Ahri 2013 annual report

ANNUAL REPORT 2012-2013

OUR MISSION Our mission is to continuously improve the quality of healthcare services provided to the communities, we serve by creating a be er environment that fosters physician participation, recognizes the value and contributions of our employees and strives to meet the unique healthcare needs of the local communities.

ANNUAL REPORT 2012-2013

T he entry of Ananthapuri Hospitals and Research Institute into

Annual Report 2012-2013

Chairman’s Message the private health care system took place in 2005 and the launch of the hospital had a overwhelming response received from the people demonstrated a long felt need for superior healthcare in a pleasant environment. Ananthapuri Hospitals Private Ltd has set up a major tertiary care hospital in the region which offered advanced medical technology and expert medical care. The Hospital was a pioneering initiative, to be developed into a centre of excellence in high technology diagnostic and curative facilities. Ananthapuri Hospitals and Research Institute has come to be known as a centre of excellence and a preferred healthcare institution in a short span of time with the wholehearted support you have extended for the past years. I express my sincere thanks for supporting our project all through the period.

I am glad to present before you the performance of AHRI during the year 2012 - 2013. We have achieved a commendable performance during this year also with the commitment and trust that the Doctors, paramedical staff and the other staff have shown towards the institution. The trust placed on us by our patients, investors, healthcare providers motivated us in achieving this performance.

3

Annual Report 2012-2013

Our hospital, continues to benchmark international best practices and constantly enhance and upgrade its facilities to increase customer comfort and convenience. It is widely acknowledged today as a reputable institution, at the forefront of private health care in the country which continues to pioneer medical procedures and technology. Over the years, Ananthapuri Hospitals and Research Institute has sustained transparency, strict compliance and a strong relationship with shareholders to build an indelible sense of trust and respect. Our operations are based on conforming to professional ethics and standards. The hospital has always maintained the highest standards in medical practice.

Our main object is to extend medical facilities of International standard to the general public of Kerala at reasonable rates and to promote Health tourism. This would help us a ract the NRI and foreigners by providing health facilities of International standards at competitive rates.

Affordable and quality health care systems would play a prominent role in making India a global health care destination. To deliver quality health care, we are adhering to modern concepts like infection control, quality improvement, credentialing and privileging of staff, patient education, respecting patients’ rights, increasing competence and accountability of the employees, and promoting team work amongst the health care providers. In all these areas we have already started progressing and have achieved quite remarkable levels.

As planned, construction of our whole project is over and the interior works on different floors are going on and is at various stages. We have expanded our facilities such as CSSD, Laboratory services, Physiotherapy, Kitchen and restaurant facilities etc I would like to express my sincere gratitude to my colleagues on the Board for their unstinted support and guidance, and to our management team and the entire team of medical and support staff who have been our ambassadors of care. I also wish to extend my gratitude to all the shareholders for their unwavering trust placed on the company which has unquestionably triggered a remarkable performance. I extend my sincere appreciation to our customers for their loyalty and support, as we look to the year ahead with renewed vigour and inspiration to be the “Hospital of tomorrow, today”.

With best wishes, Sd/Chairman & Managing Director

4

Director’s Report

ANNUAL REPORT 2012-2013

Dear Members, The Directors have pleasure in presenting the Twenty-ďŹ rst Annual Report on the working of the Company for the ďŹ nancial year ended on 31st March 2013 together with the Audited Balance

Annual Report 2012-2013

Director’s Report Sheet and ProďŹ t and Loss Account and also the Report of the Auditors thereon. The ďŹ nancial highlights for the year under review are given below: CORPORATE RESULTS The Commercial operation of the Company was formally inaugurated on 14th September, 2005.

We present before you the results of the company and its activities a er seven and half years of commercial operation of the company. The summary of the results of the activities during the ďŹ nancial year 2011 – 2012 and also for the year 2012 - 13.

Particulars (Rupees in Lakhs)

(2011– 2012)

(2012– 2013)

Income

6297

7536

Less: Operational Expenses

5146

6289

ProďŹ t/Loss before depreciation, interest and tax

1151

1247

Less: 1. Finance Cost

341

2. Depreciation

288

301 257 -

3. Miscellaneous expenditure wri en o

-

ProďŹ t/Loss a er depreciation and interest

522

Less: Provision for Tax

(105)

Add: Deferred Tax Asset /Liability

33

689 (159) (22)

ProďŹ t/Loss a er Tax

450

509

7

Annual Report 2012-2013

OUR MISSION Our mission is to continuously improve the quality of healthcare services provided to the communities, we serve by creating a be er environment that fosters physician participation, recognizes the value and contributions of our employees and strives to meet the unique healthcare needs of the local communities.

OUR OBJECTIVE 

To provide the most efficacious diagnostic and therapeutic services possible in the System, facilitated and fostered by the most modern, periodically updated equipments and patronage of reputed health care organizations all over the world, at affordable rates.



To provide supportive systems and assistance sought by other hospitals.



To establish as a center for advanced research and studies needed to improve the System.



To serve as a Research centre where the world-renowned Medical Experts can meet at conferences, periodic seminars to disseminate and share information of high therapeutic and diagnostic value.



To render altruistic and charitable services to the down-trodden and needy by conducting periodic programmes capable of meeting the objective.



To emerge and establish as the one most trusted health care centre to foster the sick.

OUR QUALITY POLICY We shall strive; 

To contribute as a tertiary hospital, superlative in services, to cater to health care needs of any kind in the best manner possible for the system today.



To offer best medical support to the patients by involving eminent medical personalities in any field of services, support staff, equipment and through personalized a ention, effective and cordial interaction by every staff of the hospital.



To provide facilities in quality at par or above standards abroad or in other states in India.



Members of various teams will work in an atmosphere of perfect harmony, mutual understanding and respect, each supporting and supplementing other’s efforts, fulfilling individual responsibilities to achieve the best result aimed by the management.

8

Improvement of Operations The company is always acutely aware that we are an enterprise engaged in an essential and critical service. Hence the quality of our service and adherence to stringent standards take precedence at the highest level. We are continuously seeking to increase the operating revenues and profitability of AHRI by the introduction of new services, improvement of existing services, developing new areas etc. We provide the best of medical and other support services to meet the present demand to provide the best patient care and comfort. Our endeavor provides best

Annual Report 2012-2013

OUR BUSINESS STRATEGY

patient care with the application of financial and operational controls. We are involved in continual development activities for the benefit of our existing facility.

Quality and Efficiency of Services Having, recognised the critical role of technology in healthcare since inception, from diagnosis to treatment, for speed, accuracy and sometimes making what is deemed impossible possible; the company will continue to make significant investments in the latest of technology and remain in the forefront of healthcare sector. We will be following technologically advanced treatment methods to increase the number of procedures done at AHRI and to make these procedures affordable to the general public. We are responding to this trend by emphasizing the expansion of outpatient services. In addition, in response to cost containment pressures, we continue to implement programs at our facilities designed to improve financial performance and efficiency while continuing to provide quality care, including more efficient use of professional and Para medical staff, monitoring and adjusting staffing levels and equipment usage, improving patient management and reporting procedures and implementing more efficient billing and collection procedures. In addition, we will continue to emphasize innovation in our response to the rapid changes in technology and market conditions while fulfilling our commitment to patients, physicians, employees, communities and our shareholders. In addition, recruiting of top-notch physicians will help to establish AHRI as an important source of quality healthcare in Kerala and neighboring states. Also we are continuously extending our services to other healthcare facilities and cases are referred to AHRI. Hospital Utilization As a provider of Healthcare, we are always and acutely aware that being engaged in an essential service that directly impact lives, underscores the need for not just the integration of sustainable practices but a sustainable mindset that permeates the entire organization.

9

Annual Report 2012-2013

Thus, a sustainability strategy and approach for the Company, and initiating action, receives priority at the highest level of the organization. We believe that the most important factors relating to the overall utilization of a hospital include the quality and market position of the hospital and the number, quality and specialties of physicians providing patient care within the facility.

Since inception, the hospital has structured its operations to ensure that it fulfils its economic, environmental and societal responsibilities in a fair and transparent manner. Generally, we believe that the ability of a hospital to meet the health care needs of its community is determined by its breadth of services, level of technology, emphasis on quality of care and convenience for patients and physicians. Other factors that affect utilization include general and local economic conditions, market penetration of managed care programs, the degree of outpatient use, availability of reimbursement programs such as health insurance, and demographic changes such as the growth in local populations. Utilization across the industry also is being affected by improvements in clinical practice, medical technology and pharmacology. In addition, hospital operations are subject to certain seasonal fluctuations.

Ability to recruit and retain quality physicians.

Typically, physicians are responsible for making hospital admissions decisions and for directing the course of patient treatment. As a result, the success and competitive advantage of our hospitals depends, in part, on the number and quality of the physicians on the medical staffs of our hospitals, the admi ing practices of those physicians and our maintenance of good relations with those physicians. If we are unable to provide high ethical and professional standards, adequate support personnel or technologically advanced equipment and facilities that meet the needs of those physicians, they may be discouraged from referring patients to our facilities and our results of operations may decline.

DIRECTORS RESPONSIBILITY STATEMENT Pursuant to the requirement under Section 217(2AA) of the Companies Act, 1956 with respect to Directors’ Responsibility Statement, it is hereby confirmed: i. that in the preparation of the annual accounts for the financial year which ended on 31st March 2013, the applicable accounting standards have been followed along with proper explanation relating to material departures;

10

Annual Report 2012-2013 ii. that the Directors have selected such accounting policies and applied them consistently and made judgments and estimates that were reasonable and prudent so as to give a true and fair view of the state of affairs of the Company at the end of the financial year and of the profit or loss of the Company for the year under review; iii. that the Directors have taken proper and sufficient care for the maintenance of adequate accounting records in accordance with the provisions of the Companies Act, 1956, for safeguarding the assets of the Company and for preventing and detecting fraud and other irregularities; iv. that the Directors have prepared the annual accounts on a growing concern basis.

OPERATIONAL ACTIVITIES AHRI, the first tertiary hospital project of Ananthapuri Hospitals Private Limited, is conceived and being implemented by a team of Professionals who are all rated quite eminent in their respective disciplines, AHRI aims to play a predominant role in the development of healthcare services in India by se ing new trends and bringing about changes cherished and earnestly sought by the society. We are steadily progressing in our Inpatient & Outpatient areas when compared to the last year. Infertility services is a new department which is introduced recently.

11

Departments Anesthesiology

Ophthalmology

Blood Bank

Orthopedics

Cardiac Surgery

Pediatric Surgery

Cardiology & Cath lab Services

Pediatrics

Dental

Physical Medicine & Rehabilitation

Dermatology

Plastic Surgery

Diabetic centre and Endocrinology

Preventive Health Check

Dietary

Psychiatry and Behavioral Medicine

ENT & Laryngology

Pulmonology

Family Medicine

Radio diagnosis

General Medicine

Respiratory Medicine

General Surgery

Thoracic Surgery

Key Hole Surgery

Trauma Care

Ananthapuri Ayurveda

Urology

Laboratory Services

College of Nursing

Gastroenterology

Institute of Para Medical Courses

Nephrology

Critical Care

Neuro surgery

Medical Oncology

Neurology

Infertility

Neonatology

Rhuematology

Obstetrics and Gynecology

Pediatric Endocrinology

OP Registrations

140000 114586

120000

122720

125637

87845

100000 80000 60000

122512

Annual Report 2012-2013

Performance Analysis

66500 47000

40000 20000 0 2006-07

2007-08

2008-09

2009-10

2010-11

2011-12

2012-13

28690

28670

2011-12

2012-13

OP New Registrations

35000 30000

30348

2009-10

2010-11

23671

25000 20000

29551

20500 16000

15000 10000 5000 0 2006-07

2007-08

2008-09

13

Annual Report 2012-2013

Total IP Patients

12000

10694

10533

2009-10

2010-11

2011-12

11453

9200

10000 7800

8000 6000

10506

5700

4000 2000 0 2006-07

2007-08

2008-09

2012-13

Total No of Surgeries 3329

3500

2952

3000 2500

3458

3197

3400

2480 2100

2000 1500 1000 500 0 2006-07

14

2007-08

2008-09

2009-10

2010-11

2011-12

2012-13

7536

8000 7000

5855

6000

5052

5000

3936

4000 3000

6297

Annual Report 2012-2013

Total Income (` in Lakhs)

2830 1939

2000 1000 0 2006-07

2007-08

2008-09

2009-10

2010-11

2011-12

2012-13

Operational Expenses (` in Lakhs)

7000

6289

6000

4844

5000

3914

4000 3000

5146

3294 1989

2479

2000 1000 0 2006-07

2007-08

2008-09

2009-10

2010-11

2011-12

2012-13

The performance of the company is veiwed mainly by the total income generated by the company and the operational expenses of the company. This is the important factor of the overall performance of the company. There is a remarkable growth in the total income of the company from ` 62.96 crores to 75.36 crores, a growth rate of 20%. We have achieved this without much facility addition. The proďŹ t of the company has grown by 13%.

15

600

500

400

300

200

100

0

Annual Report 2012-2013

509

2012-13

450

2011-12

301

2010-11

Profit / Loss after Tax (Rs in Lakhs)

GENERAL BODY MEETINGS This is the twentyâ€“ďŹ rst annual general body meeting a er the company has been registered, a er starting of the commercial operations by our company since 14th September 2005. We have completed seven and a half years of commercial operations of the company. The date and venue of the last seven annual general body meetings are as follows.

YEAR

DATE

VENUE

AGM

2005 -06

30/09/2006

Mascot Hotel, Tvpm

14th AGM

2006-07

29/09/2007

Mascot Hotel, Tvpm

15th AGM

2007-08

30/09/2008

Residency Towers, Tvpm

16th AGM

2008-09

30/09/2009

Residency Towers, Tvpm

17th AGM

2009-10

30/09/2010

Residency Towers, Tvpm

18th AGM

2010-11

30/09/2011

Residency Towers, Tvpm

19th AGM

2011 -12

30/09/2012

Residency Towers, Tvpm

20th AGM

FACILITY ADDITION Building construction As envisaged we have gone ahead with our construction of the six storied main building as per the plan. The structural work and brick work is ďŹ nished and the internal ďŹ nishing work is in progress. The total area which is proposed to be added to the existing building is around 1.2 lakh sq . The new building will have six oors similar to the existing building. The new areas which are ge ing ďŹ nished are put into operational.

16

Laundry room also has been shi ed to the new area with new equipments, separate store room, new cleaning areas etc. The new medical record area also has been shi ed to the newly constructed basement oor with racks at two levels. With this facility the medical records will have more spacious area for storing ďŹ les and facilities for converting into e-ďŹ les are also provided in this area.

Annual Report 2012-2013

In the basement oor it was proposed to have CSSD, Laundry, Auditorium, Car Parking, Pump room, Record room etc. Among these facilities CSSD, Laundry, Record room are the major facilities and these areas work has been completed and are operational. CSSD has the best of the equipments to cater to the needs of a tertiary care hospital. Separate areas for sterile and non sterile areas has been designated. Changing rooms, gauze cu ing areas, ETO sterilizer room etc.

The ground oor houses Main reception, Kitchen, Canteen, OP Pharmacy, Gi shop, OP rooms etc. Out of these the Kitchen, restaurant & OP rooms are completed and are functional. The new kitchen is spacious with advanced facilities which includes steam cooking, walk-in refrigerator for vegetables, walk-in freezer for non vegetarian items, dish washer, diet kitchen etc. The new restaurant is air conditioned, spacious with be er facilities. Also separate dining area also has been provided for Doctors in the new restaurant area. New OP rooms and toilets for the patients also has been opened in the ground oor.

In the ďŹ rst oor the internal partition work, oor ďŹ nishing work etc is over, modular partition work is in progress. In the second patient rooms and ICUs are housed. Another 20 patient rooms can be made available by October 2013. In the third oor ďŹ ve operation theatres will be operational by the end of this year. In the top oor the internal partition work is over and ďŹ nishing work is in progress.

Dierent stages of the constructions are illustrated in the following photographs

Construction work in progress

17

Annual Report 2012-2013

Construction work in progress

CORPORATE SOCIAL RESPONSIBILITY Smile Train Project Smile Train International, a voluntary international organisation is engaged in oering free cle lip surgeries for poor patients. Our department of plastic surgery has been recognized as one of the centers through which this service is rendered to poor patients. This surgery is being done by us by subsidizing the expenditure thereby partly sharing the ďŹ nancial burden of the free service. We have done a number of surgeries for cle lip in our hospital. This year we have conducted 87 free cle and palate surgeries in our institution. We also would like to spread this message so that more needed patients can be helped through this Scheme.

Charitable Activities It is a known fact that no company can survive and expand its operations unless it makes reasonable proďŹ t and cash surplus. At the same time the institution shall not forget the social obligation to the people and help various patients when they need assistance.

18

As in the previous years free medical service has been extended to deserving public by conducting free medical camps. During A ukal Pongala two medical centres were operated by the hospital. We have also extended free medical services for various social events like Asianet filmfare award function, Marathon race in connection with world environment day. This year we have done various detection camps also. 

Free Medical Camp at Avi am Thirunal Grandasala, A ukal on 07-03-2012



Medical Camp at Bethel Gram, Bethany Home for the Aged, Mukkola, Kallayam P.O., Thiruvananthapuram on 18-05-2012



Medical Camp at Rajaji Nagar, Chenkalchoola, Thiruvananthapuram on 01-07-2012



Medical Camp at PSMUP School, Mu athara, Thiruvananthapuram on 07-10-2012



Free Medical Camp at Avi om Thirunal Grandasala, A ukal, Thiruvananthapuram

Annual Report 2012-2013

Medical Camps

on 26-02-2013 

Free Medical Camp at Kairali T.V., Thiruvananthapuram on 30-04-2013

Emergency medical help preparedness during VVIP visits Whenever a VVIP visits Thiruvananthapuram our Hospital has been chosen for extending emergency medical help, at least on ten occasions this has been done.

Eco friendly Practices We have participated in Vazhiyora Thanal Scheme by plantings tree saplings along the highway and maintaining the same. Last year also we have taken part in this scheme.

The environment around our hospital has been converted into green patch with our efforts.

To add a serene environment to facilitate healing process fountains and greenery has been added in the ground floor and first floor of the hospital. The ground floor central lawn is given a new look with a different types of plants and greenery, An unique feature of our executive floor is the access to greenery from each room, which gives more ventilation and light to all the rooms in the new block.

Conservation of Water We have the most advanced technology in sewage treatment of fluid bed for Aerobic Treatment known as FAB - “Fluidized Aerobic Bioreactor”. FAB is basically a Sewage Treatment Plant in which sewage is treated in fluidized state, bacteria are grown in aerobic conditions so overall it’s a biological based system. Some of the salient features of “FAB” are Combination of A ached & Suspended Growth Processes, It is easy to operate and maintain, No short circuiting, Substantial reduction in area required. No sludge recycling, Compact Plants, Aesthetically appealing,

19

Annual Report 2012-2013

Minimum moving equipment, Freedom from monitoring of parameters, Ability to withstand power failures for longer durations, No ODOUR NUISANCE and Low chemical consumption.

This sewage treatment plant is designed to maximize the space utilization of the valuable land.

The 70% of the plant is below the ground enabling us to use the area above the sewage treatment plant. The water a er treatment is used for ushing purpose in toilets. With this system we are saving 30 to 40% of the total water requirement for the hospital.

Another important water conservation method we have adopted is the water outlets from the Air conditioning units both fan coil units (FCU) and Air handling units (AHU) is collected from each units and is centralized to a one water outlet. This water is used for cooling towers for chillers.

Advanced Life Support Ambulance A fully equipped ambulance service is available 24x7 to pick up accident victims from the site of accident, cardiological emergencies and other emergencies. There is an emergency team consisting of doctors and trained paramedical sta that can start resuscitation from the site of accident or at patient’s residence. The air conditioned ambulance has all emergency drugs and equipments for emergency intubation, multi parameter monitors, ventilators with oxygen and compressed air supply, ECG Machine and DeďŹ brillators. We have added one more mini ambulance into our emergency services to enhance our emergency medical care. The services of our ambulance has been utilized by various organizations for various events which require emergency medical help.

QUALITY ASSURANCE AND ACCREDITATION ISO CERTIFICATION Your company is recommend for ISO 9001:2000 certiďŹ cation by TUV Germany. Your company aims to achieve excellence in providing health care services as enunciated in the quality policy of ISO certiďŹ cation. The quality policy of the company is built around the following features. ď ś Medical services incorporating latest advances in knowledge, skill and technology ď ś Nursing care with the values of Courtesy, compassion and competence. ď ś Quality services achieving patient satisfaction ď ś Strive for continual improvement of quality Surveillance audit team has appreciated the quality of the work done in each departments. They also opined that ours is one of the best hospitals they have audited and mentioned that the technical stas are well qualiďŹ ed and updated

20

Annual Report 2012-2013

1. Quality Improvement programme; Sixty four quality statues monitoring programme has been established involving all departments to consistently improve the quality. The following are the highlights of this quality improvement programme;  Daily monitoring of medical records has been introduced to identify short comings of all medical records on Statistical sampling evaluation basis and trend analysis of which has indicated that we are in 80 to 90% compliance level meeting the requirements. Further improvement is in the anvil.  Patient satisfaction survey is a regular feature to know the deficiencies and the trend analysis of which shows 80-90% patient satisfaction consistently every month for the past one year.  Biomedical equipment utilization monitoring indicates that we do our best to meet the functional requirements as well revenue realization.  Turn around studies in pharmacy, diagnostic centres, OPD clinics and corrective actions has yielded considerable patient satisfaction and has started a racting patients as their choice of hospital.  Hospital infection control programme surveillance monitoring programme has indicated the safest environment in the hospital even to cater the need of patients from abroad.  Patient safe medication administration has been controlled by state of art formats and monitoring which has resulted almost nil medication errors.

21

Annual Report 2012-2013

 The state of art Triage process adopted in the Emergency and Accident care units has helped patients to give best and deserving a ention by the hospital.  Outpatient/Inpatient assessments have

become

most

scientific

through effective documentation programme and periodic trend analysis by quality department shows the state of art approach by the hospital.  Nursing assessment programme and care plan process has added very high value to the patient care programme.  Resource utilization monitoring in this programme has resulted in the most efficient revenue management  Daily quality round and matrix analysis programme of the Quality/Nursing department has yielded immense improvements in patient care process. Especially the involvement of top management in this programme has added considerable value.

2. Safety/disaster management  Management has constituted a team consisting of cream of management personnel representing medical and non medical disciplines. This team is closely monitoring the safety environment in the hospital.  Expert teams are constituted and they are functioning in the following safety programmes; i.

Code Red ; To act during fire and non fire exigencies

ii.

Code Blue; To facilitate the recovery of cardiac arrest patients at short notice.

iii.

Code white; To meet the disaster management requirements when calls for community disaster received in the hospital.

 To make above programmes continually effective mock drills are planned and conducted under the leadership of selected management personnel.  Once in every six months the above drills (Code Red, Code White, Code Blue) are organized

22

are noticed.  These mock drill helps through their involvement the following personnel to get continuing awareness and to ensure preparedness;  Fires safety team involving entire security personnel  Biomedical team  Team of Emergency physicians  Nursing staff

Annual Report 2012-2013

and based on the outputs of the drill. Corrective actions are implemented when deficiencies

 Pharmacy staff  Physiotherapy staff  PRO and related administrative support staff  Reception staff  Monthly safety rounds are organized involving Safety, Nursing and Quality team members to monitor and take corrective actions in patient and non-patient areas.  Proactive safety monitoring programme has resulted in the preventive safety measures in all new facilities establishment as well as in new process introductions.  Consequent to the feedbacks from the above team, management has added considerable resources in the areas of installation of safety equipment like sprinklers/ sensors etc.  External experts have been involved to advice on safety management.

3. Food Safety Management  Hospital has installed a state of art kitchen and dining facility to ensure food hygiene.  The implementation of the food safety programme based on ISO 22000 standards is in progress and the certification is expected to take place in another six months.  In this regard hazard analysis has been completed (Bio-physical and chemical hazards) and safety process introduction is in progress as per the standard mentioned above.  Management constituted food safety team is working for the same.

23

Annual Report 2012-2013

4. Recent NABH pre assessment audit and ISO 9001 audit have brought the facts of unique strength of the hospital especially in code blue practice.

NATIONAL ACCREDITATION BOARD FOR HOSPITALS Your hospital is working for ge ing accreditation by NABH (National Accreditation Board for Hospitals & Healthcare Providers). This activity consists of identifying process requirements as per functional requirements of hospital as well as based on NABH standards prescribed. ď‚Ş National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a constituent board of Quality Council of India, set up to establish and operate accreditation programme for healthcare organizations. The board while being supported by all shareholders including industry, consumers, government, has fully functional autonomy in its operation. ď‚Ş Hospital Accreditation is a public recognition by a National Healthcare Accreditation Body, of the achievement of accreditation standards by a Healthcare Organization, demonstrated through an independent external peer assessment of that organization’s level of performance in relation to the standards. ď‚Ş Accreditation beneďŹ ts all Share Holders. Patients are the biggest beneďŹ ciaries. Accreditation results in high quality of care and patient safety. The patients get services by credential medical sta. Rights of patients are respected and protected. Patient satisfaction is regularly evaluated. ď‚Ş Accreditation to a Hospital stimulates continuous improvement. It enables hospital in demonstrating commitment to quality care. It raises community conďŹ dence in the services provided by the hospital. It also provides opportunity to healthcare unit to benchmark with the best. ď‚Ş The Sta in an accredited hospital are satisďŹ ed lot as it provides for continuous learning, good working environment, leadership and above all ownership of clinical processes. It improves overall professional development of Clinicians and Paramedical sta and provides leadership for quality improvement within medicine and nursing. ď‚Ş Accreditation provides an objective system of empanelment by insurance and other Third Parties. Accreditation provides access to reliable and certiďŹ ed information on facilities, infrastructure and level of care ď‚Ş The standards for hospitals have been dra ed by the Technical Commi ee of NABH and contain complete set of standards for evaluation of hospitals for grant of accreditation. The organization is evaluated against Five Hundred and odd objective elements contained in ten chapters. ď‚Ş This standard has been accredited by International Society for Quality in Healthcare (ISQua).

The approval of ISQua authenticates that NABH standards are in consonance with the global benchmarks set by ISQua. The hospitals accredited by NABH will have international recognition. This will provide boost to medical tourism.

24

expert has already completed all processes to meet the NABH Standards. Gap analysis has been done 80 % is completed and we hope to go for the NABH accreditation in six months.

Pre assessment audit is completed and the ďŹ nal audit is scheduled by the end of this year. The auditors were satisďŹ ed as the number of non conformances were comparatively less and we hope we will be able to clear the main audit.

MAJOR ACHIEVEMENTS & AWARDS RECEIVED During this year Dr. A. Marthanda Pillail received the following awards: 

Life Time Achivement Award in Medical Profession by Famicom Integra



Medgate today Magazine presents MT INDIA HEALTHCARE AWARDS 2013 “ Honoring

Annual Report 2012-2013

ď‚Ş Five member quality control team under the leadership of Mr. Kalayanasundaram a quality

Excellence� India’s Top Doctor 2013 

Ever Time Achievement Award 2013 for Health b SBARMATHI CHARITABLE SOCIETY, Thiruvananthapuram.



CMAAO –IMA Oration award 2013

INTERNATIONAL CONFERENCE AND MEETING ATTENDED Course Director & Faculty-Dr.C.G.Bahuleyan, Chairman & HOD, Cardio Vascular Centre 

The INDIALIVE 2013 with American College of Cardiology from February 27th to March 2nd at Chennai, India “Case presentation – in the session Acute Coronary Syndrome – Le Main Acute Occlusion with Cardiogenic shock Speaker: Multi vessel Coronary Interventions symposium – Topic: “Revascularisation and lessons learned from recent trials Chairperson – ACS symposium



As faculty in the National Interventional Council Meeting at Calcu a on 13/4/2013



As a faculty in European Society of Cardiology (ESC) conference at Amsterdam in September 2013



20th Annual National Conference of Indian College of Cardiology meeting at Trivandrum, Kerala, India in September 2013.

Organising Chairman & Speaker: Borderline lesions on CAG: Leave them or Treat Them Prof. Dr. A.Marthanda Pillai, Chairman & Managing Director is a member of the following commi ees •

Member of Health Policy Commi ee , Government of Kerala

•

Chairman organizing Commi ee International Conference of CMAAO in September, New Delhi

25

Annual Report 2012-2013

CME PROGRAMME AT AHRI 

8/11/2012: Tachy Vision-Concept of ICD (Implanted cardiverter defibrillator)



2/2/2013: Topics: Event Loop Recorder, Coronary sinus anatomy assessment for CRT therapy, indications and techniques of CRT, CRT-P Vs CRT-D, CRT product details and trouble shooting



6/8/2013: Bio Resorbable Scafffold - Absorb

TRAINING & DEVELOPMENT ACTIVITIES OF THE HRD WING I. The HRD activities obviously commence with Manpower Planning based on the following aspects.  Adequate number and mix of staff to meet the care, treatment and service needs of the patient is arrived through regular assessment by HRM as under;  Project reports, technology advancement planning inputs are used for staff mix requirement when new project or technology is introduced in the patient care services.  Incident report analysis when caused due to staff shortage of adequate mix the human resource planning is initiated.  In the key indicators analysis when target fixed is not reached consequent to human resource constraints result in human resource re-planning by HRM.  Periodic employee satisfaction analysis with job description is done if necessity of human resource constraint is justified based don which human resource re-planning is done.

II. The next stage is the induction training programme which is given to all the new recruits.The induction training programme are held with the following objectives a. Each staff member, employee, student and voluntary worker is appropriately oriented to the organization’s mission and goals.  Hospital’s mission is;  Service with; Sincerity Solicitude and Sophistication Organizational Goals:

26

•

Total customer satisfaction

•

Reputation based business growth

•

Professional competency at par with national/International standards

Performance index of all clinical and other services best in the industry.

•

Sta satisfaction level to surpass the expectations

•

Community health care services best in the social sector

b. Each sta member is made aware of hospital wide policies and procedures as well as relevant department / unit / service / programme’s policies and procedures.

Stas are introduced to hospital wide policies and procedures through orientation of sta immediately a er joining.

Stas are provided with hand book which enlighten them on policies and procedures

Annual Report 2012-2013

•

A training matrix is prepared to plan to train stas on their departmental, units, service policies and procedures. This training is conducted by trainers identiďŹ ed and scheduled half yearly wise. c. Each sta member is made aware of his/her rights and responsibilities.

Employee hand book is provided to every employee wherein these are covered.

III. Professional training and development Professional Training and development relates to the performance in the present and future anticipated jobs. The employees are provided with opportunities to advance personally as well as professionally. Training process;  Training starts with half yearly/ annual plan prepared in matrix structured for department/processes/schedule/faculties.  Continuous education for nursing by nursing supt. (For objectives/course details refer Appendix B & C)  Periodical clinical meetings (continuous education program)  External training for sta  In house training by invited external trainers.  On job sta training. a. Training also occurs when job responsibilities change / new equipment is introduced

• Training needs identiďŹ ed ; ď‚ľ For new recruits in the interview process. ď‚ľ When technology advancement is ventured ď‚ľ When new equipment is added.

27

Annual Report 2012-2013

 When new project is introduced.  During job responsibility changes of sta.  As an outcome from employee satisfaction survey  From corrective action recommending trainings from incident report, sta appraisal continuous improvement planning.  From internal audit reports  As per request from HODs and other senior employees or top management. b. Feedback mechanism for assessment of training and development program exist.

• A er each training session feedback is collected from participants in a standard format

• HRM assesses the feedback reports and identify corrective actions in consultation with the faculty and HODs.

• Also feedback is collected from HODs on employee performance consequent to the training eectiveness IV. Safety training a.

Safety training is given to employees with the following objectives All sta is trained on the risks within the hospital environment.

• In the HRM training matrix, speciďŹ c job duties or responsibilities related to safety, is scheduled and implemented.

• Entire sta including students, contract sta, and volunteers (presently not existing in the hospital) are included in this training.

• Risks in the hospital environment departmentwise are identiďŹ ed and training material covers the same. b.

Sta members can demonstrate and take actions to report, eliminate / minimize risks.

The training session consists of in-situ training where sta demonstrates and take actions to report, eliminate/ minimize risks.

c.

Sta members are made aware of procedures to follow in the event of an incident.

Safety sign boards are displayed for guidance where essential department safety procedures exist: ďƒ˜ Laboratory safety process ďƒ˜ Radiation safety process ďƒ˜ Waste management practices ďƒ˜ Infection control practices.

28

Incident report system exists V. The required programmes to the required sta in the following areas are programmed AAC

-

Assessment and Continuity of Care

COP

-

Care of Patients

MOM

-

Management of Medication

PRE

-

Patient Rights and Education

HIC

-

Hospital Infection Control

CQI

-

Continuous Quality Improvement

ROM

-

Responsibilities of Managemnt

FMS

-

Facility Management and Safety

HRM

-

Human Resource Management

IMS

-

Information Management Systems

Annual Report 2012-2013

d. Reporting processes for common problems, failures and user errors exist.

Induction Training programme is aimed at orienting/familiarizing the new recruits to the organization.

The topics covered include 1. Organization Mission and Goals 2. Employee rights and responsibilities 3. Hospitalwise and departmentalwise policies and procedures.

4. Service standards of the organization.

5. Risk and safety awareness in the hospital environment 6. Occupational Health hazards-How to eliminate 7. Job description and Performance appraisal 8. Grievance Handling 9. Disciplinary procedures 10. Patients rights and responsibilities 11. Other behavior aspects like Team building and communication skills.

12. Customer satisfaction.

29

Annual Report 2012-2013

The trainees are taken around the hospital for familiarization and the whole training is evaluated by the participants.

ACADEMIC PROGRAMS NURSING COLLEGE We are happy to inform you that ďŹ h batch for BSc Nursing students have joined the institution and we have started admission for the second batch of MSc students in our college.

ANANTHAPURI INSTITUTE OF PARAMEDICAL SCIENCES Courses started are DMLT, DOTT, DCVT, DDT and DNT. The admissions, Examinations etc are conducted by the Director of Medical Education. 50% of the seats will be ďŹ lled up from the Merit list prepared by the DME and the remaining 50% will be ďŹ lled up by the management. We have admi ed students in all the ďŹ ve courses and courses are going on for these courses.

Diploma in Medical Laboratory Technology (DMLT) Diploma in Cardiovascular Technology (DCVT) Diploma in Neuro Technology (DNT) Diploma in Operation Theatre Technology (DOTT) Diploma in Dialysis Technology (DDT) Masters in Accident and Emergency Medicine (MAEM)

Dr. A. Marthanda Pillai, Chairman and Managing Director inaugrating the new course Masters in Accident and Emergency Medicine (MAEM)

30

Monthly clinical meetings are very popular among our doctors and nursing sta, where clinical updates are done and interesting cases are discussed.

Recognized centre for training Ananthapuri Hospitals has been recognized as a training centre for various departments.

Physiotherapy Department Students from school of Medical education, Ko ayam,

Annual Report 2012-2013

Monthly Clinical Meeting

Gems college of Physiotherapy and Christian college of Physiotherapy and similar institutions come for undergoing internship training a er completion of the Physiotherapy course.

International Students from Manchester, Cardi and New Castle universities, UK, come here for training in the Physiotherapy Department.

Biomedical Department Students who have completed Diploma/Degree/M-tech in Biomedical Engineering as well as students who are studying these courses are given training in the Biomedical Department.

The training is usually for six months and the trainees get familiarized with the day to day working of the Biomedical department such as Servicing, Calibration and maintenance of medical equipments.

Master in Hospital Administration / Business Management Students from various institutions undergoing MHA and MBA regularly do their thesis and project work under the guidance of Human Resource and Public Relations Department.

Medical Records department Our medical records department whose functioning has been specially appreciated by the ISO surveillance team is imparting handson training for students undergoing Medical Records course.

31

Annual Report 2012-2013

MAJOR EQUIPMENTS PURCHASED 1.

Lab Microscope

2.

Ultra Sound Machine

3.

Stryker ENT Debrider

4.

Blood Bank Centrifuge

5.

Laproscope

6.

Biosafety Cabinet

7.

Rotablator - Cathlab

8.

Intravascular Ultrasound System

9.

Syringe Pumps - 10 nos.

10.

Oto Acoustic Emission

11.

Multi Parameter Monitors - 10 nos.

NEW SENIOR DOCTORS JOINED THE AHRI TEAM INCLUDES  Dr. Vandana MS, DGO Infertility & Laproscopic  Dr. Mili, DCH  Dr. Rajesh Rajan, MD Ph.D, D.Card, FESC, FACC, FHAA  Dr. P. Deepa, MD DNB (Gynecology)

32

 Dr. Dalia Divakar, MD (Anesthesia)  Dr. Suresh Kumar KL, MS, MCH (Neuro Surgery)  Dr. Smitha Elizebath George (Anesthesia)  Dr. Harikrishnan (Anesthesia)  Dr. Ajmal Abdul Kareem (Cardiology)  Dr. Thankaraj (Emergency Medicine)

Annual Report 2012-2013

 Dr. Sheeja, DA, DNB (Anesthesia)

 Dr. Aneesh (Emergency Medicine)  Dr. Ratheesh MD (Cardiology Dept.)  Dr. Chandralekha Nair, MS (ENT Dept.)  Dr. Madhu Rajan MS, MCh (Cardio Thoracic Dept.)  Dr. Vishad Viswanath MD, DM (Rhematologist)  Dr. Venu Velayudhan MS, MCh, FRCS (Urologist)  Dr. Thulasidas, DLO (ENT Dept.)  Dr. Rajeswari, MD, DGO (Gynecology Dept.)  Dr. Veena V. Nair, MD, DCH, PDCC (Pediatric Endocrinologist)  Dr. Jacob John, MD (General Medicine) OPERATION THEATRES: AHRI has 4 major and 1 minor Operation Theaters. Major operation theatres are set up with laminar flow and it is designed with seamless cladding and equipped with central medical gas system, modern anesthetic machines and sophisticated theatre equipment like Carl Zeiss operating microscope, modern ventilators and surgical diathermy unit.

Operation theatres are subjected to its optimal use with proper planning for general surgeries, Neuro Surgeries, Cardiac Surgeries, Orthopedic, Gynaec, ENT, Cosmetic, Oral and Facio Maxillay Surgeries, Urology, Plastic and Ophthalmology Surgeries. To cater to the surgery load we have opened two more theaters in the Operation theatre floor.

33

Annual Report 2012-2013

24 HOUR SERVICES: •

Pharmacy Services

•

Laboratory Services

•

Radiology and Imaging Services

•

Emergency Room and Intensive Care Unit with the service of a resident Anesthetist.

•

Round the clock Services by all Specialists/Super Specialists along with Cath Lab facilities.

•

Advanced Ambulance services

•

Restaurant Services

LIFE CHECK AHRI believes in “Staying Healthy is Staying Happy” and has health check up packages for preventive Health care •

Executive Life check ( Men)

•

Executive Life check ( Women)

•

Diabetic Life Check

•

Cardiac Life Check

•

Women’s Exclusive Life Check

INFECTION CONTROL Multidisciplinary team with doctors, nurses, infection control nurses, microbiologist and administrators maintain constant surveillance over potential infection in sensitive areas of the hospital.  Meets every month and also as and when required.  Frames policies  Nosocomial infection surveillance.

MAN POWER The strength of manpower forms the basic form in which a tertiary care hospital is build up. We have put all our efforts to a ract, train and mould them to suit our requirement of total patient care. The need for qualified professionals is always a challenge and keeping this in mind we have a system of recruiting qualified staff in various fields.

The performance of our staff is appraised by the Human Resource Department and the need for

34

is provided for the staff. The staff with remarkable performance is specially considered and given be er incentives.

We depend on the efforts, abilities, and experience of our medical support personnel, including our nurses, pharmacists, lab technicians and other health care professionals. We compete with other health care providers in recruiting and retaining qualified hospital management, nurses and other medical personnel.

The nationwide shortage of nurses and other medical support personnel has been a significant operating issue facing us and other health care providers. This shortage may require us to

Annual Report 2012-2013

training is assessed by this department, specialized skill requirements are assessed and training

enhance wages and benefits to recruit and retain nurses and other medical support personnel or require us to hire expensive temporary personnel.

We cannot predict the degree to which we will be affected by the future availability or cost of a racting and retaining talented medical support staff. If our general labor and related expenses increase we may not be able to raise our rates correspondingly. Our failure to either recruit and retain qualified hospital management, nurses and other medical support personnel or control our labor costs could harm our results of operations.

MARKETING AND PROMOTIONAL EFFORTS Third Party Administrators: . During this year we have entered into insurance tie-ups with all the major insurance companies and third party administrators in the country. There is a considerable growth of patients in the last year availing the cashless facility. This trend is going to continue and we require to strengthen this department to process the bills faster.

MEDICAL TOURISM Trying to a ract medical tourists from different parts of the world for the treatment of various procedures like dental, cosmetic, plastic and orthopedic Surgeries, we are planning to have tie ups with various tour operators in the country and abroad. As a part of promotion of Medical Tourism, Government of India has invited us to participate in the IMTD Exhibition in Kuwait and we have participated in the exhibition in Kuwait.

Male consulate has recognized our hospital as one of the major referral centre for treatment and Ananthapuri Hospital forms the only private hospital recognized by the consulate for medical treatment.

OTHER ACTIVITIES: Media marketing – Articles in dailies, Newsle er, Website, Television, in-house initiatives etc.

35

Annual Report 2012-2013

AHRI COMMITTEES: For ensuring be er service and in delivering quality care to the patients various commi ees are formed to monitor and review the process.

1. Drugs Commi ee: To identify and scrutinize the drugs used in the Hospital.

2. Infection Control Commi ee: Department and hospitalwide infection control policies and procedures & their compliance.

3. Research and Development Commi ee: To involve in research related activities 4. Scientific review and Research Commi ee: This commi ee deals with all ethical issues relating to patient care, professional and research.

5. CME Programme Commi ee: To organize continuing medical education programs 6. Mortality review commi ee: Discuss special cases in the hospital.

7. Quality commi ee An apex commi ee for planning, monitoring providing resources, accountability and reviewing all activities related to the quality management system at the hospital. This includes the process of management review.

8. Transfusion Commi ee: This commi ee will be looking into the standards and functioning of the blood bank.

RESEARCH & DEVELOPMENT AND TECHNOLOGY We have formed the scientific review and ethics commi ee which is necessary for starting research work in our hospital. Neurosurgery, cardiology and ENT departments have presented their work in various conferences.

MEDICAL TRIAL An Ethics Commi ee and scientific review commi ee has been formed according to ICMR guidelines.

A multi centric national trial on nutrition and outcome in stroke has been completed.

International trial – REGENSIS STUDY in acute ischaemic stroke has been completed.

Cardiology Research Projects TUXEDO India Study Title: A Prospective Single Blind, Multi-centre, Randomized Trial to Compare the TAXUS ElementTM Coronary Stent Against the XIENCE PrimeTM Coronary Stent System in the Treatment of a Diabetic Patient Population in India.

PSEZES STUDY Study Title: A registry based on prospective study to evaluate the safety and efficacy of

36

Artery Disease (CAD) involving long lesions greater than 20 mm.

STEPPAMI Study Title: "A prospective, observational, multi-centre study comparing Tenecteplase facilitated PCI versus primary PCI in Indian patients with STEMI." Protocol No.: LA-RSH/93/2011 ACS Retrospective Study Study Title: "A Multicentre Retrospective Study to understand anti-thrombotic treatment

Annual Report 2012-2013

Zotarolimus Eluting srent (Endeavor Resolute by Medtronic) in patients suffering from Coronary

pa erns and outcomes of Acue Coronary Syndrome patients in India."

Protocol No.: TRACE/NIS-CIN-XXX-2010/1 Trivandrum Heart Failure Registry This study is supported by Indian Council of Medical Research (ICMR) is conducted by Sree Chitra Institute and other hospitals in Trivandrum. Our Hospital is one of the participating cetnre for this study. 1 year results are registered in this.

ENVIRONMENT, SAFETY AND ENERGY CONSERVATION Safety of environment and a pollution free world continues to be a key area for your Company.

The company has established and is operating a Sewage Treatment Plant for treating the waste water. As your Company is engaged in providing services, its operations require minimal energy consumption. As an endeavor to reduce and conserve energy, your company has made the following efforts.  Chiller balancing done to increase efficiency  Power factor maintained at 0.95 throughout the year for be er efficiency  To reduce water consumption water treated from STP is used for flushing, Construction, Cooling Tower and gardening.  To reduce the consumption of water sensor taps have been installed in most of the public and high consumption areas.

FOREIGN EXCHANGE EARNINGS AND OUTGO Your Company has earned foreign exchange, for an amount equivalent to Rs.1,05,09,427/- for the services rendered to foreigners during the period. The Company has incurred an expenditure of Rs.1,12,45,985/- in terms of Foreign Exchange during the year under report.

37

Annual Report 2012-2013

FINANCE CORPORATE GOVERNANCE Your company has been practicing the principles of good corporate governance since inception.

In accordance with section 383 A of the companies act 1956 and the companies (Compliance Certificate) rules 2001, the company has obtained a certificate from a secretary in whole time practice confirming that the company has complied with the provisions of the companies act 1956.

PARTICULARS OF EMPLOYEES AS REQUIRED UNDER SECTION 217(2A) OF THE COMPANIES ACT, 1956 The Company has no employees whose remuneration would exceed the limits prescribed under section 217(2A) of the Companies Act, 1956.

REASONS FOR THE FAILURE IF ANY, TO COMPLETE THE BUY BACK WITHIN 12 MONTHS UNDER SECTION 77 4(4) There was no buy back of shares during the financial year and as such the information under this section is not applicable to the Company.

DIRECTORS In accordance with the provisions of the Companies Act, 1956 and the Company’s Articles of Association, Three Directors Mr Narayana Pillai, Dr A Gopal, and Dr. N Swornam retire by rotation and being eligible, offer themselves for re-appointment.

AUDITORS The statutory Auditors M/s. Issac and Suresh Chartered Accountants Thiruvananthapuram



retires at the coming Annual General Meeting of the Company and are eligible for appointment.

38

Your Directors wish to place on record their sincere thanks and appreciation for the whole-hearted, co-operation and support received from our esteemed

Annual Report 2012-2013

Acknowledgement shareholders and investors. The Directors gratefully acknowledge the valuable and timely advice and support received from various Government Departments, Banks and other Financial Institutions. Your directors also thank the employees of the Company at all levels for their hard work, dedication and commitment.

For and on behalf of the Board Sd/Dr. A. Marthanda Pillai Chairman and Managing Director Trivandrum 05.09.2013

39

Financials

ANNUAL REPORT 2012-2013