Nov_Dec_2017 by Zyaul Designer

EDITOR SPEAK

Good times ahead for healthcare consultants in every sphere be it new projects or existing.

Magazine

2017

Volume - VIII Issue - IV Nov-Dec 2017

Rise in demand of Hospital & Healthcare consultants/Architects. India needs 1 lakh beds each year for next 20 years

ndia presently has a bed deficit of approximately 30 lakh beds as per the WHO recommendation of four beds per 1000 population. Considering even a 250 bedded hospital on an average, the country would need 12000 hospitals in the near future. As almost 80 per cent of this would be fulfilled by the private players, a huge rise in IPO's and premium commanding players in the arena would flutter bringing in interesting times for the healthcare industry. Recent spurt in Public Private Partnership(PPP) projects, and thrust on quality by the government sector and its demand (& mandate in some areas) on NABH and ISO, a lot of consultancy business is abuzz with the projects galore in the accreditation and QMS field. India to its credit already has one government hospital NABH accredited and many are in the pipeline. With CGHS making NABH mandatory for care and hospitalisation cost reimbursements, there is hectic activity seen in hundreds of hospitals waking up to the long due need for quality healthcare and applying for the coveted quality mark. The trend is on a steep rise, and it is just a matter of time when the government launches patient awareness on NABH quality in full swing. This would make the patient demand at least an ISO QMS certified hospital if not NABH.

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Contents Volume - VIII Issue - VI Nov-Dec 2017

Transplant surgeons urge national awareness campaign on hand donation �� 06 New survey finds adult vaccination knowledge gaps in India; 43% of adults feel that they lack knowledge �� 08 Association of Healthcare Providers- India, together with Bureau Veritas launched a new standard �� 10 Dr. Reddy’s Laboratories announces the launch of generic Azacitidine for Injection in the Canadian Market �� 12 Japan’s Health Ministry funds a programme for Technical Personnel Exchange in Diagnostic Sector �� 12 This World Diabetes Day, P.D. Hinduja Hospital conducted a free diabetes checkup camp at Churchgate �� 14 SRV Mamata Launches 100 Bedded State of Art Super Speciality Hospital In Dombivli �� 14 Samsung Partners with Uttar Pradesh to Set Up 20 Samsung Smart Healthcare Centres in State �� 16 AYUSH Ministry holds Review Meeting to examine the draft of National Policy of Medicinal and Aromatic Plants �� 18 Impact of air pollution on lungs and prevention tips �� 18 Precision Diabetes: Now In India �� 21 Medtronic Showcases Technology Excellence at Its R&D Facility In Hyderabad �� 22 UAE residents encouraged to come forward and donate blood to save lives �� 24 Datwyler bolsters presence in India with state-of-the-art healthcare solutions �� 24 Building a New Hospital or Modifying your Existing One: Ensure it is NABH Compliant �� 26

Cover Story

Hospital infrastructure designing can improve health of the patient

Strategic Facility planning in a Healthcare Organisation

Healthcare Financing In India: Challenges & Operation

Product Line 40-44 Indian healthcare industry in India riding the growth curve

34 O & M: Operations & Management It’s a mutual arrangement between the hospitals & Consultants

36 Energy Efficient Hospital Design in India: A New Approach to Sustainability

Expert Views

“Spencer” Best European Producer For Ems & Ambulance,

NEOSOFT: Driving Your Business and Clinical Transformation

Doctors Speak 48-54

Weight Cycling The Yo-Yo Effect of Weigt Loss And Gain

POST EVENT

Early diagnosis and good control Truth About Steroids In of diabetes can save your vision Inhalation Therapy 4

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Preventive Screening for Ovarian Cancer

India is considered a privatized health economy and around 80% of healthcare expenses are borne privately

MED EXPO LUCKNOW �� 58 24MRC NETWORK FELICITATED �� 60 ADVANTAGE HEALTHCARE INDIA �� 62 HOSPITAL PLANNING & INFRASTRUCTURE ��64

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NEWS Update

Transplant surgeons urge national awareness campaign on hand donation India has the capability and skills required to emerge as a center of excellence in hand transplants, but there is an acute shortage of donors due to lack of awareness and reluctance of families of potential donors

ndia’s top hand-transplant surgeons from Kochi’s Amrita Institute of Medical Sciences – a center of excellence in hand transplants – have urged the Government and the healthcare industry to come together to launch a national campaign for hand donation. There is an urgent need to create awareness about hand transplants in India, and encourage people to sign up for hand donation, they said at a workshop on hand transplants here by the hospital. Said Dr. Subramania Iyer, HOD, Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, who led the team of surgeons which successfully conducted India’s first-ever hand transplant in 2015: “Very few countries in the world have the capability to conduct hand transplants more so in Asia. India is now one of them. However, neither the potential recipients nor the donors or their families are much aware that hand transplants are now possible in the country. Thousands of hand amputees continue to lead the life of a cripple without realizing that with hand transplants, they can get as much as 95 percent of hand functionality back and lead a normal, productive life. It is not the shortage of skills but the shortage of donors that are the main challenge in hand transplants in the country.” Despite hundreds of people losing their hands every year due to various causes, there have only been a total of five hand transplants in India till now in India, four of them conducted at the Amrita Institute of Medical Sciences. In 2015, 29-year-old Manu TR, who lost both his hands when thrown out of a moving train by goons, became India’s first hand transplant recipient. Three more hand transplant surgeries were thereafter conducted at Amrita Institute of Medical sciences, the last one in October 2017 when Shreya Siddanagowda, a 19year old engineering girl student studying at Manipal University, got the gift of a new pair

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of hands from a male brain-dead donor. She is now undergoing post-operative therapy sessions. The first three recipients – Manu TR, an Afghan soldier who lost both his hands in a landmine blast, and a young man from Kerala working as an electrician – have already returned to their jobs and are leading an independent, productive life. Explains Dr. Mohit Sharma, Professor, Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, who is a part of the hospital’s hand transplant team: “Hand transplants are not life-saving but life-altering. They are entirely different from other transplants – the age, color, size, sex and even skin color of the recipient and donor need carefully matching. The complex surgery is conducted by a team of 25 surgeons and 12 anesthetists across 14 to 16 hours. There is only an 18-hour window in which the donor’s hands must be transplanted. The surgery today costs about Rs 20 lakhs, and the patient needs to stay in the hospital for a month.” Arms are harvested from a brain-dead donor. Each tendon, artery, nerve and vein is identified and tagged. The bones are then connected with metal plates to the body of the recipient, and a total of 25 tendons, 2 arteries, 6 nerves and 5 veins are carefully reattached. Said Dr. Subramania Iyer: “India is emerging as a center of excellence in organ transplants. While there is lot of awareness about donation of organs like cornea, liver and kidneys, not many people know that

hands can be donated too. Hand transplants is an evolving field less than 20 years old, yet it has the potential to contribute significantly to medical tourism. For example, we have successfully conducted double hand transplant surgery on an Afghan soldier who has now gone back to Afghanistan and got his job back. But for hand transplants to be more common, we need adequate number of donors. We have received more than 1,000 enquiries for hand transplants from across the country and even abroad, and dozens of patients are actively waiting for donors, yet only four or five hand transplants have been conducted in India since 2015, compared to kidney or liver transplants which are routinely conducted every week.” Dr. Subramania Iyer added: “Hands can be procured only from brain-dead donors. While traumatized relatives of the deceased readily agree to cornea donation and even of internal organs like kidneys and liver, there is marked reluctance in case of hand donation due to visible mutilation of the donor’s body. As awareness about hand transplants increase, the reluctance of the families to donate hands will come down. The media has a very important role to play in creating this awareness in the society. The Government too needs to provide financial aid to double hand amputees for hand transplants, as majority of the patients cannot afford the surgery. Organ donations will also get a boost by creating more awareness among doctors about the phenomenon of brain death. Unfortunately, the current MBBS curriculum doesn’t teach about brain death or organ donation at all.”

NEWS Update

New survey finds adult vaccination knowledge gaps in India; 43% of adults feel that they lack knowledge about adult vaccines GSK launches Vaccinate for Life campaign to improve general awareness of the benefits of vaccination throughout life and encourage more conversations between healthcare professionals (HCPs) and their adult patients on vaccination Multi-country survey reveals a communication gap between healthcare professionals and adult patients on vaccination throughout life

espite the World Health Organization (WHO) citing immunisation as one of the most powerful and cost-effective interventions in public health1, a new survey conducted by Ipsos MORI and sponsored by GSK finds that 68 percent of adults are not up-to-date with the vaccines recommended for them. Findings from the Vaccinate for Life survey of over 6,002 adults across Brazil, India, United States, Germany and Italy found that:  15 percent of adults believe that vaccinations are only recommended for children and/or babies with 21 percent thinking they are only needed for travel purposes.  Just over 3 in 10 adults report not having had any of the vaccines potentially relevant to them within the past five years  60 percent of adults say they have not received information provided by the government on the importance of adult vaccinations.*  Prioritisation of other health services: 53 percent of adults surveyed agree

www.m e d e g a t e t o d a y. co m Nov-Dec 2017

that although achieving a healthy lifestyle is important, they are more likely to prioritise other health services over vaccination. * Question 11B not asked in Brazil GSK today announced the findings from the ‘Vaccinate for Life’ survey carried out between the dates of July 6th to September 14th whereby 2,002 adults across 6 cities in India were surveyed (Delhi, Kolkata, Mumbai, Bangalore, Hyderabad and Chennai) The survey was aimed at ascertaining the awareness and attitudes towards vaccination throughout life among adults aged 18 years and over. Highlights of the survey in India are as below: While 42% of adults ranked staying in good physical health as the primary priority to them in life, staying up-todate with vaccinations is typically less important compared with other ways of staying healthy such as eating healthily, keeping active and not smoking, particularly among males.  The majority of adults surveyed in India believe that although vaccines are an effective way to prevent serious illness, however: • 34% believe them only to be required for travel purposes • 3 8% believe vaccinations are for children and/or babies only • 26% believe vaccinations are not

required if one is fit and healthy • 19% believe vaccinations are for the older population only  43% of the adults surveyed consider themselves to be not very/not at all knowledgeable about adult vaccines  Almost half (49%) of adults are most likely toturn to HCPs for advice on vaccinations over any other source of information  Of those adults who have not consulted an HCP about adult vaccines in the past year, the key barriers are trust in their HCP to inform them of relevant vaccines combined with a lack of conversation with their HCP on the need to vaccinate throughout adulthood (75% of adults agreeing) Between 45% and 50% of adults listed Tetanus, Hepatitis A and B, Influenza and the HPV vaccine as most relevant to the 18-64 years’ audience • Awareness of other vaccines which may be relevant is relatively low • 31% of adults surveyed have not received any vaccination in the past five years Adults value a range of information sources in helping them to understand record and track the vaccinations which are relevant to them → online tools, booklets and text messaging being the most useful Speaking about the Vaccinate for Life survey, - A. Vaidheesh, Managing Director, GlaxoSmithKline Pharmaceuticals Limited said, “The results of the survey highlight the crying need for awareness about adult vaccination in the country. Most people are familiar with the importance of vaccination in childhood however vaccination is equally important throughout life: for adolescents, adults and older people. According to the UNICEF and the World Bank, only clean drinking water rivals vaccination in its ability to save lives2. Despite this

NEWS Update

longstanding recommendation, the adult vaccination numbers are substantially low. The main reason behind this is a lack of general awareness – a fact that is amply established by the results of the survey.” Speaking about the campaign, Dr. Shafi Kolhapure, Vice President Medical Affairs Vaccines, GlaxoSmithKline Pharmaceuticals Limited said, “The Vaccinate for Life campaign has been created in response to the global health need for increased adult vaccination rates. The World Health Organisation (WHO) has stated that immunisation is one of the most cost-effective interventions in public health and as one of the world’s largest vaccine manufacturers, GSK is committed to creating general awareness about vaccines and to partner with others to encourage vaccination throughout life.” Mumbai Data The Vaccinate for Life survey brought out some interesting results from Mumbai too.41% of adults classified staying in good health as their top priority, followed by a successful career and raising a family (16%), financial comfort (12%), and owning a house and travelling the world (6%). In terms of priorities, 68% of Mumbaikar parents believe that keeping upto-date on their children’s immunisation is far more important than their own.

In terms of staying up-to-date with healthy habits, most Mumbaikars (80%) listed eating healthy as being most important followed by:  Not smoking (77%)  Exercising daily – (70%),  Staying up-to-date with vaccinations (50%)  Regular health check-ups (46%)  Cancer screenings(40%)  Regular dental checks (30%). As far as source of information, adults depend on a range of options with 94% Mumbaikars rating healthcare professionals as their most trusted source of information followed by:  Magazines (90%)  Friends and family (87%)  Government websites (82%)  Media reports (81%)  Internet searches (77%)  Vaccine manufacturer websites (69%)  Bloggers and online forums (61%), and said they would go by  Celebrities’ views (51%)

NEWS Update

Association of Healthcare Providers- India, together with Bureau Veritas launched a new standard ‘ResCCU Responsible Critical Care Units’ for ICU’s across India • Dr. Deepak Sawant launched the new standard- ‘ResCCU - Responsible Critical Care Units at P.D. Hinduja Hospital • ‘Is Quality Healthcare Sustainable: Issues, Concerns & Solutions’ – topic of seminar conducted during the event he Association of Healthcare and bloodstream infections can be Providers- India (AHPI), in life threatening due to the decreased association with Bureau Veritas, immunity of the patient in the ICU. introduced a new standard known as Mr. Joy Chakraborty, COO, P. D. ‘ResCCU - Responsible Critical Care Hinduja Hospital & MRC said “I Units’ at P. D. Hinduja Hospital, Mahim. would like to thank everyone that was The new standard was co-developed involved in the process of making this by awareness and knowledge partner launch and concept a success, especially Cipla and launched by Chief Guest- Dr. Bureau Veritas. The Indian Healthcare Deepak Sawant, Hon. Minister of Health industry is an extremely challenging & Family Affairs, Govt. Of Maharashtra. environment to provide and deliver This initiative was launched with the aim quality healthcare. The initiative and of amplifying the number of safety and the newly launched ResCCU standard infection control measures undertaken will act as a benchmark for hospitals by hospitals in their respective Intensive to compare themselves against and to improve their infection control measures Care Unit (ICU) departments. Chief Guest, Dr. Deepak Sawant, Hon. in an effective manner. Through this Minister of Health & Family Affairs, initiative we hope to streamline and Govt. Of Maharashtra said, “I want make easier several processes and to congratulate everyone that has measures required to provide people been part of this initiative. The Indian with a better standard of quality care and Critical Care industry is in dire need of safer medical treatment.” uniformity, not just in infection control Patients in ICU’s are extremely prone but also in providing quality care. to infections if hospitals do not follow Further, it is important to note that these the prescribed guidelines, procedures new standards need to be implemented and evidence backed infection control not just in private hospitals, but also in measures. Those most susceptible to an government hospitals, for which I will infection include patients that have been do my very best to implement. I am admitted to the ICU for a long period of thankful to all stakeholders for inviting time, are older in age (70+), have been using antibiotics for a long time, lowered me to be part of this launch.” ICU care is defined as that part of the immunity, a person in coma/shock/ hospital that is designated with the trauma, etc. management and treatment of critically Mr. Amit Ghosh, Regional Chief ill or injured patients. Infections that are Executive, Commodities, Industry contracted during hospital admission, & Facilities Division, South Asia hospital stay and post discharge are Operating Region, Bureau Veritas, referred to as Nosocomial infections/ India said, “Through this joint initiative, Hospital acquired infections. These hospitals across the country will be able infections are commonly associated with to develop, implement and provide better invasive medical devices or surgical and more efficient Critical Care services procedures. Some infections include to patients. Our aim will be to provide bloodstream infection, pneumonia, hospitals and their ICU employees with urinary tract infection, surgical site training that covers important measures infection, etc. In most cases, lower and protocols required to make ICU’s respiratory tract infection, pneumonia infection free.”

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The training will involve several pillars such as patient care (care plans, management of prevention measures, etc.) risk management (hygiene, patient safety, pharmacovigilance, multidrug resistant organisms [MDRO], etc.), infection control (drug expertise, optimal antibiotic use, etc.), regulatory requirements (national and state regulatory requirements, medical council guidelines, notifications issued by regulatory authorities, etc.) Dr. Kapil Zirpe, President, Indian Society for Critical Care Medicine said, “I congratulate those involved in initiating and developing the concept of ResCCU and bringing to light the need for compliance of infection control measures amongst hospital ICU’s. Today, Critical Care has transformed from an extended facility in a hospital to a specialization. Through this initiative, we aim to provide training and education to those working in the various ICU’s of hospitals and strive to streamline critical care across the country.” In addition, the AHPI also organized a seminar to discuss the various challenges and issues related to sustenance of quality in the Indian Healthcare industry, along with a strong focus on the future of Healthcare Delivery. Addressing the audience Dr. Girdhar Gyani, Director General, AHPI said, “On this occasion, I would like to extend my gratitude to everyone for working together and providing us with a platform to discuss and deliberate the crucial future of the Indian healthcare industry. Over the years, the focus amongst healthcare industries has moved from purely providing medical treatment, to providing quality medical treatment. However, the Indian industry still faces several hurdles that we must work together for, and overcome. Through initiatives like these, we are moving closer to our aim of creating a healthy and driven healthcare industry.”

NEWS Update

Dr. Reddy’s Laboratories announces the launch of generic Azacitidine for Injection in the Canadian Market Hyderabad, India and Princeton, NJ, USA. November 02, 2017— Dr. Reddy’s Laboratories Ltd. (BSE: 500124, NSE: DRREDDY) is pleased to announce that generic Azacitidine for injection 100 mg/vial, a bioequivalent generic version of VIDAZA® (azacitidine for injection), is approved by Health Canada. “Bringing Azacitidine for Injection to the Canadian market at this time is very important for us, as well as for

our customers and their patients,” says Alok Sonig, Executive Vice President and Head of the North America Generics business at Dr. Reddy’s. “This launch represents Dr. Reddy’s commitment to make affordable injectable drugs available in Canada.” Dr. Reddy’s is first to market with this Azacitidine for injection in Canada. Vinod Ramachandran, Ph.D., Country Manager, Dr. Reddy’s Canada says that “The approval and launch of Azacitidine

for injection is an important milestone for Dr. Reddy’s in Canada. The launch of first generic Azacitidine for injection is another step in our long-term commitment to bring more cost-effective options to Canadian patients.”

Japan’s Health Ministry funds a programme for Technical Personnel Exchange in Diagnostic Sector “Technical Training for Materializing International Diagnostic Business in India” to begin by Year-end To address diagnostic technological differences between India and Japan, a programme approved by the Ministry of Health, Labour and Welfare in Japan is introduced in India and is funded by “The International Promotion of Japan’s Healthcare Technologies and Services in 2017” conducted by the National Center for Global Health and Medicine under the Ministry of Health, Labour and Welfare, Japan. The programme “Technical Training for Materializing International Diagnostic Business in India” will be conducted by National Centre for Global Health and Medicine (NCGM) which has been approved and appointed by Ministry of Health, Labour and Welfare in Japan. The programme which will be taken forward by Japanese majors in diagnostic technologies- Konoike Transport and J-VPD, Inc. is also being supported by Embassy of Japan in India and Delhi Medical Association. The programme is part of Japan’s government efforts to push and promote its Healthcare Technologies and Services globally. Hence, the Ministry of Health, Labour and Welfare provides financial support to the programme. Mr. Tetsuji Yamada, President, J-VPD, Inc. highlighted Japanese Diagnostic technology and know-how to India and explained how to utilise the diagnostic outsourcing in Japan. “Indian demand for the medical and diagnostic industries is expanding rapidly. However, still there are many major issues to be solved which are test accuracy, quality, cost and lead-time control of transportation due to lack of technologies, manpower and facilities in the sophisticated area of Genetic testing or Chromosome inspection,” he added. Mr. Yamada further said, “Under the technical training programme nearly 10 trainees will be engaged from Indian 12

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medical organisation in December, 2017. We will arrange some visits to diagnostic labs and medical organisations.” Mr. Minoru Amano, Executive Officer, and General Manager of Medical Business Division, Konoike Transport Co., Ltd. said, “India’s healthcare sector is witnessing a double digit growth. But the supply chain is still in its primitive stage. Huge potential exists in diagnostic technologies sector in India. Japan is a big success story and we, in Japan, need to exchange our knowledge and collaborate to move to the next level. “Healthcare in India is growing at a very fast pace. It is expected to be $280 billion in size by 2020, growing at a compound annual growth rate of 16 per cent. According to Reports, the medical devices market is estimated to grow organically at 15 percent to USD 8.6 bn by 2020. (NATHEALTH - Deloitte Report). Lots of new hospitals are opening and healthcare has taken a tremendous leap in service standards. Hence, the supply chain needs to be strengthened to meet the growing demand,” Mr. Amano added.

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NEWS Update

This World Diabetes Day, P.D. Hinduja Hospital conducted a free diabetes checkup camp at Churchgate and CST station More than 1000 Mumbaikars participated in the free camp to check for diabetes P.D. Hinduja Hospital, Mahim, today conducted a free Diabetes checkup camp from 8.30am to 4.00pm at Churchgate and CST stations.Trained hospital staff conducted Random Blood Sugar (RBS) tests to check glucose levels of participants along with height, weight and blood pressure check. Result of the tests were shared with those that participated, along with expert advice on how to keep diabetes at bay. The camp witnessed participation from more than 1000 Mumbaikars. Symptoms:  Hunger and Fatigue

amongst adults. In addition, there are several cases, wherein individuals may suffer from pre-diabetes, a condition marked by higher than normal blood sugar, but not high enough to be considered as diabetes. Mr. Gautam Khanna, CEO, P.D. Hinduja Hospital & MRC said, “We are extremely proud and thankful to the Western and Central Railway for their support in creating awareness on diabetes amongst Mumbaikars. There is enough data and evidence to show that the current incidence and burden of diabetes amongst Indians is extremely alarming, with several people being completely unaware of the fact that they are at risk of becoming diabetic. Through this camp, our hospital aims to support Mumbaikars and contribute to creating 360-degreeawareness around the disease, and share advice on positive and effective lifestyle changes that will help them steer away from the chronic disease.” On the occasion Mr. RavinderBhakar, Chief PRO, Western Railway said, “Today is World Diabetes Day, an important reminder that Diabetes has become a problematic lifestyle related disease. I am proud of the initiative

Over the years, India has risen up to become the second largest diabetes nation in the world with close to 70 million patients suffering from the disease. This number is now expected to grow and reach 120 million in the next few years. The most common risk factors associated with developing type 2 diabetes involves obesity, family history of diabetes, physical inactivity and sedentary lifestyle, smoking, an unhealthy diet, age (45 and above), high blood pressure or hypertension.

SRV Mamata Launches 100 Bedded State of Art Super Speciality Hospital In Dombivli

& best outcomes, will enhance the quality of treatment for patients from KalyanDombivli- Thane region.

 Frequent urination  Increase in thirst  Dry mouth and itchy skin  Pain or numbness in feet  Exhaustion Diabetes is a chronic disease that occurs when the pancreas areno longer able to produce enough insulin or loses the ability to process the produced insulin effectively. Diabetes is classified into two categories- type 1 and type 2, wherein the latter is more prevalent

~The comprehensive state-of-the-art facility brings the latest medical, surgical techniques in Dombivli The state of art, 1st tertiary care hospital SRV Mamata in dombivli was formally inaugurated today. Hon. Minister. Shri. Eknathji Shinde, PWD, Maharashtra State, Hon. State Minister of Health Shri Ravindraji Chavan, Hon. Shri Shrikantji Shinde, MS Ortho Hon Member of Parliament, kalyan, Hon. Shri Rajendraji Deolkar Mayor, KDMC, Hon. Shri Shubhashji Bhoir, Hon. MLA, Kalyan Gramin and Hon. Shri Dipeshji Mhatre Corporator, KMDC. An acclaimed Marathi film actress Nishigandha Wad was also present on this occasion. A newly launched SRV Mamata in Dombivli is the most advanced hospital in this region; with 100 bedded world-class facility with clinical and technological advancements has 18 bed ICU,5 Nicu Bed, 3 Operation Theatre follows international standards for treating critical medical condition. Hospital is equipped with the most advanced Cath 14

with P.D. Hinduja Hospital, and pleased with the response we received from the public towards the camp. We want to encourage camps like this and encourage the public to fight diabetes.”

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lab for Cardiac Procedure. Comprehensive services include Orthopaedic and Joint Replacement, Oncology, General surgery, Bariatric and weight loss surgery, Nephrology and 24x7 Dialysis, Urology, Neurology, Neuro-Surgery, Plastic and Cosmetic Surgery, Pulmonology, Medical and Surgical Gastroenterology, Anaesthesiology, ENT, Obstetrics and Gynaecology, Paediatrics etcs. Each of these departments is led by highly experienced and skilled doctors, educated and trained at the foremost medical institutions. The nursing services and the patient-care providers are specially trained to provide compassionate care round-the-clock. Mamata Hospital is the oldest hospital in Dombivli started by Dr U. P. Rao with the objective to provide better healthcare facility. SRV hospital initiative has created a benchmark in clinical excellence by providing preventive healthcare program

“Kalyan – Dombivli and the surrounding region has been developing at a rapid pace and yet one has had to travel a great distance to access high quality medical care. We are very happy to bring our trusted superspecialty medical care to the door steps of our patients. Our new hospital in Dombivili is another milestone in this region. SRV Mamata Hospital, will bring quality health services closer for the community. This hospital was built to serve the people with the care, comfort, respect and dignity, along with the 24*7 Emergency medical Services, will set the new benchmarks in healthcare delivery and patient experience in thane down” said Dr Abhay Vispute, Director, SRV Mamata Hospital.

NEWS Update

Samsung Partners with Uttar Pradesh to Set Up 20 Samsung Smart Healthcare Centres in State To provide innovative Samsung healthcare equipment for ultrasound and digital radiology at Government Hospitals across the state

Samsung India has entered into a partnership with the Government of Uttar Pradesh to add 20 new Samsung Smart Healthcare centres across the state and provide affordable and quality healthcare to patients from the economically and socially weaker sections of society. As part of its Smart Healthcare program, Samsung will provide advanced and innovative healthcare equipment such as ultrasound and digital radiology (x-ray) machines manufactured by the Company along with a Samsung LED TV, Samsung air conditioner and refrigerator to selected government hospitals across the state. A Memorandum of Understanding (MoU) was signed between Samsung India and the Department of Medical Health & Family Welfare, Government of Uttar Pradesh in the presence of Shri Siddharth Nath Singh, Minister of Medical and Health, Government of Uttar Pradesh, Shri Prashant Trivedi, Principal Secretary, Department of Medical Health &

Family Welfare, Government of Uttar Pradesh, Smt. V. Hekali Zhimomi, Secretary, Medical Health & Family Welfare Department, Dr. Padmakar Singh, Director General, Medical & Health Services, Government of Uttar Pradesh and other dignitaries. Shri Siddharth Nath Singh, Minister of Medical and Health, Government of Uttar Pradesh, said, “We are pleased to collaborate with Samsung India for this program. We are committed to offer affordable healthcare facilities for the people of Uttar Pradesh and welcome the support from Samsung India in helping hospitals cater to the community’s needs for quality healthcare.” “Development on the healthcare front is the need of the hour. I am happy that Samsung India has made a start on that front and has come forward to set up programs like Samsung Smart Healthcare. On its part, the government is working towards creating better medical facilities for the public and the collaboration with Samsung for the Smart

Healthcare program is a step towards fulfilling this vision,” said Shri Prashant Trivedi, Principal Secretary, Department of Medical Health & Family Welfare, Government of Uttar Pradesh. This is one of the largest initiatives of Samsung under its Smart Healthcare program. “Samsung believes in transforming communities and creating a better life for people. We are pleased to partner with Uttar Pradesh to offer healthcare solutions with the effective use of technology. Through this collaboration, we aspire to provide many more people in the state easy access to advanced healthcare facilities. Samsung Smart Healthcare combines good infrastructure, latest technology and the best available medical expertise,” said Mr. Deepak Bhardwaj, Vice President, Samsung India.

With an aim to Strengthen Immunity among children, Cipla launches ActivKids Immuno Boosters ActivKids Immuno Boosters by Cipla is a scientifically developed tasty choco-bite format Immunity supplement for kids for building strong immunity in children The concern for their child’s health make mothers overprotective and they often put restrictions on their kids and end up saying NO without realizing how they perceive it and the impact it has on their personality. It is necessary that instead of saying ‘No’ to kids always, their immunity is strengthened to keep them healthy and strong from within. Therefore, Cipla, leading pharmaceutical company in India, developed ActivKids Immuno Boosters, immunity supplement for children in a unique choco-bite format, to address the growing concern of low immunity by providing up to 100% RDA of key immunity nutrients. Mandira Bedi accompanied by her 6- year old son, Vir participated in a panel discussion with three experts to discuss about the importance of immunity in children, how to strengthen a child’s immune system and how that can help moms say Yes to their kids more often. The panel also celebrated 16

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the #YesMom Day at ITC Maratha, Mumbai discussing the need for mothers to be a #YesMom. Nutritionist Dr. Niti Desai, Paediatrician Dr. Deepa Bhandarkar, along with Psychologist Dr. Sapna Zarwal too were a part of the insightful Panel discussion along with 15 mothers who have championed the #YesMom campaign. Talking about her experience, Mandira said, “At one point of time, I too was a worried mother, always conscious about Vir’s every activity, but the social experiment video conducted by ActivKids Immuno Boosters came as a revelation to me. I never realized what impact my frequent ‘Nos’ were having on my child’s developing mind. I took the #YesChallenge and I have made efforts to become a #YesMom by trying to avoid saying ‘No’ unnecessarily. I think it’s important that all mothers out there realize how being a #YesMom can bring a difference to their child’s physical and mental health. I realized

that no matter how much I try to protect him from germs and infections, it will not make much of a difference till the time his immunity is strong. Now, I focus on strengthening his immunity to make him healthy. And that has helped me in my journey of becoming a #YesMom” Dr. Sapna Zarwal, Psychologist, spoke about the impact of saying ‘No’ to kids repeatedly, “Kids are sensitive and impressionable, and thus we should take extra caution in what we say to them. We must realize that our behaviour helps shape a child’s personality. Frequent No to you kids will only affect him psychologically and they might see you as somebody who often restricts them. Hence it’s advisable to measure what all things to say No to. But also to think how will your child be affected by this.”

NEWS Update

AYUSH Ministry holds Review Meeting to examine the draft of National Policy of Medicinal and Aromatic Plants Voluntary Certification Scheme of Medicinal Plants Produce’ launched by the AYUSH Minister The National Medicinal Plant Board storage and primary processing of fresh of AYUSH Ministry along with produce at their doorsteps so as to ensure the Medicinal & Aromatic Plants quality assurance. This scheme would Stakeholders jointly organized a one give opportunity to farmers, collectors, day review meeting to examine the traders and other stakeholders to get draft of National Policy of Medicinal their raw material certified, Minister and Aromatic Plants in New Delhi. further said. Addressing the inaugural session of the The AYUSH Minister further explained review meeting, the Minister of State that More than 80% Medicinal plants (Independent Charge) for AYUSH, are sourced from the forest and this Shri Sripad Yesso Naik said that the area have the potential of generating lot Medicinal Plant Sector is an ancient as of employment opportunities. He said well as a sunrise Sector and it provides that the fringe areas of rich biodiversity diverse opportunities to the country. He sites are inhabited by the poorest of the said that India could play a leading role poor, whose incomes can be augmented in the global market of herbal product by a comprehensive strategy aimed at and herbal drugs. capacity building, provision of value On this occasion, the Minister also said addition facilities and structuring an that quality of medicinal plants based raw interface between the community and material is also one of the most important industry. aspects. This being largely a perishable Shri Vaidya Rajesh Kotecha, Secretary commodity, quality deterioration starts Ministry of AYUSH; former Secretary of almost immediately after harvest AYUSH Shri Ajit M Sharan; Ms. Shomita especially in case of herbs and shrubs, he Biswas CEO, National Medicinal Plants added. Shri Naik informed that NMPB Board were also present on this occasion. has already started a major initiative During the Inaugural session the by involving Joint Forest Management Minister also launched the “Voluntary Committee / Self Help Groups and Certification Scheme of Medicinal other similar agencies for proper drying, Plants Produce (VCSMPP)”, designed

Shri Sripad Yesso Naik Minister of State (Independent Charge) for AYUSH,

by NMPB through Quality Councils of India (QCI). The important areas of Medicinal Plants Sector like Forest & Conservation, Infrastructure, Marketing & Trade, Cultivation, Sustainable Harvesting & Post harvest Management, Quality & Certification, Research & Development, Regulatory & Legal framework, Networking & IT/Space Intervention, Finance and Information, Education & Communication and Capacity Building are covered in the 8 sessions by specialists from all over the country.

Impact of air pollution on lungs and prevention tips Pollution emitting from stubble burning in neighbouring regions of Delhi is severely impacting the air quality making it difficult to breathe in open air. The alarming level of AQI (Air Quality Index) results in respiratory illnesses and can adversely affect the lungs. The exposure to polluted air has an impact on the health of people who are already suffering from breathing disorders such as bronchial asthma, chronic obstructive pulmonary disorder, interstitial lung disease, cystic fibrosis, lung cancer etc. Also affected adversely are people in extremes of age and immune compromised individuals. In the current situation, it is advisable to limit exposure to polluted air as much as possible and it is highly recommended 18

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to use a pollution mask to avoid direct exposure to the air pollutants. Few precautionary measures to reduce the effect of air pollution are as follows: • Maintain good indoor air quality – keep your doors and windows closed and it is also advisable to install air purifiers • Wear full sleeve clothes and cover your face with a good quality pollution mask (remember to replace the mask at constant intervals. • Avoid doing physical exercises outdoors, instead prefer doing yoga indoors • Plant trees in and around your house as it will help in reducing air pollutants • Consume ginger and tulsi tea for stronger immune system

• Include anti-air pollution foods in your diet such as: Vitamin C, Omega3 & magnessium rich foods, turmeric, jaggery, walnuts etc

Dr. Shaarang Sachdev

Consultant & Coordinator – Emergency, Dharamshila Narayana Superspeciality Hospital

NEWS Update

PRECISION DIABETES: NOW IN INDIA

Dr. V. MOHAN Chairman & Chief of Diabetology, Dr. Mohan’s Diabetes Specialities Centre, Chennai, India

We all know the adage “One size doesn’t fit all” and the practical implications for this. For eg., can there be one shirt size which fits people of all sizes or one shoe which fits everyone?. Then, how can we give the same type of treatment to everyone with diabetes?. We now know that there are at least 20 types of diabetes. The diagnosis of each one of these types is based on certain tests which will help the diabetologist to clinch the diagnosis. The advantage of knowing which type of diabetes one has, is that the treatment can be tailored accordingly. For eg., patients with type 1 diabetes need life long insulin injections. On the other hand, in the ‘common garden’ variety of type 2 diabetes, the tablets may work even better than insulin!. There are however other forms of diabetes. For eg., Maturity Onset Diabetes of Youth (MODY). It is now known that there are at least 14 different types of MODY itself. Several types of MODY like MODY 3, MODY 1, MODY 11 and MODY 12 respond much better to ‘sulphonylurea’ tablets which correct the defect in insulin secretion. In

contrast, metformin is the drug of choice for ‘type 2 diabetes’ as it corrects insulin resistance. There are many instances where patients are unfortunately wrongly diagnosed to have type1 diabetes. I recall a 16 year old girl who was lean and had severe diabetes and was therefore diagnosed by her physician to have type 1 diabetes and was told that she has to take four injections of insulin for the risk of her life. Devasted, the family came for a second opinion. When I reviewed her history I saw that she had a strong family history of diabetes going through four generations. She also had good pancreatic beta cell function. On further investigations, we found that the markers for type 1 diabetes like GAD antibody test were negative. Genetic testing for MODY showed that she had MODY 3, a form of diabetes which responds to the common sulphonylurea tablets. We therefore stopped the insulin and started her on Glibenclamide, one of the cheapest anti-diabetic drugs and she responded beautifully. If the genetic testing had not been done for this patient, she would probably have been continued on life long insulin therapy. This is one example of ‘Precision Diabetes’. There are several such miracles which have happened in treating diabetes, thanks to the introduction of Precision Diabetes. At Dr. Mohan’s Diabetes Specialities Centre, over the last several years we have developed algorithms by which a precise diagnosis of diabetes can be made. Applying the principles of ‘Precision Diabetes’, it will be possible in the near future to very accurately classify a patient and determine the type of diabetes he or she has, and then decide the type of treatment that this patient is likely to respond to. These are indeed exciting times in the field of diabetology

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COVER STORY

MEDTRONIC SHOWCASES TECHNOLOGY EXCELLENCE AT ITS R&D FACILITY IN HYDERABAD Medtronic Globally Invested $2.2 Billion in R&D in FY2017 and Owns More Than 53,000 Patents Across Its Therapy Areas India Medtronic Private Limited, wholly owned subsidiary of Medtronic plc (NYSE:MDT) in India, showcased its engineering research and development (R&D) center, called Medtronic Engineering and Innovation Center (MEIC), in Hyderabad today. The site visit was part of the 5th Health Writer’s Workshop organized by Heal Foundation at Radisson, Hyderabad. Research and innovation is central to the Medtronic Mission, focused on addressing the universal healthcare needs of improving clinical outcomes, expanding global access to care, and optimizing costs and efficiencies across the healthcare continuum—through three core strategies: therapy innovation, globalization, and economic value. Medtronic globally invested $2.2 billion in R&D in FY2017 and owns more than 53,000 patents across its therapy areas. In India, Medtronic has a large footprint in engineering research and development, with two centers in Hyderabad and Bangalore, respectively. Both engineering R&D centers collectively employ more than 350 engineers, supporting global teams with product design and development capabilities to serve international and emerging markets, including India. Commenting on the occasion, Madan Krishnan, vice president and managing director, Medtronic, Indian Sub-continent said, “Meaningful innovation can come in many forms like a new feature to make a product more useful or a unique way to apply an evolving technology to a real-world problem. As a global leader in medical technology, Medtronic aspires to drive progress in innovation and devise powerful solutions with proven clinical and economic value as the basis of our offerings and value proposition. For us, our customers and patients remain at the center of our relentless pursuit to transform healthcare.” The visit to MEIC entailed first-hand immersive experience of technology innovation, precision engineering, quality, and clinical science that goes behind some of the path breaking medical technologies that are designed and developed at the 80,000 square feet state-of-the-art center. MEIC provides engineering and development support in the areas of design, analysis, hardware, software development, and testing, while developing a footprint for future product development for India and the global market. Additionally, MEIC will be leveraging the local presence and ecosystem to support regional business needs. Divya Prakash Joshi, site director, MEIC, Hyderabad said, “Medical technology is constantly evolving and we, at MEIC, make persistent efforts to collaborate with Medtronic’s global 22

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business units on engineering R&D efforts so that products reach the hands of patients and doctors on time. We are also developing market appropriate innovations to meet local and global needs and clinical challenges. MEIC continues to provide high-quality, high-performance, cost-effective engineering R&D support for our products.” The innovations showcased during the event were portable respiratory monitors (Capnostream™ 35), ventilators (Puritan Bennett™ 980 Ventilator Series), remote patient monitoring platforms (Vital Sync™), ablation systems (Emprint™ Ablation System), vessel sealing systems (Valleylab™ LS10 Generator) and neurovascular coil detachment systems products (Artisse™ detachment device). These technologies are testimonials of the collaborative effort of the R&D center in India and its global partners toward delivering meaningful and positive patient outcomes. “Our engineering research and development work at MEIC in Hyderabad further demonstrates our futuristic thinking and alignment with the government’s initiative to ‘Make in India’ and ‘Make for India’. Medtronic has been leveraging the unique strengths of India beyond just providing therapies to the patients; with a large pool of qualified engineers, talented doctors with wide ranging patient pool and hospitals providing quality care. All of these stakeholders have helped the Medtronic R&D center develop market appropriate technologies and products to serve patients with optimum clinical outcomes,” concluded Mr. Krishnan

NEWS Update

UAE residents encouraged to come forward and donate blood to save lives

Datwyler bolsters presence in India with state-of-the-art healthcare solutions

Aster DM Healthcare commits to facilitating 30,000 units of blood  To support company’s plans in India, In alignment with the ‘Year of Giving’, Aster DM healthcare together with government authorized blood banks is encouraging communities to come forward to donate blood, and support the ‘Drop of Hope’ initiative. As part of the Aster @30 anniversary celebrations’ Aster Volunteers programme, the company is committed to facilitating 30,000 units of blood donation across the GCC, India and Philippines. The campaign goes hand in hand with the DHA’s efforts to encourage voluntary blood donors and raise awareness about the importance of regular blood donation. All blood banks need to constantly replenish their stocks to avoid the risk of shortage as the shelf life of blood is not more than six weeks. The requirement of blood is imperative in certain diseases like thalassemia, hemophilia, and in medical procedures like heart surgery, organ transplants and cancer. “A little time and a small act of giving from each of us can help save millions of lives each year. We wish to do our part in contributing to the DHA’s initiative to encourage blood donation in UAE. And we are extending our efforts across the 9 countries where we are operating by committing to 30,000 units of blood donation as part of our 30th Anniversary celebrations. In the true spirit of giving back to the community, we are leveraging our Aster Volunteers programme to encourage and enable people from all walks of life, all nationalities and all ages to join us in this drive. All our doctors and staff across our units have come forward to volunteer in this noble cause,” said Dr. Azad Moopen, Founder, Chairman and Managing Director, Aster DM Healthcare. Those who would like to donate blood can visit www.astervolunteers.com and enroll to be part of upcoming drives. 24

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Common Misconceptions Myth: Giving blood hurts. Fact: The pain experienced is no more

than a needle prick.

Myth: Infections can be contracted from donating blood. Fact: A clear procedure exists for

taking blood from each donor. Sterility is maintained at all steps. A sterile, new needle is used for each donation and is then properly discarded. Use of sterile equipment and technique mitigates the chance of infection.

Myth: There is limited blood in the body and it is unhealthy to give some away. Fact: Only about 350-450ml of blood

is taken during a donation session. There is sufficient blood in the body to donate it without any ill effects. The body makes same quantity blood soon after the donation.

Myth: Age is a deterrent to blood donation. Fact: Anyone in the age group of 18-

65 years can give blood if they are fit and healthy.

Myth: People taking any medication cannot donate blood. Fact: Only certain medications such as

aspirin, antibiotics, steroids, hormones, anticoagulants, can disqualify one from donating blood. Your doctor can give you the best advice.

expansion of Datwyler India’s upcoming facility in Pune to be completed by the end of 2017; first samples to be supplied in July 2018  Facility expected to create about 500 jobs by the end of 2018, majority to be staffed with members of the local community  Expansion of facility incorporates First Line – the manufacturing concept for high-quality elastomer components  Datwyler presents its product portfolio and new health care offering at the CPhI India 2017. Datwyler, the Swiss-based leading industrial supplier that offers state-of-the-art solutions for drug packaging and medical devices announced that the expansion of its plant in Pune will be completed by end of 2017 and first samples will be supplied in July 2018. The facility underlines the company’s commitment to India and acknowledges the country’s role in the global pharmaceutical market. The expanded facility will manufacture according to the First Line concept, making India the first market in APAC region to incorporate this standard. The facility plays a substantial part in Datwyler’s efforts to cater to regional and global markets. Once the production site is fully operational, the facility will cover approximately 58,000 square feet and will create up to 500 jobs, which will be staffed by members of the local community. Set against the background of the ever-evolving requirements for drug packaging, Datwyler provides a unique range of future-proof health care sealing solutions and services for primary and secondary packaging. This includes the most advanced elastomer formulations, proprietary coatings, sterilization options, and aluminium seals for high-efficiency production lines, which not only meet the demands of current pharma trends, but go beyond them. In India, Datwyler’s core business consists of container closures. Manufacturing close to four billion components for vials, pre-filled syringes, and diagnostic devices per year, the Pune facility plays an increasingly strategic role for the company.

EXPERT VIEWS

Building a New Hospital or Modifying your Existing One: Ensure it is NABH Compliant. Here is why you need to do so and how it can be done.

Suresh Shenoy Senior Vice President ACME Hospital Projects

www.acmehospitalprojects.com

ndian Healthcare Industry is witnessing phenomenal growth at a rate of over 28%, becoming the fastest growing sector in the Country, outstripping even IT. The main reason for this growth being better standards of living, leading to more incidences of life style diseases, increasing insurance coverage and a growing popularity of India across the world, as a cost effective and high-quality healthcare destination. While this growth has brought lots of opportunities for healthcare providers here, it has also thrown up some major challenges too, those that accompany any industry or sector that goes through such a high growth phase. Of these the most important challenge being, getting ‘regulated’ by the Government, without which this growth would become unbridled with many fly-by-night operators coming into the sector, leading to a severe loss of reputation for the country. To ensure that safe, high quality care is being provided by all these new hospitals and that they meet all the Statutory requirements, the Government and key

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stake holders of the Healthcare Sector including Insurers and the large Corporates are insisting that Hospitals empaneled with them comply with the NABH requirements. Being a National Accreditation Standard, meeting the NABH automatically ensures that all Centre, State and Local Body Regulations are met by the Hospital, right from the Clinical Establishment Act, IPHSS, Fire & Safety and Pollution Control Rules, the National Building Code and required Permits from Corporation and Municipalities to build a healthcare facility. The NABH Standard is also approved by ISQua, the International Hospital Accreditation Body, thus meeting an essential requirement today for taking in patients from abroad. Compliance with the NABH is possible only if the infrastructure of the Hospital has been planned and designed keeping the requirements of the Standards in mind. The biggest impediment for many of the existing Hospitals, whether Small, Medium or Large to obtain the NABH is lack of the required infrastructure. In their journey towards the NABH, they find they have to demolish and reconstruct many parts of the existing hospital building to comply with the Standards. Thus the ideal solution is to incorporate the NABH requirements right at the design and planning stage itself of the Hospital, thereby saving a lot of money, time and disruption to operations. Some key NABH related infrastructure aspects to be kept in mind at the design stage is  Location: Suitability of the site for the new hospital with respect to Safety. Avoiding low lying area / Flood / Cyclone/ storm/ Earth Quake / landslide prone areas or on river banks, on a slope, very crowded areas, lack of easy access or availability of adequate water & power.  Adherence to the specific norms of the Local Development Authorities like Plot coverage, FSI, Setback, Parking provisions.

 Adherence to Fire Safety norms with

respect to Evacuation during Fire & Non Fire Emergencies. These include numbers, widths and slopes of Stairways & Ramps, numbers and dimensions of Lifts, Fire Lifts, Fire Extinguishers, Automatic Water Sprinklers, Smoke Detectors, Fire Alarms, Fire Hydrants, Hose Reel, Underground & Overhead Fire Water Tanks, etc.  Air Filtration Systems mandatory for OT Complex, ICUs, and Isolation Rooms.  Layout and design of all OTs & CSSDs, Organ Transplant Units, BMT Units. etc. for ensuring effective infection control.  Layout and design of Radiology, Radiation Therapy, and Nuclear Medicine etc., for Patient Safety according to AERB Guidelines.  Layout and design of Critical areas like Emergency & Casualty, ICU, NICU, RICU, Isolation Rooms, etc.  Layout and designs of Diagnostic Labs, Blood Bank, Blood Storage Units etc.  Layout and designs for ensuring proper Patient flow, Work flow, Visitors flow and Staff flow to reduce infections, cross contaminations and response times for emergencies. Other benefits being reducing fatigue and wastage of time.  Optimum use of natural light, view of exteriors for improved patient satisfaction and quicker recovery of patient  Provision for RO Plant. Essential to meet requirements of critical areas like OT, dialysis, ICU etc. Building Hospitals is highly capital intensive. So it is essential to have a good team of Hospital trained Planners and Architects, involved right from the concept stage itself. They will ensure you build right the first time itself and your Hospital is future ready, complaint with all National Accreditation and Regulatory requirements.

COVER STORY

Hospital infrastructure designing can improve health of the patient Does healthcare infrastructure is the cause of poor health

The infrastructure design of the hospital plays a very important role to make the hospital better and advance. The design of the hospital structure planned is once in life time and major changes cannot be implemented at a later point of time, so the thought process needs to be done at the initial time considering the future requirement with all the various different factors. The infrastructure design of the building should be attractive, functional and as well cater to the needs of the patient care. As a recent concept which is popularized among the hospitals, is to strongly promote wellness as opposed to only treating diseases. For a better outcome of patient results which includes safety of the patient and the infrastructure design of the hospital. In earlier days, importance was never given to facility designing which affected the functional systems within the hospital and as well the patient safety even though millions of money was poured into the construction of these facilities.

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The right components considered for the design and planning of the facility gives a very strong and positive impact and in return improves human performance and especially improves the safety of the employees, patients and their families. After a lot of research and reading through different articles, we have found out that there is a strong connection between the physical environment (Single bed or multiple beds) and patient (fewer adverse events and better quality in healthcare) and staff (less amount of stress, fatigue and high amount of deliverance in quality patient care). The hospital facility design should have adequate space for the patient to stay comfortably and also by giving adequate space for the attenders equipment and other necessities kept at a standard location and providing adequate space for documentation and work areas reduces the stress levels for the clinicians which help them to deliver better at work. â&#x20AC;&#x153;Hospitals can be a very scary place, so we have to create a soothing environment that considers the five sensesâ&#x20AC;?. In many countries, patients

COVER STORY

can choose their treatment centers, which means hospitals must compete. A patient’s overall experience depends upon diverse factors, such as medical staff attention, catering, housekeeping and the facility itself. “We know that the body heals best when it’s not in a high anxiety state and producing lots of stress hormones that raise the heart rate and lower the immune system. If we can design facilities that decrease patients’ anxiety, then we can help them decrease the pain and help them to heal faster.”Through wireless communication, an intelligent technology infrastructure enhances overall patient experience and hospital efficiency by:  Allowing medical staff to access patient files from anywhere to make informed care decisions.  Empowering nursing staff to react quickly to a patient’s needs.  Ensuring patient comfort through personal control of room lighting, temperature, window blinds and more.  Satisfying a patient’s desire to communicate with family and friends via video call or telephonic call.  Increasing staff productivity by decreasing time needed to manage systems and locate equipment.  Promoting energy efficiency by controlling and monitoring energy sources.  Saving capital expenses on devices, cabling, and commissioning for new construction or upgrades.  Reducing operational expenses through reliable network availability, scalability, and rapid system diagnosis and repair.

Natural light

Benefits: Sunlight has been shown to increase the production of serotonin (the “happiness hormone”) and decrease melatonin (the “darkness hormone”), helping to synchronize the circadian rhythm with the natural environment. Studies show that patients’ need for pain medicine was reduced by 22 percent when they’re exposed to light and a view.

Connection to nature

Benefits: Experiencing nature, whether from a window or sitting in a therapeutic garden has been associated with lowering blood pressure and stress hormones. Conversely, its absence can produce higher levels of anxiety and depression.

Studies show that trees, grass, flowers and flowing water distract and soothe patients without overstimulation. “When you look out a window at the wind in the trees, you can let your mind go somewhere else and think about something other than the fact that you don’t feel well.”

Reduced noise

Benefits: With noise minimized, especially at night, patients experience better rest and less stress, which can speed healing. Studies have shown that quiet neonatal wards may advance development in premature infants. A quieter environment may also help staff perform their duties with fewer medical errors.

Single-patient room design

Benefits: Single-patient rooms not only create a quieter hospital stay, but they also reduce patient transfers and the risk of infection. “With single rooms, patients have more privacy and research has shown they’re more apt to open up and talk to staff when they’re in a private area”. Most modern rooms also feature a specific family area because studies show that social and family support help the patient heal faster.

Serene Color palette and art

Benefits: Hospital rooms painted in soft earth and ocean tones, instead of stark white or intense primary colors, have been found to lower anxiety levels while improving mood and promoting relaxation. Studies also show that art depicting landscapes or ocean scenes is calming as opposed to abstract art, which can be stressful and disturbing for patients.

Planning of the facility in advance

The environment created within the hospital should create positivity around the people who are entering with illness. Factors such as positive distractions as we can name it has a strong impact on the staff and patients, like greenery, worship areas, scenic views, paint colors on the walls, good lighting across all the common areas and as well within the rooms, waiting zones with all facilities for families to relax as they wait for the treatment process to end, reading zone, etc need to be considered for a better hospital stay for the patients and a better working place for the employees and clinicians 

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COVER STORY

Strategic Facility planning in a Healthcare Organisation

Dr. Aniruddha Chimote

Director, Hosconnn Consulting Services Pvt. Ltd The current turbulent market conditions are forcing healthcare providers to re-examine their business model and operational practices. Healthcare is becoming increasingly complex and decisions and planning must be reframed in face of increased demand for services, new global competition and impending legislation reforms. The stress is being felt all around. Administrators and planners are being forced to base their decisions within their respective strategic context and are attempting to align buildings, services, personnel, and technology to an overall plan that looks at markets, operations, and finances as resources for competitive advantage.

Strategic Facility Plan The SFP identifies the type, quantity and location of spaces required to fully support the organization’s business initiatives and should be framed within the organization’s vision. The SFP includes three primary components: an understanding of the organization’s culture and core values and an analysis of how existing and new facilities must manifest that culture and core values within the physical space or support their change, an in-depth analysis of existing facilities—including location, 30

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capability, utilization and condition; and an achievable and affordable (approved) plan that translates the goals of the business plan into an appropriate facility response. Furthermore, to ensure that the SFP is not prepared in a vacuum and that it fully supports the business initiatives of every other department in the organization and the work performed by the organization’s employees, it must be developed holistically with input from all department heads in the organization and end users. The International Facility Management Association has further defined the SFP processsteps as:  Understanding: The thorough understanding the organisation’s mission, vision, values, and goals;  Analysing: The analysis of the organization’s facility needs;  Planning: The development of strategies that meet long-term needs of the organization;  Acting: The implementation of planned strategies. In healthcare today, challenges surface almost daily in terms of finance, reform, government mandates and policy, technology, and customer satisfaction. It is crucial that healthcare leaders step back and continually assess the organization’s strategic plan. In fact, strategic thinking, assessing and modelling are becoming requirements for an organization to survive the turbulent healthcare climate. Various business analysis techniques can be used in strategic planning, including SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats), PEST analysis (Political, Economic, Social, and Technological), to define direction. Throughout the process, strategic planning is the formal consideration of an organization’s future course. All strategic planning deals with at least one of three key business questions:

“What do we do?” “For whom do we do it?” “How do we excel?” We can then create proactive strategies to move from current state to desired state. Information technology is a large part of this equation. Therefore, it is important to be very familiar with the current state of IT, and what you will need in this area to meet future goals. Historically, organizations have developed strategic plans for three‐ to‐five years. However, with healthcare reform, new technology, and staffing issues in the industry, the strategic planning process has become more frequent, and rightly so.

7 Steps to Strategic Planning  Review/Develop Vision & Mission Although many organizations have created vision, mission, goals and objectives, these elements need to be reviewed on a continuous basis. The reason lies in the ever changing environment and business constraints forced upon organizations through government, payers, competition, physicians, patients, vendors etc.

COVER STORY

Each internal department’s vision and mission must be aligned and supportive of the overall business strategy. The mission of an organization is the reason it exists. Usually the mission takes the form of a statement, which conveys a sense of purpose to the employees, patients, physicians and the community. The mission sets the tone for goals and objectives. Information Planning

Technology

Strategic

There is a mutually dependent relationship between the organizational strategic plan and the information technology strategic plan. It is essential that when creating the overall strategic plan, a parallel process is performed to create or adjust the IT strategic plan. They inform each other. For example, if an organization’s leaders decide to start an accountable care organization (ACO), they need to understand the ability of the IT group to support it. Any organization planning to develop new delivery models such as home health expansion, accountable care processes, etc., will require both operational and information technology strategic changes.

 Business and Operational Analysis One of the key objectives of strategic planning is to understand internal strengths and weaknesses as well as external threats and opportunities, i.e. a SWOT analysis. It is critical to engage stakeholders from across the organization – and vendors as well ‐ to provide their points of view. This involvement will not only improve your plan, it will create organizational ownership, which will be important for executing and sustaining the plan. Look at these aspects from an internal and external perspective:  Company culture Company image  Organizational structure  Key staff and overall personnel Access to resources

O perational efficiency Operational capacity Market awareness F inancial resources  I nformation systems and resources

The clear (SMART) goals and staff involvement in the initial committees will help you now.

All possible strategies should be developed based on the inputs. Then the list should be narrowed down to strategies that are within the guiding principles of the organization. Guiding principles identify the “ground rules” and parameters that will inform decision making for your organization. For example, will your organization consider merging with or acquiring another organization to meet its goals? Do you want to outsource certain functions? Another decision making criterion is your organizational capacity. For example, if a goal is to increase revenue in orthopaedics by 10%, are there enough physicians to support that increase in volume? Do they specialize in the services that will meet that goal? You should have a few strategies outlined before you go to step 4.

assessment and plan is complete, leadership may not be able to allocate or assign appropriate funding, staffing or other resources to specific initiatives. The result of improper or inadequate budgets and staffing usually ends with failed strategic initiatives. It is critical to receive leadership commitment on budget and resources before execution of the strategic plan.

E stablish Appropriate Budget and Resource Allocation  Develop and Select Strategic Quite often, once the strategic Options

E stablish Strategic Objectives This step narrows the list even more by applying various models (financial, etc.) to each strategy to determine the effect it will have on the organization. This step is also where key measures and timelines are established or validated. Once the strategies are tested in this way, it can be put together to form the strategic plan. The plan’s components should be specific, measurable, achievable, realistic and time bound (SMART).

 Strategy Execution Plan Now a plan must be developed to implement the chosen strategic options. To be successful, you will need organizational ownership of the plan, which includes not only executive sponsorship, but also the active involvement of all staff members. Communicate the plan to all levels of the organization. Find champions in all areas. Define what is “in it for them.”

 Execution Review One of the critical success factors for effective strategy deployment is constant and ongoing progress reviews. Appropriate reporting mechanisms must be included in the deployment. When issues, challenges, deviations or obstacles are identified, decisions and remediation are necessary – some which may even change the strategic direction. Therefore, it is important to decide who is involved in the review process, and what exactly is reviewed.

Enjoy the benefits Once the strategic planning process is complete and executed, healthcare organizations will experience its multitude of benefits. Strategic planning creates a culture of anticipation and innovation rather than one of reaction and defensiveness. It develops a coherent and defensible base for decision making, improves resource allocation, identifies high-performing and low-performing areas, and provides an opportunity to standardize and otherwise become more efficient, improving the revenue cycle. More importantly, strategic planning helps establish the processes for delivering high quality care, and shapes the organization’s future. Healthcare strategic planning must be an ongoing process. It will be more than worth the time spent! w w w.medegatetoday.com Nov-Dec 2017

EXPERT VIEWS

HEALTHCARE FINANCING IN INDIA:

CHALLENGES & OPERATION Dr. Salil Choudhary

Senior Strategy Consultant, Hosconnn, Bangalore

conomic growth is commonly used as an indicator of a nation’s economic performance, and the level of GDP per capita is a key component of the Human Development Index of the United Nations DevelopmentProgramme, a popular indicator of national well-being. The role of health in influencing economic outcomes has been well understood at the micro level. Healthier workers are likely to be able to work longer, be generally more productive than their relatively less healthy counterparts. India is at the crossroads of an exciting and challenging period in its history. Making healthcare affordable and accessible for all its citizens is one of the key focus areas of the country today. The challenge is immense, as nearly 73% of the country’s population lives in rural areas and 26.1% is below poverty level. While on one hand, India lacks strong healthcare infrastructure, on the other hand, the country has several inherent weaknesses in its healthcare system. However most of the organized private healthcare establishmentsare confined to the state capitals or Tier I cities. Very few have made inroads in Tier II and Tier III cities. This presents the country with both a challenge and opportunity to not only increase the penetration of quality health services but also be the growth driver in these regions.

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The central government has given priority to healthcareand is making significant investments to improve the infrastructure and delivery mechanism jointly with the state governments. The National Health Policy 2017 emphasizes on the infrastructural building of PHCs & CHCs. In order to strengthen the healthcare model the government under the national health policy 2017 have decided to increase the expenditure from the government side: • Increase health expenditure by Government as a percentage of GDP from the existing 1.15% to 2.5 % by 2025. • I ncrease State sector health spending to > 8% of their budget by 2020 •D ecrease in proportion of households facing catastrophic health expenditure from the currentlevels by 25%, by 2025. However, the government alone cannot meet the infrastructure, capacity and delivery shortages existing in the current healthcare system. There has to be increased participation of private sector in the PPP schemes for infrastructure, capacity development and delivery. In order to complement the skills, expertise and resources of each other as well as alleviate the financing burden for the growth and development of the healthcare sector, the private and public sectors are

now working together at a varied pace and working model across the states in India. Some of the successful Public Private Partnerships (PPP) involves laboratory services (pathology, radiology, CT scan, MRI etc.), mobile medical units, PHC management, telemedicine services and hospital maintenance. The models that have been experimented with by the states are: contracting out, contracting in, lease, service agreements (outsourcing), buying of a product/ service, joint venture company, social marketing and franchising. The present inefficiencies and inequities in the public healthcare system in India have pushed forward the need for creative thinking and innovative solutions. New avenues for financing needs to be looked upon and the last few years have seen a boon in the healthcare financing field. Private equity, venture capital, external commercial borrowings, etc brought in new funding options besides long-term debt which was used as the primary mechanism to finance hospitals in India. Given the flurry of activity in the health care sector which includes the setting up green field projects, expanding existing hospitals and acquiring brown field facilities, there is a dire need for innovative funding mechanisms. Considering the huge need gap, rapid rate of growth and capital-intensive nature of hospitals, many players are looking for funding mechanisms beyond the conventional borrowing route.

Avenues for healthcare funding in India PRIVATE

PUBLIC

OTHERS

Debt financing

Annual govt budget for rural health

Foreign donations

FDI

Annual govt budget for urban health

PPP project funding

External commercial borrowing

Govt. funding for community programmes

Funding from various international bodies like WHO,UNESCO,etc

Private equity funds

Incentives and subsidies

Individual investors

Govt. sponsored schemes

Foreign institutional investors

Community based schemes

Venture capital funds

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O & M: Operations & Management It’s a mutual arrangement between the hospitals & Consultants

Dr. Sanjay Agarwal Managment Thought Leader, Banglore

Importance of O & M (Sharing Resources) for small and medium sized hospitals Nowadays this concept of O & M is getting popular very fast among small & medium sized hospital owners. So let’s talk about that. What is O & M: Operations &Management. It’s a mutual arrangement between the owner and the O & M provider where O & M provider completely manage the

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facility and owner pays to the O & M provider for those services. Hospital is one of the most complicated organization in terms of services and operations for 2 reasons, one dealing with human’s life and two so many activities are involved together. Nowadays patients’ expectations are much higher, which makes it challenging further. Because of all this so many policies and protocols are required. To effectively manage this type of complicated environment, highest level of skills, competence and experience is required in each and every area of a hospital. Cutthroat competition which is increasing every day in the field of healthcare also makes it a must. Another fact is that many owners who are clinicians run their hospital well as a single specialty hospital, but the moment they entr into multi-specialty hospital, they really get a tough time, again because of lack of expertise and experience to run a multi-specialty hospital. Now the question is that can small and medium sized hospitals afford this level of expertise and experience to manage

their hospital? Unfortunately the answer is no. Because it’s not viable for small businesses to spend so much on this when your base is small. You cannot deliver on bottom line in small hospitals with such type of expensive resources. Looks like a dead end. No solution!!! It seems that if that is the situation then the only solution is to make your tradeoffs in between a cheaper management with compromised operations or better (but expensive) management with a compromised bottom line. Answer is no and the O & M contract is the solution, where hospitals can have both advantages i.e. very effective management in terms of skills, competence and experience, without sacrificing on bottom line. How is that possible? In fact many hospitals’ owners argue with me that the money which we need to pay to the O & M service provider, we can keep a senior resource who can manage things effectively. Yes, then what’s the problem, still why are they unable to manage. Answer is that it’s a team work, the highest level of services cannot be delivered by one person who is leading the team, but each n every Dep head needs a proper guidance and support. That’s where the role of an O & M service provider comes. What these O & M providers do and how? How they deliver operations so effectively, without making it so expensive to the hospital owners? Simple answer is through “Shared resources”. They keep the talent centrally with them and from there they manage all these units by providing the guidance and support to other key team members sitting at the hospital. That’s how they bring efficiency in a cost effective manner and that’s why outsourcing O & M is considered a best way for small and medium sized hospitals for running their operations. This is the example of an indirect economies of scale. Basically an O & M arrangement delivers 4 things to the hospital owners:

COVER STORY

 Excellent operations and services  Cost saving  Increased top line as well as bottom line S tress free environment to run the hospital O & M is the best way for owners who are clinicians to focus more on the clinical practice without getting bothered about complex operations. It is also a most convenient way to many owners who want to either sell or lease their hospitals, because of relocation. In terms of deliverables, O & M has an extensive list. Though discussing the entire scope is not possible, still want to talk something about Hospitals’ marketing strategy, as most of the time either hospital owners’ overlook that or not capable to handle it well. In last few years scenario has changed drastically for scope, importance & perception about marketing in healthcare. It’s an entire mindset shift for marketing in healthcare. Earlier when healthcare was known only to treat diseases, marketing was not considered as a very relevant thing, but nowadays when it’s not only about treatment, but also about services, patients’ experience and so many other things added like wellness, preventive health etc, makes marketing a very important tool for hospitals to be successful. Marketing is nothing but just to create an awareness in public that you exist in this field, what services you provide and the quality of your services.

I broadly divide hospitals’ marketing into 2 parts; one for the long term impact and two for the short term gains. Long terms plans basically related to the strategy, depending on organization’s long-term vision and values. It’s more of doing good stuff internally and then let people know about it. Most of the short term marketing tools also helps in creating the long term brand value. Strong long term brand planning with an emotional connect is very important. Digital marketing is so important nowadays, in which Website, content, SEO (Search engine optimization) & SEM (Search Engine Management) and managing social media is the key for hospitals. A good CRM is a must to keep your patients engaged and happy. Direct marketing in terms of promotional activities through Brochures, SMS, Emails etc. are also a strong way to create awareness and create a brand value. This also gives a boost to achieve your short term revenue goals. A loyalty program helps to keep your patients attached with you for a longer period of time. As small and medium hospitals are generally not capable to manage all these marketing requirements efficiently, O & M gives them the easiest way out with cost effectiveness 

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Energy Efficient Hospital Design in India:

A New Approach to Sustainability AR. PREETI CHAUHAN

Associate Professor, Department of Architecture and Planning Indira Gandhi Delhi Technical University for Women

ndia is the worldâ&#x20AC;&#x2122;s second most populated country in the world with a population of 1.32 billion. It is projected to surpass China (largest population) reaching 1.7 billion by 2050. There is a shortage of 2 million hospital beds in India at present. Roughly 100,000 hospital beds have been added annually over the last decade and if India continues to maintain this rate, it will fall short of target by 1.6 million beds by 2034. With the need of as many hospitals, we may want to sit back and think about the quantum and quality of buildings we are projected to construct in the near future. Hospital buildings are major energy consumers because of their high demand of heating and cooling for controlled medical parameters and round the clock functioning. In light of present demand and growth of healthcare facilities in India, it is important to understand the energy load on the present infrastructure that will be enhanced manifold in future. When we think about energy that a hospital or any other building consumes, is it only limited to the use of energy saving devices and equipment? or envelope treatment of the building to reduce heat gain?Or can Energy Efficiency be a major role player in the planning and design stage of a hospital project. Is designing a hospital limited to providing an aesthetically functional building? Or patient centric care? Or centralized services? Or is it something beyond just that that may help in an energy efficient building? It is a well-known fact that although the component of expenditure on design of a hospital is meager compared to the expenditure on operation and maintenance of the building, yet the impact of a good design may help in reducing these costs substantially. While designing, many of us concentrated more on concept building and service design in a hospital, Are we also bringing in the relationship between the context and energy efficiency measures? Is it just use of solar panels or rainwater harvesting that may lead to an energy efficient hospital? There are three suggested schools of thought that will add to the above energy efficient measures;

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COVER STORY

 Segregation and Zoning of building components/departments as per their energy need and controlled medical environments.  Patient centric hospitals focus on therapeutic healing environments. India has defined diverse climatic zones across the country. Adopting design interventions to incorporate active and passive heating and cooling techniques may help in reducing energy consumption.  As major population of India resides in rural areas (68.84%), a part of design component may segregate energy demands based on comfort indicators for different regions like physical adaptabilities to heat and cold, socioeconomic base, cultural adaptability and regional lifestyles etc. The suggested approaches may help in significantly reducing energy consumption in these 24X7 running Buildings.

Introduction: Healthcare in India: present scenario and Hospitals as major role players in energy consumption. India faces a huge need gap in terms of availability of number of hospital beds per 1000 population. With a world average of 3.96 hospital beds per 1000 population India stands just a little over 0.9 hospital Number of Buildings

Building Type

beds per 1000 population. To satisfy this demand, the private sector is rapidly building new hospitals with the best of facilities and procedures available, which can compete, with the best hospitals in the world. This raises huge challenges in terms of the energy requirement for all these hospitals and their equipment. Successful hospital planning must be measured over a long term, not just as an inviting and attractive new building but as a structure that supports these intensive and demanding functions on a 24 hour/7 day basis over what is often more than a 50 year useful life. With round- the-clock use and high occupancy, and the need Floor Area (m2)

Annual Energy Consumption (kWh)

OFFICE BUILDINGS 145 55 88 224 10 128 22 89 101

One shift Buildings Three shifts Buildings Public Sector Buildings Private Sector Buildings Green Buildings HOSPITALS Multi-specialty Hospitals Government Hospitals HOTELS Luxury Hotels (4 and 5 Star) SHOPPING MALLS Shopping Malls

16,716 31,226 15,799 28,335 8,382

20,92,364 88,82,824 18,38,331 44,98,942 15,89,508

8721 19,859

24,53,060 13,65,066

19,136

48,65,711

10,516

23,40,939

for high capacity and redundant building systems, a hospital is also a large energy consumer and a prime opportunity for the benefits of green and sustainable design. Hospitals are the most complex buildings when assessed in terms of functionality, construction and need. Unlike any other building it is one of the major consumers of energy. They have multiple users with varied healthcare demands. There is vast diversity in the energy consumption of the different departments in the hospital depending upon the medically controlled environment, user perspective, infection control and functionality. Some areas like the Operating rooms (ORS), Intensive Benchmarking Indices kWh/m2/ year

kWh/m2/ hour

149 349 115 258 141 kWh/m2/ year 378 88 kWh/m2/ year 279 kWh/m2/ year 252

0.068 0.042 0.045 0.064 kWh/bed/ year 13,890 2,009 kWh/room/year 24,110 kWh/m2/ hour 0.05642

Source: Building Energy Benchmarking study undertaken by the USAID ECO-III Project. w w w.medegatetoday.com Nov-Dec 2017

COVER STORY

care units (ICU), Accident and Emergency (A&E); Clinical Labs etc. require specific temperature, humidity and air changes to be maintained throughout the period of use. These impose customized load on energy consumption in the building. This article intends to understand if design innovations in planning a hospital may help in reducing energy consumptions to a certain extent to make the buildings more energy efficient.

Understanding the present approach to hospital design Most of the published researchesemphasize on increasing energy efficiency of hospital buildings by use of low energy consuming equipment, high performance lamps for lighting, maintenance of boilers for heating, co-generation system for producing heat and electricity, central cooling and air conditioning systems with regular maintenance, adopting good building management systems, solar water heating and steam generating technologies, Passive heating and cooling techniques etc. Majorly simple and low cost measures are discussed vastly by many researchers concern mostly controlling heat gain or loss from a building, equipment planning, placement of windows and reflective glass etc., controlled door and window openings, sealing passages of heat flow in ducts, maintenance of machinery and medical equipment on regular basis, thermal insulation etc. Hospital design conceptualizes around many design parameters like patient facilities, dignity and privacy, healing environments, need and expectations, accessible services, adaptable accommodation, multi-functional spaces, evidence based design, need assessment and material preference, lighting and space conditioning types and methods adopted, spaces and their ambience and size have been optimally studied. Integrated and coordinated Design can make a difference to health and wellbeing in a hospital referring to the physical and social environment in a hospital, neighborhood and the community it. Maximizing green spaces, therapeutic environment and sustainable transport solutions is another parameter to design. Many energy efficiency codes like ECBC, BEE, Teri-Griha, LEED etc. have formulated guidelines and parameters for all compliance approaches. These include the building systems envelope, HVAC, Lighting, electrical power, solar hot water and pumping etc. Mentioned below are the primary consumers of electricity in a hospital:

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Baseline Energy use in Commercial Buildings (To be edited)

HVAC system + fans

35 - 50% of the total energy

Lighting

20 - 30% of the total energy

Motors

5 - 10% of the total energy

Medical equipment

10% of the total energy

Computers, Others

5% of the total energy

Maximum Energy Consumption in Lighting and Air conditioning

The rooms with large volumes, long corridors, big size of the building, loss of heat through long pipelines, loss of air conditioning through long ducting systems, steam networks with very long pipes, power loss due to harmonic currents, etc. add upto a large amount of energy consumption in the hospital building. It may be explored that other than all the above mentioned measures for reducing energy consumption in hospital buildings, if we may be able to reduce the length of ducting and exposure and segregate similar functionality areas into various zones without hampering the medical flow-paths, we may be able to reduce the energy consumption to some extent and the values maybe substantially good.This article is the first in series to approach the above-cited issue of energy loss and additional maintenance costs.

SUGGESTED APPROACH: Parameters and theory of sustainable design Energy efficiency consciousness is a not a very old concept in sustainability design. The concept or methodology of energy efficient building design has been either developed as a parallel thought process or an afterthought in major buildings in India. The technologies and methodologies related to the same is concentrating on reducing energy consumption by controlled use and maintenance of medical equipment and advanced building material and technical systems for lighting, heating and HVAC. The prime thrust is to realize energy efficiency as a design tool right from the concept to commissioning of the project. This would help to further reduce the load of electricity consumption in the building and avoid losses due to lengthy ducting and ignorant layout planning. Every healthcare architect must keep in view the four major perspective players in the design and development of a healthcare facility. They are Patientâ&#x20AC;&#x2122;s and other end-users, innovations in

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design, therapeutic healing and energy efficiency. The layout planning plays an important role guiding the way any hospital would function. Other than the medical flow-paths of various departments and their supporting infrastructure for a patient centric design, it is important to know that the placement of vertical and horizontal circulation planning also eases the end users in proper way-finding, security, privacy and reduction in the use of lifts etc. For example, in a hospital major inflowing population per day comprises of maximum floating population (those visitors coming for consultation and diagnostics in the Out-patient Department (OPD), treatment, follow-ups and observations only) as compared to the resident population (patient visitors in the Inpatient Department (IPD), Intensive care units (ICU), Operating Rooms (OR’s) and Accident and Emergency (A&E). if the layout plan is such that the floating population visits are limited to first floor only, then major population visit is pedestrianized and visitors on wheel chairs or otherwise-abled may use the ramp. This would reduce the use of Lifts to a large extent. The resident population, doctors, staff and administrators would use themwho maybe placed at higher levels in the hospital building. Similarly segregating entrances as per user mobility would enhance work efficiency, monitoring and security, privacy and ownership of healthcare workforce, decentralized work placement of reception and information staff from the billing and admissions. The various departments of a hospital building maybe segregated as per energy consumption and functionality. This would help the healthcare planners to design the vertical stacking and horizontal circulations simultaneously and with the use of energy efficiency as a design tool. The segregation would facilitate in  Reducing the length of ducting systems of Air Conditioning, Heating etc. if medically controlled departments are stacked one over the other and the supply from chillers and air handling units may also be stacked vertically. This would also facilitate in maintenance works from the service cores without any disturbance to patients etc.  Reducing the length of electrical cabling and networking throughout the building as per the need of the type of

department like stacking of all OPD areas vertically or placed horizontally over a floor plate. This may help to provide a distinguished and dedicated electrical system, air cooling/ conditioning system etc.  Reduction in the length of medical gas pipelines leading to bed head panels. If the IPD’s are stacked one over the other then the medical gas pipelines, electrical cabling, air-handling units per ward, air cooling/conditioning systems can also be stacked. This block or area may have a dedicated lift and staircase core for the patients, doctors and staff and patient relatives and visitors separately.  Reducing the length of water supply, sanitation and drainage pipelines. Streamlining of dirty and clean services in the hospital.  Reducing the length of pneumatic tube systems ducting and enhancing its functionality by stacking Departments of use vertically. This would enable faster emergency diagnostics from the Labs and vice versa resulting in faster patient treatment and minimizing triage time.  The segregation and stacking system although is a block model system yet every floor is complete in its own capacity. The reduction in lengths of the above mentioned ducts, cables and pipelines would enable a huge drop in the installation costs, maintenance costs and ease of service delivery.  It may also be noted that the OPD and Administration usually functions only till the evening hours in every hospital. If this block is segregated as a separate unit, then after the closing hours, the entire electrical supply to the block maybe shut down. On the contrary where these activities are scattered over different floor plates and different locations, the vertical lift and staircase cores and the lobbies have to be kept lit 24x7. This if observed separately as energy loss may account for a substantial cost.  Thus, Energy efficiency should be treated as a design tool from the inception of the project that would help in substantially reducing the cost of installations, operations and maintenance in a hospital building. A small measure today may lead to long-term benefits.

About Preeti Chauhan Preeti Chauhan is an Architect and Healthcare planner with a postgraduate degree in healthcare planning from MARU, London. She is presently working as Associate Professor in the Department of Architecture and Planning at Indira Gandhi Delhi Technical University for women (IGDTUW), Delhi. Previously she was working as Associate Director(Healthcare) in DDF Healthcare Consultants, a leading architecture and healthcare-planning firm.

She has a vide experience of hospital planning for more than eighteen years. She has designed more than 50 hospitals of various categories in India and abroad. Her objective is to explore innovative design techniques to make Hospitals more energy efficient and also introduce healthcare design as a core subject in the course curriculum in colleges of architecture across India.

w w w.medegatetoday.com Nov-Dec 2017

PRODUCT LINE

Indian healthcare industry in India riding the growth curve

India’s Healthcare Industry Analysis The five areas where PPP contribution can prove very valuable are:

Vivek Tiwari

Founder & CEO, Medikabazaar Health of the nation is the lifeline for its wellbeing. It is the aggregation of the health conditions of its citizens. The Indian Healthcare sector is one of India’s largest sectors, in terms of revenue and employment, and the sector is expanding rapidly. It has emerged as one of the most challenging sectors in India is expected to reach US$ 280 billion by 2020 with an annual growth of 17%. The Indian health care delivery environment is facing distinctive challenges. Inadequate infrastructure and inefficient health care delivery process further intensifies the complexity. It is estimated that almost 15% of India’s population, has absolutely no access to health care services, either due to unavailability or economic reasons. Around 75% of doctors practice in urban areas and 23% in towns, while only 2% 40

www.m e d e g a t e t o d a y. co m Nov-Dec 2017

practice in rural areas leading to very low availability of healthcare in rural areas. The Indian health care system consists of players from public sector, private sector, and other informal networks. The very size, scale, and spread of India are a huge challenge. The industry is largely fragmented with independent and privately run hospitals and health centers. It operates in a largely unregulated environment, with minimal controls on the type of services to be provided. This is further complicated by the usual Indian tendency to lack of standardization and minimal compliance though there are norms and guidelines. These challenges can be addressed efficiently through combined efforts of both public and private sectors by forming suitable public policies especially for health care delivery and incentivizing financing and provision of healthcare, and thereby increase healthcare access to the people. The collaboration between the public and private sectors of the healthcare industry, would foster Public Private Partnerships (PPPs) and encourage investment in healthcare sector to shape the future of Indian Healthcare Industry. There are five major indicative areas where PublicPrivate Partnerships could be introduced as a synergistic model to achieve the objectives of Indian Healthcare sector and the business objective of running a beneficial healthcare facility.

 Infrastructural Development Development and improvement of healthcare infrastructure to ensure that services are evenly distributed geographically and at all levels of healthcare (primary, secondary and tertiary healthcare)  IT Infrastructure of the industry – Establishing IT as the backbone of healthcare in the industry for easy data management and easy and uninterrupted access to healthcare.  Systematic operations and management – Involvement of PPP in operations will ensure efficient services and quality operations and management of healthcare facilities.  Education and Training – Education for formal education and continuing education of professional, paraprofessional and ancillary staff engaged in the delivery of healthcare  Financing Mechanism - Creation of voluntary as well as mandated thirdparty financing mechanisms The privw ate sector investments in healthcare have been driven by free market economy, and the pricing of healthcare services has been largely influenced by investment cost. Consequently, these services have remained out-of-reach of a large majority of our population due to cost consideration. In order to make PPP as a sustainable common ground for both public and private sectors and to evolve successful PPP models, it is essential to have clarity of the public and private sector positions and develop unambiguous criteria for assessing PPP models.

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“SPENCER” BEST EUROPEAN PRODUCER FOR EMS &

AMBULANCE, SAFETY EVACUATION & HOSPITAL EQUIPMENTS

Now Equiped Ambulance Bike in Delhi

Mr. Manish Malik CEO, Spencer, India Spencer India Convention had successfully launched its motorcycle ambulance at New Delhi. Mr. Manish Malik and its team had a lot of preparations to make that event successfully happened. Spencer India had taken the initiative to make India’s emergency transportation service better and advanced. Mr. Antonio ciardella and Mr. Antonino Vilardi from Spencer Italy are also part of this launch. Launching a motorcycle ambulance in India is a very 42

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clever move because we can use this facility in critical-time and conditions like cardiac arrest & multi traumatized patients in an attempt to reduce the response time. Motorcycle Ambulance are a type of emergency vehicle which either carries a solo paramedic or first responder to a patient. A motorcycle ambulance is able to respond to a medical emergency much faster than an ambulance car service in heavy traffic, which can increase survival rates for patients suffering. So, if this kind of initiative taken by other hospitals also to provide the benefits and services of this advancement to other patients. It can help us to save many life may be for more few days or time. The Ambulance bike is very clever idea because its merge a big needs in India and the entire crowded place. It needs in crowded cities like Mumbai, Delhi and even in very narrow roads. One of the biggest problems is to reach on time especially in the case of cardiac arrest.

So, to have the possibility of shifting a paramedic with right equipments on the patient very fast even the spite of the traffic is very important. The bikes are very important because they just carry most important equipments. There is a tracking system for the safety purpose of the driver and to save the time. And all above it is a very light weight device with the oxygen equipments. This is very fast invention to save the life of the patients in emergency case. Spencer believes that it is not just important to sell. Sell can be one short action and we believe in training in fact Spencer India’s trained thousands of people in our installation. We believe in serious & reliable sales services, even in India’s office. We are in special field; our product has been used daily by the pragmatics need to save life. So, they need to work very well way and should be reliable anytime they needed to be used.

marketing@spencer-india.com

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NEOSOFT: Driving Your Business and Clinical Transformation

Mr R. Jaikishan

(CEO, Shivam Medisoft)

ealthcare industry over the last decade has undergone an incredible revolution and is still changing continuously due to new research findings, medical technologies and business models. Moreover, these challenges now are further compounded by the fact that healthcare industry is totally information intensive field where “Fee for Service” has become “Fee for Value” today. Neosoft not only provides IT optimization to its healthcare partners (Hospitals/Clinics/Labs) but also scales up to their ever increasing business analytics needs. With the NABH compliance being necessary, the need for a robust HMS application has become imperative for all hospitals. NeoSoft HMS application has all those advanced features that hospitals are looking for. And, new features are being added more regularly now to meet the hospital management information demands. Moreover, Neosoft application

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having been developed on the in-house developed framework, Shivam has the enviable advantage of delivering hospital software requirements/changes in the shortest time in IT Healthcare industry. The robustness of Shivam’s framework also helps the hospitals to reduce their dependency on the software company. Hospitals having a good IT team can leverage on this advantage and thus reduce their HMS application maintenance charges/cost. With the progress of Healthcare IT into the next phase, patients today desire the same digital informatics services in healthcare as they enjoy across retail and other industries. Anticipating the same, Shivam introduced My EHR App for patients. We have dedicated apps for the medicos, for the owners of healthcare providers and the hospitals to act as a branding tool.

PRODUCT LINE

Every hospital now strives to deliver world class standards of patient care at local costs owing to the historic changes that healthcare is experiencing. Neosoft not only drives the clinical but also the business transformations. It takes care of the patient safety and clinical outcomes, reduces medication error and also improves cost control and operational efficiency. The robust security and offers flexibility to have customized web native function with superior Clinical, Financial and Operational outcomes. Neosoft is an integrated solution of all 3 operations- Administrative, Financial and Clinical. Our analytic tools help hospitals and healthcare providers to gain extra edge through actionable insights and improved service standards. Leveraging technology, Shivam introduced the Go Green Concept of “Paperless Hospitals”. All the transactions in a hospital are done using gadgets like Tabs, mobiles and Desktops. We are happy to share that

few clients who adopted this technology are delighted with the outcomes. Shivam employs professional Tech Team, qualified in JAVA with rich experience; best domain knowledge in hospital management, this strong dedicated team has a excellent track record of successful implementations across India and few abroad locations. Established in 2002, Shivam Medisoft Services Pvt Ltd, is a prominent player in the HMS (Hospital Management Software) segment. The 600+ satisfied clients, the strong technical team, the framework, the dedicated Customer Support Team, the functional knowledge of Hospital operations, etc has evolved NeoSoft HMS into a comprehensive ERP covering all hospital operations (viz from Registration to Financial Accounts) including EMR (Electronic Medical Records). Please visit www.shivammedisoft.com for more details.

DOCTOR SPEAK

STROKE IS AN EPIDEMIC, LET’S BEAT THE DRUMS! Brain Stroke / Paralysis / ‘Lakwa‘/ ‘faalish’ - in its most simplistic description , is the sudden blockade of blood vessels or rupture of blood vessels that supply the brain that can lead sudden neurological manifestations like partial weakness, facial weakness , loss of sensation , difficulty in balancing , double vision , giddiness , slurring of speech , memory and language problems etc. On this world stoke day, it’s high time we discuss about this disease, because despite its devastating nature, general public information and awareness about this condition is still dismally low. Unfortunately, ‘Brain attacks’ (strokes) are still not considered as dreaded as ‘Heart attacks‘ despite the fact that one in every six persons carry a life time risk of a major or minor stroke. It is a giant killer, being only the second largest cause for mortality and the leading cause for serious long term disability and healthcare expenditure! Once in six seconds, somebody dies of stroke and every second somebody suffers a stroke. Moreover, Asians have become more ‘stroke prone‘ over the years, as compared to their western counterparts, and it affects the relatively younger population in our part of the world , thanks to our ‘modified lifestyle ‘ , eating habits and other external factors . Awareness about this disease is important because 80 pc of the strokes can be prevented, if we take care of some essentials.

Dr. Amit Shrivastava Sr. Consultant Institute of Neurosciences PSRI Hospital

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It’s important to become ‘Stroke smart ‘!

HOW TO PREVENT A STROKE

The non modifiable risk factors for stroke are Age (risk increases with age ), Gender ( males are more prone ) and family history of strokes . The medical risk factors are  Hypertension - needs to be identified early and controlled with lifestyle changes, low salt diet and medication  Diabetes - needs to be identified and controlled with diet ,exercise , and medications  TIA s (transient Ischemic attack) - mini strokes that are subtle symptoms which reverse within 24 hrs . They are sentinel warning signs and patients who are intervened at this stage can prevent a major stroke.  Atrial Fibrillation - symptomatic / asymptotic irregular beating of heart that can produce a clot that is then pushed to the brain .  Significant heart disease causing low ejection power of the heart.  Valvular heart disease ( like Rheumatic heart disease )  Critical Carotid stenosis - the narrowing of the blood vessels that supply the brain, can be detected by a simple Doppler test.  Obstructive sleep Apnea - excessive snoring, frequent spells of nocturnal awakenings due to airway obstruction that leads to chronic sleep deprivation.  Fibromuscular Dysplasia

DOCTOR SPEAK

The modifiable Lifestyle risk factors that one can control are Obesity, smoking, excess alcohol intake , sedentary lifestyle and lack of exercise, chronic Stress , poor sleep pattern and Unhealthy dietary habits . The triad of Poorly controlled Hypertension, Diabetes and Smoking constitutes the most important risk factors in our country. Interestingly, heart attacks and brain strokes share common risk factors. In a nutshell , Walk for atleast 30 mins (around 10 , 000 steps every day) /do moderate exercises Control Hypertension and Diabetes, watch your Weight ,have a balanced diet of fresh fruits, vegetables and low fat diet , white meat and fish, practice yoga or meditation to relieve stress and get your heart and the brain pipes ( carotids ) evaluated . Low dose aspirin in men over 45 and women over 55 in at risk patients may be advised. The most important steps in stroke management are early identification and early intervention.

HOW TO RECOGNISE A STROKE.

time is brain , rush to the nearest stroke management equipped center . ACUTE STROKE MANAGEMENT -If Patients referred to a center which is equipped to treat Strokes within the “Golden period “that is 4.5 hrs, it may salvage a lot of ischemic Stroke patients. The treatment of strokes have taken a paradigm shift in the last two decades, with major advancements in drugs and interventional techniques. “Clot buster “drugs can be administered through the intravenous route, intra-arterial route and clots can be sucked out by mechanically by catheters, depending on the case scenario. With Highly advanced state of art stroke centres with dedicated Stroke ICU coming up for treatment, with comprehensive after Stroke Rehabilitation strategies, the care of stroke patients has taken a giant leap, improving the final outcomes by many folds. If we are ‘Stroke Smart‘, we can prevent it to a great extent, and in the unfortunate eventuality of a attack, prudent and timely decisions can save us from a catastrophe.

The much propagated slogan used world over “TIME IS BRAIN “lays emphasis on early treatment. The commonly used pneumonic for this is - F. A . S . T - F for Facial asymmetry, A - arm drift, S - speech difficulty T -

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DOCTOR SPEAK

Early diagnosis and good control of diabetes can save your vision

Dr. Ajay Aggarwal, Senior Consultant, Department of Endocrinology, Fortis Hospital, New Delhi

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DOCTOR SPEAK

Effect on diabetes on eyesight

Uncontrolled Diabetes can affect the eyes and vision in a number of ways. The most significant complication that can cause blindness in people with diabetes is diabetic retinopathy. Diabetes may also cause frequent fluctuations in vision, cataract at younger age, Glaucoma, decreased vision due to involvement of optic nerve, temporary paralysis of the muscles of eyes and thus double vision.

Diabetic Retinopathy

Retina is the layer at the back of the eye that is sensitive to light. Diabetic retinopathy is a term used for abnormalities of the small blood vessels of the retina caused by uncontrolled diabetes. Early form of diabetic retinopathy may not lead to any decrease in vision or symptom. If the care is not taken, then eventually the blood vessels close off. As the disease progresses, new blood vessels form. These vessels are quite fragile and bleed into the eyes causing severe vision problems and blindness. The other risk factors for diabetic retinopathy are high blood pressure, anemia, kidney diseases, and pregnancy. Symptoms of diabetic retinopathy Retina can be badly damaged before any noticeable change in vision; therefore it is essential to have periodic evaluation of eye by an ophthalmologist. Pupils need to be dilated with eye drops, so that ophthalmologist may have a good look at the back of eye. When eye checkup is done annually, doctor is able to catch retinopathy in the early stages. In this stage, the condition is easily treatable. Women with diabetes who are pregnant should have a comprehensive eye examination in the first trimester and close follow-up throughout pregnancy.

Preventive measures retinopathy

for

diabetic

High blood glucose levels are responsible for all forms of diabetic eye disease. Maintain blood sugar level within normal range. HbA1C level should be tested at least twice a year and be aimed at less than 7 percent. Work with your physician regarding medicines, meal planning, physical activity, and blood glucose monitoring for optimal blood sugar control. Your doctor may advise insulin if your HbA1c level is above 7.5% even after taking OAD’s or 9% at the time of diagnosis. The landmark Diabetes Complications

and Control Trial, proved that each 10% reduction in average blood glucose levels, as reflected by HbA1c level, lowers the risk of developing diabetic retinopathy by roughly 60% and lowers the risk of preexisting diabetic retinopathy getting worse by 43%. Don’t miss appointments with doctor. When a person is diagnosed with diabetes, it becomes imperative that one has annual vision tests and eye fundus examination.

It is better to abstain from alcohol and stop smoking

Good control of Diabetes, in addition to minimizing the risk of eye complications, goes a long way toward preventing all diabetes complications and ensuring a healthy life for people with Diabetes.A healthy diet, regular physical activity, weight loss, smoking cessation; limited alcohol consumption and proper medication all are beneficial. Modern insulin delivery device like Novo Pen, thin needles and home blood glucose delivery devices had made diabetes management really convenient. Control diabetes; get your eyes checked regularly and save your vision 

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Blue Heaven

A quarter of the world’s blind population is estimated to be in India, about 12 to 15 million. This is bound to increase as Diabetes is one of the leading causes for loss of vision in India. With an estimated 51 million people currently living with Diabetes, India leads the world in the prevalence of diabetes, and this is predicted to go worse by 2030. This is true that people with diabetes do have a higher risk of blindness than people without diabetes, but it is equally true most people with diabetes can keep these problems to minor. It is very important to realize that good blood sugar control; regular and timely check-up, proper testing and eye care can often save vision by up to 90%.

DOCTOR SPEAK

TRUTH ABOUT STEROIDS IN INHALATION THERAPY "Steroids" are mostly referred to manmade medicines. The two main types are corticosteroids and anabolic-androgenic steroids (or anabolic for short). They're medicines that quickly fight inflammation in your body. These lab-made steroids work like the hormone cortisol that is made by your adrenal glands.

Corticosteroids

Anabolic steroids can make you muscular but affect your health drastically while corticosteroids in inhalers will keep your asthma under control.

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Cortisol keeps your immune system from making substances that cause inflammation. Corticosteroid drugs, like prednisone, work in a similar way. They slow or stop the immune system processes that trigger inflammation. All forms of corticosteroids reduce inflammation in the airways that carry air to the lungs (bronchial tubes) and reduce the mucus made by the bronchial tubes. This makes it easier for you to breathe. Inhaled corticosteroids treat inflammation in the airway, and only very small amounts of the medicine are absorbed into the body. According to the United States National Asthma Education and Prevention Program (NAEPP), inhaled corticosteroids are the preferred long-term treatment for asthma. They are the preferred treatment for longterm control of mild persistent, moderate persistent, or severe persistent asthma symptoms in children, teens, and adults. They help in controlling the inflammation and narrowing of the bronchial tubes. In general, they are part of daily asthma treatment and are used every day.

DOCTOR SPEAK

Dr. Prashant Saxena HOD (Pulmonology & Sleep Medicine), Principal Consultant (Critical care Medicine), Max Smart Super Hospital, Saket.

 Children up to age 4 are usually treated a little differently from those 5 to 11 years old.  The least amount of medicine that controls the asthma symptoms is used.  The amount of medicine and number of medicines are increased in steps. So if asthma is not controlled at a low dose of one controller medicine, the dose may be increased. Or another medicine may be added.  If asthma has been under control for several months at a certain dose of medicine, the dose may be reduced. This can help in finding the least amount of medicine that will control asthma.  Quick-relief medicine is used to treat asthma attacks. But if you or your child needs to use quick-relief medicine frequently, the amount and number of controller medicines may be changed. A recent study reported that, children who use inhaled corticosteroids do not have an increased risk for broken bones (fractures) compared to those who are not using the medicine. A very small difference in height and growth was found in children who were using inhaled corticosteroids compared to children not using them.

Minimum side effects of inhaled corticosteroids Side effects (many of which occur only with high doses) may include:  Sore mouth, sore throat, or hoarseness.  A cough and spasms of the large airways (bronchi).  Fungus infection in the mouth (thrush).  Very slight reduction in growth.  Decreased bone thickness in adults.  High blood pressure in the eye or fluid build-up in the eye (glaucoma). This occurs with high doses of inhaled corticosteroids used over a long period of time. “In inhalation therapy, the medication is delivered directly to the lungs and effects faster than orally ingested asthma medications”. Most asthma controller medicines used in an inhaler therapy contain corticosteroids which are a copy of the steroids naturally produced in our body. But, many people confuse corticosteroids with anabolic steroids.

Anabolic Steroids Anabolic steroids are often misused or overused by some athletes and bodybuilders to gain extreme strength. Anabolic agents are prohibited at all times, both in and out of competition in collegiate and professional sports and appear on both the World Anti-Doping Agency (WADA) and U.S. Anti-Doping Agency (USADA) Prohibited Lists. Anabolic steroid use is also prohibited by the International Olympic Committee (IOC) as well as the National Collegiate Athletic Association (NCAA). Anabolic steroids include all synthetic derivatives of testosterone, both oral and injectable. Examples of anabolic steroids include testosterone, methyl testosterone, danazol, and oxandrolone. Anabolic steroids are performance-enhancing agents and act by increasing lean muscle protein synthesis and body weight, without increasing fat mass. Side Effects That May Occur with Anabolic Steroid Use – There is a wide array of serious side effects associated with abuse of anabolic steroids. Steroid use can alter the normal hormonal production in the body. Common side effects of anabolic steroids may include:  Severe acne, oily skin and hair  Hair loss  Liver diseases, such as liver tumours and cysts  Kidney disease  Heart diseases, such as heart attack and stroke  Altered mood, irritability, increased aggression, depression or suicidal tendencies  Alterations in cholesterol and other blood lipids  High blood pressure  Gynecomastia (abnormal development of mammary glands in men causing breast enlargement)  Shrinking of testicles  Azoospermia (absence of sperm in semen)  Menstrual irregularities in women  Infertility  Excess facial or body hair, deeper voice in women  Stunted growth and height in teens  Risk of viral or bacterial infections due to unsterile injections “The corticosteroids present in inhalers are completely safe and medically approved. They are used in very low doses (micrograms) & researchers have proved that they are so safe that they can be taken over several years. Use of inhalers right from the initial stages allows the patient to have better control of asthma and reduce greatly the recurrence of attacks, besides helping prevent complications. This further helps the patients to lead a normal and active life”.

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EXPERT VIEWS

WEIGHT CYCLING THE YO-YO EFFECT OF WEIGT LOSS AND GAIN Ms. Sakshi Chopra Bariatric Nutritonist, GIHPB and Bariatric and metabolic Surgery Jaypee Hospital, Noida

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he struggle of constant weight loss and gain is real! There are different factors that come into play while reducing the weight i.e. genes, hormones, psychological and social factors and should be acknowledged and manipulated accordingly for consistent results. The weight cycling is generally a result of a yo-yo diet, where you go on an extremely low calorie diet for a certain period and gain back the weight as you switch back to a normal balanced diet. The dieters are successful in their pursuit of losing the weight but fail to maintain it and might experience an equal or greater weight regain. Thus, the yo-yo effect is established where the person is swinging in extreme weight ranges. The various studies that circles around the ‘set point’ and body’s metabolic rate gives a profound explanation to an increased weight regain. The set point theory suggests that the body has a natural set point for storage of fat which is supported by a feedback mechanism that adjusts the metabolic rate in response to a hypocaloric diet. The lower basal metabolic rate may persist even after the transition that happens by switching to a sufficient calorie diet which results in gaining back the same weight or even more .A yo-yo diet which is marked by extremely less calories, skipping of meals and decreased portions are well correlated with the yo-yo effect of weight cycling.

There are various researches that validate that weight cycling alters the body composition with depletion of the muscle which reduces the metabolic rate and further makes weight loss more difficult. This extreme form of dieting has various ill effects on the health in terms of metabolic changes, cardiac health, immunocompetence, chronic diseases and osteoporosis. The need of the hour is to modify the lifestyle by maintaining the intake through diet and balancing the output with the help of physical activity. A holistic and consistent approach towards the weight loss, as well as management should be taken into consideration. This can be done by consistent monitoring of the weight and making small behavioural changes into the day-to-day life. The patient with super BMI with or without co-morbidities like diabetes, hypertension, metabolic syndrome, infertility can also opt for bariatric and metabolic surgery which would reduce almost 70 % of excess weight and major resolution of comorbidities also happens leading to breaking of the cycle. Thus, the aim should be to maintain a healthy weight rather than opting for unrealistic weight goals which are achieved by extreme measures but at a certain cost.

DOCTOR SPEAK

Preventive Screening for

Ovarian Cancer Dr. Amit Agarwal leading oncologist, Delhi &

Dr. Sudhir Borgonha

Chief Medical Officer, Strand Life Sciences

varian cancer is the fifth most lethal cancer seen in women in USA and UK. In India, however, it is the third most commonly seen cancer in women. The most worrisome part is that an increase in the incidence of ovarian cancer in India is noted in women younger than 60 years of age. While ovarian cancer typically develops in Caucasian women in their sixties, a younger slice of the population – ages 35-55 – is affected by

this aggressive cancer in India. Another issue with this particular cancer is that the overall survival rate is only 30% for stage III tumors and 15% for stage IV tumors. In India, most cases of ovarian cancer are detected in stages III and IV. Periodic screening for symptoms of any disease, cancer or otherwise, is the best approach for catching it early. Yet, this old jungle saying does not work very well for detecting ovarian cancer. For starters, the symptoms of ovarian cancer – bloating, difficulty in eating, feeling full and feeling the need to use the bathroom often – are generic enough to lead to a diagnosis of other health problems. So, Transvaginal ultrasound imaging and monitoring the level of CA-125 protein in the blood have been considered as optimal screening tests for detection of ovarian cancer so far. However, the latest update published by the United States Preventive Services Task Force (USPSTF) states that screening for ovarian cancer by CA-125 levels is not of high predictive value. Screening women with symptoms to understand their levels of CA-125 protein in blood, is not a useful strategy for fixing their risk for development of ovarian cancer. This means that a lot of women who get identified as high-risk ovarian cancer individuals by these tests are not actually at risk.

So, what would work as a good screening test? The answer is ad hoc genetic screening for presence of mutations that increase a woman’s risk for developing ovarian cancer.So, screening for the presence of genes involved in this hereditary syndrome is one strategy that can assess risk, far more accurately. In addition, there are other hereditary syndromes, like Lynch Syndrome and Li-Fraumeni Syndrome, which can result in the development of ovarian cancer. There are genetic tests available to understand whether genes involved in these syndromes are also present in a person. Prevention is better than cure, and through the genetic screening for ovarian cancer, one can anticipate the risk or probability of being diagnosed with the same. Therefore, it is highly advised that women go for genetic counselling where there is a family history of cancer and based on their counsellor’s advice get tested for ovarian cancer  54

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EXPERT VIEWS

India is considered a privatized health economy and around 80% of healthcare expenses are borne privately

Vivek Seigell Principal Director, PHD Chamber of Commerce

uman life is only more precious than ever before due to productivity enhancement, thanks to technological advancements, from purely an economic point of view and as also the interdependencies of and on every individual, from a social point of view. Investments and importance of Health sector which we read in print and on web are a testimony which can’t be ignored. The Indian pharmaceuticals market is third largest in terms of volume and Fourteenth largest in terms of value in the world. The country's pharmaceutical industry expanded at a compound annual growth rate (CAGR) of 9.4 per cent in 2013 to reach around US$ 30 billion in 2015 and is expected to expand at a CAGR of 23.9 per cent to US$ 55 billion by 2020. In terms of value, exports of pharmaceutical products from India increased at a CAGR of 26.1 per cent to US$ 10.1 billion during FY06– 13.The country’s pharmaceuticals industry accounts for about 2.4% of the global Pharma industry by value and 10% by volume. The generics market is expected to grow to USD 26.1 Billion by 2017 from USD 11.3 Billion in 2011.(IBEF). Considered to be a highly fragmented industry, consolidation has increasingly become an important feature of the Indian pharmaceutical market.

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Pharma Vision 2020 by the government’s Department of Pharmaceuticals aims to make India a major hub for end-to-end drug discovery. India is considered a privatized health economy and around 80% of healthcare expenses are borne privately, with majority being out of pocket expenses; in this, India is quite different from the USA where insurance pays for more than 90% of health related expenditure and the UK, where a National Health Service covers majority of costs incurred. As per capita income in India was also low ($1800 in 2014), and neither universal healthcare nor universal insurance were available, affordable access to medicines was considered a key policy goal of the Indian government. Thus, economic generic alternatives to expensive medicines were widely available in India which in turn, reduced the likelihood of high priced therapies launching successfully. Given the low per capita income and the lack of universal health care provision and the privatized health care access, the Drug Price Control order came into existence to fulfil a key policy goal of the Indian government - to provide increased access to medicines to people at an affordable price. National Health Policy 2017 is sensible and comprehensive. Significantly, the policy takes a holistic view of the health system and

achieving better outcomes across elements of access, cost and quality—all closely inter-related. The policy looks to increase access to care by expanding coverage to the underprivileged and under-served and focuses on primary healthcare packages with geriatric, palliative and rehabilitative services. It also looks at increasing hospital beds to 2 per 1,000 people from an appalling 1.3 in 2012. Importantly, there is a commitment to increasing the public spending on healthcare to 2.5% of gross domestic product (GDP) to help finance these initiatives. The health policy has also sensibly focused on being cost-effective by focusing on preventive and promotive care and trying to fundamentally change the paradigm from sickness to wellness. This is the need of the hour as its cost effectively improves outcomes. In fact, early intervention reduces costs by 10-20 times vis-a-vis late treatment in the case of diabetes and leads to 85% reduced costs and a 2 times increase in survival rates for cardiovascular diseases. Useful lessons can also be learnt from countries such as Singapore which have delivered world-class outcomes by spending among the lowest levels on healthcare (around 4.5-5% of GDP). Other health systems show that a focus on primary care reduces the mortality and morbidity of cancer and cardiovascular diseases by a good 20-50%.

EXPERT VIEWS

It is also great to see the focus on outcomes such as life expectancy and diseasespecific targets. Worryingly, we have missed achieving millennium development goals in infant and maternal mortality. And, if we don’t address the epidemic of non-communicable diseases, our growth potential will be gravely undermined. The policy also focuses on quality, recognizes the role of the private sector and envisages the creation of a public health management cadre to optimize health outcomes. Talent is a constraint at multiple levels and acceleration of capacity is critical to driving access, which the emphasis on affordability alone will not solve. The PHD Chamber of Commerce & Industry ( PHDCCI) has submitted a representation to the Expert Committee headed by Dr. C. K. Kokate, Chairman, Expert Committee, DGHS, Ministry of Health and Family Welfare, in regard to the replacement of Gelatin Capsules with Cellulose Capsules as also the safety and vegetarian or non vegetarian aspects concerning Gelatine capsules versus HPMC capsules. It may be noted that the DGHS vide notice dated June 02, 2017, had sought views of various stakeholders to address all the technical issues pertaining to replacement of gelatin capsules with cellulose based capsules for encapsulation of drugs. The notice states that “A proposal has been received to replace gelatin capsules with cellulose based capsules which are of plant origin and are safe for use as compared to animal based gelatin capsules”. Ministry of Health and Family Welfare vide order dated 20.03.2017 has constituted an Expert Committee to address all the technical issues pertaining to replacement of gelatin capsules with cellulose based capsules for encapsulation of drugs. The Committee has desired that views of stakeholders including manufacturers/ marketers of HPMC capsules as well as NGOs who are working in this area or involved in this subject may also be obtained so that a considered view can be taken in the matter. In order to examine the pros and cons of the proposal, suggestions/

comments are invited from the Stakeholder/ NGOs/Consumers within 21 days. In the meanwhile, soft gelatine capsules have been given a go-ahead, therefore there is no prima facie issue with the raw material and hence the replacement of the hard gelatine capsules being non-vegetarian is totally misplaced and uncalled for. this connection, at a meeting of the Technical Advisory Board (DTAB) of the CDSCO (the apex body to decide on technical issues) on May 13, 2016, a proposal to label cellulose based capsules with a green dot to indicate its vegetarian origin was considered. The DTAB turned down the proposal for the required amendment of the Drugs & Cosmetics Act on the basis that unlike in the case of food items, the choice of drugs is not that of the consumer (the patient) and is based on the prescription of the doctor where considerations of vegetarian origin or animal origin has no relevance. DTAB also recorded its observation that HPMC capsules are made from a semi synthetic chemical and hence cannot be considered of vegetarian origin. The Supreme Court, in its order dated March 07, 2013, Case No. 641, had ordered that there is no need for non-veg or veg labels on drugs or cosmetics and hence even the red dots which are printed on non-veg products was not implemented for medicines. Gelatine Capsules are consumed by people at large as carriers of important medicines used to cure many terminal and lifestyle diseases. The consumption of medicine is more curative than out of personal choice. Looking at basic fundamental, it is not prudent to enter the Vegetarian and NonVegetarian debate in this matter. It may further be noted, that Gelatine used in the manufacture of empty capsules are derived from an extraction process wherein no animals are harmed or killed for this specific purpose. Only the left over bones having hydroxide and collagen, which is a protein widely found in animal bones (and is not more than 2% of the total value of the dead animal) is extracted through sophisticated machineries in WHO GMP approved extraction and manufacturing

plants. Accordingly it is misplaced to have any notion that Gelatine Capsules are nonvegetarian in origin. Gelatine capsules are totally safe for human consumption. WHO as per evidence certifies Empty Hard Gelatine Capsules for its total safety for Human Beings. And so do the Pharmacopoeia of USA, Japan, European Union, United Kingdom, Australia and India. When a scientific body of the Government of India, the Indian Pharmacopoeia Commission, publishes a monograph on gelatine and empty gelatine capsules how can it then be unsafe? Presumably, the ultimate test of safety of a product is if it conforms to the specifications given in a pharmacopoeias, Several other pharmacopoeias around the world, including the British Pharmacopoeia, the United States Pharmacopoeia, and the Japanese Pharmacopoeia have confirmed its safety.

Technically speaking:  Pharmacokinetics and Pharmacodynamics properties of the drug has to be tested before it is put in to the market if the drug is encapsulated in Cellulose Capsules  Bioequivalence study for each drug would have to be carried out also  HPMC capsules are not suitable especially if the medicine has Potassium ions. Similarly for a few of the drugs, Cellulose capsules were better than Gelatine capsules  At the same time a study of end of shelf life performance for cellulose based capsules needs to be conducted and, hence, the issue of replace of Gelatine should not be taken hastily  The time taken for the above tests of bioequivalence of thousands of drugs and combinations and Pharmacokinetics and Pharmacodynamics properties will take several years followed by the long process of approval from the drug authorities and any such move could mean devoiding the 1.2 billion people of this country of basic medical and health services for that many number of years. w w w.medegatetoday.com Nov-Dec 2017

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Lucknow is Now emerging Market for

–Medical Devices & Technologies

3rd Medical Expo successfully concluded 17-19 November 2017 at KGMU, Lucknow was inaugurated by Sh. Brajesh Pathak (Minister of Law and Justice, Additional Energy Resources ) in the august company of Prof.(Dr.) M.L. Brahma Bhatt Vice Chancellor, KGMU, Lucknow, Dr. P.K. Gupta, President Elect IMA Lucknow and Dr. A.K. Sachan, Managing Director, Shekhar Hospital,& Chairman of Hind Charitable Trust, Lucknow and others. Any market is defined and sustained by quality and quantity of demand and supply. Uttar Pradesh is the most populous state of India, after a long gap of dormant stage, has started rising and gaining its prominence in Indian healthcare. However to achieve the

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desired growth and health for all objectives, Govt. needs to develop meticulous and multi pronged strategy in association with all the stakeholders of UP healthcare. To cater to ever-increasing demand for healthcare services,new healthcare facilities and technologies like telemedicine are required. However there is urgent need to boost the supply of medical products like consumables, disposables, medical devices and equipments. The local manufacturing of these medical supplies would not only enhance the availability of these products but would also affect the afford-ability of healthcare services, as local manufacturing would reduce the costs of supplies as well.

Medical Expo is back again 3rd time to showcase potential of UP Healthcare Market to Rest of India. Medical Expo is only medical event of North India .It's gives me immense pleasure that despite many challenges, we have managed to launch 3rd edition of Medical Expo. I am quite optimistic that Medical Expo would be part of transformation process of UP Healthcare. I would also try to get academicians from IIT and IIM next time to enhance and value add the experience of Medical Expo. Thanks for Visiting & Exhibiting once again to Medical Expo:Gateway to Northern Healthcare. Mr. Ramesh Tripathi Director,Swastik Project and Promoter of Medical Expo

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Medical Expo has been making contribution to UP healthcare market for last three years by bringing the suppliers of medical products, devices and equipments from all over India. All these voluntary initiatives of Medical Expo have helped the stateâ&#x20AC;&#x2122;s healthcare service providers to get easy access to latest products and technologies. These sustained initiatives over last three years have also been inspiring the local manufacturers to develop and produce these products in Uttar Pradesh. State also has all the required academic supports like IIT and IIM to harness the entrepreneurial potential in the healthcare. Swastik Projects promoted Medexpo 2017 conducted two day conference cum work shop on Hospital Planning Designing, Operations and Management. This event witnessed the assembly of the best speakers and thought leaders on various aspects of hospitals from Bangalore, Chennai, Delhi, Patna, Pune and Mumbai. The topics covered were Hospital Planing and designing, Modern OT Designing, Process Management, Materials Planing and Management, Quality Accreditations NABH &NABL, Healthcare Leadership skills, Risk Management, Medical Equipments Planning and Procurement, Media Strategy and Management etc. Our speakers were Dr. A.C. Chimote, Dr. Salil Choudhary, Dr. H.C. Ratti, Mr. Afzal Kamal (Editor-Medgate Today), Mr. Kadu and Mr. Shivam Anand Mr. Kashif Faiyaz from Hosconnn Consulting Services Pvt Ltd. Mr. Venkata krishnanand Mrs Rama Venugopal from Value Added Consulting Pvt Ltd from Chennai also shared their rich experience and insights of healthcare. Mrs. Richa Mishra Chairperson, HIMS also detailed the audience on importance of materials management. While Mr. Ashis Dutta highlighted the importance of good software SOPS in Quality Management, Mr. Zakir Hussain focused on Infection Control. This event also witnesses a detailed presentation on IVF by Dr. SarthakBakshi , CEO, IFC Chain of Fertility Centres. The conference was anchored by Ms. Faraha and moderated by Mr. Kashif. Mr. Manish was instrumental in content planning and Management. Over all it was sort of Knowledge feast for local medical fraternity. Medical Expo once again all set to offer intensive and comprehensive platform for Industry connects. Medical Expo welcomes all the stakeholders of Uttar Pradesh healthcare.

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24MRC NETWORK FELICITATED THE WINNERS OF 2017 LEADERS AWARDS

The 2017 Leaders Awards honour outstanding performance in a wide range of categories. With in-depth categories which cover everything from internal communications to public relations, as well as a wide range of industries from all across India, the Awards explore the full range of the profession, and provide a comprehensive look at the most exceptional example of communication in India. With such a scope, the 2017 Leaders Awards ensure that achievements in all fields are acknowledged. The 2017 Leaders Awards aim to recognise and reward excellence across all sectors, private, public and charity. Open to organisations of any size and individuals, based anywhere for the Indiaâ&#x20AC;&#x2122;s mainly Automobiles, Automobile Components, Aviation, Biotechnology, Chemicals, Construction, Defence Manufacturing, Electrical Machinery, Electronic Systems, Education, Food Processing, IT & BPM, Leather, Media And Entertainment, Mining, Oil And Gas, Pharmaceuticals, Ports, Railways, Renewable Energy, Roads And Highways, Space, Textiles And Garments, Thermal Power, Tourism And Hospitality, Wellness sectors. Entries are encouraged from those that feel they are working smarter than their competitors to create a business edge. Other awards are merely self-gratifying within the industry, these awards provide an unrivalled platform for winners to communicate their success and win more business as a result.

Dr. Udit Raj

Dr. Iftekhar Ahmad Khurshid

PROF. (DR.) M. WALI

(Honorable Member of Parliament & National Chairman of the All India Confederation of SC/ST Organizations)

MORBROS INDIA PRIVATE LIMITED

Avinash Singh & Afzal Kamal

DR. MD. MAHTAB ALAM

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WINNERS LISTED BELOW WITH THE AWARD TITLE -ATULYA NIRMAN MICROFINANCE ASSOCIATION

“FASTEST GROWING BRAND FOR MICRO FINANCE OF THE YEAR”

- AUM CAPITAL MARKET PRIVATE LIMITED

“MOST ADMIRED BRAND FOR WEALTH MANAGEMENT OF THE YEAR”

- DR. IFTEKHAR AHMAD KHURSHID

“MOST ADMIRED HEALTHCARE LEADER FOR CRITICAL CARE OF THE YEAR”

- HAMMURABI & SOLOMON PARTNERS

“MOST ADMIRED BRAND FOR LAW OF THE YEAR”

- IBM INDIA PRIVATE LIMITED

“MOST PROMISING BRAND FOR INFORMATION TECHNOLOGY OF THE YEAR”

- KIDZEE PRE SCHOOL, FATEHPURBERI

“MOST TRUSTED TEACHING BRAND FOR EARLY CHILDHOOD LEARNING OF THE YEAR”

- KIDZEE SARVODYA ENCLAVE

“MOST ADMIRED BRAND FOR PRESCHOOL OF THE YEAR”

- M/S UNITED ENGINEERING INDUSTRIES PRIVATE LIMITED

“MOST ADMIRED BRAND FOR HEAVY MACHINES ENGINEERING OF THE YEAR”

- MORBROS INDIA PRIVATE LIMITED

“FASTEST GROWING BRAND FOR SURGICAL OPERATING LED LIGHTS OF THE YEAR”

- MR. DHEESHJITH V. G.

“MOST ADMIRED LEADER FOR INFORMATION TECHNOLOGY OF THE YEAR”

- MR. KAMAL RAMPURIA

“MOST ADMIRED LEADER FOR FINANCIAL ADVISORY OF THE YEAR”

- MR. RENJIT KESHAV (INSIGHT JOB GURU)

“MOST ADMIRED LEADER FOR TRAINING CONSULTANCY IN KERALA OF THE YEAR”

- MR. SHYAMAL DIGAMBER NASKAR

“MOST ADMIRED LEADER FOR CONSTRUCTION OF THE YEAR”

- MR. WISHWAS JULKA

“MOST ADMIRED LEADER FOR SKILL DEVELOPMENT OF THE YEAR” “MOST ADMIRED BRAND FOR FINANCIAL CONSULTANCY IN DELHI/NCR OF THE YEAR”

- MYCORPORATION CONSULTANTS PRIVATE LIMITED - NAMAN FOUNDATION

“MOST PROMISING SOCIAL RESPONSIBLE BRAND OF THE YEAR” “MOST ADMIRED BRAND FOR ENERGY & UTILITIES IN KARNATAKA OF THE YEAR”

- OMNIPOTENT POWER TECHNOLOGIES PRIVATE LIMITED - POLYGON CHEMICALS PRIVATE LIMITED

“MOST ADMIRED BRAND FOR CONSTRUCTION CHEMICALS OF THE YEAR”

- PORWAL INDUSTRIES

“MOST ADMIRED ETHICAL SME IN MADHYA PRADESH OF THE YEAR”

- S. P. TRADERS

“MOST ADMIRED MANUFACTURING BRAND FOR PLASTIC CONTAINERS OF THE YEAR” “MOST ADMIRED BRAND FOR JEWELRY IN MUMBAI OF THE YEAR”

- SANSKAR JEWELS PRIVATE LIMITED

“FASTEST GROWING BRAND FOR PRE-OWNED VEHICLES OF THE YEAR”

- SHRIRAM AUTOMALL INDIA LIMITED

“FASTEST GROWING BRAND FOR TRAINING SOLUTIONS IN TELANGANA OF THE YEAR” - SKILLS CREATOR PRIVATE LIMITED “FASTEST GROWING BRAND FOR DATA CENTER INFRASTRUCTURE SOLUTIONS IN DELHI OF THE YEAR”

- SKY IT INFRATECH PRIVATE LIMITED

“MOST ADMIRED BRAND FOR INFORMATION TECHNOLOGY IN MAHARASHTRA OF THE YEAR” - TECHNOLOGY XPRESS INFO SOLUTIONS PRIVATE LIMITED -TRIPATH LOGISTICS PRIVATE LIMITED

“MOST ADMIRED BRAND FOR LOGISTICS OF THE YEAR”

- MS. SALMA UDAYAN

“MOST INSPIRING LEADER FOR CHILDHOOD WISDOM OF THE YEAR”

- TEESHOOD.COM

“FASTEST GROWING BRAND FOR ONLINE RETAIL IN WEST BENGAL OF THE YEAR”

- PROF. (DR.) M. WALI

“MOST ADMIRED HEALTHCARE LEADER FOR CARDIO DIABETES OF THE YEAR” “MOST PROMISING HEALTHCARE LEADER FOR URO-ONCOLOGY & RENTAL TRANSPLANT OF THE YEAR”

- PROF. (DR.) ANUP KUMAR

“MOST ADMIRED BRAND FOR IOT OF THE YEAR”&“MOST INNOVATIVE TECHNOLOGY BRAND FOR SURVEILLANCE OF THE YEAR” “MOST ADMIRED HEALTHCARE LEADER FOR DENTAL SURGEON & IMPLANTOLOGIST OF THE YEAR” “FASTEST GROWING BRAND FOR KNOWLEDGE BASED ENGINEERING OF THE YEAR” “MOST ADMIRED HEALTHCARE LEADER FOR DENTAL CONSULTANT OF THE YEAR” “MOST ADMIRED BRAND FOR ANIMAL HEALTH CARE PRODUCTS OF THE YEAR”

Chairman – The Board of Governors & Sr. Professor of Finance, Indian Institute of Finance, Indian Institute of Finance and Editor – in- Chief , Finance India)

- INVILOGIC SOFTWARE PRIVATE LIMITED - DR. TANWIR AHMAD - INTERNATIONAL FERTILITY CENTRE

“MOST ADMIRED HEALTHCARE BRAND FOR FERTILITY OF THE YEAR”

Prof. (Dr.) J. D. Agarwal

- REIT

- DR. MD. MAHTAB ALAM

- SIMFA LABS PRIVATE LIMITED

PROF. (DR.) ANUP KUMAR

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ADVANTAGE HEALTHCARE INDIA 2017

fter the successful launch of the first edition of AHCI in 2015 which was organized by Department of Commerce, Ministry of Commerce and Industry, FICCI and SEPC at PragatiMaidan. The AHCI 2015 witnessed participation from delegates over 57 countries and 110 Indian Exhibitors. The second edition of AHCI 2016 which was held from 3 5 October, 2016 at India Expo Centre & Mart, Greater Noida, NCR – India wasajoint initiative of the Department of Commerce, Ministry of Commerce & Industry, Government of India in association with the Federation of Indian Chambers of Commerce & Industry (FICCI) and Service Export Promotion Council(SEPC). The event had been supported bythe Ministry of Home Affairs, Ministry of Health & Family Welfare, Ministry of AYUSH, Ministry of External Affairs and Ministry of Tourism, Government of India and NABH. The event witnessed participation from delegates over 67 countries and 162 Indian Exhibitors The third edition of AHCI 2017 was held from 12-14 October, 2017 at Bengaluru International Exhibition Centre, Bengaluru, Karnataka. The event was organized by Department

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of Commerce,Ministry of Commerce & Industry, Government of India in association with the Federation of Indian Chambers of Commerce & Industry (FICCI) and Service Export Promotion Council (SEPC). The event is supported by Engineering Export Promotion Council (EEPC), Pharmexcil and National Accreditation Board for Hospitals and Healthcare Providers (NABH). The objective of this international summit was to promote India as a Premier Global Healthcare Destination and to enable streamlined medical services exports from India. This underlying objective is a unique conglomeration of 5Ts, namely –  Tradition – promoting AYUSH and wellness industry  Technology – promoting technologically advanced medical treatment in India  Tourism – encouraging people to travel to India for medical value reasons  Talent – showcasing globally renowned Indian talent in healthcare sector  Trade – creating unique B2B institutionalized linkages AHCI is the first ever International Summit on Medical Value Travel, to be organized in India for promoting services exports from India which brought together stakeholders from more than

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70 countries.The summit presented an opportunity to interact, network and collaborate through the hosted buyers program, the exhibition, the conference along with ASEAN roundtable as well as the visits to some of World class Hospitals, Ayurvedic and Wellness centres in Bengaluru. Inauguration The event was inaugurated by Ms. Rita Teoatia, Secretary, Department of Commerce, Ministry of Commerce and Industry in the presence of Mr. Sudhanshu Pandey, Joint Secretary, Department of Commerce, Ministry of Commerce and Industry, Dr Shalini Rajneesh, Principal Secretary, Health & Family Welfare, Govt. of Karnataka,Mr. Gaurav Gupta, Principal Secretary, Department of Information Technology, Biotechnology and Tourism, Govt. of Karnataka, and attended by senior officers from Ministry of Commerce and other participating Ministries and also attended by more than 700 delegates from 73 countries. Diplomats and senior officers of foreign Missions in India also attended the inaugural function. Exhibition An exclusive exhibition of AHCI 2017 was held at Hall No 1 and Hall No 3 of Bengaluru International Exhibition Centre, Bengaluru, Karnataka. There were more than 160 exhibitors The exhibition, proved to be a great platform to showcase India’s offerings and expertise in healthcare, in terms of Hospitals, Healthcare centres, AYUSH Hospitals, Educational institutions (Medical colleges, Nursing colleges, Pharma colleges & AYUSH colleges), Medical devices and Electronics, Pharmaceutical companies, Pharma machinery and packaging, and associated infrastructure – medical tourism facilitators, Hotels, Airlines, Tour and travel companies and TPAs. The exhibition had seen participation from all major hospital chains like Apollo Hospitals, Naryana Healthcare, Artemis Hospitals, Jaypee Hospital, Aster DM healthcare etc. Government of Karnataka participated as the Host state. There was presenceof Ministry of Tourism, EEPC & SEPC through their dedicated pavilions. Knowledge Paper Release The summit also witnessed launch of the Knowledge Paper titled ‘Indian MVT- a value driven and patient centric initiative’, at the third International Summit on Medical Value Travel (MVT) – Advantage Healthcare India (AHCI 2017). As per the study, government, along with other key stakeholders have taken several steps to improve patient experience when he/she comes to India for treatment. Among other things, medical visa issuance process has been made efficient thus reducing the time taken in visa procurement. The scope of e-tourist visa has also been

expanded to include short term medical treatment. A special category named “e-medical visa” has also been introduced. Separate immigration counters and facilitation desks have also been set up at major Indian airports to boost the Medical Value Travel Industry. The FICCI - IMS Health study was commissioned in order to establish a robust unbiased view of MVT in India vis-à-vis other Asian and developed markets, to understand the factors that attract MVT patients, and to define guidelines that can possibly strengthen India’s position as the most preferred MVT destination in Asia. The study is an effort to bring together policymakers and stakeholders and help them work in conjunction to further strengthen India’s positon as a hotspot for MVT. India has emerged as one of the major hub for provision of care to MVT patients. With the given scale of healthcare infrastructure and the projected growth, India can further strengthen its standing among current popular MVT destinations like Thailand, Singapore, Malaysia, Mexico etc. Various initiatives taken by different stakeholders in the last year have further improved India chances of becoming a ‘provider to the world’. Regional Forums Specific regional forums were organized for SAARC, CIS, Africa and Middle East regions which focussed on the challenges being faced by the hospitals and other stakeholders of the sector and the solutions as well as opportunities for collaboration in areas like skill training, use of technology, hospital infrastructure as well as quality of services. CEO’s Round Table An Indian CEO’s roundtable was organized, Chaired by Ms Rita Teaotia, Secretary, Department of Commerce, Ministry of Commerce & Industry, Government of India and was attended by stakeholders from more than 40 leading healthcare organizations Conference The two day International Conference on Medical Value Travel, featured a conglomeration of CEO’s, policy makers, national and international leaders from healthcare and allied industries who shared knowledge and best practices in the sector, and showcased the various opportunities that India offers to the world in terms of medical value travel. The deliberations, and discussions during the conference and roundtables also led to several issues as well as opportunities being discussed, which led to clear recommendations, for both industry and government which would further help in development of the sector. B2B Meetings The B2B meetings that were organized also led to fostering of business tie ups for clinical research and trials, as well as business cooperation agreements between India and the visiting countries w w w.medegatetoday.com Nov-Dec 2017

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The fourth edition of Hospital Planning & Infrastructurewitnessed 5,438industry professionals representing 2, 60,000+ bedded hospitals, making it the most successful edition till date

fter New Delhi, Nagpur and Kochi, Hospital Planning &Infrastructure (H.P.I.) Exhibition and Summit returned to Mumbai from 6th to 8th October and created a new chapter for the healthcare infrastructure and planning segment in India. The expo established itself as a unique platform bringing together critical stakeholders in the hospital design, build and management cycle with thousands of validated industry buyers including key private and government budget holders and investors, coming together to interact and witness latest innovations and trends from global and domestic solution providers. The Gold Partner for the H.P.I. Summit was DuPont Protection Solutions – Surfaces. Draeger India and Schneider Electric India were Silver Partners. Saint-Gobain India was Session Partner. It brought 5,438 key policy holders and decision makers together under one roof to improve the scope of healthcare construction in India. The expo generated more than INR 220 crores worth business volumes for the exhibitors. A recent study shows that Indian healthcare sector today is worth USD 100 billion and is expected to grow to USD 280 billion by 2020. India requires 600,000 to 700,000 additional beds over the next five to six years; indicative of an investment opportunity of USD 2530 billion. Rural India accounts for over 70 per cent of the population and is set to emerge as a potential demand source. This creates an opportunityfor Hospital Planning & Infrastructure (H.P.I.) to provide an exclusive platform for key stakeholders, potential investors and developers to congregate to address those business challenges. The H.P.I Summit concluded with soldout seminar sessions. The theme for day one was financially sustainable green hospitals. SumeshSachar, CEO, KEF

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Infra gave a presentation on Meitra, India’s first pre-fabricated hospital. The panel discussions for day one covered critical topics like pros and cons of green hospitals and greener hospitals v/s financial viability, the panellists included some of the renowned personalities from the healthcare fraternity like Lalit Varma, VP Projects, Apollo Hospitals; Rajeev Boudhankar, CEO, Bhatia Hospital; Sameer Mehta, Director Projects, Hosmac India and Nithin Hosabettu, Design Director. It was moderated by Gaurav Chopra, Managing Director, HKS India. The second session was on Electric Green: How to wire a sustainable hospital, which was addressed by Aalok Deshmukh, General Manager & Head-Energy Efficiency, Schneider Electric India. This was followed by a topic on Patient centric hospital design: Yet keeping it green by Sandeep Shikre, President & COO, SSA Architects. A case study on retrofitting an existing hospital to be green was presented by U K Ananthapadmanabhan, Director, Tenxhealth Technologies. The day concluded with announcing winner for H.P.I. &Hosmac Energy Efficient Hospital Awards 2017. Apollo Hospitals Enterprise, Navi Mumbai won the award. The theme for day two of the conference revolved around lean concepts to design and build healthier hospitals. Noted speakers and panellists included Joy Chakraborty, COO, P D Hinduja Hospital; Santosh Shetty, COO, KokilabenDhirubhaiAmbani Hospital; Satish Singh, ED, Meditrina Hospitals; Vivek Desai, Managing Director, HOSMAC; Siddharth Shah, Founder, Ascent Health; Shashi Baliyan, Managing Director, ClearMedi Healthcare; Prashant Naidu, Head- HTSI, Philips India; Sameer Singla, Franchise Manager, ASP – Johnson & Johnson. Day three of the conference began with a presentationon bringing execution efficiency in hospital projects by Aditya Kashikar, Capital Programme Manager,

Imperial College London NHS Trust; Importance of surface materials to help control hospital acquired infections by Herdev Singh, Healthcare Segment Leader, DuPont Protection Solutions – Surfaces. This was followed by a case study on technological innovations in bed head units by Ashok Ambhore, Sales Manager, Draeger India Pvt. Ltd. The panel session on this day was on technological advances and hospital design, which was moderated by Vivek Desai, Managing Director, HOSMAC. The panellists included AruneshPunetha, Regional Director – West, Narayana Health; BhumikaJeswani, Lead Architect, Apollo Hospitals; Simi Bhatia, Lab Director – Mumbai; Srl Ltd and Tusharkumar Desai, Vice President – Project Healthcare, Reliance Industries Ltd. On the third day H.P.I. Summit also hosted the second edition of architecture competition in association with Hosmac, the “Hosmac & H.P.I. Architecture Competition (HHAC)” that aimed at helping architecture students get an insight in healthcare design and functioning of healthcare centres. Hospital Planning & Infrastructurein 2018will be hosting a series of conferences in New Delhi, Nagpur, Kochi and Bangalore, by getting the experts from the industry to share their valuable knowledge and experiences to build better healthcare facilities.

INTERVIEW

A Trend-setter in the Healthcare Architecture World

Prof. (Dr.) R. Chandrashekhar

Advisor (Architecture) with HLL Lifecare Ltd. (A Govt. of India Enterprise) Consultant …World Bank & Former Chief Architect with Central Design Bureau for Medical and Health Buildings, Ministry of Health & F W ,Govt. of India

As we know you have a vast experience in healthcare architecture you have done a lot of designing projects on served countries as a chief architect to ministry health government of India according to you please define ideal hospital? Ideal hospital gets defined differently for different people such as for a poor patient an ideal hospital is different than rich and a affordable person but being an architect that too a Healthcare architect an ideal hospital should have a comprehensive approach in terms of planning i.e. planning parameter should include the Infrastructure, medical equipments and the human resources i.e. the manpower. This is the first step of ideal hospital, second as an architect or a promoter when he starts working on a hospitals feasibility project, the importance is given to its Location i.e. whether the proposed site is in a flood prone or tsunami prone or volcanic eruption or earthquake prone or what kind of a zone it is so that he is taking proper precaution at the planning stage. then comes Master planning presently you may have limited fund but your vision should be very clear so that the complete master planning of that plot and its potential usage is been planned and you have already envisage the future growth which we generally show it

in a dotted line in an our plan so that the modular development and modules are getting constructed as per the need and it also gives respect to the upcoming new technological changes, thus when the master plan is done you are making sure that the circulations are well defined that is in terms of patient movement staff movement and if it is medical institution like medical college etc.. The student movement and at the same time the segregation of support services for the hospital as an independent movement. Emergency care is always 24*7 so that is taken care independently. These are the key aspects of circulation in the master planning or the layout planning then comes Macro planning which relates to interdepartmental relationship and functional relationship so that it becomes very clear that what is your requirement for the entire hospital which you have envisaged, and Planning brief is properly made which is shared with the architect and you also define the Stacking.. Stacking is defining the facilities floor by floor. e.g. ground floor we have OPD or upper floor the operation theatres or ICU . then comes Micro planning in which we are trying to see each department in detail and its relationship and independently each department’s future growth too. In a multi speciality hospital where you have speciality like cardiology cardiac surgery, neurology neurosurgery, nephrology urology, etc.. like many other speciality, then it must be ensured that while stacking speciality floor wise, you have to take care that their OPD and their IPD and the faculty area are planned at same floor so that minimum travel distance of clinician and staff will ease out efficiency of the hospital. Highly service intensive area such as the OT, ICU and HDU are planned in one floor because the floor heights also vary generally we keep say 3.6 meter floor to floor height for other areas but when it comes to the operation theatre area we don’t keep less than 4.5 meter due to specialised air conditioning systems and other services. A service floor above OT and ICU area helps accommodating AHU (Air Handling Units) and all services and above, you can have all your residential

unit such as wards etc.. So that all the services like shaft for toilet etc... can be terminated in service floor. The other important aspect is IAQ (Indoor Air Quality) with H1N1 and Swine flu alerting you and the recent Delhi pollution has sensitised everyone about Air Quality. At the same time Doctors are concern with HAI (Hospital Acquired Infection) .Proper HVAC system with not only trapping the Pathogens thru filtration, but killing the same thru latest technologies by using UVGI ( Ultra Voilet Germicidal Irradiation) or using PHI ( Photo Hydro Ionisation) techniques in HVAC system Shortage of Hospital Space and manpower can be resolved only thru adopting use of Technology to bridge this gap. Thanks to our new government where they have promoted the digitization to a greater extent and because of that lot of things get sorted out by virtue of getting into digitization whether it is crowd management, be it parking or OPD scheduling or uses of diagnostics equipment, registration system, the laboratory system or even the operation theatre scheduling and integration of operation theatre where the consultants are consulted through technology through video conferencing and their specialized inputs are taken and that becomes a real saving of a manpower as well as time and not comprising on the quality of care. Safety, besides our standard operating procedure (SOP) like hand washing and infection control parameters The biggest challenge is safety from Structural & Non structural members like false- ceiling, AC duct, plumbing line etc… during disaster like Earth quake if they collapsed how can you evacuate the patient needs to be of great concern while planning. Infection Control parameters to be taken care at planning stage. we have also noticed that copper is anti microbial and it kills the bacteria itself so use of copper is ideal in terms of doors hardware like hand rail or door knob or even the grab bar in the toilet where 80 percent infections happens due to touch surface and the touch surfaces if are made of copper that will be a great resource in reduction in infection. Recently even pillow cover, bed sheets, curtains and hospital linen imbibing copper in the w w w.medegatetoday.com Nov-Dec 2017

INTERVIEW fabric plays major role. we can always use this kind of technology and methodology because time has come that people want safety and an infection free hospital including the clinician as well as the staff working in them. Evidence Based Design what is evidence based design? It is Healing architecture, creating an environment to the patient that helps in healing rather over dosing a patient with anti-biotic. It is best achieved bringing abundant Natural lights in the environment. Researcher have researched to an extent that light on the west side versus the eastern side and reduction in average length of stay of patient and also helped in Pain management. Design the hospital which is, patient centric, staff centric with healing environment and proper standard operating procedure and giving an environment with indoor air quality and indoor environment quality, This is what will be called Ideal Hospital What are the salient feature of Green hospital according to you? Answer â&#x20AC;&#x201C; As you are aware that I am a chairperson of IGBC ( Indian Green Building Council) Healthcare Rating. IGBC have developed a exclusive healthcare rating which is first of its kind in the entire Asia which was released last year is available in IGBC website(www. igbc.in). Even the international standard does not have exclusive green rating for Healthcare. Nowadays even in the government of India we are asking minimum gold rating of IGBC or three star GRIHA rating these are very important GRIHA is Green Rating for Integrated Habitant Assessment and IGBC is Indian Green Building Council and they also follow the ECBC which is Energy Conservation Building Code and similarly the environment protection you have to get an environment clearance etc.. These all relates to when we talk about green. Green is basically How you are trying to save the environment in terms save this planet. what Is important in a Green Hospital is firstly the protection of Indoor Environment Quality (IEQ) and well being in which we do the minimum fresh air ventilation then tobaccos smoke control then what we talk about is Healing architecture in terms of day spaces, connectivity with nature just now I explain to you that green landscape open spaces courtyards and surrounding area healing garden, sometimes even in the rooftop we have a healing garden if this is a multi story structure. 66

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We keep the Site planning with the landscape and healing garden and nowadays we use colour psychology that also helps in a green. Most importantly is the Acoustic design. if there is a noise then the patient may not be able to sleep well and if he doesnâ&#x20AC;&#x2122;t sleep well his parameter like blood pressure and other parameter may be upset so acoustic control is very important then ergonomics... the design of various spaces and the furnitureâ&#x20AC;&#x2122;s are to be stress relieving, also some spaces which we create, just by doing a little creative painting it can be a great healer and use of all low emitting material in the usage of construction that is we call volatile organic compound VOC related issues. Air quality monitoring testing after occupancy . I may create an infrastructure but end of the day I may not be getting the correct distinct, then we also have to take care of the sanitation and hygiene in which the solid waste management then your BioMedical waste management and then Infection control within the spaces which are very important then isolation rooms designs are very essentially taken care in a green hospital. Sanitation design and cleaning practices what you follow. Sustainability comes only when anything which we design is continuously monitored, we may even follow automated solid waste management and organic waste management for a better performance. Energy is one of the key issue. Hospital is the highest energy guzzler, so energy efficiency in a hospital is Key design issue hence all the material including air conditioning system using of LED lights etc.. are very important at the same time bring in as much as day light & natural light, utilisation of solar energy and solar panel using solar photovoltaic for creation of energy these are the key features in terms of saving energy and then comes the water conservation because today we have shortage of energy and at the same time we have a shortage of water, so what you do is Rain water harvesting which is essential, whether through roof or whether various means and efficient plumbing fixtures that will bring out the perfection. Dual plumbing system is one of the major saving of treated water, also waste water treatment and reuse of the same for irrigation, landscape and cooling tower etc... You will be able to see all these feature in our green healthcare rating which has been released by IGBC

So to sum up I can say in a green healthcare facility you have to rate the indoor environment, air quality and sanitation and hygiene then you have a energy efficiency , water conservation ,building material and resources so that they are all in green rated and then site selection, planning and innovation these are the key points on which your entire green hospital is adjudged.. How you will elaborate a smart hospital? Smart Hospital is a type of hospital that is able to share that domain knowledge with the same or other domain and fulfil the requirement of the obsequies and persuasive computing environment. the objective of smart hospital is Patient Centric ,should be Staff Centric then it should be Hospital Centric, in the sense, it takes care of the facility and improve resource utilisation deficiency and financial performance. Innovation is using of various new technologies in which minimum manpower is required and technology take care of things. In short Hospital system which provides facilities that are : Specific, Measurable, Achievable Realistic Time-bound Apart from Green and Sustainable design it will have Smart Patient Room, Smart clinician and Nurses with one gadget providing various information, Patient monitoring Smart device, various sensor based monitor system and E Hospital with emphasis on IT based solutions. Digital information and digital analytics also that is equivalent thought unified communication and integrated audio video and data to allow the seamless and secure communication, high speed reliable networking identification, building automated system, under Digital India, hospital will have digital governance. I believe the smart hospital in the smart city not only in the smart city it has already started in many of the corporate level

INTERVIEW hospital and even in the government hospital, the smartness is going step by step right from crowd management, the IT’s usage for the one time identification number like Aadhar is been linked with everyone so that validated data will be available in a common way with anybody using the portal they can use the data of a person to save him from any fatality. so we have already taken a step towards smart hospital but in a primitive stage , seeing very futuristic, smart hospital to be part of our countries smart cities which are upcoming. What are the major role of a healthcare consultant? As you are aware that Ministry of Health, Government of India is investing in a big way in improvement of healthcare infrastructure particularly under the PMSSY that is Pradhanmantri Swasthya Suraksha Yojana wherein they have already set up six AIIMS like institution and setting up six more AIIMS like institution and many more to come and to support to the cause with the faculty etc.. They have a parallel scheme of up gradation of existing State Govt. medical colleges with super speciality blocks where they add more post graduate seats and these PG students become the future faculty for the upcoming AIIMS and very good healthcare consultant only can fulfil GOI’s dream if the buildings are planned well as I stated about the ideal hospital earlier. Unless these parameters are considered, it becomes very-very problematic. Since Healthcare architecture is little different than the regular architecture because in this you have to account for three major component that is Infrastructure alongwith its Medical equipment and the Manpower unless these are not dovetailed together you may build a huge infrastructure and there is not enough equipment or the equipment planning is not dovetailed, you may find there is not enough space available for certain equipment when it arrives and at the same time you are not aware of the equipment details, hence the planning parameter gets upset and sometimes you may have to break the constructed wall or maybe rearrange the electrical power supply or air conditioning system. Hence comprehensive planning is key factor, so consultant should be knowledgeable and experienced in such approach to the planning. In India shortage of availability of trained Medical Architect was felt and that is the reason we have developed a master’s program for health facility planning and design and the course structure is ready which is approved but somehow due to some of the operational methodology etc..

the course is getting delayed but there are certain private institution who are willing to take up the course. Trained medical architect is the need of the hour , he as a professional to take care of the healthcare architecture because the hospital is highly service intensive where you have to have a knowledge of a specialize air-conditioning and specialize electrical planning, medical gases and modular Operation theatre and integrated theatre these are the key parameter he should be knowledgeable and once he is knowledgeable he will be planning the structural grid accordingly which will have the flexibility in planning. He will also be able to take the challenging remodelling of Existing hospital without disturbing the functioning of existing hospital. when I took over this and trained myself abroad, as you are aware I m the first PhD in the field of medical architecture in India, I felt the need of this subject very badly that is the reason we developed the course structure and similarly we also require trained healthcare engineers. Hospital construction and maintenance is much different than the any other building. How you are connected to the healthcare world after your retirement? Healthcare is my passion which motivates me to leap ahead. During my 32 years of rich experience in the Ministry of Health, all my seniors and my supporters were always motivated me to carry a step ahead that is how you see me today much busier during my post retirement by virtue of offering my services to various people besides my ministry, where I do some of the advisory roles and also to their PSU and various practicing architects who are interested into healthcare and they take my services and I am consulting to World Bank and also some of the peer review consultancy for some of the private institutions, corporate sector and also some of the institutions abroad. As academician I am visiting faculty in various Institutes, sharing experience& knowledge in Conferences and workshops and also highlighting effort of government of India in various forum ,but I know that lot needs to be done but it is always the effort of every individual that matters and I am doing my bit to serve the community because this is the time to give back to the society . As we know the air pollution is increasing day by day and it is a cause of many more diseases also so what is the role of air purifier indeed? Whenever any problem is highlighted,

immediately various companies tries to commercialize some products as an answer, in the process at least some good results are also forthcoming. I am a chief advisor with one company which is called Air Indoor assessment private ltd. it does only the indoor air quality audit of Hospitals, Institutions even residences, and suggests various corrective remedies without recommending or promoting any particular commercial brand. Thru media various sensitisation programmes are done, one has to remember these are the temporary corrective measure for short term. what we have to work towards is the root cause such as how you improve the infrastructure, how you make a public transport so viable so that people will not take car out . These are the some of the things which is to be recognized and I do agree it’s a great challenge in a very heavily populated area, and to undertake this, you need to have a proper professional study and the implementation process. Just by putting a mask or respirator or even buying some machines and trying to analyze your room air quality are few measures which can take care temporarily but core problem needs to be addressed. What is expert advice to the promoter or owner of the hospital while designing healthcare facility? Yes this is actually a summary of my talk today like in the initial stage I said a promoter or a owner of a hospital always interested in a feasibility study. As explained about ideal hospital, he has to take note of all aspect as stated. Whether it is government or private or corporate hospital, the focus is faster turnover of patient .In the case of promoters he expects faster return on investment. I would also advice that they should get into the PPP schemes i.e. Public private partnership ,so the huge amount of investment in terms of Medical Equipment is not with the promoter or the owner. He provides the space in his building and he can do PPP with some diagnostic equipment company so that the equipment is purchased or brought by the company and only they do the revenue sharing which we call it wet leasing that means promoter gives you the space and Medical Equipment co. runs the activity. Each get their agreed share.. Thus Go Green.. patient should be the focus, technology should be the key so that will make a efficient hospital and will also join the wagon of smartness.

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