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Healthcare Vol 1 Issue 1 | February 2012 | `100

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E D I S INExclulesfivroem

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ENERGY MANAGEMENT Maintaining sustainability by energy efficiency

BGS Global: Backed by a Legacy The home of India’s leading medical minds

Challenges: Hospitals are now waking up to increasing fire safety

A Synonym to Excellence: Dr. Naresh Trehan

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Foreword Dear Friends, It’s been a long journey of 15 years for HOSMAC. Since the time HOSMAC was founded, I have always believed that there was a gap for information in our industry. Since then while,we went about setting up HOSMAC’s business, in small ways we were always making attempts to bridge this gap. The last few years have seen rapid growth and the information need gap suddenly has increased. We at HOSMAC have been feeding information to you in some way. Our first initiative was the HOSMAC Pulse, which received much appreciation from the select audience which it addressed. But with the growing e-world, we had to get something which addressed you daily and hence we launched ‘Healthcare Business alerts’. These alerts have been growing steadily with more and more of you subscribing to the same. It was now time for us to get into the next level and cover a larger audience who could benefit from our initiatives. Hence, what you are holding now is the result of extensive research and thoughts put together. Due to our experience of working with you, we realised the areas of information that you seek. Here in the first issue of Healthcare Executive we have dealt with one of the most important aspect in healthcare – Infrastructure. The magazine will have a theme for every issue and all topics of that issue would be around that theme. In the forth coming issues you will see more of the various themes which will focus on important aspects of your business. Our investment towards ensuring that you get the best from around the world has taken us a step further and we would also showcase some of the best practices from around the world. In this issue you will read about ‘Lender’s Engineers’ concept from Harvard Business Review. We will continue to strive to get such valuable content to you and share with you news and happenings from around the world. We have a long way to go in order to satisfy your hunger for knowledge. But the beginning has been made and I am sure that we would only grow together from here. Your support and inputs would be vital for us to help you in making smarter business decisions. I would be waiting to hear from you on making this better with every issue. Sincerely, vivek.desai@hosmac.com

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Dear Readers, We take pride in bringing to you the first issue of ‘Healthcare Executive’. A publishing initiative by HOSMAC India Pvt. Ltd, Health Executive was conceived with the notion of aiding the reader with a ready handbook full of information that will help them take strategic business decisions. The magazine is divided into 8 sections, apart from the Cover Story. We have designed the magazine to cover each aspect of a business model of a healthcare organisation. Every issue, we will design a theme and bring to you articles related to it. For a better understanding, let me take you through the sections of Healthcare Executive: • Challenges: A new story every issue on key management issues like finance, administration, HR, etc. • Brick& Mortar: This topic would cover key aspects of building, construction and design • Case study: A case study on various subjects of implementing best practices from across the globe • Leaders speak: This would be a story authored by a leader on his experiences of running effective business • U Ask: An eminent personality would answer all the queries related to management or any administrative issues put up by our readers • Debate: It would be an opinion page where on a subject we would seek opinions from across the industry • Global Practices: Any new technology or implementation from across the globe • Focus: This would highlight on the achievements of an organisation Valuing the readers’ need of having a healthcare magazine with the likes of a Harvard Business Review, we have brought Healthcare Executive for you. This magazine will guide you by being a handbook to run your healthcare business successfully. By understanding the need of the hour, the demand of our readers, we have brought out a magazine that will bringpathbreaking ideas out from the minds of healthcare experts, onto the pages here – for our readers to take benefit from. On behalf of Team Healthcare Executive, I welcome our readers to be a part of the Healthcare Executive family! Sincerely, narendra.karkera@hosmac.com

Editor in chief Dr. Vivek Desai

Sr. Correspondent Arunima Rajan

Publisher Narendra Karkera General Manager Ganesh Lakshmanan

Marketing & Sales Head Sales Deepti Khanna Marketing & Subscriptions Isha Khanolkar

Editorial Deputy Editor Jayata Sharma-Sand

Art & Design Glowrt Design House Cover Design - Pramod J

Print and Production Printed by Abhishek Ostwal and Published by Narendra Karkera on behalf of Hosmac India Ltd., 120 Udyog Bhavan, Sonawala road, Goregaon (E), Mumbai – 400 063. Disclaimer: Views and opinions expressed in this magazine are not necessarily those of HOSMAC India Pvt. Ltd., it’s Publisher and/or Editors. We, at HOSMAC India Pvt. Ltd. do our best to verify the information published but do not take any responsibility for the absolute accuracy of the information. HOSMAC India Pvt. Ltd. does not accept the responsibility for any investment or decision taken by readers based on the information provided in the magazine. HOSMAC India Pvt. Ltd. does not take responsibility for returning unsolicitated material sent without due postal stamps for return postage. No part of this magazine can be reproduced without the prior written permission of the Publisher. HOSMAC India Pvt. Ltd. reserves the right to use the information published in the magazine in any manner whatsoever.

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Volume 1 Issue 1

CONTENTS FEBRUARY | 2012

News 08 The latest in the world of healthcare. This section has both national and international news of your interest. Read it to stay updated

Challenges 20 A feature on how hospitals have waken up to the fact of fire safety and are working to set things right. Along with a detailed note on how can a healthcare facility prevent fire mishaps

Brick & Mortar 26 An interesting insight into the importance of floor design for

hospitals and how they play a vital role in safety. The author says it’s high time hospitals must take this aspect seriously

Case study 32 A feature on the sustainable healthcare design in a Middle East hospital, the Al Mafraq Hospital. Slated to complete next year, the project has ambitious plans for its future

Cover story 36 Hospitals are now trying to incorporate energy efficient systems in their facilites for better outcomes and profitable business. The industry is now realising the fact that sustainability of a facility depends a lot on such proactive steps

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Leaders speak 46 A Harvard Business Review article on Lender’s Engineer to help manage construction risks.

U Ask 60 Uday Kumar answers questions regarding numerous hospital engineering issues. He tries answering complex engineering queries with simple and easy to undertand responses

Debate 62 An opinion piece on whether healthcare experts should be involved in town planning to chart better healthcare facilties for citizens. Features comments of prominent people of the industry

Global Practices 67 A special report on a cancer


facility that specialises in treatment for teenagers, keeping in mind their every requirement and comfort

times, the Biography of Steve Jobs by Walter Issacson; and Immortals of Meluha by Amish Tripathi

Portrait 70

Jobs 78

Dr. Naresh Trehan gets candid about his professional journey and opens up his plans for the future of his dream project

A section that would capture best jobs in the healthcare industry

Focus 72 A spotlight on BGS Global Hospital, Bangalore highlighting its achivements and numerous outstanding features

Book Review 76 Bringing you an insight into two of the most loved books of recent

Happenings 80 A listing of various events from across India and all around the world. Have a look to get updated on the same

CEO Page 82 Vishal Bali gives a peek into his favourite pass times, his vision and ambition for his career and his liesure choices Healthcare Executive February 2012 | 7


NEWS National Fortis emerges Asian healthcare heavyweight Fortis Healthcare India, owned by brothers Malvinder Singh and Shivinder Singh, recently completed its $665 million buy-out of 100 per cent stake in Fortis Healthcare International. The acquisition has been criticised by some analysts as Fortis Healthcare International is also owned by the Singh brothers. However, this deal also transforms Fortis Healthcare India — which did its initial public offering in 2007 — in the league of large hospital chains in Asia with a sizeable clout. The combined revenues of both the companies add up to over $1 billion. With 74 hospitals, 12,000 beds, 580 primary care centres, 191 day care speciality centres, 190 diagnostic centres and an employee base of over 23,000 across 10 countries, Fortis Healthcare India now has gained footprint in varied business models. Fortis Healthcare India disclosed that the acquisition was completed by its wholly-owned subsidiary Fortis Asia Healthcare (FAHPL).

“The purchase consideration for equity shares of Fortis International amounting to $262 million (after taking into account the outstanding liabilities of Fortis Healthcare International) is being funded through infusion of $262 million against redeemable preference shares of FAHPL issued to the promoters of the company,” a BSE filing read. With the deal, Fortis has become larger than its closest peer in India, Apollo Hospitals that has around 8,700 beds in over 52 hospitals. According to data, Fortis is positioned as the leading integrated healthcare services provider in Asia in some parameters. While there are larger companies in terms of revenues such as Bangkok Dusit ($1.2 billion), Parkway ($1.1 billion), Ramsay ($4 billion) and Healthscope ($2.2 billion), Fortis clearly can address larger number of patients with its 12,000 beds (10,270 in Fortis network hospital group and 1,800 beds from Fortis International).

Teamwork Communication wins best PR agency award in Healthcare Teamwork Communication Solutions, a leading Public Relations consultancy headquartered in New Delhi, has been recently conferred with the prestigious Business and Service Excellence Award for Best PR Agency in Healthcare sector. The Business and Service Excellence Awards, instituted by Brands Academy, recognize North India’s leading service organizations and professionals, who have displayed exemplary excellence in their respective fields. Teamwork Managing Director Kamal Narayan Omer received the award from Dr. Shashi Tharoor, former Union Minister of State for External Affairs and renowned author, human rights activist and a Member of Parliament in the award ceremony recently held at Gurgaon. “With its innovative campaigning modules and sound understanding of complicated healthcare issues, Teamwork has created a niche in the Healthcare communication in a short span of time,” Omer said accepting the prestigious award. “The agency handles several

communication campaigns covering almost all major issues related to health and wellness. We are really honored to get this recognition. This is the result of our sincere service commitment to our clients. This award will certainly motivate us to take our services to even greater levels,” he added. The awards were based on a comprehensive market research study and opinion surveys conducted by BIG Brands Research, one of the top market research agencies in India. Teamwork Communication, an integrated brand promotion firm designs healthcare communications campaigns that are “creative, compelling, and human”. The company has previously handled major campaigns for, World Alzheimer’s Day, National Cerebral Palsy Day, International day of persons with disabilities and campaign against Breast Cancer and female feticide among others. The company is a service provider to various healthcare organizations such as Allergan Healthcare India Pvt. Ltd., India Medtronic, Sandor, Zimmer India, Cipla and hospitals among several other corporate houses.

Nephrolife brings 1st networked dialysis to Hyderabad NephroLife, a pioneer in kidney care and a leading renal replacement therapy (RRT) provider, has established its presence in the heritage city of Hyderabad, by opening the first and exclusive state-of-the-art unit at the Challa Hospital, Ameerpet locality, to provide India’s first high-end networked dialysis under the guidance of renowned nephrologists.

The NephroLife unit at Challa Hospital has started with 8-bed capacity and will undertake capacity addition in the coming days. Well-known nephrologist Dr. Ashwin Aiyangar has joined NephroLife in Hyderabad to augment the local as well as the national teams. The Bangalore-based NephroLife will shortly expand its presence in Andhra Pradesh by

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1362_India Edge Ad


setting up more exclusive units and a flagship hospital in Hyderabad and beyond. “Our thought behind opening the NephroLife unit in Hyderabad is to bring world-class kidney dialysis services at a highly affordable price point. We are the only providers of networked dialysis in India. The dialysis can be monitored in real time – thereby improving patient safety

in the long run. It also automates the entire record entry process and ensures that our staff can focus purely on patient care,” said Shriram Vijayakumar, Founder and Managing Director, NephroLife. The quality of dialysis services provided by NephroLife is very high, thanks to a robust dialysis programme for patients. This is achieved through the state-of-the-

art networked dialysis machines and the highest spec Reverse Osmosis water purification plants, thereby affording a better quality of life in the long run to those in need. To ensure the highest quality clinical outcomes, NephroLife adopts international standard protocols and infection control precautions alongside a highly trained team of technicians and therapists.

“We at Challa Hospitals were among the first to start dialysis services in Hyderabad region. But in NephroLife, we found a focused partner who provides dedicated, top-quality nephrology care. This is a boon to those suffering from End Stage Renal Disease (ESRD) in Hyderabad”, said Dr. Jayanth Challa, Managing Director, Challa Hospitals.

Muljibhai wins IMC Ramkrishna Bajaj Quality Award

Accent MRI Pacemaker launches in India

Muljibhai Patel Urological Hospital (MPUH) Nadiad was recently declared as the winner of the prestigious ‘Indian Merchants’ Chamber (IMC) Ramkrishna Bajaj National Quality (RBNQ) Trophy 2011’ in the Health Care category. The IMC Ramkrishna Bajaj National Quality Awards (IMC RBNQA) are modeled along the lines of the Malcolm Baldrige criteria of the USA and follow a rigorous process of training and evaluation. The Award program is considered as a catalyst for nation-building. The IMC RBNQ Awards give special recognition to excellence in organisations. MPUH is the first hospital in Gujarat to win this coveted Award. The Award will be given away at a grand function following the conclusion of the ‘Making Quality Happen Conference’ at Mumbai in March 2012. The IMC RBNQA is one of the most prestigious Quality Awards in the country. The award process started in 1997 with manufacturing organizations and now covers six categories – manufacturing, service, small business, overseas, education and health care. It has four levels of recogni-

St. Jude Medical, Inc. (NYSE:STJ), a global medical device company, recently announced the launch of the Accent MRI™ pacemaker and Tendril MRI™ lead. The new pacemaker and lead allow patients to undergo full-body; highresolution magnetic resonance imaging (MRI) scans to accommodate patients’ current and future medical needs. Each year approximately one million pacemakers are implanted worldwide, and it is estimated that up to 75 % of pacemaker patients could benefit from MRI scans during the lifetime of their devices. The new Accent MRI pacemaker system is an advanced pacing platform that provides wireless telemetry and algorithms to address individual patient conditions, with the added benefit of MRI conditional scanning capability. Commenting on the Accent MRI Pacemaker, Dr. Ulhas Pandurangi, Chief Electrophysiologist at Madras Medical Mission in Chennai said, “Undertaking MRI scans in patients with pacemakers has previously been fraught with technical difficulties and challenges, and the safety was not clear. I feel, I can now advise patients that a magnetic scan can be performed without compromising the safety of the pacemaker or the patient. In this particular case, I chose the Accent MRI pacemaker because this elderly patient had neurological and orthopedic ailments, and may one day benefit

tion – Commendation Certificate, Certificate of Merit, Performance Excellence Trophy, and the most prestigious IMC RBNQ TROPHY. The Award winners were selected by a distinguished panel of judges, chaired by Mr. Anand Mahindra. Earlier, a team of specially trained examiners designated by the IMC RBNQA evaluated MPUH on seven criteria spanning leadership; strategic planning; focus on patients, other customers and markets; measurement analysis and knowledge management; workforce focus; process management; and results. The Award Criteria emphasises on openness and transparency in governance and ethics. The rigorous process began in August 2011, when the application was submitted, and a presentation was made to the Team of Examiners a month later. The experts do extensive research on the organisation for over a period of one and half months and benchmark it with the competitors. There were two days of on-site inspection in November by the team of examiners during which all the facets of our organisation were audited based on the seven-point criteria.

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from an MRI scan.” The system features an MRI Activator™ device that provides a simple alternative option for programming the device to the appropriate MRI mode for use during the scan. A single button press on the handheld MRI Activator device can be used to program the specific device parameters to be used during the MRI scan. These parameters are pre-selected by the patient’s physician and stored in the Accent MRI pacemaker. Built on the proven Tendril lead platform, the pacing lead offers unique design advantages for safe, MRI-conditional scanning. The thin diameter makes it easier for physicians to implant, as it retains the handling characteristics of the well established Tendril platform of pacing leads. In addition, the lead features Optim™ lead insulation, the first siliconepolyurethane co-polymer material created specifically for cardiac lead use. The Optim insulation is designed for long-term reliability, while providing better flexibility.


Clinigene International enters Seed Healthcare launches cloud technology for hospitals into Collaborative Clinical Research Services agreement & clinics with Pacific Biomarkers

Pune-based healthcare solutions provider, Seed Healthcare Solutions Private Limited (SHS), recently released its Palash software solution on cloud technologies for hospitals and clinics. “We have partnered with CtrlS, a data centre facility to undertake this pioneering effort for the healthcare segment,” said Narendra Barhate, CEO, SHS and Dinesh Samudra, director, Seed Healthcare Solutions. “Palash is developed on public and private cloud that will enable healthcare providers to move from capex model to opex model for their IT needs. This will not only increase their overall operational efficiency, but will also free them from making huge capital investments that are generally made in

IT infrastructure. The solution has so far been successfully implemented at over 90 clinics in India, UAE and Netherlands. Apart from solutions based on private could, we have also introduced a subscription based model for public cloud and have launched the same for the IVF Clinics across India. Subscription-based delivery model will soon be launched for General Practitioners Clinics as well,” said Barhate. SHS says that this solution will help the hospitals to reduce their operational cost by 50 to 60 %. The company has also formed a joint venture with a company called Health Information Systems in Jordan to focus upon tapping the markets in the Middle East and North America.

Clinigene International Limited, a subsidiary of Biocon, India’s largest Biotech Company, and Pacific Biomarkers Inc. (PBI), a Seattle, WA-based limited liability company recently announced a collaborative agreement to address the specialty biomarker and high-end clinical trial laboratory needs of the global pharmaceutical and biotechnology industry. Clinigene, is an India-based Clinical Research Organization (CRO) that offers end-to-end clinical and laboratory services for accelerating clinical research, and Pacific Biomarkers Inc. (PBI), is a Seattle, WA-based company that provides premier biomarker and specialty efficacy testing services to the drug development industry. “PBI is a recognized global leader in providing specialty biomarkers and clinical diagnostic assay services to discovery- and development-based life science

enterprises. We are delighted that PBI has selected Clinigene as its partner in India and we look forward to supporting PBI in extending and expanding its specialist service offerings,’’ said Peter Bains, Director of Research Services business. “This partnership with Clinigene provides us access to India, an emerging hub for drug development and contract research. Further, Clinigene’s state-of-the-art facilities and highly qualified staff help us offer to all of our clients an economic option to conduct their biomarker and specialty clinical lab tests. We are also excited about Clinigene’ s unique capabilities in cell-based assays and immunoanalytical testing services, which are of great interest to the global pharmaceutical and biotechnology community,” said Ronald Helm, CEO of Pacific Biomarkers.

Padma Bhushan for Dr. Shetty Somerset Indus Capital Raises $25M for Healthcare Fund Well known cardiac surgeon Dr. programme. Billed as the world’s Devi Prasad Shetty was recently chosen for the prestigious Padma Bhushan Award for the year 2012. Dr. Shetty, 58, founded Nara¬yana Hrudayalaya, a multi specialty hospital in Bangalore. He has also founded Rabindranath Tagore International Institute of Cardiac Sciences in Kolkata. Dr. Shetty, who has performed over 15,000 heart operations, was instrumental in the launch of the state government’s Yashasvini

cheapest comprehensive health insurance scheme, it is replicated by several states. Dr. Shetty has been planning huge expansions lately and wishes to bring affordable healthcare to every nook and corner of the country. In fact, in his recent statements, he has been heard saying that he would prove to countries with the likes of the U.S. that how an affordable healthcare system along with the best quality can be put in place.

Somerset Indus Capital Partners, an offshore private equity firm focused on making healthcare investments in India, has raised $25 million as first close from institutional and HNI investors, two sources close to the development told VCCircle. Somerset Indus Healthcare Fund has roped in eight investors including two US-based institutional investors who have a long history of investing into the healthcare space. The first close was completed last month. The PE firm is now targeting a corpus

of $40 million and it expects to raise the amount by the end of this year, sources add. However, the spokesperson of Somerset Indus Capital Partners said the firm would not like to comment on the reported developments. The PE firm has already made its debut investment by acquiring 32 % stake in privately held Sandor Medicaids Pvt Ltd, a Hyderabad-based marketer, seller and distributor of specialty pharmaceutical, diagnostic and medical technology products.

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LifeCell International to become India’s 1st & only AABB Accredited stem cell bank for Umbilical Cord Tissue banking LifeCell, the pioneers in Umbilical cord blood, cord tissue and menstrual stem cell bank has been awarded the most prestigious AABB (American Association of Blood Banks) Accreditation for its umbilical cord tissue banking services. With this achievement, LifeCell becomes the first and only stem cell bank in India to possess AABB Accreditation for both cord blood and cord tissue preservation. This accreditation has been granted following an intensive on-site assessment by AABB assessors. The assessment includes stem cell processing, cryo-preservation records, document control, inspection and testing, training of lab technicians, sample identifica-

tion, traceability and validation of cord tissue preservation to quality compliances. During this audit, it was determined that LifeCell’s level of medical, technical and

administrative performance met the standards set by the AABB. Mayur Abhaya, Executive Director, LifeCell International, said, “It is a proud moment for us that LifeCell has been the second company in the World to receive AABB accreditation for cord tissue banking which reinstates our commitment to better quality and

strengthens our position as a global leader in stem cell preservation. This also assures parents who are banking their baby’s umbilical cord blood and cord tissue stem cells with us that the sample has been qualified, collected, tested, processed, and stored as per internationally approved standards and gives them a ready access to the stem cells from any part of the world, when needed.” LifeCell has made significant investments to establish a world class in-house research facility where we developed the technology to derive cord tissues from mesenchymal stem cells in 2009. Today, LifeCell in the largest processor of cord tissue from mesenchymal stem cells in the world.

BGS Global Hospitals commissions world’s most advanced radiation therapy technology for Cancer Treatment

As a landmark development for cancer patients, Global Hospitals Group recently announced the launch of BGS Global Cancer Institute. This Institute is equipped with the world’s most advanced radiation therapy machine, TrueBeam STx. In India, there are some centers (though none in Namma Bengaluru) which are equipped with nor-

mal TrueBeam, but BGS Global Hospitals is introducing TrueBeam STx for the first time in Asia Pacific. The TrueBeam STx is an advanced radiation therapy machine engineered to perform the most sophisticated radiation therapy and radio-surgery procedures with pinpoint accuracy and ultra-fine precision. It works by choreographing highly sophisti-

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cated systems—imaging, beam delivery and motion management—and makes it possible to deliver treatments quickly while monitoring and compensating for tumor motion. It will enable faster, accurate tumor targeting in the treatment of challenging cancers throughout the body, including those in the brain, pancreas and liver. Already installed and operational, Radiation oncologists at BGS Global Hospitals are routinely performing complex procedures with amazing precision and patient comfort. Dr. K. Ravindranath, Chairman & Managing Director, Global Hospitals Group, said, “At Global Hospitals Group, we are on a constant quest to bring patients the best treatments in the form of clinical expertise and technology. Towards this, we have been continuously investing on the most advanced technologies.”

Perfint sees revenue triple to $5 million in 2012 Perfint Healthcare Pvt. Ltd, a Chennai-based medical devices company, expects revenue to more than triple to $5 million this financial year, stoked by the depreciating rupee and expected sales from a new low-cost robotic diagnostic tool for cancerous tumours. Robio EZ, a stripped-down variant of the larger Robio EX diagnostic tool, is priced at `. 15 lakh, about one-third the `. 50 lakh price tag for the full-bodied version. The low-cost variant is being made especially to service diagnostic centres in small towns and cities. The precision machines will be used for biopsies of tumours and other oncology-based tests. “Patients and doctors will prefer a less invasive procedure, but again the cost per procedure being transferred to the patient will (weigh in),” said Anjan Sen, director of life sciences and healthcare at Deloitte Touche Tohmatsu India Pvt. Ltd, when asked about the scope for such products in the Indian market. The six-year-old company has received $12 million from venture capital funds IDG Ventures India, Accel Partners India and Norwest Venture Partners and expects to raise $20-25 million over the next 18 months. The company hopes that China will be its largest market in the next three years, contributing to the $100 million revenue figure it hopes to achieve by 2016. Perfint supplies to big healthcare establishments (like Apollo hospitals and Global hospitals) and teaching hospitals in India and has been exporting equipment since April 2011. It ships equipment to West and South-east Asia, South Africa, Turkey, and the Netherlands, and expects to make a dent in the European and Latin American markets this year.


Kalyanis of Bharat Forge set up research and diagnostics centre for prostrate cancer Prostrate cancer, considered the second highest cancer among males in India with a reported incidence of 1.5 people per 1 lakh population, has grown into an aggressive type. The disease, which usually occurs in men over 50 years of age, is under-reported which leads to late detection. To address this, the Pune-based Kalyani group has funded the Centre for Prostrate Cancer which will become operational in the next few months. The Institute will house the research and day care centre while the patients will be located in Ruby Hall Clinic

To address this, the Pune-based Kalyani group has funded the Centre for Prostrate Cancer which will become operational in the next few months. The Institute will house the research and day care centre while the patients will be located in Ruby Hall Clinic

Dr Ashutosh Tewari, a urologist and the Ronald P Lynch professor of urology-oncology at the Weill Cornell Medical College, New York city, USA, has been appointed director of the institute. He will visit it every three months and set up the diagnostics, treatment, education and eventually, cure for the disease. “Indians are two times more prone to an aggressive type of Prostrate Cancer than Caucasians. We don’t know what causes it to become so aggressive among Indians, even Americans of Indian origin and it is difficult to

extrapolate the data we have on Caucasians (whites) onto Indians. We want to study the defective gene among Indians since this is a genetic disease,” said Dr. Tewari. BN Kalyani, chairman of the Kalyani group, added, “We have set up this institute as data suggests that when an Indian gets prostrate cancer it acclerates very fast. It was not a very widespread disease in India till about a decade ago. We want to create awareness that all it requires is a simple screening to detect the cancer. We also want to create a family history, to map its genetic origin.”

PE firms show more interest in Dialysis Chains Life HealthBessemer Venture Partners has raz Bugwadia, managing director care signs backed Hyderabad-based Nephroat the investment bank o3 Capital. deal with Max plus, another dialysis chain which “The size of the Indian dialysis

After eye care, dialysis chains seem to be the next target of private equity investors looking to bet on the Indian healthcare space. NephroLife Care (India) Pvt Ltd, a renal disease management chain, has raised $25 million from New Enterprise Associates (NEA) and DaVita, Inc., one of the largest kidney care companies in the USA. The deal comes soon after

plans to open 100 centres. There is also Alliance Medicorp India, a JV between Apollo Hospitals and GSK Velu’s Trivitron, which operates both dental and dialysis centres. Alliance is also looking to raise 60 crore in PE funding. Fortis Healthcare also said last month that it was planning to open 50 dialysis centres by investing over 30 crore. “Nephrology is clearly one of the single specialty themes and an attractive sub-segment in the healthcare chain. Scale and margins are good, and you can cater to a large demography,” said Shi-

services market is estimated at 480 crore with haemodialysis accounting for 77 per cent of the market,” said a note from o3 Capital, adding that 95 % of such machines are in hospitals. The deal is one of the rare transactions where a strategic and a private equity investor are joining hands to back an Indian entrepreneur. Another such deal took place when private equity firm Peepul Capital partnered with Europe’s largest loyalty programme player Payback GmbH to buy a majority stake in India’s largest loyalty card provider i-mint.

Life Healthcare Group Holdings recently announced that it has signed definitive agreements with Max Healthcare Institute Limited (MHC) and Max India Limited for the subscription of 26% of the post-issue share capital of MHC. This is subject to the fulfilment of certain conditions precedent. The subscription price is 516.5 crore. Life Healthcare will provide pro-rata guarantees for its proportionate share of the debts of MHC currently guaranteed by Max India.

International QuadMed forms partnership with MDLiveCare, extends reach of Healthcare Services QuadMed, a nationwide leader in employer-sponsored healthcare solutions, will deploy state-of-theart telehealth technology across its network of worksite healthcare clinics through a new partnership with MDLiveCare. MDLiveCare offers access to

a national network of boardcertified physicians and licensed therapists, in conjunction with QuadMed’s network, providing quality healthcare services via secure video, telephone, and email communication. Under an exclusive agreement,

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QuadMed will utilise MDLiveCare’s proven telehealth technology to create a ‘Virtual QuadMed’ approach that significantly expands the scope of its clinics, giving employees and their family members another way to access QuadMed providers and services. “Virtual QuadMed will allow us to extend our approach to patient care to a geographically distributed workforce to increase access to preventive care, and further

manage healthcare costs for our customers and their employees,” said Tim Dickman, President of QuadMed, a subsidiary of global printer Quad/Graphics. “QuadMed chose MDLiveCare as our telehealth strategic partner because its technology offers the best balance of customer functionality combined with seamless integration into our electronic medical records, delivering our patients the best

Konica Minolta launches EnvisionIT Konica Minolta Business Solutions U.S.A., Inc. recently announced the launch of Konica Minolta EnvisionIT, a new brand position that encompasses solutions and services for the healthcare industry designed with their specific business in mind. The EnvisionIT family aims to assist vertical market customers in “envisioning” how they can work smarter and more efficiently with integrated workflow solutions designed and supported by Konica Minolta. As part of the initial EnvisionIT offering, Konica Minolta will provide Managed Print Services, Managed IT Services via All Covered, integrated solutions via the bEST program, professional services, hardware and support, all under a single platform. As healthcare providers continue to look for ways to improve patient care but also drive down costs, Konica Minolta EnvisionIT Healthcare offers the necessary solutions to save money and improve overall efficiency in any size healthcare environment. Highlights of EnvisionIT Healthcare include: • Prism HealthFlow – Powered by a robust document and forms management system, HealthFlow improves workflow efficiency by

eliminating paper-based forms, while providing an integrated and low-cost document management solution for healthcare facilities. Administrators can create an endless range of e-Forms and e-Documents dynamically. HealthFlow was designed to streamline workflow while keeping patient records secure. • NSI Autostore for Healthcare – NSI Autostore streamlines workflow by providing healthcare administrators the ability to press a single button on the control panel of a bizhub MFP and automatically scan prescriptions to pharmacies or directly to electronic medical record applications. This advanced capability results in the reduction of transmission errors, lowers costs, and assists healthcare facilities in providing more timely and efficient services to their patients. “The EnvisionIT solution line is part of our targeted focus on vertical markets as we move into 2012, by delivering specially-tailored office solutions and services that bolster our award-winning product line,” said Sam Errigo, Senior Vice President, Business Intelligence Services, Konica Minolta Business Solutions U.S.A., Inc.

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continuity of care in a completely secure environment.” The new telehealth capabilities will also allow QuadMed, which operates clinics for nationwide companies like MillerCoors, Northwestern Mutual, Briggs & Stratton Corp. and STIHL, Inc., to provide more convenient care to smaller employers and employers with a distributed workforce. Integrating MDLiveCare’s technology platform with QuadMed’s

healthcare solutions is a natural fit that will deliver immediate benefits to QuadMed, its customers and their patients, according to Randy Parker, MDLiveCare Chairman and CEO. “MDLiveCare and QuadMed each offer market-leading solutions to help employer-sponsored health programs control costs while expanding access and improving outcomes,” Parker said.

Wasp Barcode Technologies launches new healthcare barcode scanner Wasp Barcode Technologies, a leading provider of small business productivity solutions, recently announced the launch of the WWS450H healthcare barcode scanner with base. Designed specifically for the healthcare industry, the scanner features fast, efficient barcode scanning, antimicrobial protection and wireless connectivity. Common uses for the WWS450H include: checking patient and prescription records, scanning medicine packaging or hospital equipment, updating inventories or scanning 2D and postal barcodes in shipping and receiving. Wasp’s WWS450H 2D barcode scanner is designed specifically for healthcare environments, allowing medical staff to treat patients efficiently and without errors. The WWS450H features built-in antimicrobial technology for protection against odor-and-stain causing bacteria and disinfectant-friendly housing to protect the scanner from alcohol cleaning, preventing discoloration, corrosions, and hardware malfunction. Both features further enable the scanner’s use in patient rooms, laboratories, and pharmacies.

“Wasp Barcode has a long history of delivering products to help businesses operate more efficiently. Over the years, we’ve received quite a few requests for a product for the healthcare industry that would increase productivity and safety,” said Brian Sutter, director of marketing at Wasp Barcode Technologies. “To answer this demand and best serve the healthcare industry, we created a product that is mobile, durable, affordable and safe to use in sterile environments. We’re incredibly excited for what the WWS450H delivers to the healthcare industry and I think healthcare professionals will see the benefits of using an asset tracking system made specifically for them.” The WWS450H includes a USB adapter for the base that can be plugged into a PC to quickly upload data up to 295 feet away from the adapter using wireless connectivity. Barcode data is instantly added to a spreadsheet, document, or database, without timeconsuming manual data entries or inaccuracies. The WWS450H barcode scanner improves patient safety, prevents medical errors and increases caregiver productivity.


Teleflex introduces Arrow® NextStep® Antegrade Dialysis Catheter Teleflex Incorporated, a leading global provider of medical devices for critical care and surgery, has expanded its interventional access portfolio with the Arrow NextStep Antegrade catheter, now available for sale in the United States. The Arrow NextStep Antegrade is a chronic hemodialysis catheter that combines a step-tip catheter’s ease of insertion with a split-tip catheter’s sustained high flow. Its unique tip is designed for smooth, over-the-wire transitions during catheter insertions and exchanges. To reduce recirculation and deliver high flow, the Arrow Next-

Step Antegrade’s tip provides two unique, complementary features: 1. The openings are reversed to take better advantage of blood flow dynamics within the heart. 2. The distal tips of both lumens are significantly separated to help enhance flow and minimize recirculation. The NextStep Antegrade is one of several options in the Arrow dialysis catheter portfolio, a portfolio built with clinical needs and preferences—and the patient’s needs—in mind. The Arrow chronic hemodialysis catheter portfolio offers both split-tip and step-tip catheters for

both retrograde and antegrade insertion techniques. The Arrow NextStep product family consists of step-tip catheters that can be tunneled using the retrograde or antegrade technique. The Arrow Cannon® II Plus and the Arrow Edge® products are split-tip catheters that can be tunneled retrograde or antegrade, respectively. Teleflex offers catheter sets with Arrow Simplicity® colorcoded micro puncture introducers and Arrow SmartSeal® Hemo-

static Peelable Dialysis Sheaths. Teleflex also provides an offering of ARROWg+ard Blue® Acute Hemodialysis Catheters in the ErgoPack™ System. These acute catheters are treated with ARROWg+ard®, Teleflex’s proprietary chlorhexidine-based antimicrobial technology. “Our interventional access products highlight our commitment to partnering with customers to help enhance patient outcomes. Our goal is to offer products that are designed for optimal performance,” said Linda Beneze, VP & GM, Specialty Products Division, Teleflex Incorporated.

PeriGen, Inc. names Allscripts Mentor Capital acquires 50% Executive Matthew Sappern of Brighter Day Health for $5M Mentor Capital, Inc. recently plus for all parties involved with Chief Executive Officer

PeriGen, Inc., the leader in perinatal-specific clinical decision support for hospitals, recently announced that it has appointed Matthew Sappern as the Chief Executive Officer, effective immediately. “We are delighted that Matt Sappern is coming on board to lead PeriGen. Matt’s proven expertise in driving the growth of sophisticated, groundbreaking healthcare IT products is a great fit for PeriGen.” Sappern, 45, joins PeriGen from his position as Senior Vice President, Client Sales at Allscripts,

a $1.3 billion global leader in the electronic medical records industry. At Allscripts, Sappern’s Client Sales team achieved record bookings in 2011. Sappern joined Allscripts in 2010 following its merger with Eclipsys, where he served as a corporate officer and Senior Vice President of Professional Services responsible for directing the Services division, encompassing the company’s consulting, implementation, and education and training services. Before that, he served as Senior Vice President of Technology Solution Services at Eclipsys, which he joined in 2003, after serving in leadership roles at WebMD, Time Warner, Primedia and Young & Rubicam. David Jahns, member of PeriGen’s Board of Directors, and Managing Director of Galen Partners, said, “We are confident that as chief executive officer, Matt Sappern will significantly expand PeriGen’s market footprint so that the breadth and depth of its innovative, clinical decision support technologies can touch more patients.”

16 | February 2012 Healthcare Executive

announced that it has executed a long-term funding agreement to receive a current 50% ownership in Brighter Day Health, LLC, pending their expected shareholder approval. Brighter Day provides face-to-face doctor interaction through secure computer video set-ups for ultra-economic health care delivery at nursing homes and similar treatment facilities. Mentor Capital is to provide $5.0 million in future growth funding for Brighter Day Health to continue its multi-state expansion plan. “Telemedicine is the fastest growing method of delivering face-to-face healthcare to patients in the United States. Brighter Day Health has been an early leader in this field and is partnering with Mentor Capital to finance our accelerated facility and video system additions.” “Reducing the cost and inconvenience of the routine or follow-up doctor visit for often challenged cancer or other patients is an obvious

a compromised patient,” says Mentor Capital CEO, Chester Billingsley. Edward Mashek, the CEO of Brighter Day Health, explains, “Telemedicine is the fastest growing method of delivering face-to-face healthcare to patients in the United States. Brighter Day Health has been an early leader in this field and is partnering with Mentor Capital to finance our accelerated facility and video system additions.” The Brighter Day Health portfolio addition brings Mentor Capital cancer and financial assets to $10 million from $1.0 million in November 2011. Mentor has approximately 2.9 million basic shares outstanding and has traded in the quarterly range of $0.10 to $0.26 per share.


Amistaff Healthcare Technology changes company name to Prophecy Healthcare, Inc® Amistaff Healthcare Technology, recognized as industry leader for online, healthcare competency testing, recently announced its new company name, Prophecy Healthcare, Inc ®. With the expansion of competency assessments and solutions now provided, the company is changing its name from Amistaff HCT to Prophecy Healthcare to better reflect the company’s comprehensive portfolio of employment prediction assessments for the healthcare industry in a time where hospitals seek ways to raise patient satisfaction ratings. Amistaff HCT’s flagship product, NurseTesting.com, was limited by the name in that it infers the company solely tested

“nurses”. With the transition to Prophecy Healthcare, NurseTesting.com became Prophecy Clinical Assessments – one part of a suite of assessments including Behavioral and Situational Assessments that generate a holistic report incorporating interpersonal competencies typically missed in traditional testing. “The unveiling of Prophecy Healthcare® marks a significant milestone for our company. Since we consolidated our business objective to focus on what we do best, testing and assessment, we were searching for something new. After 3 years of research and development on our “new” assessments, which resulted in us being able to predict the likelihood of

success of candidates before they were hired, we were looking for branding and a name that focused on the predictive value of our new service,” explained Ronald Gonzalez, CEO/Founder of Prophecy

candidates for their organisation and education coordinators evaluate and educate current staff members using the information generated from our Prophecy Assessments.”

Healthcare. “Prophecy seemed like a natural fit since its definition is on mark with what we are attempting to do with our testing: ‘the foretelling or prediction of what is to come.’ We want to help both hiring managers select the best

Effective immediately, all future business activity will be conducted using the new name. There has been no change in the company’s management or ownership leaving clients with the same Prophecy Crew Members they have grown to know and trust.

NJ to get a new cancer therapy center soon http://www.app.com

Beginning this spring, the ProCure Proton Therapy Center, 103 Cedar Grove Lane, will become one of 10 proton therapy facilities in the country, and the only in New Jersey and the New York metropolitan area. CentraState Healthcare System, a hospital in Freehold, is another ProCure partner. “It is a major accomplishment for New Jersey to have this kind of center,” said Chris Domalewski, director of marketing and business development. ProCure is a privately held health-care company that provides

proton therapy — an advanced form of radiation therapy that uses heavy charged particles — to patients with cancer, and the New Jersey center will be its third location. The 60,000 square foot building will be able to treat 1,500 patients a year at capacity and

employ 100 people, according to the center’s president, James Jarrett. “From shovel in the ground to first patient treatment will be about 24 months,” Jarrett said of the construction that began in April 2010. He further added, “We treat patients with various types of brain tumors, patients with lung cancer, a number of head and neck types of tumors, as well as prostate cancer. Within pediatrics, it’s typically brain tumors and central nervous system tumors.”

PwC US earns 2 Best in KLAS Awards PwC US has been recognised in the annual Best in KLAS Awards as the top services provider in the nation for its work in helping to improve the financial performance of hospitals and other healthcare providers through revenue cycle transformation and extended business office services.

PwC was the only professional services firm to earn two Best in KLAS awards in 2011, outperforming competitors in an independent ranking of performance data representing the collective voice of over 18,000 senior healthcare executives from more than 4,500 hospitals and 2,500 clinics

and physicians offices across the United States. The recognition signifies PwC’s leadership in the quality of its professional staff, effectiveness in resolving issues, and delivery of added value in key areas of financial performance for healthcare providers.

Oracle launches Insurance Claims Adjudication Oracle recently introduced Oracle Insurance Claims Adjudication for Health, a highly configurable, rules-driven claims system that helps payers reduce administrative costs and increase member and provider satisfaction. The application enables healthcare payers to: • Easily configure business rules to process more complex claim scenarios automatically, increasing consistency in claims payments while reducing the number of claims processed manually. • Achieve more accurate first-pass adjudication of claims, reducing the number of claims requiring Oracle recently introduced Oracle Insurance Claims Adjudication for Health, a highly configurable, rules-driven claims system that helps payers reduce administrative costs and increase member and provider satisfaction. The solution supports major medical, dental, vision and behavioral health claims.

Healthcare Executive February 2012 | 17


HCA Central and West Texas Division named among Top 15 Health Systems in the U.S. by Thomson Reuters

Covidien contraindicates the use of Duet TRSTM for Thoracic Surgery, implements a voluntary recall

In a recent announcement, HCA Central and West Texas Division, including Central Texas-based St. David’s HealthCare and El Paso-based Las Palmas Del Sol Healthcare, was named among the nation’s 15 top U.S. health systems by Thomson Reuters, a leading provider of information and solutions to improve the cost and quality of healthcare. The award recognises hospital systems that have achieved excellence in clinical outcomes, patient safety, patient satisfaction and operational efficiency, based on balanced system-wide clinical performance. Selected from more than 300 healthcare systems across the nation, HCA Central and West Texas Division was one of only two health systems in Texas to receive this ranking. The Thomson Reuters “15 Top Health Systems” study singled out 15 hospital

Covidien (NYSE: COV), a leading global provider of healthcare products, recently announced that it is conducting a voluntary recall of all production lots for the Duet TRSTM Universal Straight and Articulating Single Use Loading Units, with respect to the use of this product family in the thoracic cavity. “These steps are consistent with our belief that patient safety is a commitment that cannot be compromised. After receiving reports connecting the use of the Duet TRS with patient deaths after thoracic surgery, we have made the decision that the product should not be used in such procedures,” said Bryan Hanson, Group President, Surgical Solutions, Covidien. “Accordingly, we are advising our customers that the Duet TRS should not be used in thoracic surgery.” Covidien has received reports of 13 serious injuries and three

systems that achieved superior clinical outcomes based on a composite score of eight measures of quality, patient perception of care and efficiency. “We are pleased that our commitment to high-quality care is receiving national attention from such an esteemed organisation as Thomson Reuters,” David Huffstutler, President of HCA Central and West Texas Division, said. “The dedication of our doctors, nurses and staff to providing exceptional care to every patient every day has helped establish our system’s reputation as a national center of excellence.” U.S. health systems with two or more short-term, general, non-federal hospitals; cardiac and orthopedic hospitals; and critical access hospitals were assessed in the study. Researchers looked at eight metrics that gauge clinical quality and efficiency.

fatalities, following the application of Duet TRS in the thoracic cavity. The Company has concluded that Duet TRS has the potential to injure adjacent anatomical structures within the thorax, which may result in life-threatening, post-operative complications. Covidien is working with the United States Food and Drug Administration (FDA) and other worldwide regulatory authorities to modify instructions for use to contraindicate the device in thoracic procedures in both adult and pediatric populations. Further, the Company placed a hold on its Duet TRS inventory globally to allow for the relabeling with new instructions for use. Additionally, it is providing information to its customers on alternative tissue reinforcement products that may be used in conjunction with Covidien endoscopic staplers for thoracic surgery.

OnX Enterprise Solutions signs strategic partnership deal with MEDSEEK OnX, a leading North American enterprise data center IT solutions provider, recently announced that it has entered into a strategic partnership with MEDSEEK, the industry’s only provider of the optimal 360-degree online healthcare experience. OnX will leverage MEDSEEK’s strategic patient management solutions and OnX’s Federated Cloud Framework to help healthcare organizations optimize their IT investments. “MEDSEEK’s experience and track record aligns well with OnX as we share a common focus on reducing the cost of health care, delivering more responsive

patient services, and addressing the challenges of delivering the highest quality patient care across the entire continuum of care” According to Ed Vos, OnX President and CEO, MEDSEEK has a proven track record of providing industry-leading strategic patient management solutions. “MEDSEEK’s experience and track record aligns well with OnX as we share a common focus on reducing the cost of health care, delivering more responsive patient services, and addressing the challenges of delivering the highest quality patient care across the entire continuum of care,”

18 | February 2012 Healthcare Executive

said Vos. The partnership allows OnX to distribute all of MEDSEEK’s enterprise strategic patient engagement solutions, including clinical, consumer, employee and patient technology, to provide a 360-degree digital health experience. By reselling these solutions MEDSEEK and OnX together will expand MEDSEEK’s presence in Canada and enable OnX to continue to expand its healthcare practice.


Challenges Hold That Fire

Hospitals are now working hard to tackle the task of fire safety, says Isha Khanolkar

I

n the event of the recent tragedy at the AMRI hospital in Kolkata, there has been an impetus from the healthcare industry to ensure that they take proactive measures to prevent a repeat of such an occurrence in their own set-up. The National Accreditation Board for Hospitals and Healthcare Providers (NABH) had kept the hospital’s application for re-accreditation from November 10 of this year in abeyance because of certain ‘non-conformities’ in expected standards. In Mumbai, according to a news report, after the AMRI incident, an inspection report by the Fire Brigade department, 56 hospitals were found in gross violation of fire safety norms, of which 30 were private and 26 were state-run, civic or peripheral. At the other end of the spectrum, hospitals like Bangalore-based Columbia Asia which recently had its own brush with a similar fire at its Hebbal facility escaped the disaster unscathed with all its 79 patients being evacuated safely outside. The disparate outcomes of both the events lead us to put the spotlight on the importance

of planning for fire safety from the conceptualisation stage of a hospital. Hospital building design and ‘best-practice’ manuals demand that after appropriate fire-fighting infrastructure and equipment — from ramps to patient evacuation to appropriate numbers of fire-extinguishers — are in place, the staff needs to be periodically trained to respond to emergencies. The need for monitoring the implementation and effectiveness of fire safe building plans as well as evacuation strategies has increased with the sudden spurt that healthcare infrastruc-

20 | February 2012 Healthcare Executive

ture has seen in the recent past. The need for standards stems from the fact that the increasing number of hospitals springing in tier 1 and tier 2 cities should guarantee a minimum level of patient safety of which fire is a major component. In hospital buildings, particularly in patient access areas, the immediate and total evacuation of the building in the event of a fire may not be possible or desirable. This calls for the abidance of norms such as the National building Code, NABH (National Accreditation Board for Hospitals in India), State bye Laws on Fire Safety by

all hospitals . The Fire Safety Act–2005 states that every private or government building should follow fire safety measures like the building’s architectural design, installation of portable fire extinguisher and other measures as per the instructions of the fire department.

Fire committees a Must While standards enforced by the NABH mandate that healthcare care organisations need to have fire and non-fire emergency committees to oversee the prepared-


ness of the hospital to handle emergencies caused by fire out breaks, preemptive planning would ensure that the infrastructure is capable of withstanding such a disaster. But we have to keep in mind that NABH is not a regulatory agency and can merely ask hospitals to provide the approvals it has received from local fire and building regulatory authority to show evidence of safety. In countries like the United Kingdom, the National Health Services has drawn out specific guidelines that aid in the design of healthcare facilities to ensure that they are fire proof. The Health Technical Memorandum 05-02 for guidance in support of functional provisions for healthcare premises states that the design of a healthcare facility should ‘ensure that at all material times, patients, visitors and staff have appropriate means of escape to enable them to move to a place of temporary safety inside the healthcare premises on the same level from where further escape is possible’. Why is it then that manage-

ments fall short when it comes to ensuring that their hospitals are fire proof? The issue begins at the initial stages of building the hospital .While owners try to maximise the usage of every square inch of the hospital space to squeeze in beds for revenue, spaces for areas like fire exits and landings are thought to be a luxury. The cost for ensuring that the infrastructure of the building is compliant with fire safety norms would generally cost the promoter not more than 50-75 rupees per square foot. Sadly, this is the first cost reduction opportunity that comes into view. In certain cases, the state fire officials are also lax about the manner in which the No Objection Certificates (NOC) are handed out . Promoters thus seize the chance to be casual in their approach to the fire safety norms they are bound to follow.

Risk Assessment

According to a study on Tolerable Risk Criteria for Hospitals by the Department of Fire Safety Engineering, Sweden, the basic fire safety design

22 | February 2012 Healthcare Executive

process consists of four main stages: Qualitative Design review, Quantitative Analysis, Assessment against criteria, Reporting and presentation. During the qualitative design review the scope and objectives of the fire safety design are defined, the process performance criteria are established and one or more proposed design solutions are proposed. Using fundamentals of fire science, the quantitative analysis is conducted by using six subsystems which reflect the impact of fire on people and property on different stages of development.

Planning For Safety

Ideally owners should try and purchase plots specially designated for hospitals in their respective towns and cities. This automatically ensures your plot has adequate access width to the plot and plot size, shape is appropriate for the intended use. While planning the project the promoters or their representatives should hire specialist MEPF (Mechanical, Electrical, Plumbing and Firefighting Consultants)

along with architects to design their buildings. Fire safety will then be designed into the building infrastructure from the start. Once the building plans have been finalised, they are to be submitted to the chief fire officer of the state to obtain a clearance for the building. The building plans are then reviewed and verified for compliance by the chief fire office for suitability. If any deficiencies are found during the course of the inspection, they would be communicated to the owners/promoters. Building plans need to be submitted to the chief fire officer after verification if the hospital would be in the line of the master plan/zonal plan. Upon the clearance of the plan, the NOC from the fire and safety point of view.

Fire Proof Design

The design and construction of the building should ensure that fires are detected at the earliest possible opportunity. This requires a concentrated effort by the MEPF engineers assigned to the project to carefully incorporate the safety component into


the building without disturbing the clinical planning and services layout of the hospital. A few key elements that would lead to sound fire safety designs are enlisted below: The fire resistance of the structure of the building should be reviewed for its ability to resist collapse, fire penetration and the transfer of excessive heat. To prevent the premature failing of the structure the load bearing elements of the building should have a minimum period of fire resistance to collapse or failure of load bearing capacity. The culmination of all these efforts will result in the reduction of risk to the occupants and firefighters. Fire Zones are generally demarcated in the cities as per the National Building Code. Under the code, hospitals fall under the sub division C1 which in turn appear in the Fire Zone one category according to the code. While designing the elevation of the hospital, care should be taken to introduce vertical and horizontal fire breakers in the form of chajjas or fins to prevent fire from spreading across rooms or floors. In case of glass facades, openable windows should be designed at every floor/ room. Refuge floors, where provided, should be equipped with taps, showers to provide instant relief to burn patients. The design and construction of the building should ensure that at all times patients, visitors and staff can move away from a fire to a place of temporary safety. The fire zones would ensure all the services including HVAC get compartmentalised. The lift shafts and lift lobbies should be pressurised in case of a fire outbreak and at least one lift to be designed as a fireman’s lift. One could design the fire zones in such a way that you have at least one staircase and a bed lift with a enclosed lobby which is close to a fire tower design which could be used by the firemen to rescue the patients. The floor should be divided into 2 or more fire zones

depending on the size of the floor plate. The idea should be to defend in place in case of a fire. Location of Staircases The location of staircases should be such that the travel distance is kept as per the local byelaws or National Building Code whichever is more stringent. The internal staircases should be pressurised. According to the building bye laws set by the Ministry of Urban Development in India, the following should be kept in mind while placing the staircases for a hospital: 1. Fire escape should not be taken into account while calculating the number of staircases for the building

2. Fire escape staircases are required to be free from obstructions and directly connected to the ground. 3. The external closing walls of the staircase should be composed of brick or RCC having a fire resistance of not less than two hours. The staircase enclosures need to be ventilated to the atmosphere at each landing. 4. A mechanism for pressurising the staircase shaft should be present so that it will operate automatically on the fire alarm system or sprinkler. 5. The use of Spiral staircases should be limited to a low occupant load and is to be of a minimum diameter of 150 cm.

6. Ramps could be provided of a width of 2.4 m. 7. A separate ramp should be created at a safe distance from the hospital building. The ramp should be constructed in such manner that it has connectivity with all floors of the hospitals and despite that fire cannot reach the emergency route as it would be used for rescuing patients or their relatives during the casualty Basement and Plant Areas The access to the basement should either be from the main or alternate staircase providing access and exit from higher floors. Each basement should be separately ventilated .The staircase of the basement of enclosed type should have a fire resistance of at least two hours. Ventilation ducts should be integrated with the structure and be made out of brick masonry or RCC as far as possible. The maximum travel distance to the exit should generally not exceed 25 metres. One of the most commonly violated rules, in hospitals is that laboratories or canteens are placed in the basement, which is not permitted under the National Building Code. Heating, Ventillation and Air Conditioning Special care should be taken while designing HVAC shafts. This is to ensure that smoke or fire from the affected area does not enter the duct and transfer to rooms and areas remote from the fire. Ventilation should not be common to both the patient areas and the hazard departments. Space provisions should be made per floor to mount the AHUs. Treated fresh air ducts (TFA) should preferably be planned to take fresh air from every floor but certainly should not cross fire zones. Sprinkler systems should be extensively used to fight fire. It is observed during fires that death occurs mostly due to asphyxiation and not due to burns. To circumvent this, one could provide fans at lower levels in inpatient rooms which would get activated

Healthcare Executive February 2012 | 23


in the event of a fire outbreak and throw fresh air from outside into the rooms which would be beneficial for patients who are crouching down or have fallen down in panic. Electrical Systems and Lighting To enable essential services to be maintained, most hospitals are provided by standby generators which operate when there is a failure of mains electricity. These should be designed to provide electricity within 15 seconds of mains failure. Electrical distribution is generally provided by essential and non essential electrical circuits. These are normally segregated, however, where this is not possible, essential services should be wired in fire resistant cable. Emergency lighting should be provided by separately wired and controlled essential and non essential circuits. The luminares connected to the essential circuits are to be designed to provide between 30-50 % of the normal. Lifts Walls of the lift shaft should have a fire rating of two hours according to the National building code. The shafts for the lift are to have a vent of not less than 0.2 sq meters. Landing doors of lifts enclosures should have a fire resistance of one hour. The number of lifts in one row for a lift bank should not exceed four and the total number of lifts in one bank should not exceed eight. Collapsible gates should not be provided for the lifts and the solid doors are to have a fire resistance rating of one hour. Grounding switches should be provided on all the lifts to enable

fire fighters to ground the lift during an emergency. For the purpose of fire fighting, one fire lift should be provided for every 1,200 sq meters of hospital space.

Tools for Fire Safety

While an elaborate design for fire safety would be developed by the engineers, some basic equipment should be at the available at the hospital to enable fire fighting. Fire/smoke dampers are similar to fire dampers in fire resistance rating, and also prevent the spread of smoke inside the ducts. Fire ducts should be located at fire separation walls, point of entry of the central shaft, ducts passing through the floors and such. Fire dampers should operate automatically and simultaneously switch off the air handling unit fans. Manually operated and auto-

matic fire alarms are a must in every hospital building, but the most important criterion for the success of the fire safety system is the regular maintenance of the device to check its usability.

Safety during Construction and Operations According to the national building code, construction can be rated as type 1, type 2 and type 3 according to the fire resistance of the structural and nonstructural elements of the building. The site logistics planning should be done in such a way that there is a planned route left for movement of vehicles around the site which has to be left clear of any debris or raw materials stacked at site. Explosive devices used for blasting etc should be stacked, used strictly

Lessons for Improvement The emphasis, thus, for healthcare facilities in India today is to plan for safety in advance and invest in staff training. Recently, the Marashtra Government was mulling an option to amend rules so that new hospitals coming up in Mumbai and the rest of Maharashtra cannot have OTs and intensive care units (ICUs) on higher floors. While this decision is welcome, there is also 24 | February 2012 Healthcare Executive

a need to review the laws governing healthcare system in the country, right from making provisions of proper plots in the respective town plans, formulate policies for giving FSI to them, providing necessary infrastructure, impose uniform and stringent codal provisions pertaining to architectural, structural and MEP services design.

as per the codal provisions. Special care should be taken for the routing and joining of cables, installation of temporary power panels, their locations on every floor. An emergency evacuation plan should be chalked out and has to be clearly demarcated, barricaded and well lighted always. Design can only go so far to ensure the well being of the hospital occupants during a fire. For effective firefighting, standard operating procedures to be laid down for the hospital staff as per the NABH guidelines which should include training of personnel in using extinguishers, procedures to be followed in case of a emergency, mock fire drills, frequency of such drills, evacuation plans for shifting of patients first to a secure fire zone and then either to the ground and straight to the assembly point or reaching refuge areas and waiting for rescue team to come. Emphasis should be given on maintenance of the entire fire detection, alarm and the fighting system. With inputs from Satish Bhalerao


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brick and mortar

‘Floor’ed by the Design Even though it is perhaps the most used feature, floors are not appreciated for the asset that it is, says Arun Mathai.

T

he perception of space is only emphasised when you have a volume within defined boundaries. Any designed space by that rationale, has definitive boundaries such as walls, ceilings and floors that emphasizes the spatial appreciation of the volume within it. In vertical buildings, the volumes within the building are broken up by the floor/ceiling duality. Hence, even though it is perhaps the most used feature, floors are not appreciated for the asset that it is. Hospitals and ‘healthcare facilities’ conjure an image of something that is extremely ‘clinical’ and clean. We tend to have this subconscious perception that hospitals and healthcare facilities have a laboratory level cleanliness and seriousness that would be difficult to break away from. Far from it, hospital and healthcare facilities give the

designer an opportunity to create something interesting and functional at the same time, given the sheer number of activities that are housed within it. Within the interior design schemes, flooring gain a particular importance since it is actually the planar view envisioned by a designer and also in real perspective, flooring attributes certain character to the enclosed space. Flooring can be used potentially to a design advantage as – • Demarcation of areas – visual differentiation of public/semi – public/private or sterile/ semi-sterile areas. • Way finding techniques • Breaking the monotony in a scheme and creating interest ing visual appeal. • Flooring in any architectural context can be put under two main criteria mainly for its functional value.

26 | February 2012 Healthcare Executive

• Outdoor flooring. • Indoor flooring Outdoor flooring forms the hardscape element in the entire external design scheme. Basically, these outdoor flooring constitute the movement areas (traffic and otherwise) and are complimentary to any soft-scape (lawns, green areas, etc) that are proposed in the scheme. Indoor flooring constitutes a varied application of flooring material that would define the space that is defined by it. More often than not, contrary to the general application of flooring options seen in the outdoor flooring, indoor flooring plays a vital role in space appreciation and the visual appeal of the area. The choice in flooring with respect to its functionality and material quality will depend on the ambient quality that will be reflected in the interior scheme and hence

choosing the right flooring attains paramount importance. As mentioned earlier, healthcare facilities are by nature a clean environment. It is paramount that the cleanliness value of the flooring option is maintained and adhered to at a high standard. The important criteria a designer looks at while deciding the flooring options, especially in the field of healthcare are as follows: Ease of application: The flooring option should be such that it can be fixed with ease and by the local labour contracted (without the need of professional assistance wherever possible). Ease of maintenance: Hospitals and other healthcare facilities alike require clean environments to be maintained which translates to additional care to be taken for periodical and regular maintenance of the floors. Floor-


ing options that can undergo constant wear and tear, have better anti-bacterial qualities and require easy regular cleaning are preferred in such cases. Cost effectiveness: For a design project to be viable and practically possible, cost becomes a factor that requires consideration. A flooring option that has functional qualities suited to a clean, anti-infectional ambience as well as reduces the costs involved in material procurement, labour involved and its maintenance is best suited for this purpose. Longevity of the materials used: Resilient materials would always be preferred in the healthcare industry mainly due the heavy movement patterns encountered. In healthcare facilities, there is a constant movement of heavy equipment for clinical use as also a high amount of bed and trolley movement which results in much wear and tear of the material. Resilience in such cases, would mean being able to accommodate the heavy wear and tear and hence longevity forms a criteria for flooring selection. Flexibility of forming patterns with ease and minimum wastage: There is always scope for creating interesting flooring pattern through textures, colors and shapes. It would be prudent to use materials that will help achieve such patterns and forms with relative ease and minimise the amount of wastages. Material-wise, flooring can be classified as hard flooring and soft flooring. Hard flooring would include the use of vitrified, joint free tiles and stones (granite, marble, etc.). Soft floors have a variety of options available for use ranging from vinyl flooring to linoleum flooring to carpeting depending on the area of application. Ease of use and application is higher in soft floors than that in hard floors. However, hard floors are far more resistant when subjected to heavy movements and constant wear & tear

than soft floors. A few examples of flooring materials and the subjective use of it is discussed below:

Hard Floors

Vitrified tiles: Vitrified tiles are an excellent option for general areas within the hospital that are more public-centric such as common lobbies, receptions, outpatient departments (OPDs), utility areas, service areas, administrative areas, etc. although anti-skid options are available, a vast majority of vitrified tiles are glazed and hence treated to achieve an anti-skid property. Vitrified tiles are readily available, are cheaper than most flooring options and in sizes varying from 300x300mm to 1000x1000mm. Cleaning and regular maintenance is easy since there is not requirement for special solvents and requires normal mopping of the floors. However, vitrified tiles are not microbicidal and hence not completely infection free. Hence the use of such tiles are limited only to the areas where there would be no/ minimal risk to patient care and clinical approach to treatment. Stones: Stones (granite, marble, etc) are highly durable and available in larger sizes than vitrified tiles. Patterns in stone usually reflect a better quality of space and are usually used

28 | February 2012 Healthcare Executive

in large public areas like main receptions, waiting lounges, etc. Tiles or slabs with machine cut/ sawn edges are the commonly used types of edges. The fine edge finish simplifies the work of the fitter as these slabs or tiles fit perfectly. The machine cut/sawn edges slabs are subjected to a high speed rolling cutter blade to get a very smooth edge surface with a complementary (90°) angle at the vertices of the tiles/slabs. As in the case of vitrified tiles, stones are also non microbicidal and are restricted to use in public areas. A larger application of stones would be beneficial in outdoor flooring mainly in the form of stone paver block. Concrete paver blocks: This material can be used extensively and restricted only to outdoor flooring which would have a lot of traffic movement. Concrete blocks are cheap and highly durable. However, the aesthetic value and clinical functionality is very low. Stones and vitrified can be used in clinical areas as well to cut down on cost. However it is not advised as there will be a need for the regular maintenance and upkeep which will eventually turn out to be an expensive affair.

Soft Floors

According to RFCI (Resilient

Floor Covering Institute) resilient flooring refers to flooring materials which have a relatively firm surface, yet characteristically have “give” and “bounce back” to their original surface profile from the weight of objects that compress its surface. Resilient flooring materials are made in various shapes and sizes including both tile and roll form. Common types of resilient flooring include: • Vinyl Composition Tile • Vinyl Tile and Sheet Flooring • Linoleum Tile and Sheet Flooring • Rubber Tile and Sheet Flooring • Cork Tile and Sheet Flooring Linoleum: Linoleum is a floor covering made from renewable materials such as solidified linseed oil (linoxyn), pine rosin, ground cork dust, wood flour, and mineral fillers such as calcium carbonate, most commonly on a burlap or canvas backing; pigments are often added to the materials. The finest linoleum flooring is highly durable and can last upto 30-40 years. Because of its natural composition linoleum is considered as a better option for hospitals worldwide as it promotes a healthy environment. Linoleum is antistatic, antiallergenic and antibacterial. Permanent antibacterial characteristic of linoleum is derived from the pine resin used in linoleum production. Linoleum


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is available in sheets and require care while application to the flooring surface. Linoleum sheets are fixed by gluing it to the floors with an adhesive. The prospects of grooves in joints is avoided in this flooring option since linoleum sheets are warm welded with welding strips of appropriate colors which make the joints practically invisible and the surface even. Laying of linoleum floors are specialized and require professional expertise. Another added advantage of having linoleum as a flooring option is the colour availability, unlike other flooring options where colour is restricted to the uppermost layer, linoleum has colour that is uniform through its cross section. Linoleum flooring is highly flexible and can be used in areas where other options could easily crack. It is fire retardant but an extremely difficult material to set and is not advised to be used in areas where the floor temperature is over 30degrees due to its waxy structure. This is overcome by the application of an acrylic coating over the linoleum floors which have to be reapplied annually. Forbo flooring systems has its own brand of linoleum called Marmoleum. Marmoleum is a natural product made from 97%

natural raw materials, 70% of which are rapidly renewable, along with a 40% recycled content. The key raw materials used in its production include linseed oil, which comes from the flax plant seeds, wood flour from controlled forests and jute, the natural backing onto which the linoleum is calendared. In addition, Forbo’s Marmoleum complies with more environmental quality marks in the world than any other flooring product. Replacement of Marmoleum is easy as it requires the replacement of only the defaced area and not the entire flooring. Vinyl flooring: Vinyl floor-

ing is a synthetic product made of chlorinated petrochemicals. Sheet vinyl flooring is available in widths of 6’ and 12’ which can be installed by a common labour or by expert assistance. However, fixing of vinyl sheets need to be very precise and would be better handled by professionals. Vinyl floors are durable, available in various colours and a majority of brands that offer flooring system solutions provide a variety in the vinyl range depending on the areas of its application. Vinyl floors are fire retardant and are easily replaceable. Most clinical areas prefer vinyl flooring due to its versatility and ease of

cleaning. Vinyls are antistatic, homogenous, available with microbicidal treatment, anti-skid with a thicker top level for heavy wear and tear. Vinyls are also available as tiles for easy installations. Rubberised flooring: This kind of flooring is soft yet heavy duty and can be used in specialized areas like gym or physiotherapy. Carpets: It is another option for a soft flooring used extensively in areas dedicated to child care as well as semi-common and common areas. Carpets like most soft floor options are available in sheets and are easily fixed. However, there is a limited options for colours and requires regular cleaning and upkeep. Epoxy paints: One of the most efficient methods of maintaining joint free homogenous flooring. The application of epoxy paint requires expert assistance as the surface has to be maintained evenly. However it is an expensive option and can be used only in highly sensitive areas like OT, etc. Maintenance is also expensive as it requires a coat of infection control material over it.

How to decide the right flooring options for hospitals? Architects and interior designers alike require to opt for the best possible option in flooring based on client and end- user function30 | February 2012 Healthcare Executive


ality. A well-known adage in architecture is that Form follows function. So also the decision for the type of flooring to be used will be predominantly based on the functional aspect of the room designed. A generic overview of the functional aspect of flooring and the areas of use has been mentioned above. A few basic points of consideration that affect the choice in flooring has been mentioned. Additionally, flooring systems can be arrived at by logically analysing a few of the following points.

Design of the overall layout v/s cost and affordability It would be more efficient to decide the flooring materials keeping in mind the overall theme of the hospital and the patients it caters too. There are quite a few speciality and super speciality hospitals that provide specialized treatment options. Many of the bigger hospitals for aesthetic reasons require a better ambient quality in the common areas. Materials like combination of granite and marble or higher end vitrified tiles can be best suited for this. Likewise for hospitals that are executed with limited funds, it would be prudent to use

cheaper alternative for the same areas as mentioned earlier. Interior design scheme: It is always best to keep in mind the ambient quality of the rooms as proposed to choose a flooring that is the best option for flooring. It is observed that the interior scheme follows a certain pattern which will get some uniformity if the flooring material used follows the same pattern. Generally subtle hues are followed when it comes to clinical areas that are patient centric. Earthy tones and neutral colours so opted for the wall colours or furniture upholstery can be complimented if the colours and the textures of the floor follows a similar concept. Materials like vinyl or carpets or even vitrified tiles come in a range of colour that when used judiciously uni-

fies the overall visual perception of the space. Safety: It is a care-giver’s prerogative to provide safety and assistance to the patients they tend to. Flooring can also assist this functional concept by the use of anti-skid tiles in wet areas. Slip resistant floors go a long way in ensuring patient comfort and accessibility. Use of fire retardant materials also provides security in case of hazards like accidental fires. Durability: This can be gauged by the wear and tear factor specified by the brand in the design brochure of the material. Higher the durability more is the longevity of the material. It also means that use of highly resilient materials in a heavily used functional area translates to efficient spatial design.

Cleanliness: Hospitals involve a lot of sterile areas which require materials that are antistatic, anti-bacterial and easily cleaned without expert assistance or supervision. A rational approach towards all these aspects will help the architect/interior designer decide and arrive at the best possible option for flooring. There are other factors that could also play a role in the decision of the right material of choice like the sensitivity of the material to the environment, the biodegradable quality of the material, reduced use of chemical treatment or additives. Since we are more conscious about the environment at large in the present day society, it is natural that we choose materials that conforms to environment specifications and green building norms like LEED, IGBC, etc. on the macro scale such an informed decision will help the functional aspect of the working hospital as we would be propagating a ‘healthy’ environment. After all the purpose of hospitals is to enrich the quality of life and advocate sustainability. The Autor is Architect at EVO Architecture Studio.

Healthcare Executive February 2012 | 31


Case Study Sustainable Healthcare Design in the Middle East Al Mafraq Hospital, Abu Dhabi, UAE

Client: SEHA - Abu Dhabi Health Services Co. PJSC Architecture and Engineering: Burt Hill, a Stantec Company Expected Completion date: January 2013

A

l Mafraq Hospital is a state of the art healthcare facility that promotes sustainability and wellness as an integral part of the healing environment. Located in the central region of Abu Dhabi, the newly designed hospital is carefully situated on a prominent site directly adjacent to the existing Al Mafraq Hospital. The site offers an opportunity to express the client’s desire to have visible and timeless architectural presence set in the midst of the Al Mafraq Community. The new hospital complex boasts a striking contemporary architecture defined by four distinctive patient towers and a glass enclosed podium representing the state of the art in medical facilities.

The 272,000 square meters, 750 bed replacement hospital and outpatient clinic will offer an enhanced and comprehensive patient care program extending excellent urgent care and general medical services. Patients and visitors to the hospital will be greeted with a welcoming approach and invited into the naturally lit lobby concourse which offers hotel like lounging spaces and private and dignified patient reception areas. Way-finding is incorporated into the design fabric of the building through elegant sculptural elements and water features that orient visitors to the patient towers elevator lobbies. Easy access to the outpatient clinic is offered from the main hospital lobby through an

32 | February 2012 Healthcare Executive

enclosed pedestrian bridge. Carefully planned and located for privacy and comfort the women’s and children’s pavilion will have a separate entrance and a separate tower dedicated for specialist service for mothers and children. Each patient tower will contain no more than 30 single rooms per floor and each floor will have functional nursing stations and patient control centers. Spacious corridors will lead to private and appropriately sized rooms designed for the comfort of the patient and visitors. All rooms will have large windows and ample natural light. Special VIP floors will provide dignified suites for patients and families requiring special privacy and

attention. The new hospital facility will provide urgent care services with an expanded emergency department and critical care services. Flexibility is the key component of the facility, allowing for expansion to departments with minimum disruption. In addition to rooftop gardens and the latest energy conservation devices, the entire facility will provide enhanced patient environments and long term efficiency. The entire medical center complex is designed for sustainability and maximum energy savings.

Culture

Most of the healthcare design programs in the Middle East are led by American standards as they are recognized as being the best in the world. It is important as designers to define the spaces and proper environments within a facility and to coordinate with the healthcare staff (i.e. doctors, nurses, and operators) to best meet their working needs. The aim is to adapt to the culture in this part of the world while integrating innovation and improved practices from other parts of the world. Family centered care has been a tradition of the region for centuries and the design of Al Mafraq allows this tradition to continue in a new international setting. The planning and design of healthcare projects in the Middle-East must recognize the need to provide appropriate and


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dignified spaces for prayer for both for the patient and the staff. Further, the separation of males and females must be considered in all aspects of the design including waiting areas, hospital wards and recovery rooms. It is common for large families to accompany patients, which has a direct impact to the kinds of spaces and furniture to be considered for waiting areas. The patient room which is the heart of any healthcare institution needs to be generous in size and to allow appropriate care giver zones unobstructed by the family zones. The patient room design must recognize the numerous users of the room; the family, the

medical staff, and not the least the patient. Architects and medical planners need to consider these cultural requirements in the early stages of programming and conceptual design.

Sustainable Strategies Al Mafraq Hospital has been designed utilizing sustainable guidelines established in the Estidama and the Pearl Rating System. This system as part of the Abu Dhabi 2030 plan is a checklist of sustainable requirements similar to the LEED rating system. The design process has been a collaborative effort between architects, engineers, the

34 | February 2012 Healthcare Executive

client and Abu Dhabi stakeholders. Weekly scheduled integrated workshops resulted in establishing key sustainable strategies. These include building orientation, storm-water management, water conservation, reduction of annual energy consumption and high quality indoor air environment to name a few. The building also incorporates sustainable materials and will be sited in a landscape with a substantial component of indigenous desert plantings. The project has been designed in parallel with the Al Mafraq community master plan and will incorporate public transportation and other amenities to hospital

visitors and employees via future connectivity to the new Capital District of Abu Dhabi. The master plan design successfully integrates New Urbanist principles, and carefully considers the placement of the hospital while accommodating complex patterns of circulation necessary for the facility. Moreover, the plan’s land use program includes space for a variety of related medical programs. The master plan provides appropriate facilities and pathways to those staff and employees who wish to ride their bicycles to work to reduce the singleoccupancy vehicle traffic to the building.


the design process to evaluate go no go with systems with client. The Hospital incorporates many energy savings items including roof mounted solar panels which provide 75% of the total power requirement for heating hot water. Mechanical cooling systems for the project to utilize a flexible and zoned VAV system where appropriate (90% of building HVAC system) to reduce volume of air supply and fan energy. Further a heat pipe system for infection control was designed to separate supply and exhaust air streams which result in 50% energy recovery in exhaust air stream. Computational Fluid Dynamic (CFD) modeling was utilized in the design process for studying appropriate air flow in burns unit and operating theaters, envelope wind pressure, and smoke management systems.

Products and Materials

Energy

Extreme temperatures exceeding 50 degrees centigrade in summer months result in challenges when designing efficient mechanical cooling systems. Smart decisions can be made early in the design process by understanding a sites particular environmental attributes as well as utilization of energy modeling. For the Hospital, energy modeling assisted in determining the ideal building orientation, the appropriate building envelope and sun-screening strategy and engineering for efficient MEP systems. In parallel with the energy modeling, life cycle cost analysis was performed during

Existing wetlands on site have been retained and new ones created with native marsh grasses. These wadi landforms collect and deliver seasonal drainage water to locations where it can filter back into the water table. The wadi-scape and preserved wetland areas also help to support and nourish natural habitat for local wildlife to live. The extensive planting areas which will have significant areas of sand and wadi gravel help to reduce the overall heat island effect. They also reduce overall water demand while providing an indigenous landscape for the project. The planting layout and species selection has been designed in tandem with the irrigation system to maximize the available water resource by using technologies such as flow and weather sensors, soil moisture sensors, soil additive to increase water retention in the soil and drip

irrigation to ensure maximum water efficiency. Over 350 cubic meters of treated sewage effluent (TSE) and grey water which is separated from sewage produced daily from the hospital will be used to irrigate the landscape and provide all of the required water needs. No potable water is used for irrigation. The site landscape strategy also incorporates the planting of many existing mature native and exotic trees and date palms which will be relocated from the existing hospital site. The new medical center reflects the future of health care. The integration of outpatient and inpatient services provides the highest level of care and achieves economies of operations. Al Mafraq Hospital will offer a new experience to medical staff and patients as it will set the standard for sustainable modern healing environments in the Middle East.

Evidence-Based Design was utilized during the design process as a means to measure the impact of all design and material solutions. Every element, from the use of anti-microbial paint to bathroom placement related to slip and fall injuries was studied and analyzed to best arrive at the optimal solution. The use of rapidly renewable and sustainable materials including certified wood products for casework and wood wall paneling, linoleum flooring for corridors and patient rooms and carpet tiles in administrative areas are used though out the project. Paint systems, sealants and adhesives have been specified to reduce or eliminate where possible volatile organic compound emissions in occupied spaces.

Landscape and Water Usage The site and landscape strategy for the project incorporates a sustainable planting and design approach through created wadiscapes which have both ecological and economical advantages. Healthcare Executive February 2012 | 35


COVERSTORY

HOSPITAL ENERGY MANAGEMENT

36 | February 2012 Healthcare Executive


Y

S

Though many hospitals have tried attain energy efficiency, only a handful were able to completely build a strong energy portfolio. Here’s a look at the ground situation, solutions and current medical practices by Arunima Rajan.

USGBC’s first Leed ® Platinum Certified Dell Children’s Medical Center of Central Texas

ustainability of a hospital depends on smart decision making. Operational cost savings can be an effective management strategy during troubled economic times. Yet, several hospitals are unaware about the potential savings in energy costs, even though hospitals are the biggest consumers of power in the commercial consumer category which pays for every unit of energy consumed at a premium. An average Indian hospital consumes 2.5 times more energy than similarly-sized commercial buildings such as hotels, malls and multiplexes as energyintensive critical operations have to work 24x7, such as storage of medicines under appropriate temperatures, running of life support systems, air filtration and circulation, air conditioning and incinerators for efficient biomedical waste management. A study conducted by DSCL, an independent energy service solutions provider, which reviewed power and fuel expenses of 46 hospitals in India found that energy expenditure forms 3-8 % of a hospital’s total expenses and a whopping 15-20% of its operating and maintenance costs. “Further, the amount of energy used by hospitals is expected to increase dramatically over the next five years due to more sophisticated systems and technologies, as well as more demanding international health standards,” forecasts a study on energy efficiency in hospitals, released jointly by USAID and Bureau of Energy Efficiency in February 2009. Increase in energy costs also translates into an increase in carbon emissions. This has resulted in the healthcare industry being subject to a lot of criticism from several quarters. As per the Green House Gas Inventorying drive conducted by Eliminate Carbon along with USAID and the Bureau of Energy Efficiency in 75 hospitals across 5 climatic zones and 11 cities, the median

for GHG Emissions per-patientday (excluding outpatient count) is approximately 0.08 tons CO2e (i.e. 80 kg CO2e/patient-day. The emission rates are quite comparable to the values of a comprehensive GHG inventorying of the hotel sector for overnight stays in 4 and 5 star luxury hotels. In terms of total emissions-perhospital – the median is approximately 3,250 tons CO2e/annum. According to the database of HOSMAC, a healthcare consultancy firm, for an existing hospital with 250 beds, inefficient design, integration and monitoring of energy can lead to an estimated INR 13 crore to 19 crore lost revenue in a less than 30-year period. This brings us to the critical question: Why should a hospital try to achieve energy efficiency? According to Prof. Rangan Banerjee, Head, Department of Energy Science and Engineering, Indian Institute of Technology, Mumbai, hospitals can cut down a major chunk of their operational costs by embracing energy efficiency. “Hospitals can save up to 20 % of their energy costs by managing their energy consumption. However, the scale of energy savings varies from hospital to hospital,” he adds. Energy efficiency can lead to better patient care in healthcare facilities, emphasises Prof. Rangan, and he adds that the market today offers numerous technological solutions for healthcare providers to control and monitor energy consumption of their numerous devices. Perhaps the most commonly quoted success story of energy efficiency is that of Jehangir Hospital, Pune. During the period 2003-2006 the energy savings measures of the management resulted in savings of INR 33.12 lakhs with an investment of INR 29.45 lakhs. The Chief Engineer of Jehangir Hospital, Ignatius Joseph told Healthcare Executive that there has been a steady decrease in electrical energy consumption of the hospital despite

Healthcare Executive February 2012 | 37


an increase in bed occupancy and the addition of a number of hightech equipments. “The hospital has implemented several energy conservation measures. We consider energy saving as a multidisciplinary approach. Even budget provisions are exclusively made for energy projects. Energy consumption plans, policies and structures are reviewed periodically by the energy management team,” says Joseph. This has resulted in 9.33% reduction of electrical energy consumption. The hospital also reduced its water consumption by 22.53 %. Planning the right energy strategy for a hospital Before a hospital decides to embark on the journey of energy efficiency, it needs to understand the most financially sustainable policies for energy efficiency. Vivek Gilani, Founder and Managing Director of Eliminate Carbon Emissions Pvt. Limited (ECE), insists that every hospital must

conduct a comprehensive marginal abatement cost analysis before opting for expensive technologies. “There are numerous energy saving options for hospitals. However, hospital managements should analyse the capital investment vis-à-vis the pay back of each of these technologies before opting for them,” says Gilani.

For example, there are several energy conserving devices in lighting for hospitals like LED, CFL and motion sensorcontrolled tubelights. The cost of LED lighting equipment is much more than that of CFL. However, the scale of energy savings is not comparable. “While a hospital might have to shell out four times

How to build a strong energy portfolio for healthcare? While most hospitals have tried to integrate certain features of energy efficiency in- to the blueprint of its infrastructure, only a handful completely built a strong energy portfolio for their hospital. Interestingly, some premier brands have even undergone a complete design overhaul. Several managements were astonished by what the right technology can do to their energy bills. Energy consumption pattern

5-10%

20-30%

38 | December 2011 Healthcare Executive

HVAC system + fans 35 - 50% of the total energy

10% 5% 35-50%

Lighting 20 - 30% Motors 5 - 10% Medical equipment 10% Computers, Others 5%

more money for LED lighting, the energy savings would be a mere 20 % more than CFL lamps. Hence, a marginal abatement cost analysis should be the first step taken by a hospital,” adds Gilani. Later, hospitals can move to stage 2 of preparing a road map for progressively adopting financially less lucrative options.

Early steps to ensure energy efficiency Demand Side Management (DSM) or Energy Demand Management, which consists of operational changes and behavioural improvements is a prerequisite for energy conservation. If a hospital ignores the potential of energy side management, they often end up spending more on energy efficiency. There are several simple measures like building technology that can regulate the energy consumed by devices like HVAC or air conditioners of a hospital. Using simple technology, hospital facility managers can plan need-


A Case in Point

based lighting options for different areas, with reduced lighting for low-occupancy sections and partial switch off option when not in use. Interestingly, a simple change of setting of thermostat from 60 degree Celsius to 55 degree Celsius can result in quite a drastic reduction in the energy consumed for water heating without compromising on patient needs. Even laundry bills can be brought down by changing the fabric of the bath towel provided to the patients in a hospital. Energy audits of several old hospitals have revealed that most of them have not been even designed for energy efficient air conditioning. As a result, there is unnecessary, solar heat gain to the building envelope of the hospital. These hospitals try to fight the heat gain by using oversized air conditioners. If they incorporate simple energy mitigation strategies like green walls, better insulated windows or spectrally selective window sills, it can easily reduce the load on air conditioning system of the hospital.

How do you calculate your energy score card? The energy score board of a hospital is usually calculated by dividing the energy consumption by number of occupied beds. The first step to find out is to conduct an energy audit. However, hospitals have to shell out on an average INR 2 to 3 lakhs for energy audits. There are several

utility partners like Schneider and Honeywell, who could help a hospital cleanup its energy scoreboard. “From mapping energy consumption, through optimisation, design, delivery and life cycle management, companies today deliver practical energy monitoring and management services that results in reduced consumption and improved efficiency,” says Milind Godbole, Regional General Manager, Honeywell Building Solutions India. More companies like Honeywell are offering solutions like energy monitoring and management services, energy mini retrofit and energy performance contracting. The energy specialists of these companies would help a hospital identify areas for savings and procure and install the right equipment to optimise energy consumption throughout the building. For existing buildings, energy benchmarking is one of the options available. “Hospitals can compare their energy consumption- per- square- meter to that of another energy efficient hospital. This will help understand where the hospital stands in comparison to others,” informs Prof. Rangan Banerjee.

Leveraging smart tech Having the right technology, but not providing elements in operation is a common practice among hospitals. For example, lot of hospitals have been designed in a manner to efficiently use natural

40 | February 2012 Healthcare Executive

In 2009, Kovai Medical Centre and Hospital (KMCH)’s facilities engineering department embarked on an extensive energy audit programme in their 500-bed hospital complex with its 6,00,000 sq.ft built up area and it proved to be a real eyeopener. It revealed that adoption of good energy conservation programme, innovative energy efficiency practices and use of renewable energy sources in the existing hospital building can lead to saving of up to 20% on average annual energy costs with little initial investment. A typical building management system integrates chiller plants, air handling units, lighting controls and energy management system at KMCH. “Two of the hospital’s 500 tons Trane Centrifugal Chiller plants, their pumps, motors and 35 air handling units have been integrated. This has enabled the hospital to switch on and off all the above equipment from a remote central control room any time. This has vastly reduced the requirement of manpower and also helped in monitoring the running time of these equipment. The temperature and humidity monitoring facility available in this system for critical areas like operation theatres and medical equipment areas has helped cut down the energy cost related to air conditioning,” says U K Ananthapadmanabhan, former president of KMCH. Information Technology has a great role to play in effective energy management. Today, very sophisticated software is available which is capable of monitoring, calculating and controlling the use of energy consumption. “Digital energy measuring instruments help to measure the energy load. Once the accurate measurement is available, it is possible to detect wastage or excesses in specific areas,” claims the former president. At KMCH all high energy consumption areas like air conditioning plant, central sterilisation equipment, public and room lighting, effluent treatment plant, heater coils of the solar heaters and the like, have been fitted with digital energy meters to monitor the consumption of power. These meters have been networked to energy management system. Parameters like kilo-watt hour, power factor, voltage and current are monitored at the facilities engineering department on a 24-hour basis. “Computerised energy consumption data that is available through the software of all areas is archived and studied to find out if there is any scope for further reduction in the energy consumption by adopting certain technologies or by restricting the duration of operation,” concludes Ananthapadmanabhan. light. But, these hospitals do not have options to dim electrical lighting devices in areas bathed in natural light during the day, and take advantage of healthy sunlight. Moreover, hospitals don’t give out messages to staff or visitors to adopt simple energy conservation measures. General messages like turning off the computer monitor could easily be circulated among staff. Inmates

can be provided with tools to inform the management when confronted with energy wastage in any part of the hospital. For example, Columbia Asia Hospital in Bangalore has an SMS-based system, where individuals can send a quick SMS to the hospital management if there is any part of the hospital where there is excessive air conditioning and they want it to be regulated. They can also message and indicate if


there is a faulty switch or leaking tap. However, in this case, backing up messages with services becomes very important.

opment (USAID) and significant inputs from various stakeholders such as practicing architects, consultants, educational institutions and other governmental organisations. However the code is voluntary and is not be mandatory.

Energy audits catching up in India Certainly, managements are reacting to this demand to make their hospitals more energy efficient. Many hospitals are turning to energy audits to plug energy leakage. The change in the private sector is quite visible. “We have witnessed a significant increase in enquiries for energy audits in the last couple of years, and most of these are being converted into actual execution of energy audits. The only concern has been delayed implementation of the recommendations, though in most cases the ROI suggested is quite lucrative,” says Harsha Yadav, Co-founder of Efficient Carbon. Several government hospitals have also initiated energy efficiency retrofit projects in the last 3 years. With regards, to the market size, there are no published reports to estimate the same. There are upgrades available too. Efficient Carbon offers energy efficiency services specialising in this area to reduce the specific energy consumption of any hospital. The company approaches the hospitals with a multi-pronged strategy of curbing losses and moving to higher energy efficient equipment at a strategic level through technology upgrades. Shifting to renewable energy wherever there is scope is also emphasised. For ex-

Why is it a smart move to invest in energy efficiency?

ample, solar water heating is the biggest cost saving opportunity in the hospitals with a usual payback of 13-15 months depending on the usage. Another opportunity for renewable energy is the steam generation for cooking in a pantry through Solar Parabolic Troughs or Solar Dishes as these are commonly called.

Should ECBC code be

made mandatory? Several experts suggest that the government should make Energy Conservation Building Code, a document that specifies energy requirements of buildings, mandatory for healthcare providers. The ECBC was developed by an expert committee set up by the Bureau of Energy Efficiency, with support from United States Agency for International Devel-

Several forecasters urge hospitals to jump on the energy conservation bandwagon as there are numerous benefits. US Energy department has made a detailed list of key benefits of reducing the energy use of healthcare facilities. Entries of the ‘benefit list’ released by the department include improved profitability, reduced impact of volatile energy costs, lower operation and maintenance costs, improved environmental performance, reduced carbon footprint, bottom-line savings which enhance ability to fund patient care investments, improved facility/patient/community health as well as improved community relations. K P Sukumar Vice President, Air Conditioning and Refrigeration Service Division, Blue Star Limited, explains what are the factors which seem to be influencing decision makers to invest in energy efficiency retrofits and revamp. “Some of the major reasons are higher operational cost on account of continuous operation in healthcare establishment and high demands on indoor air quality,” says Sukumar. In addition, other market dy-

Measures adopted by the US Countries like the United States have already kick-started initiatives to reduce the greenhouse gas emissions of healthcare providers. The US Department of Energy (DOE) is counting on its Hospital Energy Alliance (HEA) to improve energy efficiency and reduce greenhouse gas emissions of healthcare systems in the country. The project involves bringing together leading hospitals and a national association in a strategic alliance states the official website of the Department of Energy. The much discussed alliance aims to leverage access to advanced technologies emerging from national laboratories. The energy department expects the HEA to act as national forum for the industry to share evidence based technology solutions and influence the energy performance of medical equipments and systems. The tools provided by HEA include the resources, tools, and strategies to identify clear pathways to cost and energy savings through efficient and renewable energy technology applications. Source: US Energy Department website 42 | February 2012 Healthcare Executive


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namics like stiff market competition, quality of services rendered to the patients and availability of latest technologies to serve patients are also indirect factors which can contribute to influencing the decision making process. G R Narasimha Rao, Senior Fellow and Area Convenor of The Energy and Resources Institute (TERI), southern regional centre, believes that the healthcare sector should move towards energy efficiency primarily due to cost reason. “Energy management could be a revenue producer as well as catalyst for better patient care. The investment to go green does not add substantially to the operational expenditures of the hospital. In fact, the rate of return for investment is quite high,” he says. Harsha Yadav, Co-founder of Efficient Carbon, an energy

“An energy master plan, that integrates energy efficiency upgrades with regular replacement cycles of energy-using equipment, will offer very attractive paybacks on the incremental cost of energy efficiency. Audits also bring to light various lowcost and no-cost measures such as tune-ups of equipment, or simple fixes in the operation of equipment, which are just no-brainers. Aalok Deshmukh, Team Leader, USAID, ECO-III Project. service company, also endorses this view. “The better the return on investments of energy strategies, the easier these are to push through for quicker implementation,” says he. In order to cater to the service conscious patient, several hospitals undergo modernisation. “During this stage, the hospital managements go for energy efficient retrofits. Finally, it all has to make economic sense. If savings from energy efficiency is not going to pay them back quickly in a reasonable time, then the investments will be difficult

44 | February 2012 Healthcare Executive

to make,” concludes Yadav.

Short payback periods Energy efficiency has a direct impact on the bottom line of the organisation. Energy efficient buildings typically cost less to operate and maintain. Lowering the operations and maintenance costs can enhance employee productivity. “Energy efficiency initiatives involve low risk and yield high returns. In most instances, in fact, the risk of energy projects is zero,” says Michael Sullivan, Vice President, Healthcare

Solutions of Schneider Electric. “Consider well proven technologies such as lighting upgrades: If a lamp puts out the same amount of light, but consumes 50 % less power, those savings are guaranteed. Most energy projects also have a payback period of one to five years and internal rates of return from 20-100 %,” adds Sullivan. More importantly, the payback period of energy projects is relatively very short. The rules of payback for energy efficiency are very simple: invest in your


upgrades and infrastructure and you can reap your benefits within a period of five years. The investment made for energy efficiency can be recovered within two or three years. This makes energy efficiency an attractive proposition for hospitals. Even experts from industry claim that investing on energy efficient infrastructure will not erode profitability. “Many think that the cost of building an energy efficient hospital will erode profitability, but a green hospital can actually increase the bottom line revenues, with a return on investment by often less than one year,” concludes the Vice PresidentHealthcare Solutions.

Why hospitals are energy guzzlers? Recognising the need to save energy industry bodies like the Confederation of Indian Industry (CII) has undertaken studies to map the energy consumption pattern of healthcare providers. According to a white paper published by CII, hospitals are labelled as energy intensive units as various equipments like the High Efficiency Particulate Air (HEPA), which prevents the

spread of disease, place greater demand on the electric system. The main contributors to energy consumption are HVAC, medical equipment and lighting, states the paper. Stringent indoor air quality (IAQ) levels must be maintained especially in operating rooms, emergency rooms, intensive care units (ICU)s and laboratories. These rooms require 15 to 20 air changes per hour. Further, certain types of rooms have special HVAC pressurisation requirements. Several units are strictly regulated for temperature, humidity and quality. This

increases the need for proper heating, cooling and fresh air intake. In addition, hospitals also require power to be provided at 100% uptime for patient care and liability concerns. Backup generators or cogeneration, also known as combined heat and power (CHP), may require increased investment.

ESCO model TERI’s Narasimha Rao moots the Energy Service Company model as a way out for companies disinclined to make huge investments right away. Under the model, energy saving solution providers

would offer complete solutions to healthcare provider including creating anenergy score card and providing solutions. The savings are often used to pay back the capital investment of the project over a 5-to-20- year period. Rao sums up: “Energy Service Company Model has not yet reached India. There is lack of awareness among hospital managements about the advantages of the real ESCO model. Several agencies have longed for the successful implementation of this model, but it has not worked out so far. But there is hope still.”

Estimated Energy Consumption in Hospitals Hospital

No.of Hospitals

No.of Beds

Estimated kWh/Bed/year

Government Hospitals Urban

3,115

369,351

1000-2000

Rs.5

369-739

Government HospitalRural

6,281

143,069

200-400

Rs.4

29-57

160,000

8000-25,000

Rs.6

1280-4000

4,00,000

3000-5000

Rs.6

1200-2000

Private/ (Multi Space/NGO Hospitals)

Estimated Electricity Consumption (Million kWh)

Estimated Electricity Cost (Rs. Millions)

22,000

Private Nursing Homes Total

Assumed Electricity Cost per kWh

31,150

1,072,420

2,878-6,796

16,841-39,922

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Leaders Speak

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U Ask Decoding hospital designs Solving the secrets of hospital engineering

M

r. Uday Kumar Alaham, General Manager, Hosmac Middle-East FZ LLC has been a practicing facility planner for healthcare infrastructure for the past one and a half decade. An ex-CIPLA employee, he is a gold medalist in Pharmacology from the University college of Pharmaceutical Sciences. He did his post graduation in hospital administration from the Indian Institute of Health Management Research (IIHMR), Jaipur. Starting his career with managing healthcare infrastructure projects, he is today managing the administrative and business development wings as well. Here, he answers some of the frequently asked questions for our readers. Q. Should all hospitals be centrally air-conditioned? Can we have general wards and corridors as non-air-conditioned? It is not necessary to have air conditioning for the complete hospital. Critical patient care departments, specially the ICU and the ICCU, which require controlled indoor air quality (IAQ) need to be provided with mechanical ventilation system or air conditioning. Hospital building majorly requires fresh air supply and higher percentage of ventilation as compared to any other institution building to ensure better IAQ. However, in the current scenario, hospitals go for vertical growth rather than horizontal ex-

require fresh air from around 100-30% in circulation, depending on the level of infection control measures adapted. And this can only be achieved using high-end air conditioning system. HVAC (heating, ventilations and air conditioning) systems should be used in these areas with micro filters and HEPA filters to maintain the indoor air quality. Air handling units also need to be placed in areas which help in sucking fresh air from outside. pansion due to constraint of land space. Thus, hospital engineering is forced to move towards the mechanical ventilation system. Also, considering the patient safety in tall structures, a cross ventilation with open windows or ventilators cannot be encouraged. If hospitals had the liberty to be just a ground + one floor structure, architects would have strived to provide ventilators, openable window design, etc to achieve the fresh air requirement as per ASHRAE guidelines for hospitals. Q. What should be the norm for back up of electricity in hospital buildings? Should we have 100% backup? Hospital buildings are extremely sensitive to any form of power failure for any reason. Some patients have to use life support equipment which runs on power supply. Medicines and patient specimens need to be stored in controlled temperature in the refrigerators. Also, lighting the circulation places is important

60 | February 2012 Healthcare Executive

for patient’s and visitor’s safety. To ensure all these parameters, hospital power system should be provided with back-ups for uninterrupted power supply. This could be done with the help of generator and central battery system for emergency lighting. As generators take time to start up, it is recommended to provide critical care areas with UPS, followed by generator back-up. Since these machines come into action only during power failure, hospitals should always have the load divided into two machines. This will ensure that the critical care departments and equipment will have further fall back mechanism. Q. What is best way to air-condition critical care units? Can window and split AC’s be used? Let me answer the second question first, critical care departments cannot be provided with controlled ventilation system using room units such as window AC or split AC units. The reason being, critical care departments

Q. What will be an ideal and cost-effective flooring material for OTs and ICUs? Hospitals in general prefer flooring which are soft in nature to help reduce the noise levels created by people and trolley movement. Critical care areas such as OT’s and ICU’s have high usage of electrical machines. Hence, electrical dissipative property is required to avoid any burns to patients undergoing surgery. Conductive epoxy, vinyl or rubber flooring is preferred in these areas. By using these materials, we also achieve monolithic surface with minimum number of joints. This helps in maintaining the floor free of any bacterial contamination. In short, the floor must be slip resistant, strong, conductive and impervious with minimum joints like terrazzo, linoleum, etc. It is recommended to maintain a minimum conductivity of 1.0hm and maximum of 10m 0hms in these areas. Today, the need for antistatic flooring has been diminished owing to the use of no-flammable anesthetic agents.


Q. What is energy recovery wheel in air-conditioning? How important is it in aircondition planning of a hospital? Operating cost plays an important role towards improving and reducing the financial viability of modern hospitals. And, energy recovery has been found to be an effective way of saving energy cost. Energy recovery wheel or enthalpy wheel are thus used in operating rooms and isolation rooms to help in recovering both sensible and latent energy. The wheel, when installed, helps in transfer of heat (sensible and latent) from the outdoor air to the exhaust air thereby preconditioning the air entering the HVAC. This also improves the indoor air quality and reduces the pressure on the HVAC systems, improving the system’s efficiency. For example, let us assume the outdoor air is around 32°C. The energy wheel

cools the air to 26oC when passed through it and transfers energy to the exhaust typically at 21o C. The HVAC will now need less energy to cool this temperature, thus saving energy cost and also maintaining the required indoor air quality at the same time. Q. What is a good structural grid for hospital buildings? Are there any standards for this? Generally, 7.2 to 8 feet is the ideal structural grid for hospital construction. A grid larger than 8 feet would surely give you greater flexibility but would be very expensive too. On the other hand, a grid smaller than 7.2 feet will be more economical but you would lose out on the flexibility. Q. What is a sick building syndrome? Is there a way to measure the gravity of the sickness? The Sick Building Syndrome

(SBS) is synonymous with the term of IAQ in healthcare construction. SBS is more relevant for commercial buildings and refers to the combination of ailments associated with an individual’s work space or residence. It is caused due to inefficient heating, ventilation and air-conditioning systems in the building. According to the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASSRAE) standards, a minimum of 15cfm of outdoor air per person has to be provided.

Q. We are planning a 200 bed multispecialty hospital in western India and would like to know where can we get infrastructure guidelines on patient safety features? The best sources for the guidelines and norms are the National Building Code (NBC), NABH and the Local Bi-laws. It is also advisable to engage professional hospital consulting or designing firms, especially while designing the hospitals.

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Debate Healthcare & Town Planning

Should we leverage the expertise of country’s business leaders to make healthcare master plans, asks Arunima Rajan

A

re our cities planned to meet the healthcare requirements of its citizens? Should we leverage the expertise of country’s business leaders to make healthcare master plans? Healthcare Executive asked leading urban researchers, town planners, top hospital managements, eminent academics about what would be an ideal town plan for healthcare in India. Some of the participants of the debate are Rajen Padukone, CEO, Manipal Health Enterprises Private Limited; Christopher Kutschel, member of Harvard Urban Planning

Organisation (HUPO); Samuel Paul, Chairman of Public Affairs Centre and former IIMA director; Hony. Brig. (Dr.) Arvind Lal, Chairman and Managing Director of Dr Lal Path Labs; Ashwin Mahesh member of Agenda for Bengaluru Infrastrucutre and Development Task Force (ABIDE); Ashish Purvankara, Joint Managing Director of Purvankara Projects Limited; V Ravichandar, Chairman Feedback Consulting Firm, Kamaljeet Kaur Siddhu, General Manager, Corporate Affairs, City Corporation Limited, Saumyajit Roy, Associate Director- Strategic

62 | February 2012 Healthcare Executive

Business Unit, Social Infrastructure Practice, Jones Lang, Lasalle, Arun Mathai, Architect, EVO Architecture Studio, Dr. Rajen Ghadiok, Executive Director, Medical Strategy, Nova Medical Centers, Navin Chugh, Head of Quality, BGS Global Hospitals, Bangalore and. What are the ways of integrating healthcare facilities in to town planning process? Navin Chug: A town plan can address the healthcare needs of the citizens mainly by creating the adequate infrastructure

required for the different levels of care that citizens will require. Prevention of overcrowding, public sanitation and cleanliness, sewers, public toilets and public water supply are important aspects of a town plan. Healthcare facilities can be planned as per the population in the given area. The primary healthcare centers must be given importance as this will be the first screening point for a healthcare problem. The government has the PHCs and the private sector has the individual doctor clinics (which are a dying species nowadays) which do this job. In the absence of


HEALTH INDICATORS IN INDIA, 1951-2009 Indicator

1951

1971

1981

1991

1999

2005

2009

Birth rate

40.8

36.9

33.9

29.5

26.1

23.8

22.5

Death rate

25.1

14.9

12.5

9.8

8.7

7.6

7.3

Infant Mortality rate

148

129

110

80

70

58

50

1321

853

810

424

407

254

212

6

5.2

4.5

3.6

2.9

2.9

2.6

Maternal mortality ratio Total fertility rate

this the load of the tertiary level healthcare providers will be very high, as it is today. This leads to a drain in resources of the public, hospital and the doctors as more and more doctors will be needed as the tertiary level that require high level of training which is very cost and time intensive, which in turn leads to a financial cycle of this own. Only those problems which cannot be effectively treated in the primary and secondary level must go to the tertiary level. Dr. Arvind Lal: The bed availability in India is only 0.9 beds per 1,000 population. This is far below the world average of 3.3 beds per 1,000 population. This means that the bed capacity of the country has to be nearly quadrupled. It is calculated that nearly 1,00,000 beds have to be added yearly for the next ten years at an average cost of about Rs. 50,000 crore per year. Therefore, in our mega cities like Mumbai, NCR of Delhi, Kolkata where population is about 2 crore each currently, town planners would be advised that they should provide for about 66,000 beds distributed in 70:30 fashion between private and government healthcare providers. The private providers should be intimately involved in the planning process. They should emphasise that land should be made available in a rational manner with

adequate FAR or FSI provision. It is unthinkable that many town planners are still stuck in a mental mode that sanctioning high FSI/FAR would tantamount to losing the country’s crown jewels. Since land is a very sticky issue, it should be decided once and for all that healthcare facilities will get priority over everything else like malls, movie theatres, food courts etc. Also, only those healthcare providers with a proven track record should be considered for allocation of land for medical facilities. Dr. Rajen Ghadiok: There are multiple facets to address when establishing a medical facility in a given community. It’s important to understand the demographic profile of the disease processes, the patient profile, the socio economic background of the

community and the availability of medical talent. An example could be that if that community had a large population of elderly people, then it would make sense to cater for a geriatric facility. Alternately, if the geography catered to a large number of schools, it would be appropriate to look at having a paediatric facility in the neighbourhood. Should private players have greater say in urban planning? Rajen Padukone: The entire spectrum of healthcare delivery is critical for the urban development and planned growth of our towns and cities. It is therefore essential that town planning considers a proper distribution of healthcare facilities across the city. The private sector is a major

investor in healthcare in any city. It is crucial that views are taken from private and public healthcare providers in the process of planning the dispersion of such facilities across the city. Ashish Purvankara: Several private players are hard-pressed to find areas that meet basic requirements like connectivity. The biggest challenge for a private player in the country is the cost and availability of land. The local as well as state governments should opt for long term plans for intelligent land use. Agencies should demarcate spaces specifically for healthcare in a city, so that we have neighbourhoods with proper social infrastructure like hospitals and schools. There is a direct relationship between the number of players as well as the cost of healthcare. If we allow more players in the sector, the cost of healthcare would also come down. Christopher Kuschel: Incorporating public health considerations is an extremely important facet of town planning, one that should be given far more weight than it currently receives. Those who have been involved with public health have an additional skill set to researching, analysing, and providing recommendations at the population level. This group is most relevant with town planning. The concept of health, as it relates to town planning

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needs to evolve from receiving acute care to considering the issue more holistically like how do we decrease pollution, provide clean water, provide multimodal transportation solutions, provide adequate open and recreational space, decrease perceptions of fear of crime, provide access to healthful food. All of these broaden the scope of health beyond the hospital/clinic itself. Samuel Paul: Town planning is a process by which future land use, infrastructure plans, regulations are designed and facilitated. Private healthcare providers should certainly participate in the process, by providing inputs and advice. Healthcare providers have to come up in all parts of the city as proximity is important for the people. Ravi Chandar: Healthcare providers can play a role in preventive healthcare by providing inputs on water and sanitation and the impact of pollution on health in particular. The challenge will be to integrate their suggestions into the overall city plan that agencies follow in practice. Arun Mathai: It would be highly improbable to suggest that any and all healthcare providers be a part of the town planning process. However, appointed personnel from existing medical bodies with some knowledge in planning would help the process. With the RTI act enforcement, healthcare providers can still seek information regarding the town planning allocations if any and voice their opinions about the same through any public forum. Navin Chug : Private Healthcare providers should be part of planning. This will prevent the overcrowding of healthcare organisations in certain parts of the city and the distribution will be even. This will reduce the travel distance and the travel time for the patients, their family, doctors, medical personnel and hospital employees. This is especially apt in case of an emergency as more lives can be saved and complications can be averted which are

a drain on the resources of the patient and his family as well as the Healthcare provider. This will also prevent overcapacity of the healthcare providers who can invest their capital in more fruitful ways and lessen the burden of capital servicing costs, which in turn will reduce the cost of healthcare to the end user. Reduction in capital inputs will also result in getting better technology to get better outcomes as more money is freed up to purchase these technologies. The city also will be able to plan for the water, roads, sanitary, fire safety, electricity, communication and transport requirements for the healthcare organisation. Currently, who plays an important role in planning for healthcare? Is it current market demand, the private players or the government? Dr. Arvind Lal: The private players are clearly driven by the current market demand and the realisation that government has

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been found wanting in the healthcare delivery area. The healthcare sector is going to see investments to the tune of Rs. 5,00,000 crore in the near future and this point has not been lost on the private

players. Also, as mentioned above, nearly 1,00,000 beds have to be added annually. The private sector has only recently come of age – this can be gauged from the fact that the two large healthcare providers Apollo and Fortis do not have even 20,000 beds between them. The government, on the other hand, means well, realises that the time has come to harness the qualities of the private sector but is unable to give up its traditional role of being the ‘sole healthcare provider. Also, the government must graduate to a 21st century mindset that they don’t know it all and that the time has come to engage with the private players in a more robust and meaningful manner. There is a dismal record of creating PPP in the healthcare sector as compared to the building of highways, airports, provision of mobile telephony etc. False promises for electoral purposes also should not be made, as in the case of previous Rail Minister asking the private sector to help open hundreds of diagnostic centres alongside railway stations. Navin Chug: The government is now collecting the data and the

Hospital bed capacity, by country Country

Beds/1000 population

Srilanka

3.1

China

3.0

Thailand

2.2

Brazil

2.4

USA

3.1

UK

3.9

India

0.9

Nicaragua

0.9

Togo

0.9

Indonesia

0.6


private organisations are setting up capacities to treat the patients. The private players are not using this data effectively and are mainly concentrating on those areas which are more profitable. This is leading to overcrowding and overcapacity in certain areas. The user is required to travel big distances leading to waste of resources and productive time. Dr. Rajen Ghadiok: Healthcare providers should be involved in town planning as identifying the appropriate location, size, type and speciality based facility is crucial to provide efficient healthcare support to the community. Currently, the government sits on the most appropriate locations; the private sector has the means, but is positioned differently; the government has neither the means nor the will to run efficient systems and so there is a miss match with the patient bearing the brunt of it all. Are our local bodies equipped to build our cities? Samuel Paul: Basic healthcare

facilities are provided by government for the most part. Private investors respond to market demand and fill in the gaps. Local governments are not meant to provide healthcare for all, nor do they know enough to do it. The healthcare needs will be met by a mix of government and private providers. Local governments should allocate space and approve plans as and when required. State government also plays a role as patients may come from other parts of the state too. Ashwin Mahesh: The Town and Country Planning Acts of each state specifically say that many other things besides infrastructure should be considered while planning. Unfortunately, this is mostly ignored by the governments. It will help if more things are done by the elected city government – water supply, police, bus service, education and healthcare. It may not immediately ‘solve’ the problem, but at least it will fix responsibility in a more accountable way. I don’t think governments ‘figure out’

66 | February 2012 Healthcare Executive

anything scientific. Rajen Padukone: Presently there is, generally, no cohesion, consultation or dialogue in the planning of healthcare services in the city between the government, public and private sectors The government’s plans and investments follow a separate trajectory and process from that of the private sector. The current market demand and availability gaps in the city drive the private providers of healthcare to consider investments in health infrastructure. Civic bodies should focus on issues of sanitation and hygiene and move from being providers of healthcare to taking on the role of planning and facilitation. They need to plan healthcare services in a city in consultation with local bodies What is the ideal town plan for healthcare in the country? Saumyajit Roy: There is no ideal town plan for healthcare. Each of our cities has unique disease profiles, healthcare supply

situations and growth potentials. Based on a detailed assessment for each city, the local government should decide how it wants to improve healthcare delivery in the city. Healthcare delivery is not about setting up of hospitals – the end objective is about providing good quality healthcare which can be done through a 360 degree approach from awareness generation, preventive healthcare, help lines, mobile care etc. As in education, it is quite clear that healthcare in such growing population scenarios will have to be delivered through a PPP approach. There have been good PPP examples and more work need to be done to find out ways in which private parties can develop health facilities. Kamaljeet Kaur Siddhu: The ideal town plan for healthcare in India should clearly demarcate tertiary and secondary hospitals in the town supported by a network of primary health centers staffed, by a physician and four paramedics for every 35,000 people or a more feasible ratio. Yes, we should empower our local bodies to address these issues by encouraging them to enter into private-public partnerships. Similarly, Housing schemes of more than 2000 flats to compulsorily have a Hospital in the Housing Scheme can help address these issues. Ashwin Mahesh: If at least 5 % of our budgets at central and stare level are assigned for health care that itself will bring about change. Also, the health implications of other sectors like ‘transport’ which affects air quality and health of citizens should also be considered. Government should first ensure the social infrastructure - healthcare, education, public spaces - before allotting land for housing. If this is done, each area will have its own social services locally, and become more livable. With inputs from Jayata Sharma-Sand


Global Practices

Reviving Cancer Care

The Teenage Cancer Trust Unit is making revolutionary changes in cancer care, finds out Arunima Rajan.

I

magine a cancer hospital with vibrant walls, socializing zones and connectivity rooms. If you think this is a farfetched idea, more a fantasy than reality, then visit the Teenage Cancer Trust Unit of Birmingham’s Children’s Hospital. To help calm anxiety of their young cancer patients, who deal with a lot of stress during their stay, the organization has come up with a unique design that challenges these problems. Instrument of Change A dedicated cancer ward for teenagers is the brain child of the Teenage Cancer Trust (TCT). Founded in 1997, TCT is a charity dedicated to teenagers

with cancer and related diseases. Understandably, the charity’s aim is to set up 22 TCT units by 2012. So far, the charity has built units in London, Leeds, Liverpool, Birmingham, Sheffield, Newcastle, Manchester, Glasgow, Southampton, Edinburgh, Cardiff and Wirral. “Dealing with cancer is frightening. Being taken away from your normal life – your friends, your environment – and put in a cancer ward with small children or older people is unimaginable. At TCT we don’t believe that is right as teenagers with cancer shouldn’t have to stop being teenagers. These units are great and become a home away from home for young people,” informs

Roger Daltrey CBE, patron of the trust. TCT seems to serve as a natural progression of movements which advocated for specialist unit for teenage cancer patients. Interestingly, the state-of-theart unit is a result of years of tireless fundraising by TCT and supporters in the region, in particular two local families. Matthew and Hilary Engel lost their 13-year-old son Laurie to a rare and aggressive cancer in 2005. Since then the family have raised over £1.1 million for TCT. Following the success of the Engels’ campaign, the charity launched a public appeal to raise the final £1 million needed to complete the unit where Laurie

would have been treated. Diane and Ken Watt lost their daughter, Maria, in 2005 after she was diagnosed with Acute Lymphoblastic Leukemia at the age of 17. The family has since raised £180,000 for TCT in her memory. Diane says “We are privileged that The Maria Watt Foundation has been associated with The Engel Family and TCT in helping to get this fantastic facility up and running for our teenagers in Birmingham. Our daughter didn’t get the opportunity to be treated in a specialist TCT unit; however through our loss we have been able to make a difference to other teenagers with cancer. This unit will make a huge difference towards the

Healthcare Executive February 2012 | 67


well- being, care and treatment of teenagers with cancer and we will continue to provide ongoing support for unit into the future.” If there was anything that the £2.8 million ward proved on October 2010, it is that the teenage cancer patients have very specific needs that can’t be provided for by children’s or adults’ wards. The other cancer trust units like Queen Elizabeth Hospital provides treatment for cancer patients with in the age group of 16 and 25. “We are incredibly excited to see the unit up and running and our patients, their families and unit staff benefit immensely from the specialist support and care provided by the unit. I would like to say a huge thank you to the Hospital and to everyone who has been involved in supporting TCT locally over the last few years,” said Simon Davies, Chief Executive of Teenage Cancer Trust. Conducive for Socializing Unlike its peers, the specialist cancer unit give teenagers a very best chance of a positive outcome. The unit in Birmingham includes six inpatient beds and will provide a home away from home for many young people and their families. Unlike ordinary hospital wards, it has a den, lounge area, private kitchen and activities area including a pool table and digital jukebox and access to media facilities such as the internet, TV and music.

ings from this evaluation clearly demonstrated that built environment is one of the key elements through which a cancer unit can deliver its philosophy. What the trust learned from the study paved the way for the design of TCT unit in Birmingham Children’s Hospital. In tune with their needs, the management has provided facilities that provide comfort, safety and reassurance for their inmates. Young cancer patients and their parents value the opportunity to lead a normal life in the hospitals. For patients, it makes the process more bearable, makes it

Why specialist units are good? Even studies suggest that adolescent cancer patients have very different needs than adults. As TCT started its journey, the members realized that a traditional cancer unit won’t help youngsters. Thus, in March 2009, the Futures Company, a strategic insight and futures consultancy, was roped in by the trust to better understand and define the impact of the design of their specialist units upon the lives of those who use them. Find68 | February 2012 Healthcare Executive

easier to engage with treatment, easier to keep going and easier to maintain existing social and support network. Thought behind the Design A team of designers, researchers as well as health care professionals have come up with this unique model to improve cancer care in oncology wards. Driven by the vision of the Trust, designer Lifschutz Davidson Sandilands broke away from the conventional design of an oncology ward to create a ward with numerous activity zones for the young patients. Unlike its

peers, the design of the hospital aims to facilitate control, comfort, stimulation, personalization and connectivity for inmates. The main accomplishment of the unit is that it allows patients to take control of important aspects of their day-to-day lives on the units like when to get up and go to sleep, what and when to eat and their immediate environment including control over lighting and levels of privacy. In order to gain positive results, they have created an atmosphere that is less institutionalized and threatening to both patients and their friends and family, so that they feel more comfortable spending time in the units. Another high priority design quotient for the team was the facilities for organized activities and equipment. Factors which help to distract from their day to day reality of cancer treatment, like access to outside space and graphics or designs on the walls and ceilings, are also some of the major features of the hospital design. Interestingly, the eye-catching unit allows patients to take ownership of their space and create a sense of home, which is


extremely important for longer term and end of life patients. An analysis of the facilities of the hospital shows that it allows patients to keep in touch with normal social support networks such as friends and family to maintaintaining touch with all aspects of life. Facilities like flexible visiting hours, social spaces to hang out and free access to laptops are some of the key features. So if you are the TCT facility of Birmingham, chances are that you will be amazed by the attention to practical details such as the angle of the TV as well as easy access to bathrooms. Dreams Fulfilled It’s no wonder that adolescent cancer patients are flocking to the hospital. It seems to serve as a natural progression of movements which advocated for specialist unit for teenage cancer patients. Hannah, 16 from Stourbridge was diagnosed with Non Hodgkins Lymphoma at the age of 15. She received all of her treatment on the Teenage Cancer Unit. Hannah says: “The Teenage Cancer Trust Unit is absolutely amazing. My cousin was treated in a children’s ward and I can really see the difference between the two. The unit is well thought out and is perfect for teenagers, just like me. When I wanted to be around others, I could hang out in the social space but I had my own space when I needed it. Being treated at this unit made a huge difference to my experience.” Acknowledging the efforts of the trust, Sarah-Jane Marsh, Chief Executive officer of Birmingham Children’s Hosptial NHS Foundation Trust says: “This unit is making a huge difference to the lives of teenagers with cancer we treat here. We have been overwhelmed by the generosity of the TCT and their supporters and would like to thank them for all their hard work in getting the unit up and running. We are very proud to a be part of this.”

Key Facts • Teenage Cancer Trust focuses on the needs of young people with cancer between the ages of 13-24 by providing specialist teenage units in NHS hospitals • Teenage Cancer Trust has built 17 units and plans to build a further 16 so that all young people needing hospital treatment for cancer across the UK have access to specialist support they

provide. Currently 48% of young people with cancer have access to their units and services • 2011 marked the 21st birthday of the very first Teenage Cancer Trust unit to open. This first unit opened in London at the Middlesex Hospital and later was transferred to University College Hospital London • In August 2005, NICE

(National Institute for Health and Clinical Excellence) published the ‘Children’s and Young People’s Improving Outcome’s Guidance’ (CYPIOG), making recommendations for the treatment and care of teenagers and young adults with cancer up to 24-years-old. It recognised the Teenage Cancer Trust model as the best care option for teenagers with cancer Source: TCT website

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Portrait Excellence Personified A continous pursuit for excellence makes Dr. Naresh Trehan a name to reckon with, explores Jayata Sharma-Sand.

H

is name is synonymous with excellence in healthcare. Having achieved numerous milestones in his career, his dream project Medanta is considered to be the best-in-class in healthcare delivery. His patients have a loyal bonding with him, and so does his associates. Yes, we are talking about Padmashri Dr. Naresh Trehan, the Chairman & Managing Director of Medanta - The Medicity. Life in the U.S. After training in general surgery and subsequently cardiac surgery at premier institutions in the U.S. (NYU Medical Centre), Dr. Trehan held important academic and clinical positions at the New York University Medical Center, Bellevue Hospital of the city of New York and Veterans Administration Hospital (Manhattan), U.S.A. His pioneering work in the field of coronary artery bypass surgery was at the New York University Medical Centre, New York, USA. India Calling In 1988, despite a successful career in the US, the want of providing his homeland with better facilities made him return to India. He thus started the Escorts Heart Institute and Research Centre – a pioneering state-of-the-art heart institute in India. Within a short period, this Centre became an important land mark in cardiac surgery and cardiology. In fact, the Centre is credited of having successfully performed over 48,000 open heart surgeries

including surgeries of coronary artery, valves, carotid arteries, aortic aneurysm, cardiomyoplasty, cardiac arrhythmias, myocardial total arterial revascularization, transmyocardial laser revascularisation, least invasive coronary artery surgery on a beating heart, reduction ventriculoplasty (Batista Operation), heart port access surgery and robotically-assisted cardiac surgery with excellent results. Some of these operations have been performed by Dr. Trehan for the first time in India. Shaping his Dream Dr. Trehan left Escorts in 2007 to give shape to his dream project Medanta - The Medicity, a multi super-specialty hospital located in Delhi’s NCR region, Gurgaon. Spread over 45 acres, Medanta is a 1,500 bed hospital with 45 operating theatres which caters to over 20 super-specialties. Medanta aims to match the standards of clinical care, research and education offered by the likes of Mayo/Harvard and Cleveland Clinics, while making treatments affordable. Besides his clinical work, Dr. Trehan takes keen interest in training, education and research programmes. He is giving a 3-year post doctoral training of international standard to 30 surgeons at this point of time. Over 20 surgeons have already been trained so far. Dr. Trehan has also presented a number of scientific papers and chaired scientific sessions in national and international conferences in the U.S., U.K., Japan, China, Israel and

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Far East countries. His boundless energy can be contagious when one sees him examining a slew of patients along with occasional visits to the OT and taking strategic business decisions; all at one time. In this exclusive chat with Healthcare Executive, Dr. Naresh Trehan shared his views on the future of his dream project and voiced his opinions on the current healthcare scenario in India. From active medicine to active entrepreneurship. Why the thought of venturing into business? As doctors, our joy mainly comes from treating patients successfully. We get satisfaction when we are able to provide the right care to them. Also, we know patients better as we are in contact with them on a daily basis. Hence, I feel that the human touch is possible to provide only when a doctor is involved in the management. That’s the reason I ventured into management. This way, I was able to plan Medanta’s healthcare facilities by keeping ahead the benefit and the comfort of the patients. Also, to make a business work, one needs to gather the right kind of people. Hence, I have chosen the staff on 3 properties. First, they are resourceful and benchmarked not just in India but against the best in the world. Second, they


have reached a stage where they are willing to give themselves entirely to the cause; by going beyond the usual clinicians work and being involved in teaching and research. And third, their ethics are clean. This is how I have been able to create a great collection of people, which embody the qualities Medanta stands for. Medanta is known for its best quality of care. How do you ensure that this standard is maintained continuously? There are 3 rules which I follow: 1) patient is of most importance 2) doctors and staff must be very efficient at all times 3) patient families must be duly taken care of. Once you have these 3 in place, you have the recepie for continous efficiency. The industry is growing by leaps and bounds. However, we still face challenges of providing cost-effective care and reaching the rural poor. How do you think these challenges can be taken care of? The biggest challenge that lies in front of us is of providing the best healthcare facilities in the lowest cost possible. And in recent times, this is proving to be a tough task. The cost of delivery is going up on a constant basis, while the affordability of patients remains

the same. For reach and affordability both, we continuously conduct free camps in rural areas, which up to an extent takes care of primary health. For complex health issues like cancer, we send around our mobile cancer detection vans. In fact, we have also included mammography equipment in our vans so that more and more women can be screened. Additionally, the PPP model can be adopted by the healthcare industry on a larger scale, which can help healthcare providers reach the most distant areas and provide care to people who have a dearth of healthcare facilities. A few years back, most corporate hospitals used to shun therapies like Ayurveda; saying there is no scientific data to prove the efficiency. But with Medanta introducing fusion medicine, it seems like times are changing. Yes, of course times are changing. At Medanta, we have recently introduced treatments that involve the combination of Ayurveda and Allopathy. I think people are now accepting the fact that Ayurveda works as good as Allopathy. In fact, it’s less traumatic to the human body as well. I believe we must start covering a larger number of patients under these treatments.

Recent mishaps have highlighted the loopholes existing in the patient safety procedures. What should the hospitals do to ensure such incidents do not happen in future? There is no doubt that the hospitals must give utmost importance to patient safety. To make sure safety is not compromised, hospitals must incorporate layers of patient safety. For instance, here at Medanta, we have fire alarms, sprinklers and exhausts, all over the place in case of a fire emergency. Additionally, we have invested Rs. 5 crore for installing huge automated exhaust fans in our basement to expel smoke during major emergencies. Also, we have our own fire team ready 24x7 and we regularly train our staff on how to handle such situations. Also, hospitals must not only install safety features, but they must also ensure their equipment is working all the time! I feel the compulsiveness must come from the top management, only then it will percolate right till the bottom. How do you think can IT help achieve world-class medical infrastructure for India? IT has been playing a major role in point of care. Technologies like PACS are benefiting healthcare delivery tremendously. The only issue with IT is that it’s too

expensive! Hence, in a country like India, where we are struggling to provide care in a cost-effective way, it becomes difficult at times for providers to adopt IT in a full-fledged way. I think hospitals must be diligent and creative while adopting IT, to reduce the cost. Maybe in future, we will have more cost-effective IT solutions. Speaking of the future, what are your plans for the next 10 years? We are planning the future step by step. Very soon we will have a Guest House ready for relatives of patients, who come from outside Delhi. They will be able to stay in a safe and reliable place. We will also build an accommodation for doctors in our campus. A medical college is on the anvil too. We have designed Medanta on the lines of Mayo and Cleveland. We have made it as the highest end of care; what patients can’t get anywhere, they will get it here. For this, we are planning 2-3 more Medantas in India. Preferably, we would cover areas of Mumbai, South and the North East. We are also going global, with our first centre already operational in Nairobi. Although it’s more of a day care and diagnostic center, we might expand it in future. Additionally, we are involved extensively in research, which we are doing in collaboration with the Duke University.

Honours & Awards • Padma Bhushan Award by the President of India in recognition of distinguished service in the field of Medicine in 2001. • Padmashri Award by the President of India in recognition of distinguished service in the field of Surgery in 1991. • Lal Bahadur Shastri National Award conferred by President of India, for excellence in Public Administration, Academics and Management for the year 2005. • Dr. B. C. Roy National Award for the year 2005 in the category of “Eminent Medical Person”. • Life Time Achievement Award - 2002 by the International Society of Cardiovascular Ultrasound. • Jewel of India in the Millennium by the International Award Committee of Wisitex Foundation in 2002. • Rashtriya Ratan Award - 2001 presented by United Indians for outstanding services, achievements and contributions in chosen field.

• AMA Physician’s Recognition Award by The CME Alliance at ISMICS-2001, Munich, Germany. • Indira Gandhi Millennium Award-2000 from All India Feroze Gandhi Memorial Society. • IMA Dr. K. Sharan Cardiology Excellence Award from Indian Medical Association in 2000. • Life Time Achievement Award–1999 from the International Medical Integration Council in recognition of the pioneering work done in developing new surgical techniques. • Distinguished Service Award in Hypertensive Vision-96 Conference, New Delhi in 1996. • International Business Acumen Award 1993 by International Business Council. • Mother India International Award–1992 by NRI Institute. • Shiromani Award for the year 1992 for outstanding achievements in the field of cardiovascular surgery. Healthcare Executive February 2012 | 71


Focus Backed by a Legacy

What makes BGS Global Hospital, Bangalore special is the fact that it’s led by India’s leading medical minds, explores Jayata Sharma-Sand

B

GS Global Hospitals, Bangalore, part of the Global Hospitals Group is a world-class tertiary care facility, a multi-super speciality and a multi-organ transplant centre. The best part of the Hospital, as they say, is that it’s powered by the leading medical minds of the country. BGS Global Hospitals is backed by a legacy of excellence in all areas of medicine with undisputed superiority in multi-organ transplantation. With the Chairman and Managing Director of the Group, Dr. K. Ravindranath, a renowned Surgical Gastroenterologist at the helm, the hospital has scaled new heights in healthcare delivery. He, along with Dr. N. K. Venkataramana, Vice- Chairman & Neurosurgeon, are setting new medical benchmarks and focus-

ing on surpassing them.

A Peek Inside

A 500-bed multi-specialty tertiary care centre, BGS Global Hospitals, Bangalore has an advanced infrastructure which includes 14 major specialty operating rooms and more than 120 intensive care beds. The focused superspeciality areas such as neurosciences, oncology, hepatology and multiorgan transplantation, GI, MIS and bariatric surgery, cardiac sciences, orthopaedics, nephrology and urology, paediatrics, etc are backed by state-of-the-art comprehensive radiology/imaging services, high quality NABL accredited laboratory services with immunology and transfusion medicine. Not to mention the medical expertise and experienced paramedical staff. The Hospital has gained rec-

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ognition for being equipped with the most advanced facilities for treatment of complex neurological problems including stemcell therapy, liver and pancreatic problems, organ specific cancer treatment, multiorgan transplantation – liver, kidney, heart, lung and pancreas. The hospital has a state-of-theart neurosciences facility providing complete care for a variety of complex diseases. It is equipped to handle all varieties of cranial and spinal surgeries including neuro regenerative medicine and management of stroke, epilepsy, movement disorders, Parkinson’s disease, pediatric neurology, neuro degenerative conditions, cognitive neurology, etc. In fact, microdialysis facility for the brain has been introduced here for the first time in the country! Many complex neurosurgeries

have been successfully performed including the world’s first successful stemcell therapy for traumatic brain injury. BGS Global Bangalore is a leader in liver transplantation and provides all types of liver transplant surgeries in India, including both living donor and cadaver donor liver transplant, split and auxiliary liver transplant, for paediatric and adults. Complex GI and pancreatic surgeries are performed laparoscopically, and the facility has pioneered in singe incision laparoscopy and bariatric surgery. The hospital is also one of the largest centres for complex congenital heart care in the city. Most major cardiac surgeries such as multiple bypasses, total arterial Bypass, valve replacement and valve repair surgeries are performed through


minimal access surgery. Cardiac interventions are also regularly performed through radial artery route.

TrueBeam – A new lease of life BGS Global Hospitals has managed to be at the forefront of cancer treatment in India, especially now with the launch of its Cancer Institute and commissioning of the world’s most advanced radiation therapy technology for cancer treatment – the first Truebeam STx in Asia Pacific. With the addition of TrueBeam STx, BGS Global Hospitals has become a complete “one-stop” destination for the most advanced radiation therapy treatments in the world. It now provides comprehensive organ specific 360 degree cancer care. While PET CT is already commissioned, the hospital will soon be commissioning Gamma Camera and Brachy Therapy machines. This latest technology targets only cancer cells in tumors even in moving organs (lungs,

prostate, and kidney) with amazing precision while sparing the surrounding normal healthy tissues. This machine has the ability to do: • Rapid Arc with gating-‘Gated RapidArc’ • All kinds of radiotherapy techniques including stereotactic procedures in a single machine. The TrueBeam STx is an advanced radiation therapy machine engineered to perform the most sophisticated radiation therapy and radio-surgery procedures with pinpoint accuracy and ultra-fine precision. It works by

Achievements

choreographing highly sophisticated systems—imaging, beam delivery and motion management—and makes it possible to deliver treatments quickly while monitoring and compensating for tumor motion.

Maintaining Quality in all Aspects The hospital takes special care to maintain quality in all areas. Quality is maintained by doing clinical audits, medical record audit, defining protocols for treatments as well as processes in the management of the hospital

BGS Global has to its credit many achievements. The Hospital has performed liver transplantation surgery for metastatic liver disease – first in India. It also has successfully performed the country’s first stem cell therapy for traumatic brain injury. The facility also has successfully performed deep brain stimulation surgery and stemcell treatment for Parkinson’s Disease. Not just this, they have conducted a surgery for rare rhabdomyoma (Intra cardiac tumour) – first in India and third in the world for a three-month-old baby. They were the first ones in Karnataka to perform the single incision laparoscopy surgery, along with minimal access surgery for mitral valve repair.

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side. There is an ethics committee, quality committee, infection control committee and a safety committee which oversee various activities. Use of quality indicators and KPIs is a must for any quality work to happen in an organisation. And hence, the head of quality at BGS Global spearheads most of these operations if not all and provides the final validity of the above.

Training & Development of the Staff For any hospital to be a success, it has to engage in continuous training of its staff. At BGS Global Bangalore, training is done right from when the staff joins the organisation. Induction training, job responsibilities, service rules, fire safety, disaster management, infection control specific training when a job responsibility changes or is added. Employee of the month and employee of the year awards are given. And, employees are encouraged to attend conferences and present papers. Appraisals


are done on a regular basis and employees are rewarded as per their scores. Various training modules are also developed with the help of the HOD as well as the head of quality.

Global Enters the Facebook Phase Who says a hospital cannot be active on a social networking site? BGS Global has gone a step ahead in spreading awareness about their services by being present on various such platforms. All the group hospitals are represented on the social media in the name of Global Hospitals India, so as to deliver the one Global experience. Global Hospitals has profiles on both Facebook and Twitter, apart from this, their blogspot is very active. Global Hospitals periodically updates these profiles and shares the latest developments, accomplishments at the Group Hospitals so as to spread the word and hope on newer cuttingedge medical solutions.

Going International

The facility gets a slew of international patients, and they make sure these patients feel at home in India as well. From the warmth of greeting at the airport to the registration and discharge, the hospital creates an unparalleled experience for international guests. The highlights are: dedicated international patient helpdesk, offshore online consultations through video calls and teleconference with treating doctors, detailed prior appointment and treatment schedule for the patient, language interpretation services, made-to-order cuisine, post discharge care, visa assistance, airport transfers and facilitation services, stay arrangements, concierge services (local SIM card, registration with police, foreign exchange, and local transport, confirmation of air tickets, shopping, and sightseeing & visa extensions), in-room internet access, cashless

insurance facility, etc.

helipad built for this.

Emergency Services

The CSR Streak

Emergency services at BGS Global Hospitals are given special attention. The department is equipped to provide roundthe-clock service for immediate treatment to the critical. A full range of critical care is offered including transport, diagnosis, treatment and rehabilitation with 24x7 access to state-of-theart imaging and diagnostic tools for immediate and accurate diagnosis of the patient’s condition, modern operation theatres and a fully stocked 24-hour pharmacy. Highlights of the department are: • 24/7 emergency services dealing in medical and surgical emergencies • Tertiary trauma centre with a trauma team, including neurosurgery, orthopedics, GI and liver surgery, cardiac care, general surgery and anesthesiology • It is equipped with emergency operation theatre, triage room, trauma bay, transit ward and shock room that is exclusively meant for patients with cardiac arrest for CPR • The hospital offers 24/7 ambulance services and has an ambulance control room. • The Department also sas a

The hospital has tie-ups with various schemes being run both by state government, central government and other public sector organisations. The services under these schemes are being offered at very subsidised prices to make it affordable to the needy. They voluntarily extend help and support deserving patients. Many free medical camps are organised in rural areas to create awareness, this is the result of the strength of their commitment

and drive towards their corporate social responsibility initiatives.

Outreach Programmes BGS Global Hospital conducts regular outreach programmes in the form of healthcare camps, awareness talks and trainings covering villages, schools and colleges and other organisations. The prime objective behind this programme is to facilitate early detection of medical illness and timely interventions taking the medical facilities to the door step of people.

Standing First The hospital has many firsts to its credit. Technologies/techniques the hospital has introduced are the first-of-its-kind in Bengaluru, like: • Asia Pacific’s first Truebeam • Microdialysis facility for the brain, first in the country STx – the world’s best and most advanced radiation • Dedicated Liver intensive care unit, largest in Karnataka therapy system • Intra operative neuro • State-of-the-art multi-organ monitoring transplantation facility with Dr. M. Rela heading the unit offer• State-of-the-art Level 1 ing living donor and cadaver Trauma center. Dedicated liver transplantation Trauma Intensive care unit – a • First to have adapted world class trauma management centre complete with almost all cases of cardiac triage area, OT and all other intervention through radial artery route facilities, a level 1 Trauma Centre as per the American • Advanced mobile lithotripsy facility standards Healthcare Executive February 2012 | 75


Book REVIEW Simplicity is the Ultimate Sophistication A biography of Steve jobs by Walter Isaacson Considered by some to be a demi god of modern day computing and slammed by several for his brash and insensitive behavior, Steven Paul Jobs undoubtedly changed our way of life. In a biography commissioned by Jobs, Isaacson attempts to encapsulate his complex personality showcasing his genius along with his hard to handle behavior. Walter Isaacson, the author, is also credited with penning the biographies of Albert Einstein and Benjamin Franklin. In assembling the biography he spent scores of hours with Jobs and interviewed hundreds of other people, including Jobs’ widow Laurene Powell; his former girl-

friends (among them Joan Baez and the writer Jennifer Egan); Jobs’ father by adoption etc. Steve Jobs was born on February 24, 1955, to two University of Wisconsin graduate students who gave him up for adoption. He was adopted by Clara and 76 | February 2012 Healthcare Executive

Paul Jobs. Clara worked as an accountant and Paul was a Coast Guard veteran and machinist. As a boy, Jobs and his father would work on electronics in the family garage. “He loved doing things right,” Jobs said. “He even cared about the look of the parts you couldn’t see.” Paul would show his son how to take apart and reconstruct electronics, a hobby which instilled confidence, tenacity, and mechanical prowess in young Jobs. After high school, Jobs enrolled at Reed College in Portland, Oregon. Lacking direction, he dropped out of college in six months and spent the next 18 months dropping in on creative classes. Jobs later recounted to Issacson, how one course in calligraphy developed his love of typography. In 1974, Jobs took a position as a video game designer with Atari. He then left Atari to find spiritual enlightenment in India, traveling the continent and experimenting with psychedelic drugs. In 1976, when Jobs was just 21, he and Wozniak started Apple Computers. They started in the Jobs family garage, and funded this venture by selling Jobs’ Volkswagen bus and Wozniaks’ beloved scientific calculator. Through Apple, Jobs helped usher in the personal computer era when he put the Macintosh in the hands of regular people. Jobs attended Apple’s first Halloween party dressed as Jesus Christ, while his most devout admirers cast him in the role of God the Father, the creator of new worlds. Product launches were staged as

re-enactments of Genesis, unveiling inventions that looked, as Jobs said about the 1988 Macintosh, like visitors “from another planet. A good planet. A planet with better designers”. The book recounts Jobs interactions with John Sculley who joined Apple as their CEO and follows him through his seemingly cruel ouster from the company .His exit marked the beginning of Jobs next venture at Next where a more humble approach helped him launch competition for Apple’s products. During this period, he also made one of the most successful alliances in animation history with John Lasseter by buying out the graphics unit of Lucas films which ended in the creation of Pixar. Pixar is credited with making blockbuster movies like Toy Story, a Bug’s Life, Wall E and Cars. The Walt Disney Company bought Pixar in 2006 at a valuation of $7.4 billion; the transaction made Jobs the largest shareholder in Disney. What ensues this success is Steve’s re-entry into the Apple Corridors when Woollard, a member of Apple’s Board, plays a key role in firing the then CEO Gil Amilio. This time around Jobs moves in with fiery passion to create some of the world’s most enviable products. The creation of the IPod helped transform the entire face of the piracy riddled Music Industry at the time. It marked the beginning of a new high in research and development in technology and Apple’s next transformational product ,the Iphone. Review by Isha Khanolkar


Mythology marries Fiction Immortals of Meluha by Amish Tripathi A mythological story presented as fiction with its own share of thriller, romance and action, ‘The Immortals of Meluha’ is the first book of Shiva Trilogy series written by Amish Tripathi. Tripathi is an alumnus of Indian Institute of Management, Calcutta. He worked in financial service industry for nearly 14 years before turning to writing. Although he originally wanted to be a historian, he chose a career in finance because he couldn’t afford the former. Set in 1900 BC in what we call the Indus Valley Civilization, the inhabitants of that period called it the land of Meluha a near perfect empire created many centuries earlier by Lord Ram, one of the greatest monarchs that ever lived. This once proud empire and its Suryavanshi rulers face severe perils as its primary river, the revered Saraswati, is slowly drying to extinction. They also face devastating terrorist attacks from the east, the land of the Chandravanshis. To make matters worse, the Chandravanshis appear to have allied with the Nagas, an ostracised and sinister race of deformed humans with astonishing martial skills! Amidst all this chaos, here appears a Tibetan immigrant who as per legends will be their savior, their God – the Neelkanth. The characterisations have been sketched to near perfection. Though we may be aware of the characters in the plot, the book describes them vividly so one can envision in real flesh and blood . Shiva ,after arrival is then taken to the capital city of Meluha, where he meets King Daksha. While staying there, Shiva and his comrades, Nandi and Veer Bhadra, encounter a mysterious woman, who though very beautiful, has a look of penance on her face. They later come to know that she is Princess Sati, the daughter of Daksha and is a vikarma, an untouchable in

this life due to sins of her past births. Shiva tries to court her, but she rejects his advances. Ultimately Shiva wins her heart and they decide to get married, even though the Vikarma rule prohibits them from doing so. Enraged by the so-called obsolete law, Shiva declares himself as the Neelkanth and swears to dissolve the Vikarma law. Daksha allows Sati to get married to Shiva. The theme, makes one comprehend that one can attain godliness only by actions .It reiterates the whole concept of “Har Har Mahadev” which reinforces that there is a God in everyone. Shiva meets Bŗahaspati, the Chief Inventor of the Meluhans who invites him and the royal family on an expedition to Mount Mandar, where the legendary Somras is manufactured using the waters of the Saraswati river. Shiva learns that the potion which made his throat turn blue was actually undiluted Somras, which can be lethal when taken in its pure form. However, Shiva was unaffected, which was the first sign that he was the Neelkanth. He also learns that Somras was the reason why the Meluhans lived for so many years. Brahaspati and Shiva develop a close friendship and the royal family returns to Devagiri. Upon learning one morning that Mount Mandar Has been attacked by Nagas an enraged Shiva declares war on the Chandravanshis. The Chandravanshi king is captured and brought in front of Daksha along with the Chandravanshi princess, Anandmayi,who tells them that they too have a similar legend that the Neelkanth will come forward to save their land by launching an assault against the ‘evil’ Suryavanshis. Hearing this, Shiva is dumbfounded and utterly distressed. With Sati he visits the famous Ram temple of Ayodhya, the capital of Swadweep. There he

meets a priest who enlightens the Mahadev on karma, his fate, and his choices in life, which will guide him. A less despondent Shiva leaves the temple with hope, and as he exits he notices Sati waiting for him and behind her a hooded and masked Naga readying for an attack. The book ends at this point. The Book provides fascinating interpretations of the caste system, various philosophies such as the nature of reality, good and evil, amongst others. Shiva’s journey is symbolic of

every human’s journey into life and enlightenment. The language is simple and everyday Indian English and sometimes falters with use of casual language.This book for one will not take you long to sail through, considering the narration style. Review by Isha Khanolkar

Healthcare Executive February 2012 | 77


Happenings National

3rd National Conference on Innovation and Challenges in Management Practices The National Conference on Innovation and Challenges in management practices will be held on 17th-18th February, 2012 at New Delhi, India. It aims to discuss new concepts and trends in the management practices today. A highly accomplished advisory board comprising of well-known names from the management field from India and abroad have been constituted to speak and discuss various related issues. Organiser: Banarsidas Chandiwala Institute of Professional Studies Contact : Dr. Satish Taneja, Director (BGIPS) or Dr. Shamsher Singh, Conference Co-ordinator Tel: 011 49020404/400, +91 9810543144 E-mail: conference@bcips.ac.in Website: http://www.bcips.a.in/conference/ index.htm

Medifest Fair India 2012 The 18th International Exhibition and Conference on Diagnostic, Medical Equipment and Technology will be held on 2nd-4th March at Hall 6, Bombay Convention & Exhibition Centre, Goregaon (East), Mumbai, India. The Fair will include about 200 different exhibitors presenting the entire medical spectrum, from diagnostics to medical equipment to the latest technologies. Organiser: Messel Dusseldorf India Pvt. Ltd Contact: Mr. Suraj Ullal E-mail: UllalS@md-india.com Website: http:// www.mdindia.com, http:// www.medicalfair-india.com

7th Nutra India Summit 2012 India’s biggest Nutraceutical, Functional foods, dietary supplements and ingredients show, 7th Nutra India Summit will be held on 15-17, March, 2012 at Lalit Ashok, Bangalore. The event will focus on empowering and ensuring Right Nutritional & Health aspect of products by providing sufficient exposure to the growing industry in India. It aims to bridge gap to share knowledge

and open gateways for Global Fraternity & Industry to venture in Indian Markets. Organiser: Council of Scientific and Industrial Research (CSIR) Contact: Mr. Niket Donde (Mumbai), Mr. Manas Das (Delhi), Mr. Manjunath Reddy (Bangalore), Narasimha Murthy (Hyderabad), Mr. Krishna Kumar. V (Chennai) Tel: +91 22 24385007 -09 (Mumbai), +91 11 23319387 (Delhi), +91 80 4113192/13 (Bangalore), +91 40 40032690 (Hyderabad), +91 98450533131 (Chennai) E-mail: enquiry@nutraindiasummit.in Website: www.nutraindiasummit.in

India Healthcare Congress 2012 The India Healthcare Congress will be held on 20th-21st March, 2012 at The Grand Hyatt, Mumbai, India. This exclusive summit aims to provide a platform for information sharing between like-minded individuals to create a tighter, more integrated relationship. The summit focuses on bringing together top level executive s and providers that are serious about taking control where they can and being at the forefront by delivering targeted messages to the right audiences. Organiser: Nnoveta Contact: Mr. Rajeev Sharma Tel: +91-40-40404160, +91 8892150990 E-mail: healthcarecongress@innoveta.in Website: www.indiahealthcarecongress.in

International

Retrofitting Healthcare Facilities 2012 Australian Healthcare week presents ‘Retrofitting Healthcare Facilities 2012’ on the 22nd-24th February, 2012 at Sebel Albert Park, Melbourne, Victoria, Australia. This exclusive event will discuss the challenges, opportunities and solutions for retrofitting healthcare facilities whilst minimising disruption, keeping control of infection and increasing whole of the life energy efficiency. This will enable the participant to gain the opportunity to network and discover how to innovate and tackle common obstacles from Australian and overseas project case studies.

80 | February 2012 Healthcare Executive

Organiser: Australian Healthcare Week Contact : Ms. Judy Hizon Tel: +61 (2) 9229 1000 E-mail: registration@igpc.com.au Website: www.austhealthweek.com.au/ retrofitting

Annual Conference on Innovations in Business and Management & Doctoral Symposium The Annual Conference on Innovations in Business and Management will be held on 27th February, 2012 at The Senate House, University of London, London UK. The conference offers researches an opportunity ti present their worj in all areas of business and management. The theme for 2012 is corporate social responsibility in a globalised business world. Areas of interest includes the global financial crisis, international marketing, differences in CSR business practices around the globe, social and cultural dimensions of business, innovations in HR practices, etc Organiser: The Center for Innovation in Business & Management Practice (CIBMP) Contact: Ms. Sally Parker E-mail: admin@cibmp.org. Website: http://www.cibmp.org/annualconference-on-innovation-in-business-management

International Management World Congress The International Management World Congress will be held on 28th-29th February, 2012 at Hotel Novotel London City South, Southwark Bridge Road, London, UK. IMWC’s mission is to encourage international business faculty members to respond to current international management issues and share ideas for global economic growth, market innovation, effective international business practices and consumer trends. Organiser: Global Journal of Strategies & Governance (Canada) Contact: Ms. Laurelle D. Gbala E-mail: imwc2012@review-gisg.com Website: http://im-worldcongress.reviewgjsg.com


CEO PAGE

“

There is always a better way! You just need to look for it

Mr. Vishal Bali CEO Fortis Hospital, India

My Life’s Goals

Aim & Ambition: To drive and lead a foundational change in the healthcare delivery sector by incorporating the advances of management and science. Vision: To make Fortis Healthcare the leading provider of integrated healthcare services in Asia Pacific powered by a team of most respected clinicians and vibrant managerial talent with focus on innovative care. Social Goal: To support the less privileged in receiving better education, that done, healthcare will soon follow. Business Goal: To balance the economic and social good in healthcare.

My Leisure Choices

Favorite Tourist Spot: Bali Indonesia. It has got nothing to do with the name, but just that this place is one holiday destination that our family loves to go each year. Music I Like: Fusion and Rock. Sports I Love: Like all our country folk, I too am a Cricket fan. I also like Tennis.

Ask my Taste Buds

Favorite Food: I love Indian and Italian food. Favorite Drink: Nimbu Pani (lemon juice), simple but the best thirst quencher.

In Awe of

I Admire: The power of nature has always struck me. It is just so divine and unpredictable.

82 | February 2012 Healthcare Executive


EASIER AND SAFER OPERATIONS IN THE SHOULDER REGION WITH TRIMANO 3D SUPPORT ARM

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Healthcare Executive - Infrastructure