most cost-effective preventive approaches for the vaccine preventable diseases. Childhood immunisation usually provides

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a very high return on investment. During the 20th century, there has been an increase in life expectancy due largely to immunisation and child survival.

Though infectious disease mortality is reduced, emerging and re-emerging infectious diseases remain a major cause of illness, death, and disability. Today, people are demanding new vaccines against COVID19, ebola, malaria, and other infectious diseases for saving lives around the world.

Currently, chronic diseases are the leading causes of death and disability worldwide and will result in over three quarters of all deaths by 2030. At present, cancers, autoimmune or immune-mediated diseases, and neuro-developmental disorders are susceptible candidates for transmission of infectious agents.

Many chronic diseases have an infectious origin, such as liver cancer (hepatitis B and C viruses) and cervical cancer (human papillomavirus) and require longterm care. Many chronic diseases are also associated with high-risk behavioural factors. Rising chronic disease also linked to changing food consumption patterns, such as processed food, especially targeted to children, has a negative impact on health.

It is time to understand chronic disease epidemiology and infectious disease epidemiology together. There are new prospects to strengthen the prevention of chronic diseases, especially cardiovascular diseases, diabetes, cancer, and chronic

CO VER STORE

respiratory diseases. Chronic diseases are generally represented because of particular health-damaging behaviors, such as smoking, hazardous drinking, physical inactivity, or overeating. The creation of smoke-free public places is important to protect non-smokers from the hazards of passive smoke to prevent cardiovascular diseases and cancer. Several lines of evidence indicate that modifiable behaviours related to dietary (consumption of fruits and vegetables, limit excessive caloric, sodium, and sugar intake) and lifestyle changes (regular physical activity and sleeping pattern) can reduce the incidence of chronic disease.

Chronic diseases are still neglected globally, receiving very few resources from development agencies and governments of low-income and middleincome countries. These diseases disproportionately affect the poor and can increase poverty. There is a vicious cycle of poverty and illness. There are several factors indicating the association between poverty and chronic diseases and their risk, such as social exclusion, inadequate education, mental stress, and poor nutritional status most likely lead to premature death. The evidence suggests that early-childhood poverty can lead to chronic diseases later in life.

The comprehensive programmes and investments in early-childhood development as one of the most cost-effective interventions to reduce the increasing burden of chronic diseases in adults and have huge immediate and long-term returns on investment.

The participation and support of development agencies and governments are crucial to prevent chronic diseases in low-income and middle-income countries. There has been a slow progression in chronic disease prevention due to lack of strong political commitment. Recently, the United Nations (UN) resolution on chronic diseases has contributed to a shift in strengthening global support for action with a priority for the prevention of chronic diseases.

A priority for primary health care, improvement of chronic disease surveillance, reorientation in stepwise approach, and strengthening of health

Currently, chronic diseases are the leading causes of death and disability worldwide and will result in over three quarters of all deaths by 2030.

systems are important to improve the prevention and management of chronic diseases in low-income and middle-income countries. An emphasis on infectious and chronic disease prevention is a key strategy for poverty reduction.

Chronic diseases negatively impact population health and accounts for seven of the top 10 causes of death. Cost, access, and quality are the key issues addressing the healthcare needs. The investments in population-health strategies appear to be costeffective to improve long-term-health outcomes and address high mortality and high-morbidity diseases.

Community-based interventions and populationwide prevention policies prove to be much more powerful. It is the time to invest in prevention methods and evidence-based programs that will increase the quality of lives.

Primary health care (PHC) is globally recognised as an essential driving force for fostering universal health coverage (UHC) and achieving the sustainable development goals (SDGs). There is a huge shortage of healthcare workers worldwide. Resource mobilisation, expanding and investing in PHC, and overall health workforces need to increase for bringing substantial health benefits and build human capital.

Additionally, research indicates that PHC is linked to more effective, appropriate, and less costly care.

To strengthen primary health care in low-resource settings, research also suggests the chronic care model needs improvement in the areas of community resources, health systems, self-management support, www.asianhhm.com

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decision support, delivery-system redesign, and consensus about health information-seeking, risk clinical information systems. PHC workers have communication, trust, and reputation management. a focal role in supporting patients to their illnesses In order to achieve behaviour change that can prevent for self-management through disease education, the acquisition and further spread of infectious motivated and skill development. Integrated primary disease, public health strategy needs a focus on health-care approaches are important in dealing with reducing disparities and inequities and to improve the growing burden of chronic diseases. health promotion and health communication.

The SDGs have increased global attention School-based and worksite educational programmes on chronic diseases to ensure healthy lives and can also play an important role in maintaining promote wellbeing for everyone at all ages to reduce physical and mental health, which includes health premature mortality through the prevention and education on nutrition and physical activity and a control strategies. The focus of SDGs is the changing wide variety of health promotion activities. environment surrounding health strategies, and fight The world tackles multiple challenges at once, and against poverty and illness. Investing in cardiovascular their resolution demands novel approaches through disease prevention is essential to progress towards innovations in public health. It is an essential step achieving SDG target 3.4. In 2017, the Best Buy in reframing the strategies in the global health interventions were updated at the World Health and development agenda to mobilise resources to Assembly and incorporated for the prevention and accelerate available cost-effective interventions for control of chronic diseases. appropriate disease management. A framework of Climate change and health have shown complex investment needs to be developed for prevention inter-relations. Investmenting in climate change and control of infectious and chronic diseases in issues and addressing vector-borne, food-borne and connection with the SDG targets and estimate the water-borne diseases can play a key role in preventing economic and social benefits of better health. roughly a quarter of global disease burden by reducing References are available at www.asianhhm.com/ environmental risks. Crosssectoral investments are Md Moshiur Rahman is Associate Professor of International Health also essential for sustainable and Medical Care, Hiroshima University, Japan. He has outstanding health outcomes and broader academic credentials combined with experiences in global health, population and health science, research, administration, and leaderhealth security, such as water ship. He has more than 20-year experiences in health-related programs and sanitation, air quality, and researches in Bangladesh, Africa, and Japan. food safety, road safety, and zoonotic disease control.

Md. Adnan Hasan Masud is a Consultant in Haematology Department, Human behaviour is BSMMU, Shahbag, Dhaka, Bangladesh. He has versatile & dynamic academic qualifications combined with excellent professional experione of the major factors for ences in clinical medicine, chest & blood diseases and leadership in the underling emergence physiciansâ&#x20AC;&#x2122; society. He has more than 15-year experiences in various health-related programs and researches in Bangladesh. and spread of infectious pathogens. These include such as hand-washing, food Sajeda Chowdhury is a multidisciplinary Researcher at Hiroshima University, Japan. She has research experiences both in molecular hygiene, exercise, nutrition biology and epidemiological field. Formerly, she worked as Lecturer practices, and improve of undergraduate medical students and Trainer of nursing students in Bangladesh. Her research interest included antiviral candidates, environmental sanitation.

Oncology and public health issues.

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AUTHOR BIO

MEDICAL SCIENCES

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TECHNOLOGY, EQUIPMENT & DEVICES

MANAGING MEDICAL DEVICES FAILURE RISK Improving health outcomes Medical devices are tangible assets that need to be maintained properly. They require a lot of investment, have a direct effect on human lives, are very sensitive, have high maintenance costs in a lot of cases, and some of them have short shelf lives. Medical devices play a critical role in diagnosis, treatment and rehabilitation of disease and illness. But the problem is that most hospitals fail to utilise the full potential of the technology that is currently available. Healthcare providers are gradually becoming aware of the need to secure medical devices.

Only after we establish clear systems and methods for analysing device failures will we begin to have a full idea of the risks involved. Once we have better visibility and control over the functional aspects of medical devices, healthcare facilities will be able to better safeguard the safety of their patients and ensure continuity of treatment.

Sanjay Jha, Director, Colmed

M

edical devices play a critical role in diagnosis, treatment and rehabilitation of disease and illness. According to estimates, over 50,000 medical devices are in use on a daily basis in healthcare facilities all over the world. Some of them are simple, while others are quite complex and combine more than pone technology. The global market of medical devices is estimated at US$150 billion, and is expected to grow at a rate of 5 per cent annually over the decade.

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TECHNOLOGY, EQUIPMENT & DEVICES

A critical resource in the healthcare ecosystem

Medical devices are tangible assets that need to be maintained properly. They require a lot of investment, have a direct effect on human lives, are very sensitive, have high maintenance costs in a lot of cases, and some of them have short shelf lives. According to estimates by the World Health Organization (WHO), over 50 per cent of the medical equipment in developing countries are non-functional, are not used correctly, and are not maintained by health facilities. Not only does it have far-reaching consequences for healthcare service delivery, it is also a waste of scarce and valuable resources. Unless hospitals have a proper policy in place for the management of medical devices, it is difficult to aright the situation.

This problem is further compounded by the fact that most hospitals fail to utilise the full potential of the technology that is currently available. If you pay

attention to the depreciation value of medical devices from procurement to use, you will notice that it is highly non-typical. On an average, 30 per cent of depreciation occurs because of incorrect specifications and over-sophistication before the device is put to use. The value depreciates even further once it is in use due to a number of reasons. These include, but are not limited to irrational use, shortage of spare parts, lack of inspection and preventive maintenance, and repair agreements with the supplier. Owing to all these factors, the value of a device falls to about a tenth of the original investment.

As a critical component of clinical and support technologies in the healthcare ecosystem, medical equipment must be managed and used properly to produce effective medical intervention.

Unfortunately lack of an optimal skill base, proper selection and acquisition, maintenance and repair

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TECHNOLOGY, EQUIPMENT & DEVICES

budget, support infrastructure, and managerial skills result in a waste of meagre resources, especially in healthcare facilities in tier 2 and tier 3 cities. Despite the huge amounts of money that is spent on medical devices, resource management is not considered an integral component of hospital policy. This is a major oversight on the part of hospitals as it fails to factor in future financial liabilities. It is not sustainable in the long run, considering the fact that medical device design is rapidly evolving with advancements in technology. These developments pose a new set of threats, which unless addressed beforehand, will end up becoming costly for both hospitals and patients, severely harming the reputation of the former and the safety of the latter. Medical devices fail for a number of reasons and all possible causes must be taken into consideration.

The Food & Drug Administration (FDA) of the United States has released countless warnings regarding the common vulnerabilities that plague medical devices. These vulnerabilities pose a threat to patient safety. The list not only include magnetic resonance imaging (MRI) machines and computed tomography (CT) scanners, but also other medical

According to estimates by the World Health Organization (WHO), over 50 per cent of the medical equipment in developing countries are non-functional, are not used correctly, and are not maintained by health facilities.

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devices like infusion pumps, electrocardiogram (ECG) machines, and lab analysers to name a few.

What complicates the situation further is the fact that clinical systems are increasingly connected to smart devices, which makes them prone to cyber attacks.

If hackers or vested interests manage to tamper with the medical devices, it endangers the lives of patients.

What makes medical devices risk-prone?

Updating medical equipment is a complicated process. Hospitals often take a lot of time before they receive the final patches. The heavy patient load also means that they have to wait to apply the patches to the equipment. To add to the woes, many healthcare facilities operate legacy systems that no longer support the new patches. A lot of medical devices have to be retrofitted for networking purposes, facilitating real time data sharing and process automation so that the device can be managed remotely by the vendors. It is essential for healthcare providers to prioritise this because if a product is not receiving updates to fix vulnerabilities, it can give unscrupulous elements an entry point into the providerâ&#x20AC;&#x2122;s network, which can put patient safety at risk.

Rogue hackers can also intrude the internal network of hospitals and take control of connected devices and steal sensitive data. One of the most famous examples in recent memory was the WannaCry ransomware attack of 2017, which targeted National Health Services (NHS) hospitals in Scotland and England, affecting close to 70,000 medical devices.

Many NHS services refused emergency cases, and even ambulances had to be diverted. If not for the built in kill switch, the magnitude of the attack would have been a lot worse. Another study found that 36 out of every 10,000 heart attacks occurred every year as a result of cyber attacks that caused a delay in treatments. According to the researchers, it took approximately 3 minutes for patients who suffered a heart attack to get an electrocardiogram after a cyber attack.

TECHNOLOGY, EQUIPMENT & DEVICES

Even a simple intrusion into a hospitalâ&#x20AC;&#x2122;s IT network can have a negative impact on the regular operations of medical devices because of their inherent vulnerability. As a matter of fact, it does not even require specialised expertise or sophisticated software to get the job done. Even a reasonably educated patient can learn about the control codes of machines and hack into these Devices. There is no denying that this is a serious risk that is only set to increase in magnitude in future.

The need for transparency

AUTHOR BIO

Another dimension to the problem is the lack of accurate repository and documentation of device failure. Healthcare providers fail to monitor the performance of medical devices and report the problems in time. Even if we somehow manage to build a report of injuries caused by device malfunctions, it will be difficult to tell how many of the faults were caused due to network tampering.

Moreover, medical device failures fall between IT departments and biomedical engineering. So unless healthcare facilities are prepared to make the information public, it is difficult to get a realistic assessment of the impact.

To address this problem, healthcare facilities must maintain a central repository of all the medical devices.

Automated systems can be used to maintain an up to

date inventory. Clinical workflows must incorporate the role of medical devices to estimate the impact of malfunctioning devices on the quality of patient care. The system must also be used to monitor device communications to identify anomalies in case of an intrusion.

Healthcare providers are gradually becoming aware of the need to secure medical devices. Only after we establish clear systems and methods for analysing device failures will be begin to have a full idea of the risks involved. Once we have better visibility and control over the functional aspects of medical devices, healthcare facilities will be able to better safeguard the safety of their patients and ensure continuity of treatment.

Sanjay Jha, IIT Kharagpur and INSEAD alumni , presently a director at Colmed, is an experienced entrepreneur with a decorated history in the medical device industry, aiming towards bring the quality of healthcare up and cost of healthcare down. In his past stints at various reputed companies like johnson and johnsons and GE Healthcare, he is known for his unparalleled skills in business strategy and business development, market analysis ,operations, innovation and entrepreneurship. He has 3 US Patents on his name.

Mr. Sanjay Jha is a perceptive and informed leader and wears a charismatic personality. He is well known for his resources, networking and contacts-a trait which every successful entrepreneur is required to possess- not just to build a world class team but also to reach out to investors, partners in customers as well.

He is tenacious, having strong build drive with nerve of steels. he plansmeticulas;y, reacts quickly and react quickly and adapt to constant feedback from the market.

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Healthcare Industry Needs More than Patient Satisfaction Surveys The healthcare industry has been asking patients how they feel for over a decade.

But patient satisfaction surveys only go so far — to really move the needle on the patient experience, it’s time the industry embraced experience management.

Susan Haufe, Healthcare Chief Industry Advisor, Qualtrics

We all are in the business of experience. Healthcare is no different. Taking care of patients all day, every day, means we deliver experiences with patients, family members, providers, volunteers - anyone who interacts within our healthcare system.

The high quality, safe, compassionate care we deliver at the lowest cost and/or value is often difficult and something we need to understand and manage closely. As a result, experience management needs to become incorporated into the day to day operations across an organisation.

But what is experience management? Experience Management (XM) is the discipline of using both experience data (X-data) and operational data (O-data) to measure and improve the four core experiences of any business: customer, employee, product and brand.

As healthcare faces the challenge of meeting consumer expectations with a workforce that is being asked to do more with less every day, compounded by an environment of changing regulations, it’s clear our industry must focus on human beings and increase our ability to adapt. This is where the discipline of XM comes into play.

XM enables an organisation to succeed in this environment by enabling them to do three things: 1. Continuously Learn - understanding how the experiences you deliver affect all the people (employees, customers, caregivers, etc.) that interact with your organisation. Learning how these experiences impact your brand and culture help you implement processes that address customer service interactions.

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2. Propagate Insights - put the right information in the right form and in front of the right people to help them make better decisions.

3. Rapidly Adapt - building the capabilities to be able to respond to insights quickly and make changes to improve the experience.

To date, patient satisfaction surveys have been the industry’s primary tool for trying to understand and manage the experiences being delivered — but their impact is limited. To truly transform experiences, it’s time to look beyond patient satisfaction surveys and move towards a more holistic approach to accurately measure and glean insights from timely, role and site-based feedback - and then use these insights to make patients feel known and understood and help systems achieve financial health and improve quality and wellness outcomes.

How can healthcare better listen to patients today?

In healthcare, we have a long history of asking for feedback from our patients and families about their perception of their experience. Recognising that patients and families do not have the clinical training to truly and effectively evaluate the clinical quality of care, asking about their service experience has traditionally been a proxy for a patient’s perception of quality.

Healthcare providers feel constrained when it comes to changing this listening strategy or adding to it in innovative and creative ways. Quite frankly, healthcare providers are stuck and frustrated with their current methodology, yet lost on what to do next.

The current patient satisfaction surveys fail to give organisations the right data, at the right time, and in the right form to surface predictive insights that matter most across the patient experience and activate the entire organisation for improved outcomes.

Healthcare needs a different way to continuously listen.

What could a different approach look like?

It’s critical to start with clearly identifying the gap that needs to be closed. Gaps exist in experiences when there is a difference between what patients and families expect and what their actual experience looks and feels like.

To understand where those gaps exist, you can use journey maps to identify all of the touchpoints impacting a patient’s experience. Using this method, you can create a roadmap for effectively capturing relevant feedback about the moments that matter the most from your patients Once you know the key moments in the patient journey, it’s time to gather insights into what’s working, what’s not and where to make improvements By adding ‘listening posts’ at each critical moment of the patient journey, you can then identify where to focus your energy and resources for the greatest impact. You can decide where best to start that might be within your contact center, through digital intercepts on your website or mobile app, or soliciting feedback after an appointment through SMS or touch screens installed on-premise.

Depending on your health system’s needs, the issues identified by your patients, and your strategies

AUTHOR BIO With 20 years of experience combining the tools, discipline, expertise, and passion to design and drive a customer-centric culture, Susan Haufe is known for organisational transformation built on brand promise, purpose, and values. She currently serves as the Chief Experience Officer, Healthcare Practice at Qualtrics. Prior to joining Qualtrics, Susan served as the inaugural Chief Experience Officer for Yale New Haven Health.

and goals, you can nimbly listen, adjust, and modify what your listening posts capture to help answer questions about the gaps that exist.

Modern feedback tools are different from the patient satisfaction surveys we have known. Questionnaires can be administered in real-time and are quick to complete. They ask a few insightful questions and are powered by artificial intelligence to create meaningful feedback experiences that strengthen the relationship with your customers (here at Qualtrics, we call this having Smart Conversations).

The approach is facile, so as you learn more about the experiences of the people that matter most (not only your patients and families, but also your staff, providers and communities you serve), you can mold and adjust your data collection to gain deeper understanding. Results are collected on a single platform allowing for deeper analytics and insight delivered in real-time.

Listening leads to insights and action.

Once you have comprehensive experience data (X-data) from a variety of sources, you can begin to layer that data with your operational data (O-data) to transform how this information leads to powerful, clarifying insights.

With your X- and O-data combined, you have the tools to start making improvements with real impact.

You know what you need to fix and what impact it will have on your most important metrics, whether it’s patient satisfaction, clinical outcomes, or business metrics like revenue and profit. By prioritising your investments in effectively measuring patient experience, you gain the insights you need to demonstrate the impact of your improvements across the organisation.

This is what XM looks like. As you strengthen the discipline of XM across your organisation, you develop habits of continuously listening, propagating insights and rapidly adapting, ultimately improving experiences.

For more information about how healthcare providers can move beyond the norm to better listen to patients, healthcare workers, and clinicians to drive maximum impact Watch webinar series - Prioritising healthcare in a world of change.

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BOOKS Epidemics and Society From the Black Death to the Present Author(s): Frank M Snowden No of Pages: 600 Year of Publishing: October 22, 2019 Description: A â&#x20AC;&#x153;brilliant and soberingâ&#x20AC;? (Paul Kennedy, Wall Street Journal) look at the history and human costs of pandemic outbreaks The World Economic Forum #1 book to read for context on the coronavirus outbreak This sweeping exploration of the impact of epidemic diseases looks at how mass infectious outbreaks have shaped society, from the Black Death to today. In a clear and accessible style, Frank M. Snowden reveals the ways that diseases have not only influenced medical science and public health, but also transformed the arts, religion, intellectual history, and warfare.

A multidisciplinary and comparative investigation of the medical and social history of the major epidemics, this volume touches on themes such as the evolution of medical therapy, plague literature, poverty, the environment, and mass hysteria.

Viruses: A Very Short Introduction Author(s): Dorothy H. Crawford No of Pages: 176 Year of Publishing: 22 March 2018 Description: Viruses are big news. From pandemics such as HIV, to swine flu, and SARS, we are constantly being bombarded with information about new lethal infections. In this Very Short Introduction Dorothy Crawford demonstrates how clever these entities really are. From their discovery and the unravelling of their intricate structures, Crawford demonstrates how these tiny parasites are by far the most abundant life forms on the planet.

In this fully updated edition, Crawford recounts stories of renowned killer viruses such as the recent Ebola and Zika epidemics, as well as Middle East Respiratory Syndrome, and considers the importance of air travel in facilitating the international spread of viruses in the twenty first century. Discussing the impact of global warming, which is increasing the range of vector-transmitted viruses such as dengue, yellow fever, and West Nile virus, she also considers the effect this will have on native populations in subtropical and temperate climates of the Americas, Australasia, and Europe. By examining our lifestyle in the 21st century, Crawford looks to the future to ask whether we can ever live in harmony with emerging viruses with devastating consequences.

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BOOKS The Pandemic Century, One Hundred Years of Panic, Hysteria, and Hubris Author(s): Mark Honigsbaum No of Pages: 464 Year of Publishing: April 9, 2019 Description: In The Pandemic Century, a lively account of scares both infamous and less known, Mark Honigsbaum combines reportage with the history of science and medical sociology to artfully reconstruct epidemiological mysteries and the ecology of infectious diseases. We meet dedicated disease detectives, obstructive or incompetent public health officials, and brilliant scientists often blinded by their own knowledge of bacteria and viruses. We also see how fear of disease often exacerbates racial, religious, and ethnic tensions—even though, as the epidemiologists Malik Peiris and Yi Guan write, “‘nature’ remains the greatest bioterrorist threat of all.”

Like man-eating sharks, predatory pathogens are always present in nature, waiting to strike; when one is seemingly vanquished, others appear in its place. These pandemics remind us of the limits of scientific knowledge, as well as the role that human behavior and technologies play in the emergence and spread of microbial diseases.

The Psychology of Pandemics, Preparing for the Next Global Outbreak of Infectious Disease Author(s): Steven Taylor No of Pages: 178 Year of Publishing: 16 October 2019 Description: Pandemics are large-scale epidemics that spread throughout the world. Virologists predict that the next pandemic could occur in the coming years, probably from some form of influenza, with potentially devastating consequences. Vaccinations, if available, and behavioral methods are vital for stemming the spread of infection.

Psychological factors are important for many reasons. They play a role in nonadherence to vaccination and hygiene programs, and play an important role in how people cope with the threat of infection and associated losses. Psychological factors are important for understanding and managing societal problems associated with pandemics, such as the spreading of excessive fear, stigmatization, and xenophobia that occur when people are threatened with infection. This book offers the first comprehensive analysis of the psychology of pandemics. It describes the psychological reactions to pandemics, including maladaptive behaviors, emotions, and defensive reactions, and reviews the psychological vulnerability factors that contribute to the spreading of disease and distress. It also considers empirically supported methods for addressing these problems, and outlines the implications for public health planning.

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BOOKS On Pandemics: Deadly Diseases from Bubonic Plague to Coronavirus Author(s): David Waltner-Toews No of Pages: 248 Year of Publishing: 28 May 2020 Description: Authored by a leading epidemiologist, this engrossing book answers our questions about animal diseases that jump to humans—called zoonoses—including what attracts them to humans, why they have become more common in recent history, and how we can keep them at bay.

Almost all pandemics and epidemics have been caused by diseases that come to us from animals, including SARS, mad cow disease, and—now—Covid-19.

Chapters are broken into short, dynamic explainers, each one tackling a different disease. Readers will discover: • Why zoonotic diseases jump from animals to humans—and why some decide to stick around for good.

• How governments have responded to pandemics and epidemics throughout history, for better or for worse.

• The role of climate change, industrialized farming, cultural practices, biodiversity loss, and globalization in making these diseases not only possible, but inevitable outcomes of our modern lifestyles.

COVID-19: The Pandemic that Never Should Have Happened and How to Stop the Next On Author(s): Debora MacKenzie No of Pages: 288 Year of Publishing: 1 June 2020 Description: Debora MacKenzie has been reporting on emerging diseases for more than three decades, and she draws on that experience to explain how COVID-19 went from a potentially manageable outbreak to a global pandemic. Offering a compelling history of the most significant recent outbreaks, including SARS, MERS, H1N1, Zika, and Ebola, she gives a crash course in Epidemiology 101--how viruses spread and how pandemics end--and outlines the lessons we failed to learn from each past crisis. In vivid detail, she takes us through the arrival and spread of COVID-19, making clear the steps that governments knew they could have taken to prevent or at least prepare for this. Looking forward, MacKenzie makes a bold, optimistic argument: this pandemic might finally galvanize the world to take viruses seriously.

Fighting this pandemic and preventing the next one will take political action of all kinds, globally, from governments, the scientific community, and individuals--but it is possible.

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