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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

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Published by ITP Publishing India

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Operations

Marketing

how to prevent employee fraud

your reputation depends on your brand strategy

Quality case study: columbia asia

Design special the changing face of hospitals

Face off

PRETTY CONFIDENT

BEAMS HOSPITAL PRESIDENT NIRAJ MANGLAM IS SURE THAT THE ADDITION OF COSMETIC SERVICES WILL PROPEL THE GROUP TO THE NEXT LEVEL


How to boost your hospital’s revenue. And profits.

Date Friday, July 26, 2013 Venue Hotel Oberoi, M G Road, Bengaluru Programme Fee Rs 9500 per participant (excl tax) Registration write to drvijay.raaghavan@med-ium.com Or call him at + 91 90080 20304

Healthcare Marketing MasterClass has been designed for Promoters, CEOs and CMOs to help them fine- tune various elements in their marketing strategy to drive profitable growth. It will focus on ready-to-implement takeaways through real-life hospital examples. It will cover various modules like Product, Branding & Pricing Strategy, Advertising, Digital & Social Media, Sales Force Effectiveness and Public Relations. Ratan Jalan is widely acknowledged as a thought leader in healthcare marketing. An alumnus of IIT and Harvard Business School, he headed strategic marketing initiatives for the Apollo Hospitals group. He also worked with Lowe Lintas, a globally renowned advertising agency for almost a decade. Winner of S P Jain Marketing Impact of the Year Award, he is a frequent columnist and has authored a cover story in Marketing Health Services, a prestigious publication by American Marketing Association. He is a guest speaker and faculty at industry forums and leading institutes like ISB, IIMs, Johns Hopkins and TISS.


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Contents

26

16

Cover story

30

Niraj Manglam, the new president of BEAMS group, is banking on world-class cosmetic services and restructuring initiatives to steer the group's expansion in the country

Bulletin 10 This month’s important news updates

32 Anuj Jindal shares strategies to prevent

Projects 14 HCG's upcoming cancer hospital in Vadodara

35 Dr AK Khandelwal suggests ways to tackle an

Radiology Business Connect 21 A guide to product developments in the sector

Marketing 37 How brand strategy affects reputation

quality 26 How Columbia Asia manages to maintain

special 40 Hospitals around the globe are getting

high level of efficiency at its nine hospitals

appearance conscious

operations 30 Importance of efficient inventory management

consumer connect initiative 46 Why outsource your ambulance fleet

4

financial fraud by employees

abusive staff member

40

Healthcare Radius July 2013

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Editor's note

july 2013 • Vol 1 • Issue 10 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

BEAMing changes

A

sign of prolific market opportunity and changing business dynamics, one more healthcare player got acquired by a PE firm! We are referring to the takeover of BEAMS Hospital by Mumbai-based PE firm Ambit Pragma and the recent exit of its founder Dr Rakesh Sinha from the venture that he had conceived in the ’90s as a chain of laparoscopic centres. Now, Ambit Pragma is repositioning the centres, offering both laparoscopy and cosmetic services, and pumping in Rs 110 crore to fuel Indiawide expansion. Find out how Niraj Manglam, the new president of BEAMS, plans to overhaul the group, optimising cost and streamlining operations, in our cover story. A major part of BEAMS’ success after its repositioning hinges on its branding and marketing strategies. Read about the secrets to branding and marketing that would enable you to carve a niche and steal a march over your competitors. Remember, however, to ensure that the products or services you are marketing are of the highest quality. As it is quality alone (both service quality and clinical quality) that can make or break your reputation and standing in the market. Groups like the Columbia Asia understand this and do all that they can across all their nine hospitals in India to constantly maintain their quality in all things they do. Learn about how the many policies, systems and processes they have in place, setting a fine example for others in the industry to follow.

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 459592 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

Rita Dutta Consulting editor rita.dutta@itp.com

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 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

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

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Bulletin Fortis Healthcare Mumbai gets a cancer centre for women to divest stake in Hoan My, Vietnam

Vishal Bali, group CEO, Fortis Healthcare Fortis Healthcare has entered into an agreement with Viva Holdings Vietnam (Pte.) Ltd, to sell its entire stake in Fortis Hoan My Medical Corporation, Vietnam, for a total consideration of US$ 80m. The offer price provides a premium to the purchase price paid by Fortis for the acquisition of Hoan My. “In keeping with our current priorities in allocation of resources and further strengthening our balance sheet, we have decided to accept this unsolicited offer from Viva Holdings,” explained Vishal Bali, group CEO of Fortis. The transaction is EPS accretive to Fortis Healthcare and post this divestment, the net debt to equity ratio of the company is expected to go down to less than 0.6x.

Health Care Global Enterprises Ltd (HCG), Asia's largest cancer care network, has entered Mumbai through a tie up with Dr Balabhai Nanavati Hospital (BNH). Together, they will start a 30-bed BNH-HCG Cancer Centre at Vile Parle in Mumbai. The centre is one-of-a-kind as it offers advance treatment for all kinds of cancers in women such as those of the breast, cervix, gall bladder and oesophagus. Said Dr Bhavana Parikh, consultant, medical oncologist, BNH HCG Cancer Centre, “The incidence of breast cancer among the urban women is on the rise and women in their early 40s are diagnosed with breast cancer, which is alarming. Ninety per cent of the breast cancers can be cured with optimal therapy if diagnosed early and patients can have good quality of life.” The centre is equipped with digital mammogram and automated breast volume—an innovative ultrasound imaging system designed to provide three-dimensional views of the breast tissue for use in breast cancer screenings. The automatically acquired images provide physicians with data about the entire breast, including coronal view—a feature, which was not available with conventional ultra sound systems. This helps radiologist differentiate cysts and calcifications from cancerous tumours. Said Dr Sanjay Dudhat, consultant, surgical oncologist, BNH Cancer Centre,

Apollo Hospitals, Chennai, bags awarD Apollo Hospitals, Chennai, has achieved Stage 6 of the EMR Adoption Model (EMRAM) from HIMSS Analytics Asia Pacific. This is a noteworthy recognition the hospital has attained for advancement in its IT capabilities further enabling it to successfully address several challenges faced by it as a healthcare provider, including one like reduction of medication errors. As of Q1 2013, just 7.3 per cent of more than 8,600 hospitals tracked by HIMSS Analytics had reached Stage 6 and beyond on its Electronic Medical Record Adoption ModelSM (EMRAMSM). HIMSS Analytics developed the EMR Adoption ModelSM in 2005 for evaluating the progress and impact of electronic medical record systems for hospitals in the HIMSS Analytics® Database.

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Dr Sandhya Kamath, Dean, KEM Hospital, at the inauguration. “With advancements in cancer treatment we are able to preserve the organs, since quality of life is as important as survival. At BNH HCG Cancer Centre, we do breast conservation surgery on almost all the patients diagnosed with breast cancer and cosmetic outcome of surgery is excellent.”

Apax nets 3-fold gain in Apollo Hospital stake sale London-based private equity firm Apax Partners has sold 19 per cent stake in Apollo Hospitals for Rs 2,240 crore in multiple open market transactions. The investor, which clocked 3.3 times profit on Rs 680-crore investments, had made a primary investment in October 2007 and followed it up with secondary deals a year later. It was the second largest shareholder after the Reddys, the promoters.

Healthcare Radius July 2013

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Bulletin

HCG inaugurates tertiary care centre

Supplier update

Samsung forays into medical equipment Samsung has forayed into India's health and medical equipment business by launching digital radiology and in-vitro diagnostics equipment and technologies under the GEO brand in the country. The GEO brand includes XGEO for digital radiography, UGEO for ultrasound diagnostic system and LABGEO for in-vitro diagnostics. In the area of digital radiography, Samsung has launched three machines, the XGEO GC80, XGEO GU60 and the XGEO GR40, which cater to requirements across all digital radiography market segments. These are being targeted at large and medium-sized hospitals. Samsung’s recently launched in-vitro devices are LABGEO PT10, LABGEO IB10 and LABGEO HC10 offer fast and accurate diagnostics, portability and other advantageous features.

HCG tertiary care centre in west Bengaluru was inaugurated by actor Puneeth Rajkumar. HealthCare Global Enterprises Ltd recently launched HCG Hospitals, a tertiary care centre in west Bengaluru. The 225-bed hospital was inaugurated by renowned super star Puneeth Rajkumar. Said Dr B S Ajaikumar, chairman, HCG Group, “We have been successful in redefin-

ing cancer care by setting up comprehensive cancer centres across India. This has been possible only because HCG joined hands with doctors across India. We believe that by participating with doctors in other specialities we will be able to recreate in them what we have created in cancer care.”

ISIC introduces hand and wrist surgery unit In order to treat complex disorders of the hand and wrist, the department of orthopaedics at New Delhi’s Indian Spinal Injuries Centre has recently set up a hand and wrist surgery unit. This department is being run by a team of highly skilled surgeons, who work closely with the rehabilitation department. Hand and wrist surgery is a specialised field of orthopaedics that requires advanced training. Patients who complain of arthritis-related pain and deformity- osteoarthritis, rheumatoid ar-

thritis, SLE, psoriasis and those with recent or long-standing pain in the hand or wrist-owing to complex fractures, dislocations, ligament injuries, avascular necrosis of carpal bones can benefit immensely by undergoing a hand and wrist surgery. Other patients who will benefit include those with deformities, stiffness, contractures related to arthritis, injury, congenital deformities, spinal cord injury- tetraplegia, nerve injury in upper limb, Dupuytren's contracture.

HP deploys virtual health platform HP has deployed a virtual health technology platform that claims to enable healthcare professionals to virtually conduct specialist psychiatric consultations with patients. This initiative facilitates psychiatric care without requiring either the doctor or the patient travelling to meet each other. HP is piloting the platform with MSC Trust, a leading NGO specialised in providing psychiatric solutions to patients in rural Tamil Nadu in south India. HP’s virtual health platform is expected to support MSC Trust’s efforts to extend the reach of psychiatric care in rural India by providing the required information technology infrastructure and improving awareness through continued education of medical personnel onsite.

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

Healthcare Radius July 2013

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Bulletin

NationWide PRIMARY HEALTHCARE SERVICE opens new clinic

Rear Admiral Ajit Tewari and Shashank Kekre inaugurate the NationWide Indiranagar clinic.

ECMO saves 9-month old A nine-month old, who suffered from a life-threatening pneumonia progressing to Acute Respiratory Distress Syndrome (ARDS), became the first paediatric patient in Kerala and the youngest in India to have successfully recovered using ECMO (Extracorporeal Membrane Oxygenation), an artificial heart-lung by-pass machine. The child was brought to the Kerela Institute of Medical Sciences (KIMS), Thiruvananthapuram, while her condition kept worsening due to a rapid loss in the functioning of her lung leading to drastic drop of oxygen levels. As ventilators weren’t helping the child, the medical team of KIMS decided on the ECMO, which allowed the affected lung to rest and given time to heal. It required an organised effort of team experts including cardiac surgeons, pulmonologists, anaesthetists, critical care specialists, physiotherapists and nursing staff. Renowned ECMO specialist team lead by Dr Pranoy Osa from Mumbai flew to KIMS for the procedure. The child was weaned off the ECMO machine after seven days of treatment and was discharged in a fully fit condition thereafter.

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‘Hospital on Wheels’ in Kerala Philips India has introduced a suite of healthcare products that can help meet the dire need for accessible and affordable healthcare in the country. A specially designed ‘hospital on wheels’, that showcases the ideal hospital setting – from ambulance to ICU – was flagged off from Kochi, recently. The vehicle is slated to travel across key cities in Kerala, before moving on to the state of Karnataka, from where it will proceed to cover other parts of India. The plan is to cover a total of 80 locations in a span of just four weeks. The vehicle is an experiential area fitted with healthcare equipment that offers state-of-the-art technologies at affordable prices. This is part of an intensive awareness campaign called IntelliSafari, through which Philips will reach out to smaller hospitals, nursing homes and clinics in tier-II and tier-III cities in India. It will reach over 300 clinicians over the next one month and familiarise them with the latest technological advancements in healthcare, available at a low cost.

NationWide Primary Healthcare Services, the Bengaluru-based chain of primary healthcare clinics, launched its new facility at CMH Road in Indiranagar, Bengaluru. The group currently has 18 clinics across Bengaluru, including five retail clinics and 13 corporate clinics. The new clinic offers a wide range of services, including family physicians, senior citizen care, preventive healthcare, woman and child care, home visits, diabetes management, 24x7 doctor-on-call, electronic medical records, lab tests and vaccinations. Highlighting the importance of family doctors in providing healthcare, Dr Santanu Chattopadhyay, founder & CEO, NationWide Primary Healthcare Services, said, “The overall health of a population depends on the strength of the primary healthcare system. We anticipate that the NationWide chain of clinics will become an important component of India’s primary healthcare system.”

It's once again time for the 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. Insituted since 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 at the Frost & Sullivan 5th Annual India Healthcare Excellence Awards 2013 will span across all major sectors of the industry such as Medical Technologies, Healthcare IT, Healthcare Delivery/ Services, Pharmaceuticals, and Biotechnology.

Healthcare Radius July 2013

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Bulletin

Rockland Qutab upgrades diagnostic facility

In line with its other group hospitals at Manesar and Dwarka in Delhi NCR, which have been built to international standards, Rockland Qutab Hospital recently upgraded its diagnostic facilities centre. The upgraded facility was inaugurated by senior Congress leader Oscar Fernandes. The ongoing upgradation includes the installation of a CT – Philips 128 Slice, and a Philips

1.5 T MRI. Said Rajesh Srivastava, chairman, Rockland Hospitals Group, “Philips 1.5 T MRI has the magnet with the best homogeneity in 1.5T with maximum FOV in the industry. This MRI equipment is proven and has an industry leading scanning protocols with the fastest scan time in its segment. Due to their better and sharper imaging outputs, the state-of-theart CT and MRI will benefit patients greatly.”

A must-attend MasterClass on marketing Medium Healthcare is conducting ‘Healthcare Marketing MasterClass’ on July 26 at Hotel Oberoi, MG Road, Bengaluru. The MasterClass, in addition to providing sound framework based on global best practices, will focus on delivering actionable insights and readyto-implement takeaways through real-life examples. Active discussion among participants during the programme will further enhance learning through reasoning. The programme has been designed for promoters, CEOs and chief marketing officers of hospitals and other healthcare service providers. It is meant to help them fine-tune various elements in their marketing strategy to drive profitable growth. It is also recommended for organisations in the government or social enterprises. To ensure an effective learning environment and individualised focus, the number of participants would be limited to a maximum of 50.

BBH offers course in quality management

CARESTREAM gets recognition

The advisory council and the faculty for the FHQM course will include Dr Giridhar Gyani of Association of Healthcare Providers of India; Dr KK Kalra, CEO, NABH; Dr Venkatesh Thuppil of QCI; Dr Pawan Kapoor of NABH; Dr Ravindra Karanjekar, chairman, Technical Committee- NABH; Dr Prem Nair, director, AIMS; Dr Arati Verma, VP, Max HealthDr KK Kalra, CEO, NABH formally inaugurated the course. care; Beenamma Kurian, nurse supervisor at St John's Medical College; Dr To give a boost to quality standards in Vikram Kashyap, principal assessor, NABH; healthcare organisations across the country, Dr Alexander Thomas, director, BBH; and Bangalore Baptist Hospital (BBH) has recently Dr Badari Datta, head of quality, BBH. Dr started a ‘Fellowship in Healthcare Quality Kalra, was the chief guest for the launch Management (FHQM)’ programme. The onefunction. In his address, Dr Kalra said that year course will provide three months of incourses like these will result in increasing house training by quality experts in BBH. The the number of qualified quality champions hospital has limited the batch to five students in the healthcare sector. to be able to mentor students better.

Carestream has earned a top rating against major competitors for its digital X-ray systems that are based on its proven wireless DRX technology. As reported by KLAS in ‘Digital X-Ray Performance 2013 – Impact of a Wireless Workflow’, the CARESTREAM DRX-Evolution scored highest for overall performance. In a survey of more than 200 radiology professionals, the report stated that: “Carestream has built on their wireless detector success with the DRX-Evolution. Providers are taking advantage of moving detectors between different rooms or mobile X-ray systems. The DRX-Evolution wireless rooms also meet provider needs with an intuitive user interface, great image quality and reliability.” Carestream also received the highest rating in three other survey indicators: ‘Implementation On Time’, ‘Usability’ and ‘Quality of Training’.

Healthcare Radius July 2013

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PROJECTS

CAD rendering of HCG's Vadodara project.

VADODARA’S FIRST Type of hospital: Cancer hospital Location: Sun Pharma Road, Vadodara Promoted by: HealthCare Global, which has a network of 27 cancer centres across the country. This is the group’s third hospital in Gujarat, with the other two located in Ahmedabad. The project is a JV with city-based surgical oncologist Dr Rajiv Bhatt. Bed strength: SX^RO \]^ZRK]O^YLO]MKVON_Z^YLON]K^K later stage Project type: 1\OOX OVNZ\YTOM^^YLOL_SV^Q\Y_XN_Z6KXNKXNL_SVNSXQ taken on long-term lease. 8_WLO\YP YY\]$0S`O YY\]SX^RO \]^ZRK]OKXN^aYKNNS^SYXKV YY\] in the next phase. To be commissioned by: November 2014 Status: Foundation stone has been laid. Construction will start after a month. Land area: 36,000 square feet In built area: 50,000 square feet

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Healthcare Radius July 2013

HCG’s Cancer Hospital in Ahmedabad

Project designed by: Ahmedabad-based architect. Cost of the project: Rs70 crore (which is inclusive of construction and equipment) What’s on offer: Medical, surgical and state-of-the-art radiation oncology services, besides linear accelerator, PET-CT, state-of-the-art pathology and BMT facilities. USP of the project:>RS]aY_VNLO^RO \]^MYWZ\OROX]S`OMKXMO\RY]pital of Vadodara. Linear accelerator and a PET-CT are being offered for ^RO \]^^SWOSX@KNYNK\K Types of rooms: General wards, private and deluxe. Number of doctors: 50, with 15 super specialists Catchment: Mainly from Vadodara and surrounding districts of Godhra, Bharuch, Anand and Narmada, along with from Maharashtra and Madhya Pradesh.


                

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Cover story

We are adopting BPR to bring down the overall cost of operations, and this has significantly increased our gross profit margin�

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Cover story

More than

skin deep Taking over as president, after the change of ownership of BEAMS Hospital, Niraj Manglam is banking on world-class cosmetic services and restructuring to steer the group's expansion Interviewed by rita dutta

It was in the year in 1995 that laparoscopic surgeon Dr Rakesh Sinha and his wife Dr Manju, an anaesthetist, founded laparoscopic surgery centre—BEAMS Hospital in Mumbai. While private equity firm Ambit Pragma first invested and then acquired BEAMS from the Sinhas, the group in partnership with UK-based NU Cosmetic Clinic, forayed into the cosmetic segment. Now, Niraj Manglam, founder of Nu Cosmetic Clinic, has taken over as president of BEAMS, overhauling the group to improve its operations and bottom line. He shuttles between UK and India and is taking several measures to ensure that the Indian cosmetic surgery business is on par with the best in the world...

How has the business growth of BEAMS been after its recent change of ownership? It was in 2010 that Ambit Pragma invested in BEAMS, acquiring majority stake. Finally, in April, this year, Dr Sinha exited BEAMS to pursue individual practice. And Rajeev Agarwal, who heads the healthcare and wellness sector of Ambit Pragma, invited me to take over as the president of BEAMS. Regarding the business growth, post Dr Sinha’s exit, I am happy to share that we have clocked a revenue growth rate of 120 per cent in the last two months. BEAMS has been promoted as a laparoscopy centre. Would not the brand get diluted with the group entering the cosmetic segment? Not at all. While it is true that laparoscopy surgery is needed for medical conditions and cosmetic procedures serve aspirational needs of people, there is a synergy between the two. Both mainly cater to the female populace, though the number of male patients is also on the rise, and thus, the products are complementary. Foraying into cosmetic segment has only widened the service portfolio of BEAMS and improved its bottom line.

But is it a good idea to club cosmetics with laparoscopy as the target patient base for the former is the affluent class? It’s a myth that only the affluent opt for cosmetic procedures. Across the world, the working class and middle class segments are equally instrumental in driving the cosmetic market segment. The demand for hair transplant in India is the main driver in cosmetic segment for men, followed by liposuction, rhinoplasty and tummy tuck. Demand for laser treatment, say laser hair removal, is also increasing as everyone is looking for a more credible provider. You built a chain of cosmetic centres in the UK. What drew you to India? I am in the cosmetic surgery business for over 14 years now. After setting up 16 Nu Cosmetic Clinics in the UK, out of which, three are surgical centres, I wanted to venture beyond the UK market. Apart from my Indian connection, what got me interested in starting here was the urge to have a pie of the vast Indian cosmetic surgery market, which stands at Rs4,000 crore and is growing at an annual rate of 14 to 16 per cent.

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Need for hospitalisation in BEAMS

70% cases Cosmetic: 30% cases

Laparoscopy:

What are your impressions of the current Indian cosmetic market? Prior to our entry in India, we surveyed the market extensively. I personally went shopping for various treatments in cosmetic and wellness centres in Mumbai, Pune, Delhi, Kolkata and Bengaluru to get a first-hand feel of how things stand instead of relying solely on secondary data. I was shocked with what I came across: the focus of most centres is only to make money! And for that they often misguide gullible patients to go for procedures that they don’t need. One of the clinics that I went to suggested that I needed a hernia operation as well! None of the centres I visited were interested in solving the problem of the patients. Though some of the centres have good infrastructure and cutting-edge technology, they lacked clinical governance and did not possess an integrated approach to patient care. They were not transparent with regard to information to patients, be it about procedures or billing. Most were found offering different price packages to Indians and medical tourism patients. What horrified me the most was the way in which surgery is being conducted at many of these centres, where the OT is located in a corner room or in the basement lacking adequate risk management measures for infection control. The centres do not comply with any patient safety guidelines while doing a procedure under general anaesthesia (GA). They are not being inspected or monitored for the activity performed. I fail to understand why healthcare is not treated like any other

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BEAMS is concentrating on giving an umatched surgical experience.

business, where customers are well-informed and not taken for granted! We clearly see that it is our responsibility to educate the clients of all associated risks and complications. What about the established market players in the segment? There are players like VLCC and Kaya Clinic, mostly focussing on the nonsurgical segment. However, the surgical cosmetic business in India is mainly led by independent cosmetic surgeons, who personally conduct most procedures. There is a lack of corporate players in this area, and that’s why there is no consist-

Revenue drivers in cosmetic segment for BEAMS

15%

30%

15% 10% 30% Hair transplant Tummy tuck Liposuction Others Rhinoplasty

ent practice as the market is very fragmented. While some hospitals do have a surgical cosmetic wing, none of them are dedicated units. What made you open the cosmetic centres under the BEAMS banner? I had approached Ambit Pragma for investment in cosmetic centres in India. Being majority stakeholders in BEAMS, Ambit suggested that I check out the BEAMS set-up. So, in June 2012, I visited BEAMS and meet their surgeons and came back very impressed by the world class infrastructure. Be it the OT, patient safety measures, risk management protocols, clinical governance, quality initiatives, everything was on par with global standards. In fact, in some things I found that they were doing better than international standards. So, BEAMS was an ideal partner for us. But why go for a strategic partner? Tying up with a known and established player is better when debuting in an unknown market. It gives you speed of execution and ease of operation with the local knowledge the partner brings to the table. Moreover, with around 60 per cent of our cosmetic business being surgical, we needed a proper hospital set-up and not a clinic set-up. Setting up a standalone cosmetic centre would have cost us as much as Rs8 to 12 crore per centre as opposed to Rs2 crore that we spent with BEAMS. Thus, in December last year, we merged the Indian arm of Nu Cosmetic Clinic with BEAMS. Soon after, we rolled out our second centre in Bengaluru, and first ones

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in Hyderabad and Amritsar. Now, all BEAMS centres have a cosmetic wing. In most of the centres, we have had operational breakeven within the first five months.

Rapid fire

How are you handling the Mumbai business with the new centre under renovation? The original centre now belongs to Dr Sinha. Our new centre in Mumbai, located close to the previous centre, would be operational by August. Till it is ready, we tied up with Hinduja Hospital for surgical cases, while halting our non surgical work for the time being. Why did you decide to shift the headquarters from Mumbai to Bengaluru? My first choice was Mumbai. That was before I visited Bengaluru. When I visited the garden city, I realised that the intellectual resources available there were on par with Mumbai, but cost less. Also, infrastructure cost in Bengaluru is one third of that in Mumbai. We have plans of consolidating our presence in south India, with centres in cities like Chennai, Mangalore and Secunderabad. Hence, having the headquarters in Bengaluru, makes logistical sense for us.

BEAMS centre in Hyderabad.

Learning from the Indian market We need a thorough pre-assessment of the market before launching a centre in a city. We had to close down our unit in Indore after one and half years of operations as the market was not mature enough. Procedures requiring hospitalisation Around 70 per cent for laparoscopy and 30 per cent for cosmetic. We follow the guidelines of the Royal College of Anesthesia, which states that patients undergoing GA can be discharged on the same day only when they are accompanied by an adult companion. Else, they should be discharged if they meet Royal College Anaesthetisa- discharge criteria.

Challenges to growth In India, it is about trained manpower, the referral system and lack of acceptance of innovation. Here, everyone likes copying tried and tested business models. If BEAMS is introducing a novel concept of care, which is protocol based and follows an integrated pathway, it is taking time to be accepted. Plans for strengthening laparoscopy Earlier, BEAMS focussed on gynaecology-related laparoscopy. Now, we will be also adding arthroscopy, GI, urology and general surgery. Markets to explore South Africa, the UAE, some east-Asian and European countries (like Spain and Italy) But as of now, our focus is on the UK and India.

BEAMS is shifting its headquarter from Mumbai to Bengaluru.

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BEAMS has now done away with posh interiors to optimise costs. What are your expansion plans in India? We are investing $20 million or Rs110 crore to set up centres in Delhi, Chennai, Ahmedabad and Pune. We are also looking at Mangalore and Secunderabad. All these centres would be operational in the next two years. In what ways are you planning to enhance patient communications at BEAMS? When patients leave a hospital in India, all that they are given is a receipt with little or no information about their clinical condition or what they are supposed to do after leaving the hospital. At BEAMS, we empower patients by imparting as much clinical information as possible. And we communicate in a language they understand. For instance, most hair transplant patients neither understand the technical difference between procedures nor have an inkling about the number of grafts they would need. So, we are training our staff to communicate with patients in a way that they understand. Also, we are transparent in billing; we offer fixed packages, with no hidden charges. If a patient is unhappy with the outcome, we provide repeat treatment at no extra cost. What are the recent initiatives taken up after you took charge as president? Initiating BPR to bring down the overall cost and this has significantly increased our gross profit margin. While the average gross profit margin in laparoscopy and cosmetic is around 50 per cent, for us, it is 60 to 70 per cent in cosmetic and 50 to 60 per cent in laparoscopy. To ensure cost optimisation of new projects,

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BEAMS is training its staff to reduce dependence of surgeons.

we have adopted a dual approach. First, we eschewed the concept of going for swanky interiors as they make no difference to the clinical outcomes. Second, we have stopped outsourcing project consultation. We have entrusted the task to our projects team. This has drastically reduced the cost per surgical centre from Rs20 crore to Rs12 crore. To make treatments affordable, we follow an integrated care pathway. We have been training our nurses, counsellors and allied healthcare

Info on centres Hub: 4,000 square feet size, Rs12 crore investment Spoke: 1,500 to 2,000 square feet size, Rs2 crore investment professionals to reduce dependence on surgeons. The BPR is also focusing on improving patient experience and functioning of marketing and sales. We recently started offering pick-up and drop for patients on the day of the procedure. This gives us control over the process, ruling out the chance of patients coming in late and has greatly enhanced customer satisfaction. Any other cost optimisation measures? We have also started following the hub-andspoke model in cities, where we have multiple centres. So, each city would have one surgical

centre and more than one nonsurgical centre. For instance, in Bengaluru, the Koramangla branch is the hub, while the Jayanagar branch is the spoke. While the spoke offers OPD consultations and dermatological procedures that do not require GA, the hub does the surgical procedures that require GA. The investment for the hub is around Rs 12 crore, while for a spoke it is around Rs 2 crore. What will differentiate BEAMS from others in the cosmetic segment? Unlike existing competitors whose business is driven by its nonsurgical techniques, for us, around 60 per cent business comes from our surgical business. We have introduced a protocol-based and process-based approach to clinical care. We follow an integrated care pathway, whereby there is equal involvement of the physician, surgeon, psychologist, nurse, allied healthcare professionals and technician in the overall treatment. Unlike in the west, in India, right from technique selection, risk assessment to the procedure, every step involves the surgeon. Plastic surgeons do hair transplant themselves! BEAMS is trying to change this over-dependence on surgeons. While the physician is important for pre-assessment, discharge, and the treatment has to be done under his supervision, the actual technique, say a hair transplant, can be carried out by a well-trained allied healthcare professional with equal ease and success. And the surgeon is free to do more surgical procedures. It also reduces the cost of treatment, which pass on to the patient.

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RADIOLOGY BUSINESS CONNECT

K S Biomed

Rotograph

FOCUSED ON CUSTOMERS, DRIVEN BY PEOPLE

W

hat started as a small organisation in Ahmedabad, Gujarat, back in 1996 is today one of the important players in the radiology equipment segment with pan-India presence. K S Biomed Services offers need-based solutions to the dynamic radiology industry through a rare combination of offerings: new products as well as refurbished products. The company offers services, technologies and products in various areas of healthcare covering about 10 technologies and more than 20 product solutions. The company assists its clients through ‘total instrument management cycle‘, best in industry service solutions, selection of current technology platforms, project engineering, installation, commissioning and life-time maintenance.

Nova3000

The company’s strength has been its people and innovative concept-based product solutions. The company believes in building strong and lasting customer relations. “We work with our clients rather than for them” says Kaushik Shah, who steers the India business for the company. “We believe in people who create solutions rather than designations, which end up on management hierarchy,” he says indicating the strong people driven approach the company believes in. Some of the leading brands that the company represents in India are Fuji Films, Samsung Medison, Anatomage, Shimadzu, Medrad, Perfint & Villa Systemi Medicali. The company is a leading provider of refurbished imaging and represents reputed technologies of Siemens ad GE Healthcare.

REFURBISHED SOLUTIONS KS Biomed’s refurbished products includes: s Siemens mammography solutions: With 1000/3000/3000 NOVA, these offer best in class mammomate. The company has installed over 95 systems across country and has exported them as well. s GE Lunar BMD (dexa) solutions: Excellent fan beam technology systems of GE LUNAR MODEL: PRODIGY, the company has installed over 20 systems in just a span of 18 months across the country.

FEATURED SOLUTIONS KS Biomed represents Samsung Medison’s robust imaging solutions in India. Some the products include: SonoAce R5 and SonoAce R7 Ultrasound System. SonoAce R5 is a practical, efficient and

Healthcare Radius July 2013

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Radiology business connect

comfortable OB/GYN ultrasound system. The SonoAce R5 is designed to provide not only with the latest in diagnostic functions, but also the greatest possible user convenience. Synthetic aperture control is a method for overcoming the limits of the physical channel by using software. To create one scan line, the TX and RX are performed twice. Using synthetic aperture enhances the channel twice, for better resolution and penetration; however, the frame rate is halved and the two RX signals are mixed. The benefits are enhanced resolution and enhanced penetration. The system is based on harmonic imaging. The basic theory of harmonic imaging is that body tissue reflects ultrasound signals at twice the scanning frequency - the second harmonic of the scanning frequency. Although harmonic imaging is common in ultrasound, Samsung Medison has taken the technology one step further. There are many types of harmonic imaging. Tissue harmonic imaging does not use contrast agent and uses the harmonic generated within the body tissue. Harmonic imaging using contrast agent injects contrast agents into blood vessels to increase the generation of harmonics, then the harmonic signal generated in the blood vessel is used to obtain

SonoAce R7

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the image. Colour/power Doppler harmonic imaging using contrast agent is another type of harmonic imaging. When the flow of blood in blood vessels is monitored in the colour/power mode, clutter can act as an obstacle. Contrast agents reduce clutter in harmonic imaging, thereby resulting in more accurate blood vessel monitoring. The last type of harmonic imaging is transient echo imaging (triggered harmonic). Full Spectrum Imaging: Spectrum imaging is designed for imaging by using the entire frequency territory supported by the probe, no matter how the TX frequency is designated. The frequency range can be broadened for better penetration and resolution. When creating a 2D ultrasound image, the signal returned by the SonoAce R5 TX frequency drive of wideband frequency divided into each sub-band is generally not consistent. Thus, if the image is composed in this form, speckle is reduced and the overall contrast resolution improves with improved SNR (Signal-to-Noise Ratio). Full Spectrum Imaging is also applicable in harmonic imaging. In general, harmonic imaging has a higher frequency than fundamental imaging, in that an image with better resolution may be obtained. However, a higher frequency results in a loss in penetration. On the other hand, fundamental imaging does not have better resolution than harmonic imaging. SonoAce R7 is a slim and ultra compact system with advanced performance. With its innovative, ergonomic, and ultra-compact design, increases patient throughput by providing a simple user interface and Samsung Medison's outstanding 2D/Colour performance. Multi-beam processing: Multi-beam imaging is a technique involving creating

several scan lines of images in one TX. The Multi-Beam technique is possible through digital beam-forming, and is a function that cannot be done with existing analog beam-forming methods. Synthetic aperture: Synthetic aperture control is a method for overcoming the limits of the physical channel by using software. To create one scan line, the TX and RX are performed twice. Harmonic imaging: The basic theory of harmonic imaging is that body tissue reflects ultrasound signals at frequencies at twice the scanning frequency, or the second harmonic of the scanning frequency. Samsung Medison's Harmonic Imaging is an advanced version of conventional harmonic imaging. Full Spectrum Imaging: Spectrum imaging is designed for imaging by using the entire frequency territory that the probe supports, no matter how the TX frequency is designated. The frequency range can be broadened for better penetration and resolution. Speckle Reduction Filter™: The SRF function reduces speckle artefacts and low signal artefacts in the background and in organs. The resulting image has a more clearer image than the original image. DynamicMR™: DynamicMR™ significantly reduces artefacts such as misleading speckles and noise of a 2D ultrasound image, through an innovative second-stage filtering by Object Filtering and Pixel Filtering. AutoIMT™: Automated measurement of the intima-media thickness of the carotid artery wall is a widely-used function. It provides instant measurement and the Mean, Max, Standard Deviation and the Quality Index at the touch of a single button.

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RADIOLOGY BUSINESS CONNECT

Allengers Medical Systems

TRANSFORMING CRITICAL CARE A

llengers Mobile DR Systems have changed the way a hospital handles trauma patients by increasing the multidisciplinary approach and improving working relationships within the trauma, emergency, ICU and general wards. The attributes that make the mobile DR an indispensable unit in ER, Trauma, ICUs and wards are: s)NSTANTIMAGESFORIMMEDIATE assessment. s&ASTERTHROUGHPUTOFTRAUMA patients, thereby reducing treatment time. s3WIFTEREXAMINATIONSDUETO high definition digital images produced within seconds AFTEREXPOSURE s&ASTERTREATMENT as the

MobilX DR

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Healthcare Radius July 2013

IMMEDIATEREPRODUCIBILITYOF images enables trauma assessment teams to act instantly on the CLINICALINFORMATION&OREXAMPLE DOCTORSCANINTERPRETFRACTURESIMMEDIATELY in the emergency / trauma room. Also this accelerates diagnosis and treatment plans as the patient is not required to be TRANSFERREDTODEDICATED8 RAYROOMS RollX DR

s%FlCIENTPROCESSHELPINGCORRECTMISTAKES sooner. With images displayed on the integrated monitors, retakes can be immediately undertaken and additional image views can be chosen. s)NCREASEDPRODUCTIVITY3INCETHEREARENO processing delays, the trauma team now can concentrate more on treatment than on WAITINGFORTHEIMAGESTOSTARTTREATMENT s-ORECONVENIENCEASIMAGESCANBE archived directly at the patient's bedside. 4HEPROMPTEXAMINATIONSVIAMOBILE$2 also have direct benefits to the patient ASWELL$IGITALIMAGESDELIVERFASTER diagnosis as such shorter waiting times, quicker treatment thus saving precious LIVES ASPROMPTDIAGNOSISISARECIPEFOR prompt treatment, especially where time is CRUCIAL4HEUSEOFTHEMOBILE$2SYSTEM FACILITATESIMMEDIATEPATIENTMANAGEMENT

based on instant digital images, diagnosis ANDLESSREPEATS RESULTINGINLOWERLEVELSOF PATIENTANXIETY4HISMAKESINTERACTINGWITHTHE patient or his attendant a much smoother and POSITIVEPROCESSFORTHECONCERNEDSTAFF 4HEQUICKEREXAMINATIONSTHROUGHAMOBILE DR are much less traumatic to children. !TTENDANTSOFTHEPATIENTSAREALSORELIEVEDBY NOTCARRYINGlLMSTOANDFROMTHEX RAYROOMS anymore and are at ease at how little time the IMAGINGEXAMINATIONSNOWTAKE ESPECIALLY when their ward is critical. 5NDERMOBILE$2SYSTEMS!LLENGERSOFFERS -OBIL8$2AND2OLL8$2THATHAVEBEEN DESIGNEDTOSUITDIVERSENEEDSOFALLTYPES OFCENTRES WHETHERBIGORSMALL!PARTFROM these mobile wonders, Allengers also has a RANGEOFlXED$2MODELSFORVARIOUSOTHERAP plications and procedural needs. In the years to come, these mobile DR models would truly turn out to be a revolution in critical care. &ORMOREINFORMATIONONTHESESTATEOFTHE art DR Systems, log on to www.allengers.com


Consumer Connect Initiative

Cone Beam Computer Tomography A Blessing for Modern Dental Radiology

F

rom ‘wooden chew stick’ to modern advanced tooth brushes, from powdered pumice stones and strong wine vinegar to tasty and healthy tooth pastes and from mere dental practice to today’s modern advanced dentistry, our teeth at last are ‘honoured’ with much better care. The best example of advantages of modern dentistry is the fact that more and more youngsters are visiting the dentists than aged patients looking for simple dentures. Merely from basic dental care, today this branch of healthcare has grown to cosmetic surgery, implant dentistry, root canal treatment, sedation dentistry, painless extractions, advance dentures, tooth colour filling or even dental jewellery. All above new advancement are predomi-

nantly supported by Dental Radiography, which has seen a paradigm shift from simple dental X-ray plates to modern times digital radiography, CT Scan, Cone Beam Computer Tomography or CBCT (a specialised dental CT) or even MRI in some dental analysis. For the above mentioned modern dental treatments, dental radiography from multiple angles is a must. CBCT has revolutionised bone analysis and bone treatment planning to a great extent. Today, it is the best technique available for most effective pre-operative dental assessment. It also helps wonderfully in post-operative assessment for treatment planning which results in faster and accurate patient recovery. One can reconstruct 3-dimentinal view of skull or any maxillo-facial region in all three

planes i.e. Sagital /Axial and Frontal. It’s a must technique for dental trauma patients, dental implant, TMJ’s analysis, orthodontic treatments, and also for diagnosis of any pathology or cyst in dental care. It is an excellent quantitative and qualitative analysis tool for modern dentistry. The above mentioned advanced radiography tools specialised in dental care are the need of the hour for modern radiology clinics in India. The increased level of awareness about the techniques is creating an ‘assured promise’ of faster returns in Digital OPG or CBCT by radiology set ups. The time has come that the dental care modality be made a part of all advanced radiology set ups which will help investor, referring dentists and patients to a great extent.

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quality

The group conducted a time motion study to reduce the waiting time for patients.

Pillars of excellence

The quality framework of Columbia Asia Hospital stands on the edifice of compliance, monitoring and continuous improvement

I

t was around 2.45 pm in January 2012, when a maintenance supervisor at Columbia Asia Hospital at Hebbal in Bengaluru noticed a fire breaking out in the basement of the twostoried hospital building. An explosion of UPS batteries stored in the basement had started the fire. Much before the fire spread to the first floor and even before fire fighters started their work, the hospital staff sprang into action to contain it. All the fire hydrants and sprinklers were activated, windows were broken open, all 79 in-patients, including the ones on ventilators, and women in labour, were shifted to nearby hospitals. The entire process of taming the fire and the evacuation of patients took all of 30 minutes! Even today, the incident is often cited as an example of a fire situation well-controlled and a disaster well-averted. Had it not been for the

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efficient quality framework of the Columbia Asia Hospital group and the rigorous training to employees, the staff at the Hebbal facility would not have been able to handle the situation with such ease. “Our quality programme is built on the principles of achieving medical excellence, practising evidence-based medicine, medical audit and continuous professional development,” explains Dr Sudipta Datta, VP, quality assurance, Columbia Asia Hospital.

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or a group with a chain of nine hospitals in India, the documentation part of drafting policies and manuals on quality, be it service quality or clinical quality, is done by the South East Asia corporate office of the group, located in Kuala Lumpur. This part mainly pertains to signage manual, communication manual and hospital design, which are sacrosanct and cannot be altered by any country office.

However, when it comes to operational manual and hospital policies, the India Management Office (IMO), based in Bengaluru, can provide additional guidelines to amplify or clarify, without altering the tone and spirit of the document. For each group hospital in India, the policies, forms and formats have to be approved by the IMO. It’s only the operational manual that individual hospital is allowed to customise as per regional needs. Over all, the quality structure of the group can be divided into compliance, monitoring and continuous improvement. Compliance stands on the tripod of statutory compliance, hospital policy and accreditation. Statutory compliance entails applicable local laws, such as licenses required for operating lifts, pharmacy, blood bank, NOC for the building and license from pollution board. It includes around 35 to 40 licenses that are either given one time, like

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quality

hospital registration and occupancy certificate, or to be renewed at regular intervals. Most licenses fall in the second category. The centre head of the hospital, along with the legal and quality department, keeps an eye on the license expiry date and applies for renewal at least three months prior. Statutory compliance also includes mandatory reporting of cases like that of dengue and malaria to the health department. Then, there is a manual on hospital policies and guidelines, which has 21 chapters covering departments such as for IT, HR, infection control, radiology, lab, pharmacy, support services, disaster management, marketing, customer care, nursing, central procurement and finance. For every department, there is a scope of service, which can be elaborated upon by each department.

T

oday, any hospital with an eye on quality attaches great significance to accreditation. So, accreditation is an essential part of quality compliance at Columbia Asia. With four hospitals located in Hebbal, Yeshwanthpur, Palam Vihar and Mysore being NABH accredited and the labs in Yeshwanthpur, Hebbal and Palam Vihar being NABL accredited, the group’s hospitals rigorously follow NABH and NABL accreditation guidelines. Right now, the Patiala unit is in process of getting the NABH accreditation. “All Columbia Asia hospitals have now been mandated to undergo NABH accreditation. It’s usually after a year of operation that we prepare the hospital for it,” says Dr Datta. However, drafting policies and setting oneself on the path to quality is one thing, and ensuring that standards are being complied with, quite another. For Columbia Asia, monitoring quality occurs through tools such as quality indicators, incident reporting, patient feedback, mock drills, committees and auditing. The group follows 64 quality indicators (a measure of efficiency of service) as laid down by the NABH, which has enabled the hospital to improve its turnaround time for various activities. Dr V Srilaxmi, manager, operations, Columbia Asia, informs that at the Hebbal branch, the quality indicator has helped reduce the waiting time for OPD patients. From the feedback gathered from a sample size of 100 patients, over six months, the hospital found that the waiting time for four renowned doctors was around 40 to 45 minutes. Assessment revealed that the long waiting time was

Every year, each of the group’s nine hospitals undergoes internal auditing by the India Management Office. the result of more walk-in patients than patients with appointments. “We reduced the consultation time per patient from 20 minutes to 15 minutes, and this automatically accommodated more OPD appointments. We also increased the number of in-house doctors in OPD to cater to the wide influx of OPD patients,” says Dr Srilaxmi. The astute strategy paid off. A study of 100 patients conducted six months after adopting the measures showed

Our internal auditing is quite detailed. From the roof of the hospital to its basement, every aspect of the hospital building and its service is audited” Dr Sudipta Datta VP, Quality Assurance, Columbia Asia Hospital

that the waiting time for patients for the same set of doctors had reduced to 20 minutes. To further strengthen its processes, efforts are on to automate data collection for quality indicator. This would help reduce manual errors and ensure data entry in a systematic format.

I

ncident reporting is another important tool that the group uses for monitoring. The hospital has categorised incidents as adverse, near miss and sentinel. Adverse event relates to incidents like patient fall, roof collapse, needle-stick injury and sparks in the electrical system. Near-miss events are incidents that could have gone wrong, like a nurses was about to give wrong medicine to a patient. And sentinel events are ones that have the potential to irreversibly damage the reputation of the hospital, such as amputating the wrong leg or operating on a wrong patient. Whether it’s nurses, administrative staff, doctors or technicians, the hospital staff has been trained and empowered to raise incident report by entering into the quality indicator system, which details the nature of the event, the name of the staff entering it and the date and time of the event. Of course, there are instances of confusion over the category in which the event has to be reported in and also reluctance to report such incidents from new recruits. Such confusion is sorted out with training. “We believe that there is no human being, who cannot be trained to improve on services,” says Dr Datta.

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quality

It also takes time to train people to promptly report about the significance of incident reporting. One aspect that has encouraged staff to report such incidents is the lack of punitive action. The hospital looks for a pragmatic approach to solve the problem and prevent recurrence than hauling up an individual or a department for a mistake. Investigation of an incident is required to be completed within 24 hours of occurrence. At the hospital level, this is discussed in monthly review by the quality and safety committee. At the IMO level, trend analysis is done through quarterly data review. While the IMO has access to the various types of incidents that get reported, it has empowered the individual hospital to look into such events and devise action for its nonoccurrence. “We don’t encroach upon an individual hospital territory, unless it commits the same mistake again and again, or if it’s a sentinel event,” says Dr Datta.

A

uditing is another facet of monitoring that helps review the efficiency of the set processes, identify good practices, lists scope for improvement and lays the foundation for training and education. All Columbia Asia hospitals go through both external and internal auditing on a periodic basis. The external auditing is done by the group’s corporate office in Kuala Lumpur as well as by NABH and NABL. Every year, the south east Asia office chooses one India hospital for almost a week-long auditing. The group’s NABH-accredited hospitals go through mid-term assessment every one and half years, while the NABL-accredited labs go through the same every year. Internal auditing of all the nine hospitals, except the ones that corporate office is auditing, is undertaken every year by the IMO. Each audit takes around three days, whereby every

The group’s emphasis on mock drills on a regular basis helped it avert any loss of life during the fire outbreak at its Hebbal unit. department is audited as against a given checklist that is shared with the hospital beforehand. The audit team usually comprises eight management experts of the group, some of whom are heads of other hospitals of the group. “The internal auditing is quite detailed and minute. From the roof of the hospital to its basement, every aspect of the hospital building and its service is audited,” says Dr Datta. The audit report is shared with the HODs and facility head and action plan suggested for improvement. However, the best of audits and quality indicators lose their significance if the patient feedback is poor. There are no two ways about the fact that the true reflection of service quality is patient’s level of satisfaction. So, the customer care department of each hospital goes through every patient feedback. The hospital specially looks into the ones, with extreme ratings such as very good feedback and very bad feedback. The customer care calls up the patient in both cases. “While the poor feedback makes us identify the flaws and improve upon them, the excellent ones help us strengthen our services,” says Dr Datta. Constituting various dedicated committees that look into various areas of operations has also helped the hospital continuously monitor

All staff members including nurses have been empowered to raise incident reporting.

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its quality of service. The various committees formed are drugs committee, medical records committee, infection control committee, medical practices committee, quality assurance and safety committee, operating room committee, code blue committee, code pink table top committee and code red table top committee among others. The committees meet monthly, bi-monthly or quarterly. To prepare its staff to handle disaster, the group lays equal emphasis on conducting mock drills, be it for code red, code yellow, code pink, drug recall, CSSD recall, lift entrapment and spill management. Since it’s not feasible to have physical mock drills more than twice a year, the group uses the innovative ‘table top’ mock drill concept. “In ‘table top’ mock drill, conducted in the board room, each department of a hospital is asked to respond to a hypothetical disaster situation,” says Dr Srilaxmi.

T

he improvement part of the quality structure looks into enhancement in infrastructure, processes and HR. The hospital constantly seeks improvement in infrastructure, like introducing a sample collection wing, which would enhance quality. When changes in infrastructure are not feasible, it works around the problem. The group also employs lean six sigma to improve processes. In the recent past, the group conducted two lean six sigma studies to reduce the turnaround time of health check-ups and radiology report collection. It constantly invests efforts in training and development of its employees—be it nurses, doctors, technician or administrative staff. It usually takes more than a year for a new hospital to understand, imbibe and comply with the quality motto of the group and it takes that much time to analyse the results. However, set processes and ongoing efforts have enabled the group to raise its bar on quality with each passing day.

Healthcare Radius July 2013

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Operations

Stock advice Get your inventory management in shape as it directly affects patient care By Dr J Sivakumaran

I

nventory management is crucial in any industry, more so in hospitals, where it is an essential ingredient for the hospital’s existence and sustainability. Optimal inventory levels not only bring efficiency in operations but also increase profit margins. Any small saving in the material cost will have a multiplier effect on the bottom line. The challenge confronting hospitals is the optimal resolution of the trade-off between overstocking and shortages, without compromising on service levels. While overstocking would lead to an increase in carrying costs, shortages lead to disruption of work, loss of production and a consequent loss in profits. While the monetary loss for a manufacturing unit on account of stock-outs can be recouped by working overtime or by stepping up pro-

30

duction, the repercussions of stock-outs in hospitals can be far more grave and irreversible, traversing beyond mere monetary concerns. In hospitals, timely treatment or the lack of it can be the sole differentiating factor between life and death. In such a scenario, efficient inventory management becomes a crucial function, directly driving patient care outcomes. If both purchase and store functions are integrated under one head, the accountability and control is better. Consistent coordination between these two functions is needed to avoid bottlenecks. The lead time for procuring each item should be known to both store and purchase personnel for proper planning. Based on historic consumption, a rough estimate could be drawn and order could be released. Because there are fluctuations in requirements, it is es-

sential to conduct a day-to-day review of stock levels. It is advisable to have separate location for receiving stocks from the vendors, where items would be counted, specifications checked, recorded and documented, before getting transferred to the central store. This leads to a robust internal control system with clearly defined staff and departmental accountability. At the central store, items should be properly stacked in such a way that one item occupies one bin/location. This ensures easy identification and smooth flow of material. It is important for the material personnel to understand not only the name of the items purchased but also their usage, and importantly to know how these are billed and recovered. Any item purchased should be billed either to the patient directly or should be part of a package. It is a better practice

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Operations

tion of such items. The moment a non-moving stock is sighted, contacting the concerned user and requesting for usage will be the best way to utilise the stock. Being pro-active in keeping the user departments informed about slow moving stocks helps ward off frivolous purchase requisitions besides ensuring a quicker stock turnover. In addition, contacting suppliers and requesting them to replace slow-moving stock with moving stock is the next best alternative that helps convert a slow moving stock into a moving stock well within expiry. Help can be taken from concerned nurses/ technicians who will then promptly remind the doctor at an appropriate time. Software support will be highly needed for identification and analysis of non-moving stock. If the

There are many scientific inventory control methods for other industries, but no proven method available for hospitals� to have at least two alternatives of good brands for any item, to avoid supply disruption and last minute buying at a higher cost. As far as possible, it is advisable to buy directly from manufacturers or from authorised distributors to ensure quality. Having a contract with vendors to take back short expiry items (with say less than three months to go before expiry) against replacement with fresh stock is a good practice. Lack of proper internal control on inventory can lead to shrinkage of inventory due to pilferage, damage, loss, deterioration and expiry. Frequent physical stock taking activity (not only in stores but also the stocks at various wards) with special attention to expiry will provide insight into the status and movement of inventory. In the healthcare industry, it is observed that, over a period of time, non-moving items tend to get accumulated. This may be due to user’s change of preference, introduction of a new brand, technology change and change of doctor in a speciality, among other factors. Proper system should be in place for identifica-

non-moving/expired stocks are identified and reduced from the inventory, the efficiency of the department improves. While there are many scientific inventory control methods available for manufacturing and other industries, there is no proven method available for hospital environment. The ABC method could be used for reference, but it is difficult to follow as the consumption fluctuates with occupancy and widely varying prognosis of each patient. In other words, even if the occupancy is constant, due to heterogeneity of services, the consumption will fluctuate. To have closer control, stock of individual items could be calculated in terms of number of consumption days based on the average monthly consumption. Here, we can make use of ABC classification. A category items, constituting 70 per cent of the inventory value could be stocked to last for seven consumption days, B category items being in the middle rung in value terms (20 per cent) could be stocked to last for 15 consumption days and C category items being the least in

value (10 per cent) could be stocked to last for 30 consumption days. Once these parameters are set, non-moving/slow moving stock can be identified based on their levels. There is no universal postulate defining ideal stock levels as it varies from hospital to hospital. The stock holding in terms of number of consumption days and number of rotations of stocks made in a month are ratios, which should be measured. In metros or tier-I cities, almost all the stocks would be available locally whose lead time will be shorter. But in tier-II or tier-III cities, not all the items will be available locally, entailing a longer lead time for procuring them from outside. Hence, it makes sense to procure them in bulk. An efficient store can rotate the stock at least four to five times in a month. Let us look into an example of a 175 - 200 bed setup. Stock value as on 31.3.2013 (Rs in lakh) Main Store

21.50

OT Store

10.50

Cath lab Store

12.50

Sub Stores

5.50

Total stock

50.00

Total Consumption for the month

200.00

Avg. Consumption per day (200/31)

6.45

No. of days stock holding (50/6.45)

7.75 days

Monthly stock rotation(200/50)

4 times

The number of stock points and the variety and quantity of each ward stocked has a tremendous impact on the total inventory value. It should be kept in mind that stocks are equivalent to cash, and need to be managed efficiently. For nonmoving stocks, carrying cost will be high, thereby denting profits. Few of the stocks could be kept at one location of each floor and the other wards of the floor can share the stock. Having a stock point run by store personnel in each floor/critical wards will ensure accountability and more efficient inventory management. The hospital should facilitate seamless transmission of information regarding stock levels to various wards. This will help bring down the inventory costs of a ward to a considerable value.

Dr J Sivakumaran is senior vice president, SPS Apollo Hospitals, Ludhiana.

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Operations

Prevent employee fraud 32

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Operations

Hospitals are fertile grounds for embezzlement. Here’s how to eliminate the chance of foul play By Anuj Jindal

R

isk management is crucial for hospitals, especially to manage financial frauds by employees. This subject has been little discussed by managements either because they are not aware that risk exists, or because they are reluctant to admit of such incidents in the open. And it is due to this reluctance that the financial regulation and risk management systems are weak in most hospitals. A financial fraud in a hospital occurs when an employee or a group of employees take advantage of the weak financial management in the organisation or exploit cracks in the processes meant to deal with the organisation's finances. A fraud can occur anywhere in a hospital where one or more employees deal with cash or make decisions pertaining to purchase, sales and cancellation of bills. Any hospital, small or big, can be impacted by financial irregularities of its employees at lower or even the highest management levels. There are certain fault lines that are the breeding grounds for financial frauds in hospitals.

B

illing is one department that is prone to most frauds. Because most payments are in cash, billing staff has to deals with large amounts of money. The risk is accentuated in organisations, where the transaction volumes at billing counters are high, thereby making it extremely difficult to catch employees if they embezzle cash in one or two transactions. It has been observed that frauds by billing staff mostly pertain to cancellation of bills. The fraudster benefits from a weak process, where checks and balances are missing in authorising bill cancellation. Either there is no supervisor to authorise refunds or the supervisor does not make an effort to meet the patient directly while authorising a bill cancellation. In one of the known cases of similar frauds, it came to light that one billing executive at a hospital embezzled more than Rs5 lakh by cancelling bills in a systematic fashion over three years of her service. In another hospital, some indi-

A fraud can occur anywhere in a hospital where employees deal with cash or make decisions on purchase, sales and bill cancellation viduals from billing and accounts departments colluded to embezzle more than Rs30 lakh over four years by manipulating bills. In many organisations, where the management reposes blind faith on its front line staff managing the cash, the frauds can be severe.

I

f there is one dream job in a hospital to make a quick buck, it has to be that of head of purchase department. In many hospitals, the purchase head is entitled to make big ticket purchases as well as buy consumables for the hospital. It is in this discretion that the potential frauds are waiting to happen. The competition among the suppliers has only made the problem worse as some suppliers can stoop to any kind

of business malpractices to close deals with client hospitals. The purpose of the purchase department is to negotiate prices with various suppliers and choose a particular vendor. In both of these activities, there is a huge scope for financial manipulations if the process is not transparent. Consider the case where your purchase manager favours one vendor over the other because of collusion between the two or when he does not negotiate hard enough on the supplier's price because of his 'cut' as a percentage of the price. This is an indirect financial fraud and more difficult to catch because one needs to understand the intricacies of medical purchase process to identify potential incidents of fraud.

W

hen a function deals with selling of items, the standard practice for financial control is by regulating and monitoring the function from the purchase and inventory side. By balancing purchases and valid sales, an organisation can effectively ensure that both ends are tightly supervised. However, majority of hospitals fail to realise the importance of this basic principle and the one department where they are hit the most is pharmacy. Similar to

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Operations

Fraud spots The breeding grounds for financial frauds in hospitals are:

▪ Billing ▪ Purchase department ▪ Pharmacy Strategies to prevent frauds:

▪ Active supervision ▪ Policy on purchases ▪ Compliance to standard procedures ▪ Audit billing, pharmacies also deal with large amounts of cash and it is a widespread practice that the pharmacies don't provide bill for all of their sales. It is a cakewalk for fraudsters to make a sale without documenting it and embezzle the cash. In an incident that smacks of managerial apathy, the accounts department was happy they were receiving full cash from pharmacy sales as per the MIS from their software, but nobody bothered to question about the money that was collected for unbilled sales. So, whose fault was it? In my observation, the problem lies with non-compliance to three basic steps that a pharmacy department needs to follow. 1. At the time of receipt of pharmacy stocks, proper GRN in the records should be done immediately. 2. The master table of items should have no redundancies, i.e. a particular medicine should be named uniquely in the system without duplication. 3. Periodically, the pharmacy should conduct physical stock verification and reconcile the figures with the stock register.

S

o how does one control and reduce/mitigate this risk? What are the mechanisms to avoid frauds or catch the fraudsters? One way is through active supervision. Sometimes the problem simply is managerial apathy. At times, the supervisor or the manager is not diligent in performing his duties. The solution lies in training the managers to make them knowledgeable in fraud prevention techniques and holding them accountable for errors made by their subordinates. For instance, when encountered with requests for cancellation of bills or where one observes a pattern in refunds by a particular employee compared to his/her peers, the supervisor is expected to make surprise checks

34

For all the fear that the word 'audit' generates, the value it creates for the organisation is immense.

Ensure that more than one quotation is received for purchase of items priced above a particular level and ensure that no bills are cancelled, if he doesn't get to meet the patient in person or talk to the patient over the phone. Fraudsters generally fear and avoid active supervision. Another way is to have a policy on purchases. Purchase department can be regulated by framing clear rules and policies on receiving quotations from suppliers and forming a multidisciplinary purchase committee, rather than depending on the unilateral decision making of a purchase manager. Ensure that more than one quotation is received for purchase of items priced above a particular level or where the order value is higher than a particular threshold. Talk to your peers to randomly figure out their purchase prices to ascertain whether you are paying appropriately for the items. Compliance to standard procedures helps too. Whether it is a central store or a pharmacy store, make it a point that GRN is done immediately when the items are received or at least before stocks are transferred out of the stores.

Proper documentation of GRN gives you an idea of how much total quantity was received during a period. Ensure that all sales are billed. Conduct surprise checks to find out whether established procedures are being followed. For all the fear that the word 'audit' generates, the value it creates for the organisation is immense. Physical stock verification should be conducted at regular intervals and should be supervised by third parties to ensure that inconsistencies are captured and root cause of inconsistency identified. Similarly, the accounts department should audit collections by reconciling collections with actual OP and IP numbers. Experienced auditors are also smart enough to catch patterns in irregularities and even in pin-pointing accountability. Effective risk management and fraud prevention requires management commitment, active supervision in key departments and full compliance to established procedures. There is a huge amount of money that a management can save by following these simple principles.

Anuj Jindal is executive director at Optis Healthcare in Bengaluru.

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Operations

Behaviour matters What to do when a staff member gets abusive By Dr AK Khandelwal

S

urgeons hurling instruments at assistants or walking out in the middle of a surgery, physician humiliating nurses, healthcare staff getting physically assaulted by senior hospital members. Shocking, as they may seem, such occurrences are more common that one would think in healthcare organisations. They are examples of disruptive or abusive behaviour, which has been observed in almost all members of the healthcare team, be it doctors, nurses, pharmacists or technicians. However, when a doctor exhibits such behaviour, it may have the greatest impact because of the position of authority s/he wields as a member of the healthcare team. The rate of such incidents is alarming. As per a study by the American College of Physician Executives, more than 95 per cent of physicians reported encountering “disturbing, disruptive, and potentially dangerous behaviours on a regular basis.” In another study covering more than 140 hospitals, over one-third of the participants reported nurses leaving institutions because of disruptive behaviour by physicians. Twenty-three percent of nurses reported at least one instance of physical threat from a physician. According to yet another study, around 18 per cent of nurse turnover is directly attributed to verbal abuse. According to AMA, ‘disruptive conduct’ is: “personal conduct, whether verbal or physical, that affects or that potentially may affect patient care negatively constitutes disruptive behaviour.” These may include disrespectful, profane, demeaning, or rude language, sexually inappropriate speech, sexual boundary violations/inappropriate touching, intimidation, harassment, racial/ ethnic innuendo or insults, tirades and outbursts of anger and throwing objects. Criticising other caregivers in front of patients or other staff, comments that undermine a patient’s trust in other caregivers or the hospital, repeated, intentional

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Operations

Dos and Don’ts of addressing disruptive healthcare provider DOS  Act

promptly on every incident of disruptive

conduct. 

Speak about errors in private.

Involve a third person in the conversation.

State that you are representing on behalf of

Plan your strategy beforehand.

Refer any past violations if they have

hospital management.

occurred and identify any patterns of misconduct that are in evidence. 

Refer the staff code of conduct and any prior agreement by the practitioner to comply with it.

Clearly state the consequences of this or future violations.

DON’TS 

Do not get provoked. Keep cool.

Do not get judgmental, focus on the incident

Don’t allow the disruptive practitioner

only. to change the subject—agree to talk at another time about his or her concerns regarding other staff members or about quality issues. 

Do not make excuses for the disruptive behaviour.

 Avoid

‘circling the wagons‘ to put up a show

of collegiality. 

Do not get intimidated by threats of legal

Don’t fail to investigate ’quality concerns‘

Do not allow a disruptive doctor/staff

action. when alleged by disruptive practitioners. member’s allegations of wrong-doing by others to distract you from addressing that doctor’s own unprofessional conduct.  Avoid

manufacturing evidence of clinical

deficiency to support allegations of unprofessional behaviour. 

Not clearly communicating behavioral expectations (e.g. through a code of conduct or compact).

Do not avoid to strictly enforce a code of conduct.

 Avoid

responding to a physician’s disruptive

conduct differently from other healthcare provider.

36

non-compliance with organisation rules and policies, deliberate interference with the smooth functioning of hospital or medical staff operations, inappropriate comments in the medical record—especially those impugning the quality of the work done by others, unethical/dishonest behaviour, repeated lack of response to calls from other health personnel and unwillingness to work collaboratively.” It also includes inappropriate arguments with patients, their families, hospital staff and other physicians. The effect of disruptive behaviour on a healthcare organisation is manifold. ‘Sentinel Event Alert’ by The Joint Commission on July 9, 2008 observed that it can lead to medical error, decreased patient satisfaction, high staff turnover, preventable adverse outcomes and increased cost of care. It also leads to poor patient satisfaction. Leaders of healthcare organisation should take initiatives to minimise this problem to improve organisation’s performance. JCI prescribes following guidelines to prevent such behaviour. 1. Educate all team members, physicians and non-physician staff, on appropriate professional behaviour defined by the organisation's code of conduct. It should include training in basic business etiquette and people skills. 2. Hold all team members accountable for modelling desirable behaviours, and enforce the code equitably among staff, regardless of seniority or clinical discipline in a positive fashion through reinforcement and punishment. 3. Develop and implement policies and processes that show ‘zero tolerance' towards intimidating and/or disruptive behaviours. Incorporate the zero tolerance policy into medical staff bylaws and employment agreements as well as administrative policies. 4. Ensure that staff policies regarding intimidating and/or disruptive behaviours of physicians are complementary and supportive of the policies that are present in the organisation for non-physician staff. 5. Reduce fear of intimidation or retribution and protect those who report or co-operate in the investigation of intimidating, disruptive and other unprofessional behaviour. Non-retaliation clauses should be included in all policy statements that address disruptive behaviour. 6. Respond to patients and/or their families involved in or witness to intimidation and/ or disruptive behaviour. The response should include hearing and empathising with their concerns, thanking them for sharing those concerns, and apologising.

7. Create a plan on how and when to begin disciplinary actions (such as suspension, termination, loss of clinical privileges, reports to professional licensure bodies). 8. Provide skills-based training and coaching for all leaders and managers in relationshipbuilding and collaborative practice, including skills for giving feedback on unprofessional behaviour, and conflict resolution. Cultural assessment tools can also be used to measure whether or not attitudes change over time. 9. Develop and implement a reporting/surveillance system (possibly anonymous) for detecting unprofessional behaviour. Include services of ombudsmen and patient advocates to provide feedback from patients and families, who experience intimidating or disruptive behaviour from health professionals. 10. Monitor system effectiveness through regular surveys, focus groups, peer and team member evaluations. Have strategies to learn whether intimidating or disruptive behaviours exist or recur, such as through direct inquiries at routine intervals with staff, supervisors, and peers. 11. Support surveillance with tiered, non-confrontational interventional strategies, starting with informal conversations, directly addressing the problem and moving toward detailed action plans and progressive discipline, if patterns persist. These interventions should initially be non adversarial in nature, with the focus on building trust, placing accountability on and rehabilitating the offending individual, and protecting patient safety. Make use of mediators and conflict coaches when professional dispute resolution skills are needed. 12. Conduct all interventions within the context of an organisational commitment to the health and wellbeing of all staff, with adequate resources to support individuals whose behaviour is caused or influenced by physical or mental health pathologies. 13. Encourage inter-professional dialogues across a variety of forums as a proactive way of addressing ongoing conflicts, overcoming them, and moving forward through improved collaboration and communication. 14. Document all attempts to address intimidating and disruptive behaviours.

Dr AK Khandelwal is medical director at AnandaLoke Hospital & Neurosciences Centre, Siliguri, West Bengal

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MARKETING

Positioning is not what one does to the product; it’s what you do to the mind of the prospects.

It's all about branding Not just quality of healthcare delivery, but your marketing and branding strategy too can make or break your reputation BY TEAM HR

A

\ORY]ZS^KV]LOXO ^SXQOXY_QR from their marketing campaigns? It does not seem so. According to C Ashok Kumar, senior vice president, marketing & business development, BGS Global Hospitals, Bengaluru, while 50 per cent of the IPD patients are routed through the OPD, actively promoting 9:.]O\`SMO]aY_VNVOKN^Y]SQXS MKX^SXM\OK]O in bed occupancy rate. The problem partly lies with the low spend on marketing and PR. According to a study, for a hospital that spends around zero to one per cent of its gross revenue on marketing and PR, its combined sum of revenues from empanelled, companies, TPAs,

corporate health programmes is around 15 per cent, and when it spends one to six per cent, the revenue shoots up to 27.8 per cent. The survey reveals that a median bed occupancy rate of less than 70 per cent can be partly explained by a lack of emphasis on marketing. “However, marketing is too important to be left only to the marketing team,” said Ashok Kumar while speaking at the MDP programme on marketing, organised by AMEN in association with MS Ramiah Medical College and Hospital and Hospaccx India Systems. For the event, Healthcare Radius was a media partner. According to Dr S Kumar, president, medical education, Gokula Education Foundation,

“Before we attempt marketing, we need to build our brand, equity, quality and systems that are internalised with our system of healthcare delivery.” He said that the value of a silicon chip does not lie in the sand from which it comes, but it lies in the microscopic architecture engraved upon it by the ingenious human mind. So, what is a brand? According to David Ogilvy, it is a complex symbol, an intangible sum of a product's attributes, its name, packaging, and price, its history, reputation, and the way it's KN`O\^S]ON+L\KXNS]KV]YNO XONLcMYX]_Wers' impressions of the people who use it, as well as their own experience. Said Abhinandan Dastenavar, group marketing head, hospital

Healthcare Radius July 2013

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Marketing

It’s better to be first rather than the best. If not, then you have the positioning problem.”

Abhinandan Dastenavar, Group marketing head, Hospital chain, Kirloskar Group

chain, Kirloskar Group, “Positioning is owning a consumer’s piece of mind. It is not what one does to the product; it’s what you do to the mind of the prospects.” And the trick is to get there, first. In fact, it’s better to be first rather than the best. “If not, then you have the positioning problem,” said Dastenavar. The branding approach should be not to create something new or different, but manipulate what’s already in the mind. To find a unique position, one must ignore the conventional logic that warrants finding the concept inside the product. “One must rather delve inside the prospects’ mind. One should concentrate on the perception of the prospects not the reality of the product,” said he. The three Cs of brand positioning are to be crystal clear, consumer based and relevant, and credible to the consumer. While positioning, one has to communicate in a language the consumer understands and from the consumer’s point of

view. In addition, one needs to be distinctive, focus on building brand elements into powerful discriminator, be persuasive and sustainable. While choosing the brand name, one has to see whether it’s simple, would be acceptable in all languages, appropriate when geographically spread and amenable for easy registration. The hospital’s website should be leveraged fully as the customer has a perceived impression about the brand which is based on the information presented on the website. Attractive images, easy navigation, simplified information, interactivity and being user friendly all contribute towards building that impression. It is important to use relevant pictures that emphasise the brand positioning. “Using same images to create a particular distinction will establish the brand in the minds of people. The quality and type of images used is crucial to creating the brand,” said he. The process of brand positioning should entail identifying the business’s direct competition, understanding how each competitor is positioning its business, documenting the provider’s own positioning, comparing the company's positioning to its competitors' to identifying viable areas for differentiation, developing a distinctive, differentiating and value-based positioning concept and creating a positioning statement with key messages and customer value propositions to be used for communications development across the variety of target audience touch points (advertising, media, PR, website). There are plenty of brands, which have

Studies reveal that spending on marketing and PR is directly proportional to gross profit margin.

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gone for repositioning and there a variety of reasons for that. “The most common reason is as a reaction to change,” says Dastenavar. The change could be environmentally driven, such as economic fluctuation, political changes, or the green movement, or consumer driven, such as changing tastes or preferences. It can also be competitor driven, such as a new brand launch from a competitor that makes the position obsolete or inferior, or internally driven, such as a change in corporate strategic direction or

To attract medical tourism patients, we use aggressive marketing and awareness programmes, publishing details of core competencies and rates of all procedures in international magazines and newspapers.”

Parveez Jameel, Senior Manager, International Business, Fortis Healthcare

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Marketing

C Ashok Kumar at the MDP programme on marketing, organised by AMEN.

Before calling for a media interaction, the hospital must internally discuss what it wants to reveal.”

Rita Dutta, Consulting editor, Healthcare Radius

acquisition of new technology, science, or other asset that gives the brand a competitive advantage and valuable differentiator. Jui Hong Teoh, brand director, Phische Advertising has said, internal branding is an important element of the branding game. It is important that every element of your business is aligned with your branding strategy—including people. The bigger your organisation is, the more it takes to educate your people. The above statement was seconded by Tarun Katiyar, principal consultant, Hospaccx India Consulting. He said that while linking marketing, or rather internal marketing with hospital architecture, “It’s important that a hospital uses its logo with specific colour in internal areas like OPD, entrance, registration counter, billing counter, ‘May I Help You’ counter, signages and reception back drop. Even the television showing patient education films should use the hospital logo,” said he. Properly highlighting the name and logo of the hospital in the external facade is equally important. As staff are the brand ambassadors of a hospital, the manner in which they conduct themselves creates a brand image. The uniform they wear must reflect the corporate

colours present in logo. However, internal marketing is more than highlighting logos. Said ViveK Shulka, AGM, Business Development and Corporate Relations, DM Healthcare, “Internal marketing involves tools such as e-mails, posters, memos, newsletters, employee portals, internal events and joint staff meetings.” According to him, one has to be careful in selecting what one wants to market. Marketing something that no one wants to buy is risky, expensive and can even backfire. Peter Drucker had once said: There will always be a need for some selling. But the aim of marketing is to make selling superfluous. The aim of marketing is to know and understand the customer so well that the product or service fits him and sells itself. Ideally, marketing should result in a customer who is ready to buy. All that should be needed is to make the product or service available. Furthering Draker’s thoughts, Usha Manjunath, Dean-Academic & Student Affairs, IHMR, Bengaluru, spoke about the seven marketing Ps: price, product, promotion, place, people, process, physical environment. She suggested mixing the seven Ps to create a product or market that offer the target market is desirous of. Today, marketing to attract medical tourism patients has assumed significance, with the medical tourism market growing at a rate of 30 per cent per annum. According to Parveez Jameel, Senior Manager- International Business, Fortis Healthcare, “The various outreach programmes in international markets that Fortis undertakes consist of medical camps, CMEs for doctors, exchange programmes for nurses / technicians, fellowship programmes for doctors, tele medicine initiatives, surgical camps, initiatives for up-gradation for post-op care. The crucial strategies used by the group to

While 50 per cent of the IPD patients are routed through the OPD, actively promoting OPD services would lead to significant increase in bed occupancy rate.”

C Ashok Kumar, Senior vice president, Marketing & business development, BGS Global Hospitals, Bengaluru

attract medical tourism market are aggressive marketing and awareness programmes globally, publishing details of core competencies, advertising rates of all procedures in international magazines, journals and newspapers. Enlisting details like telephone numbers, e mail ids of hospitals and executives dealing with medical tourism on the website and having brochures giving details and pictures of specialties, consultant’s detail and procedure rates. The initiatives have shown results. Receiving patients from nearly 33 countries, Fortis has treated more than 15,000 patients for complex surgeries across super-specialties. The tourists mainly come for cardiac, bone and joint, brain & spine, MAS, bariatric surgery, transplant programme and oncology Today, media relations is an important facet of hospital marketing. According to Rita Dutta, consulting editor, Healthcare Radius, some of the facets of good media interaction involve appointing a media co-ordinator for smooth and easy flow of information, deciding on the purpose of the meeting, being prepared with facts before the interview and to be willing to provide with additional information and pictures, when asked for. The name and number of the hospital co-ordinator should be displayed on the website. “Before calling for a media interaction, be it a press conference or a one-on-one interaction, the hospital must internally discuss what it wants to reveal. Furnishing information and then asking journalists to withhold it reflects lack of confidence,” said Dutta.

Healthcare Radius July 2013

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Design special

Healthy designs

Hospitals around the globe are paying as much attention to appearances as they are to quality of service by Joanne Bladd

Moorfield's Eye Hospital, Dubai

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Design special

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Design special

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he UK’s Royal London Hospital made headlines in February when it unveiled a $1.5m playroom and roof garden for its children’s ward. The seventhfloor space is dotted with oversized furniture, enormous toys and a vast television, an Alice in Wonderland-like design with bold printed wallpaper and giant skirting boards. Outside, a forest-themed terrace holds a tree house, teepee and timber canopy, with small tree stumps for seating. The contrast to the clinical, utilitarian style often associated with government hospitals is dramatic. “We wanted to create spaces that would allow escape from the confines of hospital beds,” says Siobhan Carr, a paediatric consultant involved in the design of the space. “[We wanted] to facilitate a healing environment, especially for children with long stays.” Healthcare design worldwide has undergone a revolution in recent years. Hospitals and clinics have morphed from drab, anonymous buildings into bright and airy spaces, punctuated by warm colours and plush furnishings. Patient rooms today are more likely to resemble luxury hotel rooms than wards, featuring polished wood-

veneer finishes, artwork and natural light. In the GCC, this trend is largely a reflection of the rise of private healthcare. “Patients have much more choice in where they are treated so there is a lot of competition among hospitals,” says Bram Lansink, marketing director for Philips Lighting in Middle East & Turkey, “That means making a hospital less clinical and more home-like.”

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esearch has shown that patients tend to judge healthcare facilities on non-clinical factors, such as appearance and the friendliness of staff. Attractive hospitals are perceived to offer better care. “The idea is that you can use design to create an environment that is appealing to the patient, that offers a good experience and projects a pleasant, but professional feel,” says Lansink. In waiting areas, this has meant a shift away from the traditional lines of fixed seating and bright lighting. Chairs now are moveable, and grouped in pods or clusters so patients or visitors can sit together. Stark whites and greys have been exchanged for bright palettes such as those seen in Moorfield’s Eye Hospital Dubai; the clinic’s waiting room pairs bold yellow furnishings and

blue carpeting with muted walls, creating a sophisticated but welcoming space. “We tried to move away from the idea of a standard waiting area,” says Yahya Al Tahan, the former design director of Hamilton International, which designed the clinic. “Instead of plastic, uncomfortable chairs, we gave a lounge feel with sofas and armchairs to create an extension of the home. Hospitals can be very stressful places, but a calm waiting space can improve the experience.” Other facilities use their waiting areas to showcase their design or build in interactive entertainment tools. In Dubai Bone & Joint Clinic, the walls feature white circular disks, accentuated with lighting, which were selected to reflect the practice’s interest in gene therapy. “The patient’s experience starts as soon as they enter the hospital,” says Al Tahan, now the managing director of consultancy Grid Design. “The design should reflect the ethos of the hospital.” It isn’t just window dressing. Research shows that the design elements have a direct impact on patient health. Hospital wards with dingy décor, poor lighting and high noise levels work against wellbeing, lengthening the amount of time

Phillips lighting was used in Imperial College Diabetes Centre, Abu Dhabi.

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Design special

patients need to spend in hospital. By contrast, spacious rooms that let in daylight, use soundabsorbing surfaces to lower noise levels and feel homely can speed the rate of recovery. “The more we can help to reduce the stress level of the patient the easier the healing process will be,” says Caroline Kelly, senior design researcher at healthcare furniture company Nurture. Product companies are at the forefront of creating solutions for patient-centric care. Philips Lighting’s HealWell application plays into this trend, by using natural and dynamic lighting to support the patient’s cycle of sleeping. The colour and brightness of the light can be adjusted, for a soothing ambience.

“The system mimics the way biorhythms follow sunlight, varying the light levels according to the time of day,” says Paolo Cervini, general manager of Philips Lighting, Middle East & Turkey. “It brings the benefits of natural daylight into the room, which can help decrease the length of the hospital stay. With the right applications, the hospital itself contributes to healing.”

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ospital design trends aren’t limited to patients. The layout and design of a facility impacts staff workflows and productivity. Patient rooms must allow for the quick access of medical equipment, and have space for bed movement. Corridors, the busiest part, must be light and airy, while being wide enough for

gurneys, and free of equipment and furniture. Functionality is key. In Moorfields, for example, the appointment rooms are clustered closely together, facing the patient waiting area, but are also linked by a second corridor that is hidden from view. This allows staff to move between the rooms without crossing the waiting space, maintaining efficiency but also creating a tranquil environment. Digital whiteboards also allow staff to see clearly which patient is in which room, and how long each has been waiting. The clinic itself follows a circular design, which is highlighted with colours to help guide patients around the facility. In healthcare, more than most building types, functionality and design must go hand-in-hand.

Grand designs It’s an indication of how significantly healthcare has changed in recent years that hospitals are now regularly lauded for their innovative designs. In its annual list of the world’s 25 Most Beautiful Hospitals, the website HealthExecNews showed how flair and functionality can be used to support patient care. Among its top-ranked hospitals were: Clemenceau Medical Centre, Lebanon This Beirut-based hospital won praise for light glass and concrete exterior, and its spacious interior rooms that promote “5-star hotel ambience”. Patient rooms are equipped with internet access and televisions, while the design of the wider hospital supports innovative medical technologies. The City Hospital, UAE The design of this 226-bed Dubai facility is closer to a luxury hotel than a hospital. Patients and their families have access to a heated indoor swimming poor, spa, sauna and Jacuzzi, while a VIP floor offer separate elevators, entrance and a valet service. The interior uses warm tones and natural daylight to promote a calm, soothing experience.

Lighting design from Moorfield's Eye Hospital, Dubai.

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Legacy Salmon Creek Hospital, USA This hospital draws the eye with striking elevated glass walkways, and its use of stone, glass, brick and metal. Its interior uses natural light and warm hues to bring the outdoor in, while courtyard spaces and terraces help to connect patients and visitors with the outside world.

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Design special

Hi-tech healthcare Hospital rooms are becoming increasingly technology-focused to help patients engage with the outside world and their own treatment. Interactive screens, for example, allow patients to see scheduled activities for the day ahead, access educational materials and receive updates on their care. Other hospitals offer video screens to allow patients to surf the net, Skype with friends or watch television. “As technology becomes more pervasive throughout the healthcare experience, opportunities for better care increase, but new obstacles arise,” says Caroline Kelly, senior design researcher at Nurture. “Intuitive designs to support technology… are intrinsic to shaping the industry effectively in the overall interest on health and healing.” Nurture has created its Regard technology solution to capitalise on this trend, a line of seating and furniture that incorporates plug-in spots. Users can utilise these spots to watch a medical video, charge their phone, or even to catch up on work using their laptop. The system has been designed for ‘transitional’ moments, such as between the waiting room and consultation room. “This space often gets overlooked,” says Kelly. Regard aims to “[create] spaces that promote self learning, group learning and doctor-patient consultation.”

Finishes and furnishings should prevent the spread of bacteria, be suitable for heavy use and be easy to clean and maintain. “Functionality…is obviously another top priority,” says Kelly. “Healthcare environments need solutions that can stand up to the rigours of 24/7 use.” Nurture’s ‘Pocket’ workstation is a case in point. The portable unit supports mobile healthcare, allowing medical staff to manoeuvre quickly and quietly. Its surfaces and storage spaces can be adjusted and easily cleaned.

W

Moorfield's Eye Hospital, Dubai.

ell-designed healthcare facilities play a key role in improving the efficiency of hospital care, and in improving the experience of the patient. Hospitals that are inviting and homely help to reduce the length of patient stays, create a better working environment for staff, and bolster productivity. “It’s time to take a new look at healthcare,” says Kelly. “Designers need to challenge conventions, build on what works already and use research to arrive at new solutions.”

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CONSUMER CONNECT INITIATIVE

Leave it to the experts Ruchika Beri of Ziqitza Health Care Limited makes a case for hospitals to outsource their ambulance fleet

O

ver the last few years, the business of healthcare has been growing at an exponential rate. With tremendous competition from all corners, hospitals and nursing homes around the country are feeling the need to prioritise on their core competency, which is ‘managing their patients and providing excellent treatments’. Most leading hospitals and nursing homes in India are now outsourcing other aspects of hospital management like catering, housekeeping or pharmacy to experts in the respective domains so that they can focus on improving their core competence. One of the key issues faced by hospitals is PDQDJLQJWKHLUĂ HHWRIDPEXODQFHV7RFDWHUWR the acute need of well-equipped and mainWDLQHGĂ HHWRIDPEXODQFHVLQKRVSLWDOV(PHUgency Medical Services are being outsourced to state-of-the-art companies, ensuring that the end consumer in this cycle is the focus of everyone’s attention. 7KHEXVLQHVVPRGHORIDPEXODQFHRXWVRXUFing has indeed picked up over the last few \HDUV7KHELJJHVWDQGEHVWKHDOWKFDUHIDFLOLWLHV are outsourcing the management of their ambuODQFHĂ HHWWRH[SHUWDPEXODQFHRSHUDWRUV7KLV leaves them with a lot of time on their hands to focus on aspects of their business that they are the best at. Professional approach to management, attention to detail and a highly process oriented system allows for smooth functioning in every VHWXS7KHPRGHOEULQJVZLWKDODUJHQXPEHURI EHQHĂ€WVDQGDGYDQWDJHV$QGLWLVDQDEVROXWH must that each and every nursing home evaluates and assesses the need of this great help and makes decisions accordingly. %HQHĂ€WVRIDPEXODQFHRXWVRXUFLQJDUHOLVWHG below: Customisation: (PHUJHQF\DPEXODQFH operators across the country are exploring options for the management and operations of advanced life support ambulances for hospitals, nursing homes and other healthcare facilities.

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Healthcare Radius July 2013

Ziqitza Health Care Limited (ZHL) provides fully equipped and customised ambulances along with manpower that is trained, so that hospitals and nursing homes can focus on providing the best levels of healthcare treatments to patients who need it the most. 24/7 Services: Medical emergencies come unannounced and therefore, it is important that we make efforts to be prepared, in case we are put in such a situation. Companies like Ziqitza offer a whole range of services, which include live GPS tracking of the ambulances, information on location of the ambulance, the speed at which it is travelling and the distance it has FRYHUHGLQDGD\$OOWKLVLQIRUPDWLRQFDQEH gathered effectively with the help of advanced WHFKQRORJLFDOWRROV$GHWDLOHGUHSRUWLVSURYLGHG to the hospitals and this facility also helps ensure 365 days uptime for the ambulance for the hospitals. Improved technology and design:7RGD\ ambulances are designed and operated based RQLQWHUQDWLRQDOVWDQGDUGV7KH\DUHHTXLSSHG ZLWKPRGHUQPHGLFDOHTXLSPHQWOLNHGHĂ€EULOlators, ventilators, pulse oxy-meters, cardiac PRQLWRUV(&*VXFWLRQPDFKLQHVUHVXVFLWDtion kits, syringe pumps and many more life saving equipment. In addition, patient transfer

equipment like collapsible stretchers, scoop stretchers, spine boards, canvas stretchers and stair chairs cum wheel chairs are also a part of these ambulances. Trained manpower: It is crucial that the ambulance crew is trained and is able to provide adequate care during emergency or transfer situations. ZHL ensures that medical technicians and drivers on board the ambulance are trained LQKDQGOLQJWKHVHVLWXDWLRQV7KH\DUHSURYLGHG best in class training by LIHS, the International 7UDLQLQJ&HQWUHRIWKH$PHULFDQ+HDUW$VVRFLDWLRQ $+$ HQDEOLQJWKHPWRVWDELOLVHSDWLHQWV and transfer them safely with medical support.

Ruchika Beri is assistant manager, marketing, Ziqitza Health Care Limited.


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