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Registered with Registrar of Newspapers under RNI No. MAHENG/2012/46040, Postal Registration No. MH/MR/N/242/MBI/12-14, Published on 27th Total number of pages 48 of every previous month. Posted at Patrika Channel Sorting Office, Mumbai-400001, Posting date: 30th & 31st of every previous month

Aligning business and healthcare in India Published by ITP Publishing India

JASLOK 40 YEARS OF SERVICE

INFRASTRUCTURE SPECIAL

REACHING

OUT SHRIRAM VIJAYAKUMAR, FOUNDER, DAVITA NEPHROLIFE, ON BUILDING THE COUNTRY’S LARGEST PRIVATE RENAL CARE NETWORK

FURNITURE PLANNING HVAC MAINTENANCE DRYWALLS SECURITY SYSTEMS


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Contents

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Cover story Shriram Vijayakumar, founder & CEO, DaVita NephroLife Pvt. Ltd on creating the country’s largest private renal care network

News 10 This month’s important news updates Project 15 10 things you didn’t know about Jaslok

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34 Why several hospitals have switched over to drywalls for internal walling

Hospital

37 Leverage the experience and knowhow of a specialised team in project management

Hospital Infrastructure 22 Go for furniture that is automated, durable,

38 Integrating three key components of an intelligent security management system

anti-microbial and enhances patient comfort

26 Simple steps to be kept in mind when

41 Why hospitals are opting for vinyl flooring in critical areas

planning a hospital to avoid deviations and delays

28 Routine maintenance of HVAC system helps

43 The importance of adopting healthcare analytics in the Indian subcontinent

prevent problems and brings down energy costs

30 Sustainable design practices in healthcare

Consumer Connect Initiative 45 India’s first revolutionary mobile operating

buildings have many benefits

table and other featured product

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Editor's note

August 2013 • Vol 1 • Issue 11 ITP Publishing India Pvt Ltd Notan Plaza, 3rd floor, 898 Turner Road Bandra (West), Mumbai – 400050 T +91 22 6154 6000

Deputy managing director: S Saikumar

The trendsetter

W

hile we applaud the global journey of a few Indian healthcare players, let’s not overlook the scanty presence of internationally acclaimed players on the Indian soil. Call it reluctance to operate in the corruption-ridden Indian business environment or work in a system that relies less on protocol and process or sheer inability to implicitly trust the Indian partners, such global collaborations are few, and often have culminated in failures. The parting of ways of Singapore-based Parkway Group and Mumbai’s Asian Heart Institute is a classic case of such partnership gone kaput. But young and globe-trotting Indian healthcare entrepreneurs are not deterred by such gloomy precedence. Shriram Vijayakumar, who founded NephroLife, has managed to partner with USbased NEA, one of the world’s largest VC firms, and US-based Davita, which has its footprints in 10 countries. The proof of the successful collaboration lies in the group’s ten-fold growth since the partnership. What makes DaVita Nephrolife’s case study a compelling read is its incredible journey, starting out as a local player with one dialysis centre to bursting onto the national landscape as the largest renal care player in the private sector, while continuing to serve a much-neglected market demand for quality dialysis care. But to zoom at breakneck speed and not hurtle down the road, the projects team and the management need to well-informed about various aspects of projects, be it project planning, planning for furniture, drywalls, flooring, security, green building initiatives or HVAC. Our ‘Hospital Infrastructure Special’ is the litmus test to find whether you and your project director are following the latest tools, gadgets and techniques required for a modern hospital. If yes, then you are definitely in synch with the changing times. If not, it’s time to review and eschew archaic concepts before they impede the road to development.

Publishing director: Bibhor Srivastava Group editor: Shafquat Ali T +91 22 6154 6038 shafquat.ali@itp.com

Editorial Consulting editor: Rita Dutta T +91 9980 588199 rita.dutta@itp.com Managing editor: Shiv Joshi T +91 22 6154 6034 shiv.joshi@itp.com

advertising Business head— Tushar Kanchan T +91 9821 580403 tushar.kanchan@itp.com Regional sales manager — South: Sanjay Bhan T +91 9845 722377 sanjay.bhan@itp.com

studio Head of design: Milind Patil

production Deputy production manager: Ramesh Kumar

circulation Distribution manager: James D’Souza T +91 22 6154 6032 james.dsouza@itp.com

Cover image: Nilotpal Baruah

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

Printed and Published by Sai Kumar Shanmugam, Flat no 903, Building 47, NRI Colony, Phase – 2, Part -1, Sector 54, 56, 58, Nerul, Navi Mumbai 400706, on behalf of ITP Publishing India Private Limited, printed at Jasmine Art printers Pvt.Ltd., A-737/3, TTC

Rita Dutta Consulting editor rita.dutta@itp.com WRITE TO THE EDITOR Please address your letters to: The Editor, Healthcare Radius, Notan Plaza Third Floor, 898 Turner Road, Bandra West, Mumbai - 400050 or email rita.dutta@itp.com. Please provide your full name and address, stating clearly if you do not wish us to print them. The opinions expressed in this section are of particular individuals and are in no way a reflection of the publisher’s views.

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Industrial Area, Mahape, MIDC, Navi Mumbai. India and published at ITP Publishing India, Notan Plaza, 3rd floor, 898 ,Turner Road , Bandra (West), Mumbai – 400050 Editor: Rita Dutta

Published by and © 2013 ITP Publishing India Pvt Ltd Title verification no. RNI No: MAHENG/2012/46040

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Healthcare Radius August 2013


Bulletin Medica Consultancy forays into Afghanistan

In war-ravaged Afghanistan, it is but obvious that the morbidity and mortality rates are significantly behind indicators of other developing countries. Maternal and neonatal mortality alone account for 16 per cent of the total deaths in the country. In an attempt to improve the country’s healthcare delivery, the Ministry of Public Health Afghanistan (MoPH) had entrusted Kolkata’s MedicaSynergie with the task of assessing the demand for beds (for general as well as maternal and paediatric purposes). Medica was also asked to carry out a feasibility study to determine the viability of a PPP model for Kabul’s Sheikh Zayed Hospital, a 100-bed women and paediatric facility that has been built with the financial support from Sheikh Zayed Foundation of UAE. Assessing the feasibility of the envisaged PPP arrangement, a detailed demand and supply side assessment pertaining to maternal and child health services in Kabul city was undertaken by Medica. Says Ayanabh Debgupta, CEO, Medica Consultancy, “Even though almost 70 per cent

of the healthcare in Afghanistan is funded by development partners, the country is facing an acute crisis in terms of availability of quality human resources to meet the demand for commissioning and operationalising additional 2,200 beds built by generous foreign aids for over a decade.” To meet the present demand in the next 30 years, Medica has suggested that Afghanistan requires 46,000 additional beds, out of which 12,000 for obstetric and gynaecology, and 7,193 as NICU beds. It has further recommended that the PPP model for Sheik Zayed Hospital is required to be designed with diligence, considering the vision of MoPH, its intended welfare service delivery model, larger role of the hospital in Afghanistan healthcare system and the interest of the private partners. “After analysing the technical and financial feasibility, we have suggested that the hospital can provide 10 per cent of its services free or charge approximately $60 million as lease fee in the next 25 years. Hence, a Build Refurbish Operate & Transfer (BROT) model for 25 years has been proposed for the project,” said he.

FMRI gets 4 star TERI GRIHA rating Gurgaon’s Fortis Memorial Research Institute (FMRI) has been recognised as a green building and awarded four star rating by TERI GRIHA. The rating system evaluates building projects on several aspects of environmental sustainability. It emphasises the use of recycled and low energy consuming materials, energy efficient designs and deployment of solar energy. Some of the stringent standards in the use of eco-friendly construction materials and design at FMRI include deployment of autoclaved aerated blocks in building construc-

tion, low energy materials and low volatile organic compound paints in interior finishes and minimising the use of ozone depleting substances. Focus on continued energy conservation has been led by the optimisation of building design, use of low emissivity glass for the building en-

velope, deployment of solar energy for lighting and hot water, and use of highly energy efficient fixtures and equipment managed centrally by a computer-based building management system. Water conservation measures in the hospital include the reuse of treated water and provision

of water harvesting pits for ground water regeneration. Additionally, care has been taken to conform to noise level standards both within and outside the building. Said Daljit Singh, president, Fortis Healthcare Ltd, “Right at inception, we took a conscious call to weave ‘green building’ principles into the design of the FMRI project. The four star rating is a significant step forward in our endeavour to build a brand that is sensitive to environmental issues and committed to promoting sustainability”.

One million Indians die every year due to inadequate healthcare facilities and 700 million people have no access to specialist care in India

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Bulletin

Columbia Asia, hebbal launches paediatric gastroenterology services

Columbia Asia Hospital, Hebbal has launched a comprehensive paediatric gastroenterology service. A team of trained and experienced consultants including a paediatric gastroenterologist, paediatric surgeon, paediatric allergy specialists, and dietician and paramedic support staff will offer comprehensive evaluation and treatment for children and adolescents with disorders of the digestive system. “It will be one of the few centres dedicated to paediatric gastroenterology in the country,” said Dr Prashanth, general manager, Columbia Asia Hospital, Hebbal.

The services in the department include a feeding clinic, which is a specialised unit to evaluate and treat children with fussy feeding, feed refusal and faltering weight. It also includes paediatric endoscopy services and a paediatric food allergy clinic that will diagnose and treat severe food allergies and atopy (hypersensitivity) in children. The department will also treat constipation, foetal and urinary incontinence and toilet training issues. In addition, also on offer are Ph studies to diagnose troublesome reflux, available only at a few centres in India.

Max Elite Institute of Orthopaedics & Joint Replacement launched

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DR GUSTAD B DAVER Joins HN Hospital Dr Gustad B Daver, who played an important role as director, professional services and consultant surgeon at PD Hinduja National Hospital, has joined as medical director of Sir HN Hospital in Mumbai. The hospital is run by Reliance Foundation. Speaking about the appointment, Nita Ambani, chairperson, Reliance Foundation, said, “This is part of our endeavour to modernise the hospital into a world class, super specialty centre that will provide quality and affordable healthcare.” Dr Daver holds a three-year post-doctoral fellowship at Baylor College of Medicine, Houston Texas in Cardiac & Vascular Surgery & Multi Organ Transplant Surgery. He has been the dean at Grant Medical College and Sir JJ Group of Hospitals and professor and head of general surgery.

Affordable joint replacement in Hyderabad

In an effort to reach out to all segments of the society, NHMalla Reddy Narayana Multispeciality Hospital, Hyderabad, has introduced the lowest ever ‘joint replacement surgery’ treatment package in Andhra Pradesh. The hospital will offer two varieties of implants – Indian and international, depending on the patient’s choice and requirement at a reduced cost. According to orthopaedic surgeon Dr Anjani Kumar, “Joint replacement, though an optimal solution, proves to be a costly affair for the mass. However, through this initiative of ours, we aim to reach out to the masses and provide them with a helping hand in making quality treatment more accessible.”

Max Super Speciality Hospital, Mohali has announced the launch the Max Elite Institute of Orthopaedics and Joint Replacement. The 100bed institute will have integrated modular OTs, digital operating suites to telecast live surgeries, space suits in OTs for minimum infection rates, OPD lounge with video conferencing and audio video counseling, specialty ICUs for high dependency joint replacement patients, and stateof-the-art physiotherapy and rehabilitation for ortho and joint replacement patients. Said Dr Ajay Bakshi, MD & CEO, Max Healthcare, “The launch of the Max Elite Institute of Orthopaedics and Joint Replacement is a natural step in our journey to provide international standards of care to residents of the region.”

The institute will bring to Mohali the latest path-breaking technology—pin-less navigation system. According to Dr Manuj Wadhwa, director and head, Max Elite Institute of Orthopaedics and Joint Replacement, “This is a unique technology, which is the first of its kind in North India, and will revolutionise the field of orthopaedics, making ortho-surgery safer and less painful. Pin-less navigation system is less invasive for knee replacement patients. The system uses infrared cameras and tracking software to conduct knee replacement surgeries, hence eliminating the use of traditional pins." The institute claims it would be using the digital integrated modular operation suites, for the first time in the region.

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BULLETIN

VC FUNDING IN HEALTHCARE IT SHOWS RECORD GROWTH Venture capital (VC) funding in the healthcare IT sector continues its rapid growth in another record quarter with $623 million raised. There were 168 funding deals this quarter compared to 104 the previous quarter and 163 in all of 2012, as per a report by Mercom Capital Group, llc, a global communications and consult-

A BOOK FOR ADMINISTRATORS

is now on pace to exceed $2 billion in 2013,” commented Raj Prabhu, CEO of Mercom Capital Group. “What

Chief Minister of J&K, Omar Abdullah, has recently released the book ‘Hospital Administration: Principles and Practices’ authored by Dr Yashpal Sharma, Dr RK Sharma and Dr Libert Anil Gomes. According to the authors, it is a comprehensive book on the subject of hospital administration, which is bound to attract a lot of attention from various healthcare organisations and hospitals from public as well as private sectors in view of the growing demand for better healthcare facilities from the stakeholders. The topics covered in the book include: clinical care services, nursing services, support services, medical records, hospital hazards, medicolegal aspects, public relations, medico-social services and evaluation of hospital. Targeted at administrators and managers, the book has covered the responsibility of the hospital organisation towards the patient, the various facets of patient care, both clinical and managerial issues like ward management system, administrative procedure, intricacies of authority responsibility and model regulation and resource management approach. The basic steps of corporate planning towards good human relations and productivity have also been highlighted.

to spur EHR adoption and practice-focused technologies, “open data” is doing for consumerfocused companies that turn data into usable applications and services.” The impact of healthcare data on innovation, products and private investments is evidenced in Mercom’s Q2 2013 report.

ANOTHER FIRST FOR HCG HealthCare Global Enterprises has performed navigation surgery for bone tumour in India. The surgery was performed on a 19-year old, boy, diagnosed with osteosarcoma, a malignant bone tumour. With the tumour was weighing 900 grams and 20 centimetres in length, the thought of an amputation loomed large, but CAT saved the patient limb and improved his quality of life. CATS technology is a specially designed software for orthopedic oncology, which shows real time images of the tumor while operating, which enables the surgeon to be accurate in the resection of the tumor. CATS give precise directions as guided by preloaded images of MRI, CT and PET scans, during surgery.

The marked shift of VC money going from practicefocused technologies towards consumer-focused technologies in Q1 has picked up pace this quarter with consumer-focused companies receiving twice the amount of funding ($416 million in 112 deals) compared to practice-focused companies ($207 million in 56 deals). Consumer-focused companies specialising in apps, wearable devices, sensors, remote monitoring, patient engagement, rating/shopping, and social health networks for physician-to-physician, physician-to-patient and patient-to-patient were all prominent this quarter, whereas medical imaging, data analytics and EHR/ EMR companies were among the practice-focused technologies that received attention this quarter, the report pointed out.

FROST & SULLIVAN HEALTHCARE AWARDS

Frost & Sullivan (F&S) has announced its 5th Annual India Healthcare Excellence Awards 2013 to be held on September 27, 2013, in Mumbai. This awards platform evaluates companies on their outstanding performance in healthcare and life sciences sectors and recognises those that have demonstrated best practices. Instituted in 2009, over the years, Frost & Sullivan awards have become an industry benchmark, purely due to the recognition they bring to the companies. The award categories that would be recognised will span across all major sectors of the industry such as Medical Technologies, Healthcare IT, Healthcare Delivery / Services, Pharmaceuticals, and Biotechnology.

AHPI’S FIRST SEMINAR Association of Health Providers (India) or AHP BIEC, Bengaluru, on September 5 and 6, 2013. The theme of the seminar is ‘Improving patient safety and reducing cost of healthcare’ and it is aimed at helping healthcare professionals develop compeof healthcare delivery and patient safety in hospi-

tals. The seminar would be addressed by experts of repute, based on their experience of patient safety The seminar is aimed at a diverse set of healthcare professionals, be it policy makers, clinicians, administrators, quality professionals and nursing supervisors, among others. AHP has posted further details on its website, www.ahpi.in.

BONE CANCER AFFECTS 1 IN 10, 000 PEOPLE AND IS MORE COMMON IN CHILDREN AND ADOLESCENTS.

Healthcare Radius August 2013

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Bulletin

Supplier update Carestream DR gets FDA clearance Carestream Health has received FDA clearance for a new wireless digital radiography (DR) detector designed to offer high quality, low dose X-ray exams for paediatric, orthopaedic and general radiology applications. “This smaller detector can enhance patient care for premature babies and infants in paediatric ICU. It can fit into a tray located underneath an incubator, so technologists can obtain the images needed to monitor the condition of these fragile babies without moving them— which is an important benefit,” said Helen Titus, Carestream’s Worldwide X-ray Solutions marketing director. She added that hospitals can also use the new detector to capture extremity and other general radiography exams. Its smaller size (25 cm x 30 cm) and high DQE (detective quantum efficiency) can lead to lower dose than computed radiography cassettes or gadolinium scintillator detectors.

Viroblock launches new face mask

Viroblock SA, a Swiss start-up, has presented new data at ICPIC 2013 in Geneva, showing that its face-mask containing proprietary novel cholesterol depletion technology traps and kills over 99.9995 per cent of H1N1 flu viruses (swine flu), 99.999 per cent of H5N1 flu viruses (avian flu) and 99.997 per cent of human corona viruses on pass through air. According to the company, the mask aimed at helping protect people from these respiratory pathogens is up to 100 times more effective than other similar masks. Aerobiology tests, carried out in high security laboratories, create a mist of viruses on the outside of the mask, a pump is used to draw air and viruses through the mask, and finally testing for live virus occurs on the inside of the mask. “We believe that our protective face-mask can help protect healthcare, agriculture and security workers effectively, with added advantages of comfort of wear and easy identification,” said Dr Jamie Paterson, CEO, Viroblock.

Philips expands its eICU network Philips India, the leader in critical care equipment, announced the expansion of the network of hospitals connected using the IntelliSpace Consultative Critical Care (ICCC) solution, based on by Philips’ global eICU platform. This solution enables an intensivist at a central location to monitor patients in distant multiple ICUs, almost in real time without compromising on quality of information available. The new hospitals added to this network include Aditya hospital (Warangal, Andhra Pradesh), Sreeranga Hospital (Chengalpet, Tamil Nadu) and Geetanjali hospital (Tiruchirapalli, Tamil Nadu). These hospitals will be connected to the Chennai-based InTeleICU, which will act as the command centre monitoring the ICUs of the newly connected hospitals. Some of the benefits of ICCC include access

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eICU helps remote monitoring of patients to qualified experts and facilities from tier-I metro cities, ability to deliver the same level of care to hospitals in tier-I and tier-II cities and providing consistent practice standards of critical care medicine, meaningful alerts and dashboards that make it convenient for intensivists at the command center to act quickly on critical patients.

Piramal launches diagnostic devices Piramal Enterprises’ diagnostic division has launched three new devices in the QDX Range Right-here-Right-now. They are QDx A1c, India’s first voice guided diagnostic device that measures HbA1c; QDx HemoStat, which detects the level of Haemoglobin in five seconds; and QDx VitD, the world’s only device that helps detect Vitamin D in 10 minutes. Commenting on the launch, Vijay Shah, executive director and chief operating officer, Piramal Enterprises said, “The recent launch of QDx A1c, QDx HemoStat and QDx VitD is in line with our division’s vision of bringing affordable instant diagnostic solution through our point-ofcare product range. These devices are the first-of-its-kind revolutionary instant diagnostic devices in the Indian market that are poised to change traditional diagnostic methods to instant diagnosis.”

SAMSUNG Launches DR & IVD equipment Samsung India has launched DR and In-vitro diagnostics (IVD) equipment and technologies under the GEO1 brand in the country. The GEO brand includes XGEO for DR, UGEO for ultrasound diagnostic system and LABGEO for in-vitro diagnostics. "We are leveraging our strengths in technology and R&D to offer medical products that enable fast, easy and accurate diagnosis to both doctors and patients. We are focusing on time engineering that enhances the efficiency of all products being used in hospitals and clinics. By upholding customer values as its top priority, Samsung will continue to develop products, which will improve the quality of people's lives through its advanced technologies and contribute to the growth of the global medical equipment industry," said Dinesh Lodha, vice president, Health & Medical Equipment Business at Samsung Electronics.

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PROJECTS

10 things you didn’t know about... JASLOK HOSPITAL

16 27 38 49 510

The hospital is founded by businessman Lokoomal Chanrai and his wife Jasoti. Their vision to introduce an ultra-modern medical facility in Mumbai was realised by Chanrai’s brother-in-law Dada Mathradas Assomull, under the guidance of Dr Shantilal Mehta.

Jaslok Hospital & Research Center was established on July 6, 1973, and inaugurated by the then Prime Minister Indira Gandhi. It recently celebrated completing 40 glorious years of service.

Jaslok has many firsts to its credit. Among the most noteworthy ones is that by the department of assisted reproduction and genetics. Under its director Dr Firuza Parikh, it is responsible for the birth of more than 5,500 babies and for the first ICSI baby in south east Asia. The centre set up the first PGD lab in India in 1999 for testing certain genetic disorders by using FISH technique.

The renal transplant department of the hospital, started in the year 1975, has done more than 2,300 renal transplantations, which it claims is the highest in the city of Mumbai. Majority are live-donor related, while a few are cadaveric renal transplantation.

Under neurosurgeon Dr Paresh Doshi, the hospital pioneered deep brain stimulation surgery (DBS) for Parkinson’s Diseases in India. Today, the hospital has performed over 250 DBS surgeries.

Under the aegis of cardiologist Dr Ashwin Mehta, Trans Aortic Valve Impingement or TAVI, an alternative to open surgery for patients with high surgery associated risks, was performed for the first time in India.

The Digital Subtraction Angiography department of the hospital was the first in India to have 3D rotational angiography, to perform the first coil embolization of aneurysm and the start carotid stenting in this region.

Jaslok performs the highest number of Endo Venous Laser treatments of varicose veins in the country

The hospital was the first in the country to acquire high-end 3 Tesla Tim Trio MR scanner as also the first to have a 16 slice SPECT–CT.

It was the first hospital in south east Asia to install MR-guided focused ultrasound surgery unit—a revolutionary nonsurgical technique.

Healthcare Radius August 2013

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COVER STORY

Reaching out Shriram Vijayakumar, founder & CEO, DaVita NephroLife, on creating the country’s largest network of private renal care centres INTERVIEWED BY RITA DUTTA

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Healthcare Radius August 2013


Cover story

In 2009, NephroLife started as a standalone dialysis centre in Bengaluru. After entering into a partnership with DaVita and NEA, the company got a new name —DaVita NephroLife Pvt. Ltd—and a fresh infusion of funds to the tune of $25 million. Today, the group has created a network of 14 renal care centres, both standalone and in association with hospitals and is chalking out plans for more. How has partnership with DaVita and NEA impacted growth? Let me start by telling you something about our partners, New Enterprise Associates (NEA) and DaVita HealthCare Partners Inc. NEA is one of world’s largest VC firms with about US$ 13 billion in committed capital. But NEA isn’t just an investor, it is has expertise in healthcare as well, making it a true partner—we have benefited from their know-how in scaling up rapidly and their analytical method of looking at business models. Our other partner, DaVita is the dialysis division of DaVita HealthCare Partners Inc., a Fortune 500 company that, through its operating divisions, provides a variety of healthcare services to patients throughout the US and other countries. As of March 31, 2013, DaVita has operated 41 outpatient dialysis centres in nine countries outside the US, in addition to the 1,991 centres they operate in the US. DaVita has helped us achieve higher clinical quality, safety protocols and world-class training standards. Also, their standards of reporting, data collection and analysis, along with their expertise in managing distributed networks of clinics and partnerships with hospital networks has helped us enhance our clinical performance. I’m happy to say that we are the only provider in India to deploy online data collection and monitoring of patients on dialysis in real time across our network. Latest networked machines and software have enabled us to deliver a long-term outcome-based dialysis experience. This ensures better quality of care and improves longevity of patients.

How has the group grown since it opened its first centre? Our initial vision was to start two centres in Bengaluru, for which we raised an angel investment of $1.4 million (Rs6.5 crore) from a family office fund, ROI capital advisors, led by our chairman Dev Kumar Roy. We rolled out our first centre in December 2009 at Shantinagar in Bengaluru. This was a first-of-its kind standalone kidney care centre in Bengaluru with 21 beds for dialysis, a day-care surgical suite for vascular access, OPD rooms, diagnostics and value added features. We started our second centre in April 2011 at the Excelcare Hospital in south Bengaluru. The turning point came later in 2011, when we partnered with NEA and DaVita—we grew from two centres to having 14 renal care centres spread across Bengaluru, New Delhi, Pune, Hyderabad, Chennai, Puducherry and Hosur in various service delivery formats. We are on

The group's first centre at Shantinagar, Bengaluru.

Types of centres at DaVita NephroLife It has centres within tertiary care hospitals that fulfil the need for critical care, transplant services, major procedures, out-patient and dialysis and provide the entire gamut of services. It has 25-bed flagship standalone centres and centres within secondary care hospitals, both providing renal care clinics, dialysis day care and add-on services like OTs for minor procedures, on-site diagnostics and so on. It also has standalone ‘satellite’ dialysis centres (10 –15 beds).

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Cover story

track to provide over one lakh life-saving dialysis treatments this year to patients across India. Be it in terms of patient flow or revenue, we have grown tenfold since the partnership. From stand-alone dialysis centres to integrated kidney centres, tell us how you made the transition? The dialysis market is still in its infancy in India and to be a larger national provider, one has to constantly innovate – not just in terms of business models, but also in terms of technology, clinical offerings, staffing and branding. When we started, we were primarily keen on starting freestanding dialysis centres with a range of services under one roof. Along the way, we expanded to create kidney care networks in multiple locations in each city that include both stand-alone and inhospital centres. This allows us to offer patients a full range of services and treatment modalities for holistic nephrology care. What is the business model and infrastructure like for each centre? We have multiple formats of clinics right from stand-alone dialysis centres to stand-alone

Man behind the initiative Shriram Vijayakumar began his career at Mars & Co, a boutique consulting firm based out of New York. During his time there, he advised Fortune 500 Companies in FMCG, automotive and health insurance verticals in the US, China, Hong Kong and India. He then returned to India as CEO of NU Hospitals, a 75- bed nephro-uro speciality hospital. He has a double major in Economics & Information Systems from Carnegie Mellon. He wanted to start NephroLife after seeing the deplorable plight of dialysis patients in India.“The family would often sell their homes or cars or spend their lifetime savings to undergo dialysis, but still receive a low quality of life at substandard dialysis facilities primarily within hospitals. I felt there was a great need to offer world-class dialysis facilities with a holistic approach to care, which would improve quality and longevity of life for patients at affordable prices across the country,” he says, adding that his vision is not only to treat those who require dialysis, but also to work on prevention, screening and community health measures in partnership with primary healthcare providers and hospitals.

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integrated care kidney centres with multiple services to box-in-box centres within secondary and tertiary care hospitals, where we manage the entire department of nephrology. In terms of engagement with partners, we typically operate either independently within these locations on a variable share or fixed rental model. Or, we work on a JV model with hospital partners or nephrologists as applicable, where we share the investments and returns in an equitable manner. Why should hospitals partner with DaVita Nephrolife? Right from nephrologists’ coverage, trained dialysis technicians, reprocessing teams down

Be it in terms of patient flow or revenue, we have grown tenfold since our partnership with NEA and DaVita

to dietician and psychology support, we provide everything one needs for complete renal care. In fact, even premier institutes like Johns Hopkins in the US partner with DaVita. In India, we work with hospitals such as Primus, New Delhi, Frontier Lifeline, Chennai, Ruby Hall Clinic, Pune, Noble Hospitals, Pune and several others. Furthermore, we offer well-designed, spacious and bright dialysis centres of high quality with strong emphasis on safety and protocols. DaVita’s expertise in managing over 1,56,000 patients comes in handy here. We have deployed the DQI (DaVita Quality Index) for dialysis at all our centres. Right from branding of the centre, awareness programmes and doctor engagement, patient education, our dedicated approach ensures faster scaling up and greater satisfaction among patients. You have more number of centres with partner hospital than standalone centres. Going forward, will there be equal focus on both? Yes, we currently have four stand-alone kidney care centres and 10 centres within hospital locations across the country. But going forward, we are committed to growing both formats, since they serve different patient needs. Our hospital locations typically service wider patient needs, including tertiary care, in-patient care and transplant, while our stand-alone centres focus more on out-patient nephrology services, vas-

The pick-and-drop services of the group enhance customer satisfaction.

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Cover story

cular access and dialysis in convenient locations for patients. In each city we are operating in, we would typically have multiple formats as part of our ‘kidney care network’. What is the market potential for dialysis centres? The current dialysis market size in India is about $350 million and it is growing at about 20-25 per cent, annually. Unfortunately, about 3,50,000 people in India reach end-stage kidney disease every year. These people require dialysis or a transplant to stay alive. More than 85 per cent of them would die within the first year due to inaccessibility to care or inability to pay for it. India is also among the countries with world’s highest prevalence of diabetes and hypertension, leading causes of kidney failure. These factors have created a huge demand for dedicated dialysis centres. Today, dialysis facilities are mostly offered by hospitals since the majority of nephrologists work with hospital groups and patients typically come only at the end stage, which requires intensive care support. In the US, hospitals typically only do acute dialysis or initiation of dialysis after which patients are discharged to standalone centres for long-term chronic dialysis. This is primarily because it is neither cost effective to provide dialysis within a hospital, nor is it a core competency for hospitals since their bandwidth can be spent more effectively on high-end services and in-patient care. We believe that dialysis is best managed by kidney care experts, both within and outside hospitals in dedicated centres. A dialysis patient visits us 120 to 150 times in a year for life-saving treatments. So, you can’t treat him like a regular patient, which is ‘admit, treat and discharge’. Dialysis patients need to be monitored throughout the year and the process of delivering high-quality dialysis requires constant attention to everything from water quality, machinery, training documentation to infection control and clinical outcomes. Dialysis alone has over hundred processes and protocols, which needs continuous monitoring and this complexity is best managed by experts with a keen focus. The bulk of in-hospital acute dialysis and out of hospital dialysis in the US is managed and operated by dedicated kidney care providers. For example, in the US, DaVita treats virtually one third of all kidney care patients. Like I mentioned before, this gives us immense scope.

The group's centre at Kilpauk, Chennai.

What are the dynamics of starting a dialysis chain? Dialysis centres are capital intensive since the cost of machines and RO plants is on par with that in developed countries while that of infrastructure (land, water, power) is often more than what it is elsewhere. The cost per bed for a dialysis centre with facilities like beds, RO plant and other equipment is around $25,000 to $40,000. While it is capital intensive, it is profitable business. At a steady state, the EBIDTA margin for a well-managed chain should be around 20-25 per cent. What are the challenges associated with a managing dialysis chain? It is a challenge to provide global standards of care at prices that are affordable to patients across the length and breadth of India, which is why, as a group, we have a laser sharp focus on single centre cost structures. We are working towards minimising overheads and improving efficiency through technology constantly. We pay great attention to detail in every clinical process across distributed locations. This is challenging since it not only requires well-trained clinical teammates, but also a strong operations team that can supervise and

Dialysis services drive the group’s revenue.

ensure adherence to processes along with systems and technology that make it seamless to report and audit. It also takes a strong culture of teamwork between our nephrologists, clinical team and operations team to ensure the daily commitment to process and high levels of integrity and excellence to ensure quality. One large challenge is the massive shortage of skilled talent—right from technicians, to

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The differentiator What sets DaVita NephroLife apart Total kidney care: It supports patients need right from prevention of kidney disease for high risk patients to managing early stages of kidney disease to end-stage requiring dialysis or transplant to in-patient nephrology care at partner locations. It also provides vascular access services, dieticians and psychologists to manage care beyond dialysis. Patient scorecards: A team of doctors, technicians, dieticians and psychologists continuously tracks overall outcomes and progress over time. Patients are apprised and are included in a care group as well. There is an annual award for patients, who have done exceedingly well. It serves as a reminder to others that it is possible to live well on dialysis. Value added services: Dialysis is a gruelling four hour, thrice weekly procedure that a patient has to undergo. The company’s doorto-door pick-up and drop service coupled with bedside entertainment and individual LCD Screens and WiFi connectivity helps make the ordeal comfortable. Technicians training and audits: A one-of a kind dialysis academy trains technicians as per global standards. A special team conducts performance audits on an on-going basis on various parameters.

The group has adopted a team approach and leveraged IT to reduce the burden of nonclinical work of its nephrologists. nephrologists—in the dialysis sector. We have only about 800 – 900 nephrologists for a billion plus people as against the US, which has 3,000 nephrologists.

13% 4%

So how do you surpass these challenges while creating more centres? In multiple ways. In India, nephrologists are often expected to look at every little nonclinical aspect as well—check if the RO plant is working, see if patient data is collected properly and ensure technicians are trained. In our centre, we depend on a team approach to look after patients and also leverage IT to reduce the burden of our doctors. By using Hospital Management Software or CCTVs to monitor patients and GPS-equipped vans to improve efficiency on shift timings, we build in an extra layer of vigilance and safety into our systems. Such measures have enabled the doctors to serve more patients and reduced the time they waste on non-core activities. We also emphasise on imparting skills training. We have started the DaVita NephroLife Academy, which offers a rigorous three to six-month course that imparts both theoretical and practical knowledge to nurses and technicians. We aim to train about 100 students every year – many of whom may be placed within our nationwide network. In fact, the first batch of our academy, comprising 24 students will pass out soon.

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DaVita NephroLife’s investment per centre 31%

52%

Dialysis machine and RO Patient safety equipment Furniture Interiors

Skills enhancement is equally important. With newer technologies, latest protocols and our research-based approach to safety and care, our SOPs and modules for technicians also undergoes revision at constant intervals. In fact, we have DaVita’s specialists in biomedical, safety, coming to India to specially train our teammates.

What determines the success of a dialysis centre? The important determinants of success for a dialysis centre are a high quality team consisting of nephrologists, clinical team, operations team, having infrastructure cost in-line with revenue per treatment and a strong patient flow to achieve utilisation. What is the road ahead? The need for high quality kidney care is growing across India and we are looking at expanding our presence in both large cities in India and smaller under-served locations. We are exploring opportunities in cities like Mumbai and Delhi-NCR. In all the cities, we will expand both by opening our own free-standing centres and by partnering with professional hospitals. Over the next five years, we intend to have presence in the top 10 cities in India with multiple centres in each along with a presence in tier-II and-III cities, where there is an opportunity for large scale single centres.

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Hospital Infrastructure special

Finalising furniture? Go for one that is automated, durable, anti-microbial and that enhances patient comfort By Rita Dutta

The right furniture solutions support caregivers in diagnostic, therapeutic, nursing and even rehabilitative procedures.

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re you still manually shifting ill patients from beds to wheelchairs during transfers? Are you still wheeling obstetric patients from their beds into labour rooms? Are you using regular furniture for obese patients? If yes, then you are not only using archaic concepts of hospital furniture but also greatly inconveniencing patients. Today, the hospital furniture market, pegged at Rs1,000 crore and growing at the rate of 15 per cent per annum, offers a wide variety: from mechanised beds to seven-function beds, beds that can transform into procedure tables or wheelchairs, beds that can be monitored by HIS, furniture customised for obese patients, and many more.

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The concept of hospital furniture has changed vastly from what it was two decades back, when the designs were bulky and mechanical and the focus was on the functionality and doctor’s requirements. Back then, furniture was either made of mild or stainless steel and was paying no heed to patient safety guidelines, caregivers’ ergonomics or standards. With healthcare delivery being also about providing good patient experiences, there is a paradigm shift in the approach to hospital furniture. Now, the market, dotted with players like Godrej Interio, ArjoHuntleigh and HillRom and Janak, offers sleek, automated and motorised beds, integrated with leading-edge technology like software for patient monitoring, protocol reminders, weighing scales and

touch screen panels. According to Poornima Alexander, healthcare interior consultant, “Today, the emphasis is on furniture that is rust-proof, light weight, smart and consisting of antimicrobial material.” A wide range of raw materials and processes are now available for medical furniture. Beyond steel and metals, there is a range of plastics available, specially treated for bacteriostatic properties that helps enhance patient hygiene. Says Swapneel Nagarkar, senior vice president, Godrej Interio, “With these materials, even the design language has shifted from geometric shapes to organic, rounded, contoured forms with reduction in metal contact or sharp edge contact to patients.” Even the colours are gradually moving beyond

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20 point guide to furniture planning 1. Nature of the facility and the patients being treated: For instance, chairs in a obstetrics facility need to have firm cushions, while a facility treating arthritis patients would need to be of proper height to enable patients to rest their knees without discomfort. “A facility treating obese patients, on the other hand, would need to take into account the width of the chair and safe working load. Also, patients with special needs would require specific features in furniture,” says Ritesh Dogra, engagement manager, Medium Healthcare Consulting. If patients are at risk of bedsores or pressure ulcers, they need beds with tall air mattresses, which could be active/passive. The bedside rails need to be high enough to shelter the patient along with the mattress. 2. Second, capacity, operations and work flows: In facilities with high bed capacity, distances between departments and wards will be far. Says Swapneel Nagarkar, senior vice president, Godrej Interio, “Whether patients will have to be transferred on wheelchairs, stretchers or on beds need to be decided. Accordingly, the decision on number of wheelchairs and stretchers, as well as castor specifications on beds, have to be finalised.” 3. Space allocation, width of doorways, corridors, elevator doors: Ideally, at least 100 sq ft footprint needs to be allocated to include a bed plus circulating space around it, in static condition. When a bed is to be moved with patient, corridors and elevator doors need to be wide enough to accommodate entry of a bed and a caregiver alongside. “In case corridors have many turns, we recommend beds with castors having directional locking / with a 5th castor to help turn the bed around sharp corners with ease,” says Nagarkar. 4. Budget: A patient bed is available in the range of Rs 5,000 to Rs 3,50,000, so budgeting is important. 5. Caregiver SOPs, protocols, and usage habits: If patients have to be moved frequently over long distances, the product design needs to facilitate mobility. High ground clearances provide ease of mobility, usage and maintenance. “Transportability of the furniture is extremely

crucial for patient comfort,” says Dr Bhimwal. 6. Durability of product: It is important from the investment and patient safety point of view. 7. Suitability: Beds and lockers with wooden panels may be unsuitable in critical care environments as they encourage bacterial growth. This can be prevented by products made of bacteriostatic additives. 8. Upgradeability: Ease of disassembly and upgradeability is important for a hospital in growth phase. 9. Maintenance: It should be easy and inexpensive to maintain, repair, and clean. 10. Furniture configurations: This should match the needs of different types of family members, age groups and different healthcare settings. “A round table consultation encourages patient physician interaction much more than a traditional consultation across the table,” says Dogra. 11. Compliance with patient safety guidelines and suitable standards: Reflecting increased sensitivity to patient safety, the US FDA has defined guidelines for product design to prevent safety hazards to patients. “CE certification for a particular product is applicable only if the integrated product has been audited by the standards. It does not apply if a component of the product is from a CE certified source,” says Nagarkar. 13. Compatibility with other equipment: As furniture is part of a larger context of the healthcare environment, it must be compatible with medical equipment. For instance, if there's a C-arm X-ray facility to X-ray patients on the bed. The bed

must be designed to permit use of the C-arm. 14. Involvement all stakeholders: Promoters, doctors, nurses and anyone else who are the end users of the furniture must be involved. 15. The ROI: Factor in the ROI. Say a marginally high investment in stretcher with five castors (with the fifth castor in the middle) can ensure easy patient movement, requires less manpower and reduces damages caused while movement, typically by hitting fixed surfaces such as walls. Hence something repeatedly used but as simple as a stretcher could be a good investment in the long run. 16. Clutter-free structures: Cluttered design makes cleaning difficult, and adversely impacts hygiene. Seek clutter-free, sleek designs for ease of cleaning and usage. 17. Management involvement: One of the common mistakes is to entrust the overall furniture planning and procurement to either a third party contractor or the procurement department. While the former would be guided by considerations such as look and feel (without considering the clinical parameters), the procurement department would be interested in financial negotiations. 18. Availability of spare parts and after sales support: This is crucial for maintenance. 19. Vendor selection: The decision to buy from a particular vendor should be made after visiting some of the existing set ups, rather than a discussion on the furniture based on brochures alone. 20. Imported furniture: If opting for imported furniture, it is essential to check whether the company has a local partner / authorised service centre in close vicinity to each facility, to ensure minimum down-time.

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Hospital Infrastructure special

Today's hospital furnite is automated and motorised making the job of hospital staff and caregivers easy.

The design language has shifted from geometric shapes to organic, rounded, contoured forms with reduction in metal contact or sharp edge contact to patients” — Swapneel Nagarkar Senior vice president, Godrej Interio

Besides functionality, the design needs to meet health specifications, standards and also needs to save space that could be utilised for patient care” — V Jayachandran Projects head, HCG

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conventional blues and greens to softer shades of grey, peach and brown, to create a warmer, pleasant and welcoming ambience in the healthcare facility. In vogue is coloured furniture that goes with the interiors of the hospital.

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edical furniture plays an important role—it supports the care delivery process, ensures patient safety and comfort, as well be aesthetic. “The role of furniture solutions based on ergonomics and evidence-based design is recognised. Automation and motorisation in hospital furniture has enhanced patient autonomy and accuracy of product function, as well as reduced dependence on caregivers. In this way, the experiential aspects of a healthcare facility can be enhanced,” says Nagarkar. The right furniture solutions support caregivers in diagnostic, therapeutic, nursing and even rehabilitative procedures. Today’s hospital furniture defines both the patient’s experience as well as catalyses the delivery of improved treatment outcomes. As far as design is concerned, the furniture has to first serve its intended function. Experts point out that within patient care, critical care units and intensive care units have distinctly higher degree of functionality and features required, compared to patient rooms, recovery rooms and wards. Also, patient mobility products like stretchers on trolley, emergency trolleys, wheelchairs and transfer trolley systems are also complex and vary according to needs of the facility. According to V Jayachandran, projects head, HCG, besides functionality, the design needs to meet health specifications, standards and also

needs to save space that could be utilised for patient care. The designs have to be patient-centric and ergonomic. Customisation is a must, and the highest degree is required for products like stainless steel trolleys in OTS, instrument trolleys, anaesthesia trolleys, and carts and furniture meant for SS and CSSD. As sensitivity towards patient safety and ergonomics has increased, regulatory authorities like the FDA have defined standards for designs of medical furniture.

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ith varying needs, it is important to plan for furniture that not just serves the function but provides patient convenience and satisfaction as well. For instance, a chair specifically designed for blood collection can greatly enhance patient experience. Similarly, attention has to be paid to chairs in the waiting area, which is one of the first touch points for a patient. A comfortable seating arrangement helps reduce patient’s anxiety, while adding to staff efficiency. Then come the beds, the element an inpatient will be most in contact with. Experts say that the quality and comfort of the patient’s bed and mattress can be a key factor in the perceived quality of the patient’s experience, as well as a factor in the actual outcome of the treatment. “Poorly designed furniture can cause discomfort and even risk to patients, by way of safety hazards like entrapment, nosocomial infections, bed sores, all of which complicate treatment and prolong hospitalisation. The risk extends to caregivers, who in turn may suffer undue discomfort and strain by handling non-ergonomic furniture, be at risk for infections, musculoskeletal disorders

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It is proven that a round table consultation encourages patient physician interaction much more than a traditional consultation across the table” — Ritesh Dogra Engagement manager, Medium Healthcare Consulting

The demand for Chinese furniture is driven by the availability of quality stuff at a reasonable price” — Poornima Alexander Healthcare interior consultant

and occupational stress,” says Nagarkar. Experts say that similar to the meticulous planning that go for design and architecture, manpower, finance, medical equipment and others, a hospital needs to pay equal attention to planning its furniture. One should begin planning by carefully visualising different hospital spaces. For instance, a typical consultation room, when thought through would have

In vogue is coloured furniture that goes with the interiors of the hospital. implications on the type and design of the furniture. So, the furniture would also be different due to the sheer nature of speciality. Recognising that patient experiences begin with their families entering the lobby of the healthcare facility, and continue during and beyond hospitalisation, some healthcare providers are preferring an integrated approach to healthcare facility designing, wherein the interiors of the entire facility are planned in a coordinated manner, to achieve synergy between people, spaces, equipment, furniture elements, to provide healthcare service with better outcomes and patient experiences. This synergy optimises their budgets, as well as their operational efficiency. However in most cases, furniture planning is either a routine order or an afterthought. It is a proven fact that hospitals which do not pay heed to furniture planning, eventually compromise on standardisation, quality and durability. And when they upgrade their operations, they usually incur higher costs in the long-term, in form of high maintenance, poor service levels and down-time. According to Dr KS Bhimwal, project director, Rockland Group of Hospitals, “A greenfield project earmarks anything between one to three per cent of its budget allocated for hospital furniture. For an established hospital, the furniture cost is a part of its maintenance, unless one decides to modernise a unit.”

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he investment on furniture varies from department to department. Says Ritesh Dogra, engagement manager, Medium Healthcare Consulting, “Investment in furniture is higher in areas that require a great degree of infection control. Greater need for infection control would mean lesser number of moving parts in any such furniture and easy access to

these parts to ensure that they can be cleaned and disinfected frequently.” In addition, areas, which have a strong physician-patient interaction (such as consultation rooms), or places, which have a potential to make a patient comfortable (such as sample collection room), need a higher investment in furniture. And what are the key departments for which furniture are specially ordered? “It is waiting area and reception to suit the hospital ambiance, master health checkup, ICU’s, LDRP suits, VIP suits and executive chamber and conference rooms,” says Alexander. Hospitals are either fabricating furniture on the site or buying them directly. The trend of procuring furniture from China is catching up as in the case of Medica Synergie or Rockland Hospitals. Stating the reason for its popularity, Alexander says, “The demand is driven by the availability of quality stuff at a reasonable price— at 30 per cent cheaper rate than Indian goods. The Chinese furniture can be customised for hospital requirement, like printing hospital name and logo on it. Also, different accessories for a patient bed is available as per the hospital requirement.” In the years to come, it is said that evidencebased design would play a key role in any decision on hospital furniture. Hospitals are also expected to go for furniture that are more HIS friendly, anti-microbial, durable and has in build X-ray plates to take a digital X-ray without moving patient from beds. Experts state that with the decision on choice of a healthcare facility being largely made by the patients, a well-designed hospital with the right furniture would not only contribute to the overall healing and enhance the patient experience; it would also be a significant and sustainable differentiator.

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Plan to succeed Keeping these simple steps in mind when planning a hospital helps keep deviations and delays away By Krishnendu Ghosh

H

ospital planning is a complicated process. However, it can be simplified and all deviations and delays can be avoided, if all the phases are understood and strictly followed. These phases are: 1. Conceptualisation/Inception: This step involves the decision to build a hospital. The type of hospital to be built, whether it should be a corporate, non-profit voluntary or trust hospital, should be decided at this stage. The target group to be benefitted from this venture should also be considered. 2. Detailed project report/ technical and financial feasibility report: Extensive data is required while preparing the report. The data is gathered by primary (meeting user consultants, hospital administrator and health agencies) and secondary (census, demography, geographic data, morbidity and mortality statistics, need and demand) surveys conducted. The report is as good as virtually visualising the entire hospital. In-depth technical knowledge is required to prepare this report. The report also estimates the viability of the project and explores the possibility of raising funds from investors (in the form of equity), stakeholders, banks and other sources (joint ventures). The outcome of the report will determine the bed and facility mix that would be an integral part of the hospital. It should be noted that the bed and facility mix should be correlated with client’s capability (to manage specialisations) and comfort (vis-a-vis resources to build hospital as well as revenue sharing analysis with visiting consultants). 3. Site Selection: It should take into consideration transport modalities available for quick

26

access to the hospital, environmental factors (wind, rain, sun, smoke, height of neighbouring buildings), sources of water supply and electricity. There should be good communication system operating in the locality (phone lines, mobiles and internet connectivity). 4. Master Plan: Preparation of master plan is to establish circulation routes (both internal and external) on the site where various departments and buildings that make up the hospital can be established with no inconvenience caused. It can be written, sketched or depicted by a model. It may include future plans, expansion of particular areas and identify buildings for expansion. 5. Architect brief/ functional brief: An architect brief is the written expression of the ‘functional need’ of the client, prepared in consultation with various professionals in the planning team. The contents of the functional brief includes a broad description of the project, schedule of accommodation, functional policies and procedures, staffing and equipment requirements, functional interrelationships among departments. The outcome of this activity will lead to space programming and room data sheet. 6. Preliminary drawing/ Working drawings: Depending upon the space programme and room data sheet, the architect converts the functional brief into working drawings. At this stage, structural drawings, mechanical, electrical and plumbing drawings, HVAC drawings, landscape drawings, low voltage electronic drawings and others are done and requires inputs from different engineers. This stage also includes preparing bill of quantities. 7. Actual construction: This stage involves notifying tenders, calling for quotations, and finally, selection of tender and awarding of contract before starting the actual construction.

This stage also entails the entry of project management consultants who functions to visualise that cost, quality and time in the project is not compromised. 8. Equipment planning: This involves planning of the biomedical equipment like short listing of companies, selection of the models, model demonstration, quotation from the companies and negotiations. This is followed by installation of equipment and installation report cross checking. 9. Staffing: As detailed in the project report, selection of all grades of staff and designation are recruited within the system. This is followed by training of the staff recruited. 10. Commissioning of the hospital: This involves forming a commissioning team, which includes heads of administration, clinical service, nursing, finance, human resources, branding and development and stores and purchase. The team is concerned with development of an operational system and framing policies and procedures. NABH standards are taken into consideration while developing the standard operating procedures for each department. The sequence of stages of commissioning the entire hospital is also decided by the commissioning team. 11.Trickle-down period: The trickle down period is the time taken from commissioning of the hospital till satisfactory functioning of the hospital is achieved. This may prolong even to a few years. A well planned project will have a short trickle-down period.

Krishnendu Ghosh is chief consultant and strategist with Hosconnn, Kolkata.

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Hospital infrastructure special

Keep up the upkeep Routine maintenance of HVAC system helps prevent unexpected outages, extends the life of the system and brings down energy costs By Team HR

I

t is said that the basic function of the heating, ventilation, and air conditioning or HVAC system in any facility is to comfort occupants by maintaining the indoor air quality through different levels of filtration and air changes per hour. It also maintains positive pressure, negative pressure, particle count, air velocity and laminar flow. But when we refer to HVAC system in healthcare, it requires a whole new level of efficiency as indoor air quality plays a significant role in patient healing. As medical facilities have elevated level of pathogens, stringent controls are necessary for the safety of patients as well as hospital staff. HVAC is a necessity in hospitals as a wide range of services and functional units such as diagnostics, ICUs, surgery suites, clinical laboratories, emergency rooms and CSSD, are required to perform under certain controlled environmental condition. According to Dr Praneet Kumar, CEO, BLK Super Speciality Hospital, Delhi, “There is a need for providing optimal humidity and temperature in healthcare settings for smooth functioning of various types of equipment as they function and at adequate efficiency and accuracy under specified environmental conditions only.” Various diagnostic equipment is operational under specified humidity and air quality, including ambient temperature marked for such equipment. Also, storage of drugs

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Use of pre-filters and high MERV filters in the outdoor air intake will reduce the number of particles entering the building” Abootty K, Director projects, KIMS Healthcare Group, Thiruvananthapuram

and reagents is to be maintained at specified temperatures, food and beverage services and laundry services require steam generation, thereby requiring boilers and other heat generating needs. It is needless to say that a modern day healthcare set–ups cannot be functional without a HVAC system.

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hat’s why routine maintenance of HVAC system is a must—it helps prevent unexpected outages, reduces contaminants in the form of air borne microbes, viruses, odour and volatile organic compounds, extends the life of the air conditioner and reduces energy costs. Lack of maintenance of HVAC systems can have dangerous consequences. Says Jai Paul, VP, engineering and maintenance, Medica Superspeciality Hospital, Kolkata, “The first risk of not maintaining the HVAC system is the danger of infection. For instance, if HEPA filters efficiency is not monitored, the particle

count will go up and may cause immediate infection break out.” On the other hand, if the positive and negative pressure of isolation rooms is not maintained, the immune-compromised patients can acquire infections or it will lead to spread of infections of existing patients. If proper temperature and humidity is not maintained in the orthopaedic OT, the cement will dry and the joint replacement will never be proper. Adds Major General (Retired) Naresh Vij, director, projects and engineering, PD Hinduja National Hospital, Mumbai, “When not properly maintained, the HVAC system are likely to under–perform or may fail altogether, leading to inadequate cooling and filtration, which may adversely affect the performance of the diagnostic machines or may present inaccurate and misleading results or may not perform at all.” Inadequacy in air quantity and distribution may also result is spread of nosocomial infec-

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In many hospitals, HVAC system is considered to be more of a luxury than a necessity and hence not considered in budget allocation” Milind Chaudhari VP, HVAC, GMP Technical Solutions

tions. There have been many instances where patients have been affected by malfunctioning of HVAC systems, leading to infections that have had crippling effects like blindness and even death.

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ut are hospitals paying due attention to it? According to Milind Chaudhari, VP– HVAC, GMP Technical Solutions, in many hospitals, HVAC system is considered to be more of a luxury than a necessity and hence not considered in budget allocation. “Inadequate work-out and checking various engineering options available, not understanding the importance and ways of energy conservation has led to cutting corners, often at the cost of quality,” he laments. He further adds that as engineering services in hospitals do not have any revenue-generating value, the HVAC system is neglected in many hospitals. Also, as the initial cost of providing good engineering services are high, it leads to

sub-optimal planning of services like HVAC. So, the need of the hour is to to include HVAC in budget, have a comprehensive maintenance plan for HVAC system, and use standardised training programmes for people who maintain them. Such training should emphasise on compliance with HVAC maintenance protocols, proper disposal of HVAC filters, and recognition and management of occupational risks. Suggests Abootty K, director projects, KIMS Healthcare Group, Thiruvananthapuram, “A lead government agency should monitor for indoor air quality. The lead agency should coordinate with all Government and professional organisations that have responsibility for indoor air quality. In addition, the agency would be responsible for identification of the deficiencies in the science base, in technology development, in the technical evaluation capability, in the training requirements for building owners/operators, and in information sharing to improve HVAC technology, operations, and function.”

For a better HVAC system Here’s how you can improve the efficiency

filters that do not cause excessive pressure drops.

of the HVAC system.

The use of higher rated filters can significantly

1. Hospitals need to seal, caulk, and replace

increase their efficiency and cleaning filters

gaskets to minimise air leakage between the

extends their longevity.

6. The heat load and energy calculations should be done to maintain optimum efficiency. 7. The instruments and gauges should be calibrated. The readings trend is to be plotted and action taken at the right time.

filter and the filter housing and in the return

4. Building operators should change filters routinely

air distribution system. The efficiency rating of

based on manufacturers’ recommendations or

filter is only applicable if the air actually passes

when pressure drop across the filters becomes

through the filter media. Leakage of air from

excessive (indicated by filter gauge pressure).

distribution level,” says Maj Gen (Retired) Naresh

the HVAC system compromises function. Return

Clogged filters reduce air flow. Furthermore, in

Vij, director, projects & engineering, PD Hinduja

air distribution systems typically consist of sheet

humid climates microbes that are entrapped

metal duct work and plenums and vertical

in filters can actually grow in the filters and

pathways constructed of drywall or masonry

seed the air as it is filtered. The manufacturer’s

of air exchange rates and pressurisation. Not all

materials. Says Abootty K, director projects, KIMS

recommendations on the life of the filter are

HVAC systems have adequate capacity to meet

Healthcare Group, Thiruvananthapuram, “Use

based on average conditions. Actual ambient

the higher design heating and cooling loads that

of odourless mastic and/or other appropriate

operating conditions can alter the concentration

would result with increased air exchange rates.

sealants reduces air leakage. If replacement of

of dust and mould particles in the outside air,

However, increasing the rate of air exchange

seals in the return duct work or other structural

increasing the particles trapped in filters.

is possible in some systems, though it might

pathways is part of the routine maintenance of

5. It is crucial to have Planned Maintenance

increase operating costs. These costs may be

the HVAC system, the pressurisation control, air

Service (PMS) in place. “Daily, weekly, monthly,

exchange rate, and effectiveness of the filtration

quarterly and six monthly and yearly routines

will be enhanced.”

are to be carried out under PMS. At each PMS,

8. “All volumes control damper, including fresh air dampers, should be adjusted to correct air

National Hospital. 9. One needs to consider improvements in control

justified in buildings that are thought to be at high risk of a bio-attack. 10. Buildings should be commissioned during the

the readings of the HVAC system should be

initial phases of design and construction, and re-

intake. “Use of prefilters and high MERV filters

taken before and after to compare with standard

commissioned (which means re-evaluated after

in the outdoor air intake will reduce the number

results. The readings should be logged every four

a period of time) routinely during occupancy.

of particles entering the building and decrease

hours and the trend should be observed,” says

“Many buildings have never been commissioned,

the exposure of building occupants if a bioattack

Jai Paul, VP, electrical and maintenance, Medica

and so there has been no formal evaluation of

occurs via an outdoor release or a release

Superspeciality Hospital, Kolkata. When there are

the effectiveness of the HVAC systems. Buildings

directly into the air intake of a building,” says

deviations that reveal the performance gap, one

that were not initially designed and planned

Abootty.

needs to analyse and carry out and corrective

properly, should be re-commissioned on a regular

action.

basis,” says Abootty.

2. Hospital should install filters in the outdoor air

3. Hospitals need to use highest efficiency report

Healthcare Radius August 2013

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Hospital infrastructure special

Think green

Adopting sustainable design practices in healthcare buildings has many tangible and intangible benefits By Tarun Katiyar & Srilakshmi Krishnaswamy

S

ustainable development has been defined by the Brundtland Commission as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs.� Sustainable or green building design is a leeway to create harmless, environmental friendly and healthy building while minimising the impact on natural resources. The built environment has profound impact on the health of its users. Using sustainable strategies in building design and construction softens the negative impact on the planet by way of reduced energy and water consumption, less landfill waste and better reduced disturbance to ecological components. In the present era, built environments have become a source for prolonged ailments, and pose a threat to human wellbeing. Threats may occur in the form of toxic emissions from materials and machines being used, unclean ambient air or lack of exposure to nature. For example, using ozone depleting refrigerants for cooling or using interior materials with carcinogenic substances increases the potential for skin cancer and spreads the disease, using mercury

30

based instruments for measuring temperature and blood pressure contributes to air and water pollution, and indirectly to brain damage. These adverse discoveries have made it necessary to adhere to alternative healthcare design that will render improved and healthy healthcare environments.

A

dopting sustainable solutions is not just about creating an environmentally friendly environment, but about devising a healthcare arrangement that ropes in all essential factors that address human needs. In this regard, being a pioneer in green building design, in 2009, the US Green Building Council (USGBC) had formulated a green building rating system—LEED for healthcare that lays out in detail, the design and construction requirements needed to be incorporated in a healthcare facility to be certified as a green building. The rating system was primarily developed for inpatient and outpatient care facilities and licensed long-term care facilities. It may also be used for medical offices, assisted living facilities and medical education and research centres. The standard provides sustainability

solutions for design and construction activities of both new buildings and major renovations. Incorporating sustainable or green design has both tangible and intangible benefits. The immediate, tangible and quantitative advantage of green design is energy and water savings up to 30 to 50 per cent. In addition, it has proven beneficial in reducing operational and maintenance costs as well. The intangible and qualitative advantages of green design include healthier indoor spaces, enhanced indoor air and environment quality, better natural lighting applications, improvement in comfort and well being of its occupants and users (thus improving employee attendance and productivity), conservation of scarce natural resources and enhanced marketability of the building. As it can be seen, sustainable architecture will not only contribute to quantitative benefits, but also significantly add to the social and economic wellbeing of other communities, and the strategy begins right from the site itself.

H

owever, it also has its drawbacks. To enhance sun exposure, as a green measure, the building orientation needs to be in east-west

Healthcare Radius August 2013

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23-07-2013 13:41:21


Hospital infrastructure special

Steps towards sustainable design Green design strategies that can be incorporated in healthcare facilities: 1. Using Variable Air Volumes (VAVs) air handling units in HVAC systems as it reduces energy

and exterior paints, pumps and fittings reduces Persistent Bioaccumulative and Toxic Chemicals (PBTs) releases. 8. Using sound insulation materials and acoustical

consumption. Since dehumidification rate is high,

finishes as high sound levels within healthcare

it prevents causing adverse health effects and

facilities are perceived stressful for all occupants

thus quickens healing.

including patients, visitors and staff. Studies have

2. Using refrigerants that do not contribute to ozone depletion in HVAC systems. 3. Providing places of respite outside the building

confirmed that noise induced stress also creates emotional burnout among nurses and impedes their working efficiency. On the other hand,

envelope, such as a garden, courtyard or a

lower noise levels have shown positive effects

simple open space exposed to sunlight, will

among staff that included increased workplace

help in alleviating the stress factors, and relax

social support, improved quality of care for

the human mind. 4. Opting for commodities that do not exceed

patients and better speech intelligibility. 9. Using products with very low VOC or no VOC

emission limits to prevent contaminant releases

content and completely avoid using refrigerants

from combustible products like boilers, steam

with Chlorofluorocarbons (CFCs). VOCs are

generators and water heaters.

known for their adverse health and environ-

5. Incorporating a garbage collection system

mental effects. For example, Formaldehyde, a

to facilitate reduction of waste generated by

VOC present in major materials like paints, ad-

building users that is hauled and disposed off

hesives, wall boards, tiles, when emitted causes

in landfills and incinerators, through reduction,

irritation and discomfort. Methylene Chloride,

reuse, recycling and composting. A dedicated

present in adhesive removers and spray paints,

space for separation, storage and collection of

is another VOC that is hazardous. In its process

garbage materials may be established, with a

of vaporization, it gets converted to carbon

minimum segregation requirement to paper,

monoxide (CO) and thus because becomes

corrugated cardboard, glass, plastics, metals,

a source of various CO related diseases and

batteries and mercury-containing products. 6. Using only Light Emitting Diodes (LED) and

disorders, including cancer. 10. Employing permanent entryway systems along

Light Emitting Capacitors and avoiding the

the direction of travel. The entryway mats

usages of T-9, T-10, T-12 fluorescents or

capture dirt and particles and prevent them

mercury vapour type high intensity discharge

from entering the building, thus minimising

(HID) lamps as it has been found that nocturnal

the building occupants’ exposure to hazardous

exposure to fluorescent lights suppresses our melatonin production, which has been linked to cancer generation. Also, its usage has the risk of being exposed to UV and electromagnetic radiations that have adverse health effects on humans, and because of its usage of mercury when broken, there will be toxic contamination of the ambient air. 7. Using non-lead or cadmium containing interior

particulates and chemical pollutants. 11. Providing individual access to thermal and lighting controls to both staff and patients improves their productivity, comfort and well being.

12. Providing maximum exposure to daylight and ventilation through windows and skylights, maximising open spaces, and using health faucets, dual flush water closets, waterless/sensor urinals and carbon dioxide sensors.

direction as it influences the entry of natural light and provision of shades in the building. So far as the building contains recycled resources, the location of the building will be affected by humidity, the circumstance of the surrounding area. Other major disadvantages of green building design are cost and time. Not only will design and construction of green buildings comparatively consume longer time, but they will also require larger initial investment. Incorporating sustainable design in Indian healthcare scenario has two aspects: urban and rural. In the rural context, it is an expensive and complicated task, right from procuring green materials to rural sites, to running a healthcare facility in those sites, as the site conditions might pose unpredictable challenges with regards to the feasibility of such projects. On the urban front, currently, the sustainable or green building trend has finally found its way into healthcare facilities. Increasingly, stakeholders in healthcare design are concerned over the environment and are working to better comprehend the new process, challenges and opportunities offered by specific sites. Sadly, the current economic financial system is yet to realise the true value of how spatial design in itself contributes to user wellbeing and efficiency. Monetary factors are put before the design. More so, often healthcare investors are so blinded by the immediate expenditure that they fail to see the benefits of green design. Cost is the primary factor in most decisions. In designing sustainable buildings, there are both high cost and low cost green buildings. Sustainable design does demand increased initial cost. In fact, the impact of high capital cost is diminished when compared to the benefits it incurs post a certain payback period. Also, as per research there is negligible price difference between the design and construction of sustainable buildings and conventional buildings. What comes after opting for sustainable design is the potential for energy cost savings, staff retention, better recruitment, increased productivity and a healthier indoor environment.

Tarun Katiyar is a principal consultant and Srilakshmi Krishnaswamy is an architect with Hospaccx India Systems.

Healthcare Radius August 2013

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HOSPITAL INFRASTRUCTURE SPECIAL

Drywalls: In demand Find out why several hospitals have switched over to drywalls for internal walling BY TEAM HR

34

Healthcare Radius August 2013


Hospital Infrastructure special

H

ealthcare institutes are increasingly opting for drywalls. As per estimates, in all major cities of the country, there is at least one ongoing hospital project that is using drywalls. Several hospitals like the Asian Heart Institute and Seven Hills in Mumbai; BEAMS in Bengaluru; Medanta and Fortis Memorial Research Institute (FMRI) in Gurgaon; Wockhardt Hospital (now Fortis) in Kolkata and Mumbai; Vasan Eye in Surat and hospitals from Narayana Hrudayalaya group have chosen drywalls over traditional construction for both critical and non-critical. Common areas, pharmacies, canteens, patient cabins, diagnostic rooms, MRI areas (which includes lead shield drywalls for X-ray rooms), and OPDs are some of the non-critical areas with drywalls. Whereas, in critical areas it used with a protective coating of PU, epoxy and vinyl. Moisture resistant drywall systems are being used in wet areas of the hospital. Here’s a perspective of a few hospitals on the reasons they opted for drywalls:

Why go for drywalls

Narayana Hrudayalaya Hospitals Most of the Narayana Hrudayalaya hospitals use drywalls in corridors, OPD areas, wards, offices, cafeteria, IT and conference rooms. According to Viren Shetty, senior vice president, strategy and planning, Narayana Hrudayalaya, “The areas that are built conventionally by drywalls are OTs, dialysis rooms, ICU/ITU, bathrooms, scrub rooms, CSSD, stairwells and lift shafts.” The fact that erecting a drywall takes about 70 per cent less time than it takes to raise a brick wall of the same thickness was a primary reason that the group opted for drywalls. Like many others, the group first went for 9” or 4.5” brick and cement type of masonry because masons were considered an inexpensive resource. However, the bricklaying and plastering work at its projects got frequently delayed because of unavailability of masons during festive, election or harvest seasons. When it switched over to drywalls, the group was able to complete a job that used to be measured in months, in a few days. Other factors that made the group choose drywalls were its light weight and the flexibility it allows. Drywall-covered walls may sound hollow when one knocks on them, but they are capable of resisting high impact. Interestingly, when Narayana Hrudayalaya was considering drywalls, many people in the organisations were sceptical about the material’s ability to absorb the impact of trolleys hit-

Drywalls are easy to work with

The present drywall market in India is about 5 lakh square meter, excluding wood-based partitions. Currently, healthcare contributes 5 - 7 per cent to this market. ting them. “That may have been true of drywalls from decades ago, but as we used high-quality sheets, the wall didn’t dent even after we ran a trolley into it many times,” says Shetty. According to him, skilled people are important to install drywalls as improperly installed drywall will develop cracks along shearing edges, especially around the door frames.

Asian Heart Institute, Mumbai The 120-bed hospital uses drywalls in both patient and utility rooms. The hospital has gone

• Since it takes 70 per cent less time than conventional construction, the faster turnaround time provides huge labour savings and expedites the process of utilisation of space. • Being light in weight and both the input material and waste material are in dry state. • Drywalls allow design layout changes, a crucial factor as hospitals go for frequent upgrades. Cut-outs and windows in drywalls can be made in several designs and needn’t follow a rectangular geometry. • As the plasterboards and steel framework used in drywalls are moisture resistant, there are less chances of microbial growth. Special water-resistant drywalls, or green boards are available that come with an additive, which makes them mould resistant. • Drywalls made from gypsum plasterboards offer a higher acoustic performance (with insulation rating up to 74 dB). They have a fire rating (between 1/2 – 4 hour) at a thickness much less than brick walls. • Through better acoustics and fire protection, drywalls contribute towards better working ambience and occupant's comfort and protection. Experts say that its low thermal conductivity and high thermal resistance results in reduced electrical consumption, thus reducing the load on the AC units. • The smooth finish and crack-free surfaces give drywalls a pleasant appearance. • Being dry construction, drywalls save precious water. Drywalls, which are made of gypsum, can be sourced from natural reserves. • Drywalls offer pre-provided slots and creation of cavities between two separating walls easily to accommodate all required services. Another key area, where drywalls make a difference is the passing of services through walls.

for drywalls as they are eight to 10 times lighter than bricks or blocks. This reduces the weight on the slab. It then doesn’t become mandatory for building a beam below it for support. Dr Ramakanta Panda, vice chairman, Asian Heart Institute, informs, “Reduction in weight resulting in reduction of structural load was one of the primary reasons we went for drywalls.” Since drywalls are practically weightless, they don’t need to follow the profiles of underlying beams and can be placed anywhere.

Healthcare Radius August 2013

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35 23-07-2013 13:44:18


Hospital Infrastructure special

Vendorspeak

E

verest Industries Limited has been in the drywall market for over six years, holding 60 per cent market share in the healthcare segment. Biloy Mohapatra, senior manager of the company’s marketing department speaks about the benefits of drywalls for healthcare players.

Viren Shetty, Narayana Hrudayalaya Hospitals

What are the benefits of using drywall vis-à-vis conventional material? The typical benefits of drywalls vis-à-vis conventional material are: a. Drywalls are 1/4th the weight of conventional walls and hence contributes significantly to the reduction in structural cost. b. Drywalls can be erected in 1/3rd the time as compared to conventional walls, which means faster completion of project—time is money. c. Through drywalls we can achieve better performance parameters i.e better sound insulation and fire rating, through sleeker walls as compared to conventional walls. d. Drywalls help in economical use of material and better waste management at site. Why should hospitals particularly go for drywalls? In healthcare, this is the fastest growing construction segment in India today. In a healthcare institute, the life span of technologies are approximately five years, with up-gradation being rapid. Constant modernisation forces alteration in design layout. Often, design loadings are outdated before the facility is complete. As drywalls are light in weight, they do not require beam support. Hence, they adopt changes in the design layout most effectively and conveniently.

Dr Ramakanta Panda, Asian Heart Institute, Mumbai “The straightness of the partition proves to be a challenge in some cases and a tendency to bend is not uncommon. Also, the skill of the installer is crucial in terms of correctness of joint ceiling as the finishing of the wall, either paint or wall paper, is contingent on product quality and correctness of installation,” he cautions. It is also to be noted that these walls cannot carry weight and hence, if any heavy installation (say a television, sink or shelf ) is required to be supported by this wall, appropriate reinforcements have to be provided to allow to wall to withstand the weight.

For which areas can hospitals go for drywalls? a. External walls as it improves the ‘building envelope performance’. Also, the cooling costs are reduced. b. Non-critical areas like patient cabins and OPDs and common areas like administrative offices, cafeteria, medicine retail counters and MRI rooms. c. Wet areas like washrooms and utility rooms. d. Critical areas with specific surface finishes and coatings, as applicable to the required clean room ratings. Why should hospital use Everest Drywalls? The moment we think of drywalls, the first thing that strike us is the strength of drywall. All Everest Drywalls, similar to conventional walls, fall under ‘severe duty’ of impact resistance. Impact is a common phenomenon in hospital environment. Everest Drywalls provide complete solution for external wall, internal wall and wet area walls. Everest lead shield drywalls are an ideal solution for MRIs. It is moisture resistant and hence mould and algae resistant. Our drywalls easily accommodate wet cladding of vitrified and ceramic tiles on their surface, with tile adhesives. It has better acoustics and fire rating as compared to similar drywalls of competitors. Loading has to be planned in case of drywalls. However, post erection, constant unplanned loading are seen on hospital walls. Everest Drywalls can take 65 per cent higher unplanned loading compared to other similar products in the market. In case of any changes in the design layout, 60 per cent of an erected Everest Drywall, can be salvaged and reused. This is the highest as compared to its competitors. The metal frame, which is used as a skeleton for Everest Hollow Drywall system are made of Galvalume and not Galvalised Iron as in the case of the competitors. Galvalume metal frame are resistant to corrosion and thus is an ideal choice for a hospital.

FMRI, Gurgaon Says Surender Kumar Dhiman, general manager, projects, FMRI, Gurgaon, “We have used gypsum board drywall on the fifth floor of our hospital as this is an area which is slated for modifications at a later stage.” A key reason that the hospital went for drywalls is that traditional construction material not only occupies a large amount of space at

36

the site, but the shifting of the material creates disturbance in the hospital. It also results waste being accumulated at the site. The sound-proof quality of the walls was another key factor that made FMRI opt for them. Compared to conventional walls, like wooden, brick, block or concrete, which offer

poor sound insulation, drywalls made from gypsum plasterboards offer a higher acoustic performance. “Since dry walls are soundproof, laying of services in these walls would be easier,” says Dhiman. They also facilitate a disturbance-free environment in hospitals, thus ensuring faster patient recovery.

Healthcare Radius August 2013

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23-07-2013 13:44:22


HOSPI INFRA

EXPERT BENEFITS The benefits of hiring project management consultants

Get a specialist

Leveraging the experience and knowhow of a specialised team, project management focuses on helping the client achieve measurable results

A

industry has to grow, in terms of increase in the bed capacity, technology and skill enhancement, and most critical being the geographical outreach. The industry, in order to bridge the gap, has to overcome many challenges that impact the cost of delivering qualitative healthcare services. They are land and infrastructure, reach and serve (affordable models are more sought after), trained human resources for providing healthcare services and back up of medical, engineering and support services at remote locations. However, one of the foremost challenges is creating the building infrastructure capable of delivering the desired medical services and adhering to standards (prescribed by architectural, accreditation, engineering bodies) and compliance with regulatory bodies such as corporations, AERB, FDA and others.

processes helps to translate the business goals/ strategy into an executable programme and projects to be delivered. 2. The hiring organisation stands benefitted as its strategic goals, converted into a project, get clearly defined with respect to scope, specifications, targets, budget and quality. 3. By adapting a good PM process comprising conceptualising, defining, planning and scheduling, costing, execution, monitoring, control and closure

BY SANJAY KULKARNI s the number of healthcare projects continues to grow and their complexity increases exponentially, there is a renewed interest in adopting project management approach as a tool for successful business launch and expansion. Although the quantum of projects delivered may have increased, only a fraction of them are successful in accomplishing desired delivery in terms of scope, time, quantity, quality, and cost targets. Adopting a more disciplined and customised Project Management (PM) approach for managing a portfolio of projects help organisations succeed in achieving their growth which is aligned with their business plans. The Indian healthcare industry stands at a critical juncture, facing increasing challenges, to meet the wide gap in demand and supply of medical services. The ratio of bed to popula-

include: 1. The PMS approach with its concept, tools and

enables hiring organisation to establish full control

To address these challenges, one needs the experts services of healthcare project management specialists, architects, medical planners, interior designers, technical consultants and healthcare administrators among others. With increased recognition by the healthcare promoters for hiring project management and development services (PMDS), it is imperative to understand the need and role played by the service providers. Project management is a methodical approach applied to a project from its conceptualisation to operation. The role played by Project Management Consultants (PMC) for successful delivery of the project will be an integral part of the project, scope management, design management, procurement management, time and cost management, quality management and compliance, human resource management, safety and OH, communication and documentation management, risk forecasting and its management and

of the project life cycle on a time scale. 4. The hiring organisation derives enhanced productivity from the resources deployed, as the overall project plan built with an effective and sound portfolio and protocol management empowers the resources, with clearly defined objectives to be accomplished on a pre-determined time lines. 5. Continuous monitoring and reviews of targets v/s actual achievements, which is an integral part of PMS, enables and supports organisation on project status with data and facts relevant to task-wise and milestone-wise performance, analysis of delays, risks, cost overrun, capital needs and value realisation. 6. Recent trends in PMS include project portfolio management (PPM), which is a move by organisations to get control over numerous projects by evaluating how well each project aligns with strategic goals and quantifying its value. An organisation will typically be working on multiple projects, each resulting in potentially differing

The PMC is a dependable partner in planning, building, and restructuring healthcare facilities. Through domain knowledge, experience and network, the PMC can provide the much needed additional value, thus providing a comprehensive and reliable implementation and project delivery. Leveraging the experience and knowhow of a specialised team, project management focuses on helping the client achieve measurable results. They help achieve new levels of project that are scalable, and projects range in size and complexity to encompass everything from facilitating localised spatial reorganisation, to changing or adding equipment or building an entire hospital from the ground up. The projects can last a few weeks or several years,

amounts of return or value. The company or agency may decide to eliminate those projects with a lower return in order to dedicate greater resources to the remaining projects or in order to preserve the projects with the highest return or value.

but each transforms healthcare and delivers measurable results. Facing the challenge of building or restructuring a healthcare facility to accommodating client needs within budget and on schedule are deliverables of the PMC.

Sanjay Kulkarni is associate vice president, healthcare projects, Property Solutions India Pvt.Ltd.

Healthcare Radius August 2013

37


Hospital infrastructure special

Keep them safe

It helps to integrate the three components of an intelligent security management system – access control, video surveillance, and real-time location system By Steve Nibbelink

A

s healthcare facilities grow and provide around-the-clock care, they become increasingly vulnerable to a wide variety of security threats. Countryspecific healthcare guidelines mandate varying levels of security under ‘environment of care‘ standards. The first responsibility and mission of any healthcare organisation is to ensure patient safety and quality patient care. The security and safety team and hospital policies and procedures, and their technology tools and solutions are all designed to support this lifesaving mission. The goal of a hospital’s security and safety team is to create an identifiable and repeatable process for each of the challenges identified during risk assessment and gap analysis and in the ongoing security management plan. The team has the opportunity to utilise technology, or physical security components, to create a safe and secure environment for everyone and everything on the hospital campus. These components of physical security include: 1 Access control 2 Video surveillance 3 Infant tagging 4 Patient management

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5 Intrusion detection 6 Intercom communications 7 Panic alarms 8 Staff management 9 Asset management/RTLS 10 Mass notification communications 11 Visitor management 12 Parking management 13 Emergency communications 14 Smart/financial cards If each of these technology systems is purchased, administered, and maintained on a separate basis, it incurs undue expenses and operational inefficiencies. However, when they are part of an integrated, technology master plan, the organisation can improve security and operational efficiencies, while also reducing the associated cost. In fact, they can save between three and 10 per cent of hospital expenditures.

T

he statistics regarding crime and violence in hospitals is staggering, and clearly indicate that security is a concern for hospitals around the world. For instance, the International Association for Healthcare Security & Safety (IAHSS) 2010 Crime and Security Trends Survey reports four categories of criminal incidents— simple assault, larceny, vandalism, and burglary—accounted for 91 percent of all reported crimes in US hospitals

in 2010, nearly double the figures of the last survey in 2004. Additionally, a 2011 study by the Emergency Nurses Association reports that from January 2010 to January 2011, more than half (53.4 percent) of nurses reported experiencing verbal abuse and more than one in ten (12.9 percent) reported experiencing physical violence over a seven-day period. In Australia, one study shows that violence generated from clients, patients, visitors, and relatives accounts for 56 percent of the violence reported in public hospitals and 41 percent of the violence reported in private hospitals. To address concerns and issues in workplace violence, in June 2010, the Joint Commission published Sentinel Event Alert #456, regarding violence in the healthcare setting, which calls for each healthcare facility to have a documented workplace violence programme and process. Yet another challenge is preventing prisoner escape from healthcare facilities. In 2011, the International Healthcare Security & Safety Foundation (IHSSF) commissioned a study that identified the location and percentage of prisoner escapes from four main areas in a hospital: Emergency room 14.1 per cent, outside the hospital (e.g. hospital entrance, parking lot, etc) 17.2 per cent, clinical treatment 39.4 per cent and restrooms 29.3 per cent. So, what puts

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Hospital infrastructure special

Today's video surveillance systems are cutting edge, enabling monitoring all important areas of the hospital.

hospitals at risk for crime and security risks? The risk factors include: ► 24/7 accessibility to public. ► Predominately female staff. ► Increase in workplace violence. ► Availability of drugs on premises. ► Money available in cash. ► High concentration of people in a single area making it ideal target for terrorism. Hospital security is risk-based and incident driven – and as such, hospital security departments are especially challenged to provide a safe and secure environment for their patients, visitors, staff, and assets. And each healthcare organisation has its own set of unique security and safety risks, depending on demographics, service offerings, and administrative strategy. The security of the healthcare organisation is seldom responsible for all the components of the protection programme and security management plan (See figure 1 on the next page).

H

ealthcare facilities use a variety of security technology and solutions that depend on a variety of factors, including physical structures, services provided, demographics – patient, workforce, and community, administrative strategy, organisational culture and community culture. Each healthcare security team examines the details of these factors to determine the best mix and use of security

Hospital security concerns  Workplace violence  Infant/paediatric area(s)  Emergency room & clinical areas  Internal/external theft  Parking lot security  Staff safety & security

technology. We will examine a variety of these technologies and how they might be used in the hospital. Access control: It is defined as the means by which people are granted or denied access to restricted areas throughout the campus. These areas may include the emergency room, maternity area, paediatric area, intensive care units, pharmacy and parking garage among others. Today, the technology involved and the decisions in design, administration, and use of an access control system can be much more complex, but managing the access to the healthcare facility remains a prime concern for the organisation. One of the largest security challenges hospitals face is how to secure a space that is intended to be not only a public environment, but also an inviting one. This means that a balance between permissiveness and

control is needed, both in the chosen technology, as well as the healthcare facility’s security culture. While sophisticated technology can be a real asset to an organisation, it only takes an unsuspecting ‘helpful and courteous’ employee to defeat the security of the system, by holding open a door for a person with security threat. The access control system can be used for the staff, the patients, the visitors, the vendors and the public. Now, with the patient, the public, and the staff in mind, how does the facility’s management begin to evaluate the many types of access control systems that are available in the market today? Furthermore, in a growing and changing healthcare environment, what is the best kind of access control to meet the current and future needs of security and integration with building, energy, and power solutions? Video surveillance: Today, the video surveillance technology is remarkably different. The new-age cameras have embedded processors that enable video to be compressed within the device and transmitted over real-time IP networks. Megapixel camera technology has ushered in a new era for the video security industry—providing clear, detailed, and expansive images—while combining sophisticated features such as wide dynamic range; low light, anti-bloom capabilities; and thermal imaging into a single, intelligent camera. The video

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Hospital infrastructure special

You can allow only authorised personnel in certain areas using access control systems. management software can use new technology as well as extend the life of older camera technology, to better utilise the hospital’s current assets and recording solutions. Digital video recorders (DVR) and network video recorders (NVR) can be managed and utilised in both distributed and centralised command and control environments. They have the ability to locate data, process images, and transmit vital information immediately with the ease of graphical user interfaces and interpretive software. The command and control centre can display only the video required for a specific alarm or condition, based on the individual event, the location at the healthcare facility and the security parameters established. Technology can provide the responding security personnel the situational awareness knowledge so they can remedy an incident in an effective manner. The concept of being able to view and record any camera, at any time, from any location is fundamental in optimising hospital security with video surveillance.

Hospital Technology Concerns  Access control & video surveillance  Patient management solution  Asset management solution  Convergence – IT & security  Integration to other security products

Patient, staff, and asset tracking & management: Whether your patients are in a longterm care facility, behavioural health facility, or a general or acute care hospital, their protection and safety are critical. Technology today provides security professionals with the means to incorporate patient management technology into each area (public, restricted, clinical) throughout the healthcare facility and integrate the technology solution into the other components of the healthcare security plan. Through a variety of RTLS and Wi-Fi system solutions, tagging technology, and management software, the patient becomes part of the safe and secure environment. This solution creates both local and campusFigure 1. Collaboration needed for security for healthcare facilities wide protection zones, enabling the security team to identify, track, and locate patients, staff, and assets throughout the campus. For instance, when an alarm goes off, real-time video can be displayed at the security command and control centre, to provide surveillance of location, the individual and / or asset involved in the event. The integration of the access control system

40

can provide strategically managed access points to filter the adverse event to selected areas, where security and staff can resolve the issue. The alarm conditions can be configured based on type of patient, areas or zones within the hospital, for emergency response in workplace violence or security incidents, for managing and monitoring patient flow and associated choke points, for managing and monitoring hand hygiene compliance standards and the use and location of hospital assets, such as medical equipment for patient care. On a daily basis, patients, visitors, staff, and community enter and interact with their local hospital and healthcare providers – most of the time unaware of the security and safety professionals and technology needed to provide a welcoming, safe, and secure environment. Providing such an environment is a collaborative effort between the security and safety team and all the other departments in the hospital, and is a basic requirement and expectation for every healthcare organisation. Intelligent security management solutions, such as patient and staff management, asset management, access control, video surveillance support the security team’s mission with real-time actionable information that enables them to detect anomalies and respond more quickly to potential threats before they become incidents. Furthermore, by aggregating all hospital security data onto one user-friendly dashboard, security personnel can easily monitor their entire hospital campus. In addition, by using a common IP-based IT infrastructure, integration of security solutions with facility and building management systems leads to an increasingly intelligent, efficient, and cost-effective healthcare facility. Furthermore, this same open protocol enables hospitals to leverage their existing security investments, while also taking advantage of newer and more advanced technologies to create a comprehensive security approach. With an intelligent security management solution in place, hospital executives can be rest assured that their facility is well equipped with the fundamental tools needed to support the life-saving mission of their healthcare organisation.

Steve Nibbelink, CHPA is the global director for healthcare security and RTLS solutions for Schneider Electric.

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Embracing modern thinking

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Hospital infrastructure special

Critical cover

Hospitals are opting for vinyl flooring in critical areas By Team HR

T

he flooring of a hospital has to be resilient, match various sections and have a high degree of resistance to rough use due to high footfall a healthcare set up receives. Also, the flooring has to be anti-skid, anti-scratch, anti-static, anti-stain, fire-resistant and germ-free. But, when it comes to choosing the flooring for critical areas in a hospital, one has to pay extra heed. It is observed that Indian hospitals are opting for vinyl flooring over hard tiles in areas

like OTs and ICUs. Vinyl flooring, available in sheets and tiles, is preferred for being an attractive, durable, hygienic solution with extreme resistance. It is easy to maintain and has fungiostatic and bacteriostatic properties. Due to these features, the Hong Kong government has instructed all its hospitals to go for vinyl flooring to prevent re-emergence of the SARS virus. Vinyl flooring is also preferred as it does not trap dirt or create dust particles, which may lead to static charge in the presence of electronic equipment.

Says Satyendra Khurana, VP, Project, Columbia Asia Hospital, “In vinyl flooring, the joints are welded and hence grooves avoid the chances of infection. Also, the 90 degree corners between skirting and flooring can be avoided by using vinyl since it comes with a cove former for the skirting.� He adds that the material is easy to install and durable and can be replaced easily and quickly, thereby reducing shut-down time for maintenance of flooring. Vinyl is also preferred for its ability to withstand knocks and abrasions. Vinyl sheet may

ICU of FMRI has vinyl flooring.

42

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Hospital Infrastructure Special

include plasticisers, which help make PVC flexible and resilient and stabilisers, which are added to minimise degradation of vinyl from heat and light. Many vinyl sheet flooring products are heat-sealed to form a seamless surface that prevents the collection of water, dirt and other contaminants. As these products are based on a polymer that is naturally fire retardant, vinyl flooring products have excellent fire-resistant qualities. According to Abhishek Saraf, joint managing director, Square Foot, “Vinyl is cost-effective, when compared to other hard floorings. Also, it comes in numerous colours.” No wonder then the market for vinyl flooring, which is pegged at over 2 million square meter, is growing in double digits. Experts say that looking at the benefits vinyl floorings offer, there is bound to be an increased acceptance of seamless vinyl floors among more hospitals and clinics. Analysts foresee vinyl floorings being an integral part of hospital design in the coming days.

Flooring in OTs has to be joint free to prevent germ build up.

Expertspeak Thomas Schneider, GM, Tarkett Western Asia and

and market for homogeneous PVC flooring is

Abhishek Saraf, joint managing director, Square

growing in India. Worldwide, only PVC flooring

Foot, on flooring choices in critical areas.

is used in hospitals. In India, ceramics are still used in some hospitals as people are sometimes

What characteristics should flooring in

not aware of the extreme resistance of these

critical areas of a hospital have?

products. But gradually, as product awareness

Thomas: Flooring in critical areas shall be

grows, India will adopt vinyl flooring in all areas of hospitals.

seamless, bacteriostatic and fungiostatic. Homogeneous PVC flooring is seamless when

Abhishek Saraf

Thomas Schneider

Saraf: Worldwide vinyl is used while making hospitals. Initially, Indian hospitals were made

hot welded. PVC rolls shall be coved to the wall for allowing better cleaning on the edges.

It is better if these products are delivered in

by using usual tiles or marble floorings. Today, a

Saraf: Vinyl flooring, which comes in two

rolls rather than tiles to minimise the number of

majority of hospitals are opting for vinyl flooring.

types—homogeneous and heterogeneous—

joints and to allow coving to the wall for better

should be used in critical areas. In any area of

maintenance.

What are the challenges to maintaining

a hospital, homogenous flooring is used due to

Saraf: OTs must have anti static flooring with

flooring in critical areas?

its basic characteristic of withstanding pressure

carbon backing.

of any kind of trolley movement. Additionally,

ICUs, NUCUs and CCUs

Thomas: Hospital owners need to follow the maintenance recommendations of the producers.

flooring must be antifungal, antibacterial,

Thomas: Resistant homogeneous PVC flooring

Saraf: Moving equipment in the hospital can

monolith flooring (without joints) and anti static.

coated with IQ PUR to allow restoration when

leave marks on the flooring. It also results

micro scratches appear due to heavy traffic

in shedding particles of flooring. Using good

What kind of flooring should one go for in

Saraf: As patients are kept under observation

quality homogeneous flooring makes it easier

the areas mentioned below and why?

anti-bacterial flooring is must.

to maintain. It is important to maintain

Emergency rooms

HDUs and MICUs

hygiene in every section of the hospital,

Thomas: Resistant homogeneous PVC flooring

Thomas: Same as ICU.

critical or otherwise. Anti-fungal and anti-

coated with IQ PUR to allow restoration when

Saraf: Homogenous vinyl flooring

bacterial flooring helps you to do that. Limited manpower is another challenge. Keeping

micro scratches appear due to heavy traffic Saraf: Homogenous vinyl flooring

OTs Thomas: Conductive or dissipative PVC flooring.

What are the global vis-à-vis Indian trends in

flooring clean becomes difficult due to limited

flooring of critical areas?

manpower. Therefore, the cleaning process has

Thomas: As everywhere else, the demand

to be mechanised.

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Hospital infrastructure special

Analyse this While healthcare analytics is increasingly been used by hospitals in the US, its usage in India is still quite poor By Amit U Jain

H

ealthcare analytics is the use of data, information technology, statistical analysis, quantitative methods, and mathematical or computer-based models to help hospital administrators gain improved insights into their business operations and make better, fact-based decisions. Analytics has three components: 1. Descriptive analytics, which uses data to understand and interpret past and present events. 2. Predictive analytics, which analyses past performance and forecast. 3. Prescriptive analytics, which uses optimisation techniques for future decision making. As per latest data, healthcare analytics is being increasingly used by hospitals in the US. In fact, in just a couple of years, almost half of the US hospitals would be adopting healthcare analytics. However, In Indian healthcare context, analytics is yet to be given its due importance, despite the fact that enables rational and strategic decision making, resulting in ‘sustained success and profitability’ in the long term. As every activity has to be value-added to the patient and bears a cost to the provider, there is little room for redundancy. So to be able to optimise both, the past and current state of affairs are to be objectively defined and measured by assigning numbers to them and converting these numbers (data) to information by applying analytical tools. The entire process can be modelled and further extrapolated to forecast trend of events. In the process, not only can you have a fair idea of the cost effectiveness of a process by activity-based costing in the past, but can also straighten the process for future. Not only op-

44

Analytics @ work Where analytics can be useful 1. Outpatient registration: Waiting line model. 2. Disease specific outcomes (both clinical and managerial)- ALOS in ICU, infection rate and antibiotic use rate, drug related events. 3. Patient specific data (longitudinal) can be monitored, stored and used for predictive and prescriptive analysis. 4. Clinical parameters in ICU can have predictive analysis and forecasting to raise alarm to avert life threatening condition. 5. In supply chain management, data regarding the demand and safety stock in different context (from pharmacy and material store to ward shelf) can be optimised using different optimisation software and ‘just in time’ can be achieved. 6. Quality indices like adherence to SOPs and

erations, prescriptive analysis may further aid in tactical and strategic decision making of the organisation. So, analytics in reality can form and reform processes and can help build and strengthen culture in healthcare institutions. In essence, analytics can be used in every aspect of the healthcare industry, starting from Patient Care Cycle (PCC) and allied functions like operations, finance and costing, supply chain management, human resources, marketing and quality to even technical and procedural medical activities. In the entire PCC, an intelligent and efficient HIS (hospital information system) captures critical patient data at various Points of Service (PoS)—front office, nursing stations, doctors consultation chambers, ICU, OT and others, through an integration of software programmes and devices (biometrics, barcode readers, RFID, DICOM and PACS integration). This has resulted in an increase in the traditional analytical tools. This data, when combined with globally acclaimed medical guidelines (such as ICD-10 diseases classification by WHO) and comprehensive patient profiles, helps indentifying gaps in patient care, cost efficiency of not only the organisation but the entire healthcare eco-system. Though technically, these are not new or tedious applications, administrators need to be more receptive, which requires building a culture where such things are accepted as routine. This will bring more clarity about the rational and scientific functioning of the organisation and stakeholders. Prospect of healthcare analytics in India is enormous as the complexity of healthcare delivery is high. For the government, prudent resource allocation needs a descriptive and predictive analysis of data of different running programmes. At the end, analytics can be termed as an essential macronutrient and an agent of change that will enhance the healthcare industry.

checklists, incidence reports, DRAE, point of care can be measured and optimised. 7. In operation theatres, resource allocation with regard to the material consumption and staffing can be taken care of, by linking activities to data endpoints.

Amit U Jain is healthcare IT specialist with Hosconnn.

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Consumer Connect Initiative

Maquet launches mobile operating table Fortis Hospital, Mumbai, installs YUNO OTN from Maquet Medical India

M

aquet Medical India has launched India’s first revolutionary mobile operating table - YUNO OTN. It is new special-purpose OR table for three disciplines: orthopaedics, traumatology and neurosurgery. The state-of-the-art table was developed in collaboration with surgeons from the specialist fields of orthopaedics, traumatology and neurosurgery. The Yuno OTN -is specifically developed to enable all surgical procedures to the upper and lower parts of the body to be carried out on just a single operating table and with the very highest degree of precision.

Dr Kaushal Malhan

The table meets all requirements of a comfortable surgical workplace: With an adjustable height range of 600 mm, the table allows the surgeon to work ergonomically during operations in a seated or standing position. With its narrow – and yet very stable – column, the table ensures the excellent accessibility of the surgical field. The Yuno OTN is also very user and patientfriendly when it comes to imaging procedures: With its unique features and premium posi-

tioning, YUNO OTN from Maquet has been first installed at Fortis Hospital, Mulund, Mumbai. According to senior orthopaedic surgeon for knee and hip surgery, Dr Kaushal Malhan, Fortis Hospital, Mulund, “To get desired patient positioning on general table, it has always been a case of multiple arrangements, along with time consuming accessory attachments with compromise. We chose Maquet, Yuno OTN as we needed a dedicated orthopaedic table.”

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Consumer Connect Initiative

The table offers single hand operational arrangements. It’s less time consuming and gives desired patient positioning in ergonomic way. “Besides all standard surgeries, it is especially geared towards making minimally invasive operations easier,” says Dr Malhan, adding, “The table has special traction assembly which not allows fracture surgery of all kinds with ease but also allows me to do the anterior direct minimal access hip replacement surgery through a small incision with very quick recovery for the patient.” The use of metal-free carbon-fibre structures

ensures excellent radiotranslucence, making repeat intra-operative repositioning unnecessary in most cases. According to Dr Malhan, the table can be extended to allow the surgeon to fix complex pelvic fractures percutaneously (without opening the fracture through big operations). “The mechanical arm (TRIMANO) on the table serves as an extra robotic type assistant and reduces the need for one assistant surgeon. My shoulder arthroscopic and upper limb minimal access work has become much easier and quicker on this table,” says he.

Also, it allows surgery in positions not possible on other tables and improves the surgical result. It allows safe and stable patient positioning for patients as heavy as 450 kliograms. The stability and modular design of the Yuno OTN enables the table to be elevated at a height presently not possible on any other table in the market. “This makes it very convenient for me to do the surgery at a comfortable height. The operating systems and attachments are designed to allow quick and easy patient positioning and manoeuvrability,” says Dr Malhan.

Featured product Product: VARIOP Type: Modular OR system Company: MAQUET

As one of the world's leading providers of operating theatres, MAQUET offers medical solutions that set new standards for the ideal care for patients in terms of quality and functionality. After in-depth dialogue with customers, medical planners and architects, MAQUET develops intelligent room concepts. On the basis of this, modular OR system VARIOP has been developed. With maximum flexibility and quick access to all areas of installation, VARIOP is a future-proof concept. The constant exchange with users and planners, MAQUET has developed a special understanding of the requirements in hospitals. The far-sighted planning uses all resources efficiently and allows plenty of room for future changes. The modular room system VARIOP combines functionality, design and the highest hygiene standards in a unique way. The use of colours and images creates a pleasant atmosphere in which clinical staff and patients feel comfortable. The division into three wall elements not only allows rapid ergonomic coordinated assembly steps, but also in the event of a subsequent conversion or when servicing OR ensures shortest downtime. The large and smooth elements are easy and quick to clean and offers quickest availability at the highest hygiene standards in daily surgical procedures. It’s time saving, thanks to swift implementation of VARIOP and the flexibility is due to modular construction. It offers economic efficiency, thanks to standardised elements and investment security of its inter-changeable modules. VARIOP is preferable in a life cycle analysis to conventional construction costs. Whether new construction or renovation, modernisation or enhancement measures VARIOP adapts to all spatial conditions. Some highlights of the product are as follows:

Illuminated Wall Element with LED light The illuminated and printed wall elements allow various individual design possibilities. A warm and pleasant atmosphere is created. Due to the flexibility of VARIOP, the illuminated wall elements can easily be integrated into an existing VARIOP room. Application areas can be entrance areas of OR departments, corridors of OR departments, recovery rooms, intensive care units and isolated rooms.

46

Illuminated Ceiling Element The illuminated and printed ceiling elements are bright and dazzle-free. The patient e.g. in the ICU is stimulated and the room is enlarged, giving the feeling of an “open sky”. The illuminated ceiling elements are flushmounted in the ceiling, thus underlining the unique design approach offered by VARIOP. Application areas are corridors of OR departments and ICUs, intensive care units and isolated rooms and recovery rooms.

Standard Lights for VARIOP As a full solution provider, MAQUET has its own room lighting. The highclass and anti-bacterial epoxy polyester surface coating is resistant to cleaning agents and disinfectants. It is integrated into the VARIOP ceiling cassettes and blends in perfectly with the entire room system.

Integration 42” Monitor Flush, frameless integration into the VARIOP wall elements ensures optimum hygienic conditions and an appealing design. The monitor is easy to open for maintenance purposes. All data sources can be displayed directly in the OR. The highly integrated products such as surgical tables, surgical lights and ceiling service units allow for a smooth workflow and promote the best possible surgical results. Medical, functional and economic efficiency are combined in a unique way. This leads to a standard that customers appreciate worldwide.

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Profile for Healthcare Radius

Healthcare Radius Magazine, August 2013  

Healthcare Radius Magazine, August 2013  

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