Management Practices at Hospitals - India

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BMS project to understand healthcare industry in India and future potential. Data and content basis research in year 2006

BMS project to understand healthcare industry in India and future potential. Data and content basis research in year 2006

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  • 1. A project report on Management practices at Hospitals Submitted by: Kunal Bharat Mehta Roll no 21 University of Mumbai Third Year Bachelor of Management Studies Ramniranjan Jhunjhunwala College Ghatkopar (West) Mumbai-400086 1
  • 2. Declaration I Kunal Bharat Mehta of Ramniranjan Jhunjhunwala College of TYBMS hereby declare that I have completed my project on “Management practices at hospitals” in the academic year of 2005-06. I also declare that the information given in this project is true and original and to best of my knowledge. ------------------------Signature of student 2
  • 3. Certificate I, the Principal of Ramniranjan Jhunjhunwala hereby certify that Kunal Bharat Mehta, student of Third year Bachelor of Management studies has completed his project on “Management practices at hospitals” in the academic year 2005-2006. The information submitted is true and original to best of my knowledge ______ _______ Signature of Signature of Project guide Principal 3
  • 4. Acknowledgement I would like to express my gratitude to those who have helped me to turn this project into reality. Firstly I would thank Prof. J. C. Saboo who supported me in each and every aspect related to the project. I would also thank Wockhardt Hospital, Mulund for giving me summer placement and opportunity to get close to Hospital management. I also thank Mr. Mallikarjun (Executive officer) at Wockhardt Hospitals, Mulund, The administrative staff at Bombay Hospital, Marine Lines and at ESIC Hospital, Mulund Kunal Mehta 4
  • 5. Executive summary The job of medical care, today, is no more a one man show. Modern hospital organization involves heterogeneous group of specialized personnel. It is teamwork and successful operation of any hospital organization depends on the services of a large number of personnel specialized in different areas of medical science and management. Thus this calls for an effective and perfect management of hospitals. There is no room for a single mistake in case of hospitals as it can cause a death of the patient and a challenge for existence of the hospital. This project deals with different aspects of management practices followed at hospitals. Firstly the project deals with the hospitals statistics and the importance of hospitals in India. Today Indian hospitals are thriving to provide world class facilities to Indian residents as well as foreigners at best quality standards and prices. Next the project consists of classification of hospitals and the activities at hospitals. This helps the management to form out efficient strategies to make the administration flow smoothly. For this the information was collected from each type of hospitals one is private, one government and one trust run hospital. 5
  • 6. Details regarding the sources of the information in the project  Summer placement at Wockhardt Hospital, Mulund  Personal visits to ESIC and Bombay Hospital  Internet  Magazines and bulletins The project also covers some informative inserts from Dr. Agarwal, Dr. Kamle, it also has interview of Mr. Vishal Bali, President (OperationsWockhardt). 6
  • 7. Management practices at Hospitals Contents 1. Business Of Caring a. Hospitals- The Concept…………………………………. 10 b. Statistics Of Hospital Industry…………………………... 12 c. Indian stand……………………………………………… 14 2. Classification of Hospitals 16 a. On basis of objectives…………………………………… 16 b. On basis of ownership…………………………………… 17 c. On basis of medicine…………………………………….. 18 d. On basis of size………………………………………….. 18 3. Identification Of Activities At Hospitals 19 • Medical services…………………………………………. 19 • Customer care Department………………………………. 20 • Nursing Services………………………………………….21 • Central sterile supply Department……………………….. 22 • Dietics Department………………………………………. 22 • Pharmacy………………………………………………… 22 • Pathology…………………………………………………23 • Radio imaging…………………………………………….23 • House keeping services………………………………….. 24 • Out patients Department………………………………….25 • Engineering ………………………………………………25 7
  • 8. • Ward services……………………………………………..26 • Fire, security and safety…………………………………..26 4. Visit To Hospitals a. Private (Wockhardt Healthcare Centre, Mulund)………. 27 i. Achievements and features……………………….. 28 ii. Wockhardt – Harvard medical alliance……………30 iii. Technology and key expertise……………………..32 iv. Quality management……………………………… 36 b. Government (E.S.I.C Hospital, Mulund)……………….. 37 i. Introduction ………………………………………. 38 ii. Statistics…………………………………………... 40 iii. Model hospitals………………………………….... 42 c. Trust Run Hospital (Bombay Hospital, Marine lines)….45 i. Introduction……………………………………….. 46 ii. Services…………………………………………… 48 iii. Specialties and supportive services………………..49 5. Next Big Business 50 a. Interview of Vishal Bali…………………………………. 51 b. Right investment decisions……………………………….53 c. Future Prospective……………………………………….. 57 d. Eight steps in building a world class facility hospital…… 59 6. Conclusion……………………………………………………... 63 7. Bibliography…………………………………………………… 64 8
  • 9. 9
  • 10. Hospital – The Concept Caring for the sick and infirm and nursing them back to health is not something that one likes to associate with making money. That someone could be profiting from another person’s ill health does indeed, sound rather insensitive. But, then, do emotions really have a place in the world of business? Not quite. The fact is that healthcare is, today, the world’s largest industry. And this industry, comprising pharmaceuticals, hospitals, nursing homes, laboratories, day care centers and others, is slated to become one of the most promising businesses for India riding on the wave of a growing middle class and changing disease patterns. With the passage of time, it is natural that a change in perception is visible. Yesterday, the hospitals were considered as almshouses. They were set up as a charity institution to take care of the sick and poor. Today, it is a place for the diagnosis and treatment of human ills, for the education, training and research, promoting health care activities and to some extent a center helping bio-social research. The document of World Health Organization (WHO) makes a clear-cut exposition of the conceptual aspect. It is stated in the document that the hospital is an integral part of a social and medical organization, the function of which is to provide for the population complete health care both curative and preventive and whose out-patient services reach out to the family in its home environment; the hospital is also a center for the training of the health workers and for bio-social research. 10
  • 11. The viewpoints expressed in the WHO document have enlarged the functional areas of modern hospitals. It is against this background that the hospitals rekindle new hopes and aspirations to the people of the society. The WHO documents further consider hospital a complex organization. It is complex in the sense that multi-faceted developments in the society have made the people of the society more conscious of their rights. Today, they demand modern and the best possible means of medical care and health education. They want everything not only within the 4 walls of the hospital but also at their doorstep or in the vicinity of living places. This has made a hospital a complex organization. Of late, a hospital is also considered a major social institution for delivering of health care, offering considerable advantages to both patient and society. It is considered to be the place for the diagnosis and treatment of human ills and restoration of health and well being of those temporarily deprived of. 11
  • 12. Dose of Healthcare Statistics Healthcare is one of the most essential services in any growing society. Propelled by an affluent and health conscious growing middleclass, the healthcare industry in India grew by more than 13 per cent per annum in the last decade. Market India’s healthcare industry is estimated at Rs 1,500 billion or USD 34 billion. This works out to USD 34 per capita which is 6 per cent of GDP. Of this 15 per cent is publicly financed, four per cent is from social insurance, one per cent private insurance and the remaining 80 per cent being out of pocket as user fees (80 per cent of which goes to the private sector). Two thirds of the users are purely out-of pocket users and 90 per cent of them are from the poorest section. Healthcare statistics India has 5,03,900 doctors, 7,37,000 nurses, 162 medical colleges, 143 pharmacy colleges and 3,50,000 chemists. There are 15,097 hospitals accounting for 8,70,161 hospital beds in India. There is an extensive three-tiered government healthcare infrastructure comprising 23,000 Primary Health Centers (PHC) and 1,37,000 sub-centers serving the semi-urban and rural areas and 3000 (CHC) Community Health Centers 12
  • 13. A Healthy Business Traditionally healthcare has been one of the crucial sectors for any economy. For most of the developed countries, healthcare spending accounts for more than seven percent of GDP. Today, healthcare is the largest industry in the world with revenues of$2.8 trillion. In the US, healthcare is a $1.4 trillion industry, accounting for 13.7 percent of GDP and is estimated to expand to a size of $2.2 trillion by 2008. In India, the industry is worth about Rs.100, 000 crore and accounts for nearly five percent of GDP. Amit Bagaria, CEO of Asian Health Services says, “Not many people realize that it is close to Rs 100,000 crore industry and employs 60 lakh people directly and 20 lakh indirectly. Compare this with the Information technology, which is Rs 40,000 crore and employs only three lakh people. Another important finding is that in the development cycle of an economy, for the last 25 years before a nation reaches developed status, healthcare is the fastest growing industry.” The industry is expected to register a 17 per cent growth and reach a size of more than Rs 2,25,000 crore by 2005-06” Healthcare industry growth (‘000 Rs crores) 13
  • 14. 250 200 150 100 50 0 2000-01 2002-03 2005-06 Indian Stand • India’s health expenditure is 5.6 per cent of GDP, whereas most established market economies spend 7-10 per cent of GDP on health. USA spends over 14 per cent. • US has 2,340 doctors as compared to India’s 143 doctors for very 10,000 people • On an average, 80 out of every 1,000 children die. This figure is just 9 in the US and 30 for every 1,000 in Thailand. • Life Expectancy in India is amongst the lowest at 55.5 years compared to US at 75.5 years and 66.5 years for Thailand. • Compared to Brazil’s 4300 beds, India has only 1,600 beds. Potential The potential of health services sector is immense in India as there are more than 140 million upper and middle class, growing at over four per cent per annum with combined annual income of over Rs 820,000 crore. 14
  • 15. These people have confidence in healthcare products and services offered by private hospitals. The quality of healthcare has improved considerably with the availability of world class high-tech medical equipment and information technology. However, the low penetration of health insurance is limiting the growth of these world-class services. Privatization of insurance sector has led to spurt in health care services. Less than 10 per cent of the Indian population is covered by some form of health insurance. Insurance is expected to be the main driver for raising quality consciousness and increased demand for better standards, hospital accreditation and Patient / Management Information Systems. The voluntary health insurance market estimated at Rs 4 billion is expected to be Rs 130 billion by 2005.The healthcare business for IT services comprises of players like government, insurance companies, consumer and corporate hospitals is about Rs 500 crore which is a pittance compared to the contribution of healthcare industry to national GDP which is growing at a rate of about 10-15 percent annually. The MBPO (medical business process outsourcing) will be the next boom the Indian knowledge economy will witness as it has massive potential for outsourcing within the US healthcare industry. This time outsourcing won’t be the once fashionable and now dead medical transcription, but would be more for processes like medical billing, claim processing, disease coding and forms processing which easily gives returns of USD 16-18 per person per hour, much higher than the billing rates in other BPO verticals. According to a Frost and Sullivan Study, the Indian medical hardware market (equipment and devices) is estimated at Rs 65.32 billion in 2001, 15
  • 16. growing at 12 per cent per annum, which is almost double the market size in 1993. With India becoming a healthcare destination, Health Tourism Industry, stands at Rs 1200-1500 crores, and growing at a rate of 30 per cent annually is bound to grow at a faster rate. Lower production costs and skilled workforce has attracted multinationals to set up R & D and production centres in India. In the long run these R&D centres will help develop low-cost medicines for the Indian market. Hospital – The Classification There are different types of hospitals serving the multi-faceted needs of the society. There is distinction in their structure, function and performance. This variation is due to their distinct nature and form. Classification of hospitals help the management to manage in a better manner as there are many specialties of each type of hospital. CLASSIFICATION ON THE BASIS OF OBJECTIVES The first criterion for the classification is objective. Here the main objective of establishing a hospital is taken into consideration. Some hospitals are set up with the motto of imparting medical education, training and research facilities whereas in some other hospitals, the prime attention is on health care. 16
  • 17. Hospital Teaching cum research General Hospital Special Hospital 1. Teaching-cum-Research Hospitals These hospitals are teaching based. They are found engaged in advancing knowledge, promoting the research activities and training the medicos. As for example, All-India Medical Institute, New Delhi, Post-Graduate Medical Education and Research Institute, Chandigarh, etc… 2. General Hospitals The general hospitals also offer teaching and research facilities but these objectives are secondary. The main objective in the general hospitals is to provide medical care. As for example, different medical colleges and district and sub divisional hospitals. 3. Special Hospitals The main objective of special hospital is to provide specialized medical services. These hospitals concentrate on a particular organ of the body or a particular disease. These are multispeciality / superspeciality / criticare type of hospitals. 17
  • 18. CLASSIFICATION ON THE BASIS OF OWNERSHIP Hospital Private Hospital Government Hospital Trust run Hospital 1. Government hospital The government hospitals are owned, managed and controlled by the government whereas the semi-government hospitals are found acting as an autonomous body. 2. Private hospital These types of hospitals are owned privately and have no government interference. They provide quality service to there customers. These hospitals are internally managed. 3. Trust run hospitals These types of hospitals are under control of the trust and all the decisions related hospitals are taken by trustees of the hospital CLASSIFICATION ON THE BASIS OF MEDICINE 1. Allopathic 2. Ayurvedic 3. Homeopathic 4. Others 18
  • 19. CLASSIFICATION ON THE BASIS OF SIZE Hospital Teaching Hospital District Hospital Tehsil/Taluka subdivisional Hospital Primary Health Centres On this basis, there are variations in the size of the hospitals. As such, the teaching hospitals generally have 500 beds, which can be increased according to the number of students. The district hospitals generally have 200 beds, which can be raised to 300 depending on population. The teshil / taluka / sub-divisional hospitals generally have 50 beds that can be raised to 100 depending on population. The primary health centers generally have 6 beds that can be raised to 10 beds. 19
  • 20. Identification of Activities at Hospitals While designing the organisation structure, management must identify the various activities to be performed in order to achieve the organizational objectives. The major objective of hospital organisation is “care of sick” for which it requires some basic activities on its medical as well as no medical (managerial) side. On medical side it requires clinical activities, general surgical and specialized surgical activities, anaesthesiological activities, maternity activity, nursing activity, pathology and other laboratory activities, radiology activities, pharmaceutical, dental, dietary and house keeping activities are: Medical care is the major function of hospital organisation. Some of the major medical activities are: MEDICAL SERVICES: The medical staff doctors are the back bone of hospital organisation. Doctors may be classified under three categories: • Highly professional - specialized doctors, Honorary specialized doctors and General Doctors) with some / no experience and no specialization in any branch of medical science). • Highly professional, well trained and experienced doctors are the real asset of hospital organisation general duties of doctors include diagnosis of illness or state of illness, instruction to patients, instruction to nurses or the matron about the patients needs by way of 20
  • 21. medicines and other facilities, consulting the medical record of patients, consulting the other doctor or doctors regarding the patients and all the activities which are deemed to be an element of medical care. • The head of the institutions is also a doctor having specialization in one of the medical areas. But a man may be a first class surgeon or physician, but that does not necessarily make him a first class administrator. His duties as doctor itself are very hard and tiring both, physically and mentally. • A apart from this, the head of the institution has to look after so many other things such as supervision and control over personal, purchasing, storekeeping, kitchen, laundry, toilet, maintenance of equipment and instrument etc,. Hospital abroad now has a cadre of hospital administrators who combine some knowledge of medical system with sound management principles. CUSTOMER CARE DEPARTMENT This is the department which has direct interface with the customers either physically or over the phone. This department acts as a single source for a customer in the hospital and is the basic entry and exit point for anybody who visits the hospital for any service. The customer care department functions as a centralized information, registration and billing area. Thus patients and relatives know that they have to visit just one place for all their queries for any of the services available in the hospital. 21
  • 22. The core functions of the department are:  Providing information on the hospital, the services offered, doctors, package charges, etc. to the patient and relatives  Telephone operating, organizing OPD appointments for all in-house and visiting doctors, handling admissions, cath labs, report dispatch etc. NURSING DEPARTMENT Nursing services form an integral part of any hospital. Nursing is both art and science and it’s a profession that calls for commitment, maturity (emotional) and an ability to access and synthesize information quickly and correctly. The nursing staff acts as abridge between doctor and patient. Nursing department works through nursing staff that is competent and humane in its functioning. The staff provides assistance to doctors to carry out treatments efficiently. The nursing staff works in operation theatre, intensive care unit, surgical intensive care unit, intensive cardiac care unit and out patient wards and rooms. Normally nurse patient ratio is maintained at 1:1 in ICU, ICCU and SICU while in other clinical wards it is headed with one head nurse with 30-35 nurses. 22
  • 23. CENTRAL STERILE SUPPLY DEPARTMENT (C.S.S.D.) Infection control is the major activity in the hospitals. CSSD works towards infection control by ensuring medical or surgical supplies and equipment that are cleaned, sterilized, stored and issued for patient care. CSSD uses auto clave machines for steam sterilization, E.T.O (ethylene oxide) sterilizer for cleaning and disinfecting. CSSD provides sterile instruments, linen and dressing materials for the various invasive and non invasive procedures to be carried out during treatment of patients. DIETETICS DEPARTMENT The meal for a patient has an important role in treatment plan. The dietetics department prescribes and provides well planned meals to patient in accordance with there therapeutic needs. Dietetics department also does counseling of patients to adapt and incorporate dietary modification in their daily routine to promote better health status. Dietetics department acts as a link between the dietary prescriptions given by the doctors and the likes and dislikes of the patients. It monitors and executes the therapeutic diet orders through Foods and Beverages services. PHARMACY DEPARTMENT It is the area of increasing importance. This department is often combined with central sterilization and 23
  • 24. stores. The staff has to be well trained and has to be looked after properly at all levels by the pharmacists. The role of hospital pharmacy in ensuring proper care in preparation, labeling, storage and distribution of drugs and sterilized material is of prime significance. Avoidance of any kind of error is the most important here. A hospital in modern era cannot do without good and qualified a pharmacist, who has to supervise, guide and control the performance of its subordinates. Quality control is and important need in this area and hospital structure should encourage and provide all the facilities to the pharmacists in organizing it PATHOLOGY DEPARTMENT The pathology department provides valuable services in the diagnostic areas through various tests. The department has various sections such as Biochemistry, Hematology, Serology and Microbiology. The pathology department conducts following tests:  Routine and special tests in Hemet  Routine and special tests in biochemistry  Hormone Assays  Drug levels  Infection Serology markers DEPARTMENT OF RADIO-IMAGING Radio imaging department plays a vital role in diagnostic work-up of every patient. The department has all advanced modalities/machines available to perform the Radio imaging for diagnostic purposes. 24
  • 25. The modalities which should be available with the department are as follows:  Conventional Radiography  Sonography  CT  MRI  Mammography HOUSE KEEPING DEPARTMENT Their major focus is house keeping i.e. to maintain high level of cleanliness and hygiene conditions in such a way only essential things are kept and its easiest and fastest accessibility is ensured. It is a systematic for better work place. It assigns a place for everything and ensures everything in its place it is a starting point for every improvement activity. The benefits received by house keeping: • Person feels happy while working in clean place • Searching of matter is not required • Less rework in the work is resulted • More productive space available • Anything abnormal is seen immediately • Productivity improvement takes place • Avoids accident prone environment 25
  • 26. OUTPATIENTS SERVICES Out patients services constitute one of the important functions which most hospitals under in their areas encompassing attention to those patients who may not require use of a bed. Generally hospital beds are not available in sufficient numbers, nor are they indicated for all those who need diagnostic services. Beds are costly to build and maintain, and it is often economic waste to utilize inpatients cure when out patients services would serve the purpose. The emergency clinic is major unit of the out patient department. Here the attention to the patients needs must be available around the clock, every day of the year. ENGINEERING SERVICES A hospital is described by some administrators as a ship at high seas. Almost all kinds of emergencies that arise in a ship are required to be attended to in a hospital. Sudden failure in some of the installations in operation theatre I.C.C.U, Kidney units etc. can seriously jeopardize the life of patients. Here some hospitals administrative have advised experience marine engineers in hospitals. These engineers possess the know-how to deal with sudden situations that arise and have to be dealt with without outside help. 26
  • 27. WARD SERVICES Ward is the heart of the hospital where the patients are kept. The major objective of the hospital is to take care of the sick and injured. Other purposes are research in medical field, training and teaching of medical nursing and many other personnel. All these functions are carried out mostly in ward or depend on those personnel who spent most of their time in wards. FIREFIGHTING, SECURITY AND SAFETY Hospital can be victim of fires, theft and accidents. While the first can be dreadful situation for the sick and other relatives, the second and third would result in indiscipline, dissatisfaction and poor and bad image of the hospital. In order to solve these problems it is advised to have a separate section for this as the training, duties and requirements of the staff in emergencies are quite different from other personnel. They are like the ‘armed forces’ having special and important role to play. 27
  • 28. 28
  • 29. Wockhardt’s achievements  24th largest wealth creator  Ranked amongst the 50 most valuable companies in India  Rated among the Top 10 emerging Corporate in India (Economic Times, 1999)  Wockhardt employs 2700 people of which more than 1300 constitute the field force covering 1, 50,000 Doctors  35% of total sales come from International Business  Listed on Bombay Stock Exchange, National Stock Exchange and on Luxembourg Stock Exchange  R&D programme rated among the top 3 in the country with R&D spend of 7% of sales - one of the highest in the country.  Managed by the "Best" Board of Directors in the pharmaceutical industry (Source: Business Today, May, 1997 survey.)  "Pursuit of growth with excellence in the field of pharmaceuticals and healthcare" Profitability through:  Quality of products and services  Increasing investment in R & D  Competent scientific and managerial manpower 29
  • 30. Salient features • A very spacious hospital with carpet area per bed of around 1100 sq.ft. • A 222 bedded hospital, which includes 100 Intensive Care beds, with all its services. • Highest Nurse: Patient Ratio of 1:5 due to which they are better equipped to handle patient's complex health conditions. This is one of the highest nurse patient ratios in India. • The management comprises of highly qualified professionals, who have brought with them rich experience which enables the hospital to be run on truly professional lines. • Central Music System. • Central Paging System. • Central Fire Detection with interlined Central Sprinkler System. • Well controlled & safe climate with soothing ambience are special features of the hospital. • 100% standby power backup for the hospital with critical areas like Operation theatres and ICU further backed up with UPS. • Linen and Laundry Services • A high class Cafeteria on Level 3 • A well setup Chemist Shop. 30
  • 31. • Ambulance services. • Fully computerized system with high end Application Servers & Backup Servers. Wockhardt-Harvard Medical Alliance In pursuance of its vision to establish state of the art medical facilities in India with high degree of clinical excellence Wockhardt Hospitals has entered into an alliance with Harvard Medical International (HMI). Harvard Medical International is a self-supporting subsidiary of Harvard Medical School, which is developing a Wockhardt Healthcare System that sets its own unique standards in patient care in this part of the world. Harvard Medical International (HMI) “a non-profit organization” was established to extend Harvard Medical School’s tradition of improving the quality of health care through excellence in clinical medicine, medical education and biomedical research. Adhering to the standards that have made Harvard one of the most respected academic medical institutions in the world, HMI utilizes the talents of the Faculty of Medicine, its affiliated institutions and selected strategic partners. It has an extensive knowledge base in clinical and biomedical research. 31
  • 32. Drawing upon the resources of Harvard Medical School and its affiliated institutions, HMI is creating unique programs for Wockhardt hospitals committed to high quality healthcare. The guiding principles used by HMI in this relationship are to maintain medical integrity, objectivity and academic independence. Harvard Medical International will associate with Wockhardt Hospitals in improving patient-centered quality care particularly in the areas of:  Facility development  Leadership development  Nursing excellence  Clinical education and clinical investigator training  Quality management  Adapting to managed care environment  Organizational strategic planning and development  IT strategies and provider network development  Faculty development and leadership programs  Quality management and accreditation of systems  Research program development  Joint National symposia on topical issues Another significant endorsement for Wockhardt Hospitals is its tie up with many global health insurance giants. Wockhardt Hospital is the first recognized hospital in South Asia on the worldwide panel of Blue Cross Blue Shield, the largest provider of health insurance in USA. The list of tie ups includes: 32
  • 33.  Blue Cross Blue Shield Association, USA  Bupa, UK  AEA International Inc., Singapore  Global Emergency Services Inc., USA  Medex Inc., USA  Global Medical Management Inc.,USA  Assist America Inc, USA  Gesa Assistance, Singapore Technology The Wockhardt Hospital provides you with the new generation cutting edge medical technology and the world-class quality treatment with care. We possess advanced state-of-the-art facilities and infrastructure benchmarked with the best hospitals in the world. Cutting edge technologies include: • New generation Cardiac Cathlabs with Electrophysiology Labs • Operation Theaters designed to global standards • Sensation 10 CT Scanner • Functional MRI with Spectroscopy 33
  • 34. • OPMI MultiVision, a new generation microscope used for Neuro navigation. • Suite of Endoscopes for Minimal Access Surgery and Arthroscopy • Lithotripsy • Modern Kidney Transplant Units • Intravascular Ultrasound • High Technology Dialysis Units • Cutting-edge technology for Anterior and Posterior Ophthalmic segment surgery Key Expertise Wockhardt Hospitals has conceptualized unique facilities and services, some of which are pioneering global achievements in hospital services: 1. Virtual Family Visit 2. Life Link 3. Health Angel 4. Monitor Your Patients Live 5. Wockhardt Cardiac Line 6. Touch - Screen - Kiosks 7. Specialized Services In Urology, Gastro-Entrology Ophthalmology 8. Laboratory and Imaging services 9. Intra-ocular lens implant and phaco-surgery for Cataracts 34 and
  • 35. 10.A state-of-the-art Dental Department 11.Annual and pre-employment check-ups Wockhardt hospitals prospective employee should have exposure in different facets of HR, viz 35
  • 36. • Competency based recruitment and selection • Competency based training and development • Competencies and performance management system • Creating a culture of competence • Industrial Relations • HR Processes • IT & HR integration • Organization Development Being a service sector there is no particular product but for them their service is the product for marketing. They strive to create a culture that supports empowerment, continuous improvement and customer satisfaction. There is no such thing as a quality problem but it has opportunities to improve. For the quality improvement they have some measures such as customer feedback forms (taken from patients) on which they work upon for further improvements. Some principles followed by Wockhardt Hospital for betterment of total quality management: • Customer is the ultimate determinant of quality. Services and programs are designed with the need of the customer in mind. • Quality is build into the process from the beginning, and not simply derived from customer complaints. All level of an organization is involved in producing the quality product and not just tries to modify it before delivery. 36
  • 37. • When customers are assessing quality, they are not simply comparing us to our performance last year, but to every other organization that is serving their needs. • Since improved quality comes from improvement during the processes leading up to the delivery of the service, all levels and divisions of the organization is involved in developing quality. Quality Management of Wockhardt Hospital  Customer focused organization: - It depends on their customers, and therefore need to identify and understand their present and future needs in order to be able to meet requirements of customers and strive to exceed them.  Leadership: - Management is not an administration activity; leadership is needed to provide unity of purpose and direction, and to create environment in which people in an organization become fully involved in achieving the organization’s objectives.  Documentation and Record Keeping: - Important papers related to the service are maintained with care and their records are kept systematically. 37
  • 38.  Involvement of People: - People’s co-operation and involvement allows their abilities to be fully and effectively used towards benefit of an organization.  Systematic approach to management: - Identifying, understanding and managing a system of interrelated processes for achieving objectives contribute to effectiveness and efficiency of an organization.  Improvement as a regular practice: - It is a permanent objective of an organization.  Factual Approach to Decision Making: - Effective decision is based on the logical and intuitive analysis of data and qualitative information.  Supplier Relationship: - Relationship between the organization and its suppliers has to be mutually beneficial that will enhance the ability of both organizations to add value. 38
  • 39. Introduction The Employees' State Insurance Corporation (ESIC) of India is one of the largest social security organizations providing medical insurance cover and delivering of medical care to 35 million beneficiaries through 140 hospitals and 1500 dispensaries. The objectives of this study are to understand the costing of medical care at ESI hospitals and suggest systems for egovernance to facilitate the coordination between ESIC, ESIS and the beneficiaries. Towards this, selected a large ESI hospital, namely, the ESI General Hospital at Bapunagar, Ahmedabad and gained very useful insights about the systems currently in practice for offering medical benefits to the insured persons and their beneficiaries. This working paper brings out our detailed analysis of the working of ESI hospital, Bapunagar in delivering medical care under the ESI scheme. On papers, the ESI Corporation appears gigantic with 140 hospitals spread all over the country; boasting a capacity of 26,000 beds and 39
  • 40. employing 14,000 doctors and 45,000 paramedics. More than 3.5 crore people are covered under the ESI scheme with annual revenue of a whopping Rs 1,510 crore. Despite this, the scheme has been largely unable to provide quality healthcare services due to poor infrastructure, cumbersome procedures and lack of professionalism. Though a massive premium is collected under the scheme, hardly 16-18 per cent (around Rs 244 crore) of the revenue is spent on the beneficiaries. Three TPAs Chennai-based Apollo Hospitals, Mumbaibased Sedgwick Parekh Health Management Services and Pune-based ICAN Medicare Pvt. Ltd have made a bid for the scheme, it is learnt. Each TPA is said to have presented a different model which the Corporation is looking into. ‘‘It is definitely a positive sign that at least our proposals are being considered,’’ says George Mathew M, managing director, ICAN Medicare. The Labour Ministry has directed the Employees State Insurance Corporation, ESIC to set up a model Hospital with modern computerized facilities and services in each state. He said that ESIC is going to make ten of its hospitals totally computerized in the near future. The Corporation would also establish two to three hospital of specialized nature for treating Cancer, Kidney and Coronary diseases. Shri Yadav said that he would have no objection to open 50% of occupancy of such hospitals to general public on payment basis in order to run these hospitals efficiently. The Labour Minister also disclosed that his Ministry is making a proposal to take back such ESIC hospitals which are not reportedly run by the State Governments properly. ESIC is at present managing 9 of 140 hospitals directly. Shri Yadav said that the coverage 40
  • 41. of the ESIC is not enough and should be extended to bring in more workers within its ambit. Expressing concern over the lack of social security to a majority of workers in the unorganized sector, Shri Yadav said that we will have to look for necessary umbrella security cover to them. He said "the umbrella legislation will aim at providing protection to agricultural workers, construction workers, home-based workers, beedi workers, self employed, artisans and craftsmen. Shri Yadav said that 92% of the 40 crore workers are in the unorganized sector and the Labour Ministry has a tremendous responsibility in looking after the interest of the workers who constitute 40% of the country’s population ESIC India 2004-2005 Number of state covered 25 No of implemented center 687 Employers 2.54 lakhs Insured person 79.10 lakhs Insured women 13.40 lakhs Beneficiaries 307 lakhs Regional/ Sub Regional offices 38 Branch/pay offices 808 ESI hospitals 143 ESI annexure 43 ESI Beds 27099 Specialists 322 41
  • 42. ESI Dispensaries 1452 Insurance Medical Officers 7100 Insurance Medical Practicener 2511 Out patient attendance 8 Crores Inpatients 4.5 lakh Income for 2003-04 1,97,564.00 lakhs Expenditure for 2003-2004 1,17,048.00 lakhs 42
  • 43. Model Hospitals 43
  • 44. To ensure that there are proper secondary care facilities for the beneficiaries, the E.S.I.C has decided to set up one Model Hospital in each State. The proposed Model Hospitals are being identified out of the existing Hospitals to provide all modern infrastructure facilities, staff and equipments as per E.S.I. norms and to act as referral hospitals for the entire State to provide state of art secondary care services. The Model Hospital will have all general specialties along with support services of Radiology, Laboratory, Store and Pharmacy, Operation Theatres, Medical Records, Dietary services, Laundry, CSSD, Engineering services, Ambulance services, Telephone, house keeping, horticultural development works, waste management systems, facility for training, Library etc. To facilitate community services, staff accommodation, cafeteria, parking areas, recreation facilities etc., shall also be provided. To start with, staff to manage these hospitals will be made available on deputation from the State Government for an initial period of 3 years. The details of the Model Hospitals have been circulated to all the State Governments for accord of consent for specific hospitals to be developed as Model Hospital based on accessibility for beneficiaries and availability of staff. The State Governments of A.P., Bihar, Orissa, Tamil Nadu, U.P., H.P., Punjab, Kerala, Rajasthan and Gujarat have sent their consent. To ensure proper functioning, quality assurance programme will be instituted to monitor the functioning of various activities of the Model Hospitals. Recruitment and selection 44
  • 45. Recruitment and selection were as per the guidelines for Central Health Services. Being an autonomous body, the process of recruitment and selection was conducted by the organization, and not through the Union Public Service Commission. An average recruitment cycle for the recruitment of medical officers took one and a half to two years to complete with no certainty of the successful candidates joining the organization. The respondents (doctors) felt that this could be shortened by adhering strictly to the established protocols for speeding up the process. Performance appraisals The performance appraisal was done on the basis of annual confidential reports (ACRs). Nearly half of Insurance Medical Officers (IMOs) and specialists felt that the reporting and the reviewing officers usually did a “generalized/subjective” reporting than a “customized/objective” appraisal and reporting in the absence of output indicators. The role of the reviewing officer was unclear, since he/she was too far away and not really associated with the manner of working of the individual being reported upon. It was felt that this mechanism sometimes results to identical appraisal between a non-optimal and an optimally performing worker. This was a major concern for the respondents. Also identified gaps were practically not followed up for remedial action. These perceptions have the risk of transforming as demoralizing and de-motivating factors for an efficient employee. 45
  • 46. Training process at ESIC hospitals  Induction training– The Regional Office of the ESI Corporation conducted this training. Content areas were informally communicated by headquarter.  Promotional training– No formal promotional training was conducted for doctors. The respondents felt that unlike the induction training program where a reasonably accurate figure was not available regarding the training load, for promotional training, the same could be calculated on a yearly basis and an appropriate calendar for formal training could be drawn up.  Orientation training– Requests for such trainings were processed as per the guidelines of the existing training ‘policy’ document. Regarding other trainings deemed appropriate by the authorities, information regarding the personnel to be sent, the timing of the training was communicated to the individual through his/her immediate superior for compliance. 46
  • 47. 47
  • 48. Introduction Bombay Hospital and Medical Research Centre - an institution in itself Mumbai, the centre for quality medical care not only across India, but also the South Asia. A city that has a rich medical history. Situated in South Mumbai is the Bombay Hospital and Medical Research Centre, the medical hub of India's biggest metropolis. Established over five decades ago, in 1952, The Bombay Hospital was the result of the enormous philanthropy displayed by Shri Rameshwardas Birla, Founder Chairman of the Bombay Hospital Trust. It began as a 440 bed hospital whose objective was, in its founder’s words, “to render the same level of service to the poor that the rich would get in a good hospital.” Today, the hospital has grown to house over 830 beds, some of the country’s most advanced diagnostic & surgical equipment, and offers a comprehensive range of specialized medical services. The objective however, remains unchanged. This is why 33% of the patients treated are in the general ward and pay only for their medicines and consumables. The free OPD at the hospital successfully treats in excess of 1,00,000 patients each year. Ever since it was established in 1952, the Bombay Hospital has instilled in its patients a sense of genuine trust. Trust that has been built by combining superior medical treatment with a caringly humane attitude. Which is why, in excess of two lakh people confidently walk through its hallowed doors every year, year after year. 48
  • 49. It is on this sound foundation that the hospital has based its pursuit of excellence in every field of medical specialization. This has seen fruition in the form of the Medical Research Centre now known as the M P Birla Medical Centre. The Bombay Hospital presently ranks among the finest multispecialty tertiary level medical centers in the country. The internationally renowned panels of doctors and consultants in every field of specialization have, at their disposal, cutting-edge equipment. Supported by a highly trained and professional nursing staff. Little wonder then, that the Bombay Hospital attracts patients from every strata of society. Be it a factory worker from rural India, a high-flying executive from a multinational company or the likes of former Prime Minister and Governor of Maharashtra. The Bombay Hospital has 830 beds, of which 300 beds are free and another 200 beds are heavily subsidized. About 60% of the operations performed by our surgeons are free or against very nominal charges. On this bedrock of charity relentlessly building the bedrock of excellence in the Hospital by continuously refurbishing its spaces, installing the most modern medical equipment and injecting professionalism and dedication in management team, so that world class doctors can discharge their duties and responsibilities in an academically stimulating and hassle-free environment. 49
  • 50. A patient being treated in one of the many Deluxe Rooms of the hospital A quick glance at Bombay Hospital and Medical Research Centre • 4 buildings with 5,00,000 sq. ft.built up area • Total number of beds: 830 • Critical care and recovery area: 110 beds • 22 operation theatres • 3200 full-time employees • 240 eminent consultants • 200 skilled resident doctors R D Birla International Cardiac Centre • The country's latest Coronary Artery Bypass Grafting Complex • 35 recovery rooms • 4 dedicated operation theatres • Two cath labs & angiographies • 1800 surgeries and 4000 angioplasties & angiographies conducted every year Department of Neurosurgery and Neurology • Capable of treating all types of brain tumors and spinal surgeries • 4 dedicated operation theatres • 18 post-operative beds in the recovery room 50
  • 51. • Equipped with operating microscopes, CUSA Department of Orthopedics • Complete hip/knee/shoulder/elbow replacements done • 5 dedicated operation theatres • Spinal corrective surgeries performed • Trauma care centre Department of Cancer • Surgical treatment • Radiation therapy • Chemotherapy • Comprehensive cancer care Other areas of specialization • Plastic Surgery • Pediatrics • Medical oncology • Ophthalmology • Dental Care • General Medicine Supportive Facilities • M P Birla Library • Museum • S P Jain Auditorium 51
  • 52. • Birla Matushree Sabhaghar • Nurses Training Institute • Pharmacy • Executive Health Scheme 52
  • 53. Vishal Bali (Vice President-Operations Wockhardt Hospitals) How do you assess the impact of corporate hospitals on healthcare sector? There has been a sea change in accountability and today’s managers realize that it is equally important for their institutions to excel both in clinical arena as well as delivering consistently on patient service expectations. How different is running a corporate hospital from a trust hospital? The style of management will always be different primarily because the methodology for both is different. While the decision making in a trust hospital takes into interest the divergent opinions of various trustees, the corporate hospital will have a faster decision making process for it gives higher accountability to the operating team. How different is Indian pattern of hospital administration as compared to the west? The administration systems of corporate hospitals in India compare favorably to those of the hospitals abroad primarily because the hospitals here have adopted a leaning system from the West and have a constant exposure to those facilities. 53
  • 54. We need to basically improve and make a differentiation that administration is not the same as managing the hospital. Our systems need more and more managers rather than administrators. How has hospital administration in the corporate sector changed? There has been a sea change in the accountability and today’s managers realize that it is equally important for their institutions to excel in the clinical arena and delivering consistently on patient service expectations. As enterprise expands what will become critical is that the healthcare system speaks a common language irrespective of the specialties. What is the pattern of administration for Wockhardt? All our hospitals are professionally managed by group of professionals who are both by education and by experience experts in the field of hospital management. Wockhardt is associated with Harvard Medical International (HMI). Do you in some ways follow the administrative pattern of HMI? Wockhardt’s association with HMI has benefited us immensely in setting systems in the clinical and administration which conforms to the standard followed by Harvard Medical School. What has emerged is a focus on training and education on an ongoing basis within our healthcare system. 54
  • 55. How to make THE RIGHT INVESTMENT DECISIONS while planning a hospital project? Making right investment decisions while planning a hospital project is crucial to its long-term sustainability. This is because; project costs directly influence the pricing strategy of services. There have been numerous instances of budgeting going haywire leaving the poor patients (who often have no choice) to foot the bill, say consultants. To steer clear of a negative balance sheet, budgeting time and money right at the conceptual stage of building a hospital is essential, feel experts. Hospitals are in red because their investment plans are not based on budgetary allocations for different infrastructural areas, says Dr C P Kamle, an international associate of American Institute of Medicine and Hans Finne International. A botched hospital project may have several reasons for failure. Broadly, project costs can be split in the ratio of 60:40 for construction of the building and capital expenditure towards equipments respectively. Alternatively, it could be 40 per cent for building; 40 per cent towards equipments; 10 per cent towards operational expenses; and the rest for human resources. This later model was followed in the case of Apollo Indraprastha hospital in Delhi. Project analysis 55
  • 56. Dr Kamle says 3-4 percent of the total budget should be allocated for preproject analysis. “It is necessary to spend on preparing a good technofeasibility report, which will also have competitor’s structure, disease pattern, and SWOT analysis of hospital”. Experts say a sound project analysis can facilitate acquisition of finances on softer terms. “I have come across cases where promoters have copied reports from other hospitals. The result is that banker is reluctant to fund as there is a question mark on project feasibility. This delays the project further and also increases the costs,” explains Dr Kamle. Concurs Dr Kothari, “Financial feasibility report must work like a bible and project finances must be tied up accordingly. Project management is all about completing with quality and containing cost.” What is also essential is frequent project assessment, he adds. Infrastructure Dr B V Venkatesh, administrator, HOSMAT hospital, Bangalore says the process of budget allocation for hospital infrastructure is two fold. A hospital has to allocate 70 per cent of its budget for good quality infrastructure. Quality infrastructure will definitely reduce the maintenance cost in the long run. Land cost According to Dr Kamle, land should not be bought anywhere simply because it is cheap. Water availability, soil, air direction, natural sunlight, etc, have to be taken into consideration, he says. “For example, if ample sunlight is not available, one has to go for artificial illumination, which in turn increases initial plus recurring costs, not to mention that natural light aids speedy recuperation.” Land cost should come within the five per cent 56
  • 57. limit of the total investment, says Dr Praneet Kumar, head, strategic planning, Fortis Heart Institute. “In Mohali, Fortis spent eight to nine per cent of the investment (Rs 13.5 crore) on land acquisition. This high price would also affect the pricing of services. Medical equipment Allocation for medical equipment generally accounts for 30-40 per cent of the total cost. Experts say it is very important to stick to the allocated figure. However, this is hardly the case. “Not more than 10 per cent of people think of budgetary allocation while shopping for equipments. Most buy them because it is a fad to install sophisticated equipments. This is also true for implementing process management tools,” says Dr Kamle. Having said that it is important to realize that at these competitive times, it always pays to acquire cutting-edge technologies. Apollo Delhi ploughs back 80 per cent of its revenue every year in to technology up gradation, according to managing director Dr Yogi Mehrotra. Similarly, Wockhardt Hospitals, Bangalore spends around Rs 1.5 crore every year. Says Dr M E Yeolekar, dean, Lokmanya Tilak Municipal General Hospital, “In up gradation of equipments, departments like cardiology, orthopedics, obstetrics, gynecology, radiology and diagnostic are given priority since there is a high turnover of patients here. Hospitals tend to discourage purchase of expensive equipment with limited utility. Equipments for rare disorders always take a backseat. Funds are canalized in buying equipments, which serve multiple departments and for diverse ailments. For instance, a C-Arm serves the departments of surgery, orthopedics and different other sub-specialties.” 57
  • 58. Human resources Human resources form a most important link in hospital management. This function accounts for 12-18 per cent of the project cost. Here again, hospital adopt different strategies. The popular one is to lure specialists from other competing hospitals. This, feel experts, could be detrimental in the long run since the sense of ownership is lost in financial bargaining. Dr Kamle feels that hospitals should employ full-time specialists and encouraging them by providing remuneration along with perks and foreign trips proportionate to the work generated for the hospital. This, say others, will instill a sense of ownership in their minds resulting in overall growth in business prospects. Operations While running a hospital, methodological calculation of economics must be the norm. “Profit centre mechanics demands that each department be converted into a profit centre. Profit does not mean commercialism. The money has to be ploughed back in so many ways like salaries, up gradation, maintenance etc. Even a front office or house keeping gives profits, though intangible,” explains Dr Kamle. “For instance, in case of a department like radiology, depending on investment, costing is done, revenues are calculated and budget is allocated on the basis of this projected revenue. The head of department must be then entrusted with 58
  • 59. the budget and is responsible to run it profitably,” he elucidates. Lokmanya Tilak Municipal General Hospital, with 1400-odd beds spends around Rs 3.5 to 4 crore annually on its infrastructure maintenance. Dr C P Kamle, Future prospective In order to capitalize on all these opportunities, we have to create a conducive environment by: Attracting investment • Granting infrastructure status to the healthcare sector. • Create fiscal policies, like providing low interest rate loans, introducing tax holidays for investment in low per capita income states, reducing import/excise duty for medical equipment, et cetera, to promote investment in healthcare services. • Facilitating various clearances and certification like medical registration number, building number, anti-pollution certificate etc. Changing the legislation • Mandating the employers to buy group or individual medical insurance for their employees to ensure a certain minimum financial coverage. • Mandating the private sector units, that takes advantage of improved fiscal policies, to commit resources to remote rural/under developed sectors. 59
  • 60. • Create an autonomous body to standardize on medical messaging, codes and vocabulary, content and format, identification standards and security. • Mandate the healthcare service providers to transmit selected patient data to the government for analysis. This data will be analyzed to identify trends and evolve policies. • Create a national database of health care providers, their facilities and services. This will create awareness among the population towards quality health care. • Streamline the process of handling patient grievances. • Create a nation-wide agency to deal with patient requests like ambulance hotline, emergency/first-aid consultation, trauma helpline etc. IT initiatives • Sharing of patient information between providers, with patient and payers. • Security and privacy services. • Need for standards for messaging, codes and vocabulary (CPT, ICD), content and format standards (MR, lab report) To witness a successful revolution in healthcare, we need to bring these arrays of activities together. If this works for India over the next decade, the vast population living in rural and urban areas will bear the fruit of success 60
  • 61. Eight steps towards building a world class facility hospital Hospital management is totally different from managing any other property. Be it hotels or corporate buildings the plan and purpose of their infrastructure is totally different from that of a hospital. The following are some of the tips that hospitals must keep in mind to erect a hospital with an effective infrastructure. Location Building a hospital is not an easy job. If there is one thing that the industry agrees on, it is the fact that clients or ‘patients’ who come to the hospital are not there out of choice. They visit a hospital because they are forced to do so. In this scenario the first thing that I would look at before setting up an infrastructure is the location of the hospital. The property must be accessible to people from all walks of life. Unlike certain industries that cater to the rich who can afford their own mode of transportation, hospitals must be accessible to everyone. This location should be one that can be permanent since people associate a hospital with a location. Vehicle Parking 61
  • 62. The second thing that I would look at is the space for vehicle parking. Though most of our hospitals are in the main road we try to set up our property where we are also connected to a small lane wherein people can park their vehicle. Setting up our properties in L-roads reduces the trouble for the patients to search for vehicle parking. Building Building is another major area that one needs to look at carefully before setting up a hospital. The facility for outpatients must be different from those of the in-patients. Outpatients might bring in infections with them, which might spread to the inpatient that has undergone an operation. Hence an inpatient area must be accessible only to the inpatients. Construct the hospital in a way that the two need not any time have to use the same area. Operation theatre Gone are the days when loved ones of the patients waited outside eagerly to know how an operation went on. All our operation theatres have an observation gallery from where attendants can watch and see how the operation proceeds. This way they would know exactly what was happening in the room, which increases the awareness of operations amongst the general public. At present this is being implemented in a few hospitals but as awareness increases patients would look for a hospital that is transparent. So while building a new hospital it is best to build it according to the latest standards and guidelines though you might spend a little more. Another facility that could be included is to be able to talk to those in the observation gallery right from the operation theatre. This 62
  • 63. further reduces their fear and assuring that the doctor is in touch with them. Equipment Remember that a hospital is not a five star hotel. We need 5-star doctors with good surgical skills. People do not come to the hospital for its ambience. They come because of the efficient staff and the equipment handled by them. While it is very important that your hospital is hygienic, clean and comfortable it would be foolish to make it look like a 5-star hotel and hike the prices. Monitoring activity Monitor every activity that happens at the hospital. In our hospital we have cameras in the operation theatres and I an able to see what happens in all the four operating theatres. A television is kept in the outpatient area where they can also get a feel of what happens at the hospital. This kind of a transparent atmosphere eases any fear. Train your staff The patient comes to the hospital as a last resort. When he comes in he does not want to feel dejected further by the attitude of the staff. Hence the staff needs to be trained to be courteous to people. Have a counselor at the hospital that would be there for the patient both during pre and post operation period. Our post operation counselor at the hospital dials all the 63
  • 64. patients who have undergone the operation that particular day to ask them how they feel etc. Maintenance Building a hospital is not over with developing infrastructure and starting operations. The success of the property depends on constantly maintaining and updating the facilities. Employ an effective housekeeping department that can constantly maintain the hospital. Appoint microbiologists to test the sterilization levels. Manage your waste effectively. Don’t just burn them or dispose them, as they would only pollute the surrounding areas. The Indian healthcare industry is keeping up or even moving ahead of the developed world. With a steady increase in population India needs more hospitals. With increase in awareness amongst people these hospitals need to be of world class standards to survive in the industry. What better way to do it than to start efficiently and keep up the standards year in and year out! Dr Amar Agarwal 64
  • 65. Conclusion The success of hospital is usually attributed to the skills of its doctors and nurses, but there is a club of behind the scene personnel, who are always on toes to keep the wheels of any healthcare facility smoothly turning. Hospital administration is all about weaving the different units of a hospital together into a cohesive whole. Management tools play important role in the day to day functioning of a hospital. A few hospitals have training programmes for their staff and use incentives to ensure that their employees function in a competent and professional manner. There must be coordination and understanding between various departments and this can only be achieved if the administrative and the medical staff have tolerance and respect for each other. Nowadays hospitals have to be hi-tech to be efficient in their operations. Using HIPePS (Hospital information resource planning system) makes the hospital keep all the patient records and all government related information under password system. Wockhardt 65
  • 66. Hospital uses Wipro’s HIPePS. This project work has made me understand the management of hospitals from in depth. Before selecting this topic as my final year project I was just having the basic idea and I wanted to get more information on this topic. The ECONOMIC TIMES has stated the hospitals to be the next big business and good forex earner for the country so let us wait and see the dream and statistics come true. Bibliography • www.wockhardthospitals.com • www.bombayhospital.com • www.esic.nic.in • www.healthcaremanagement.com • Healthcare issue 2003-04 (Economic Times Group) • Modern healthcare magazine • Wockhardt induction guide • Human resource development in a government health organization: views of doctors Vivek Handa, A.K. Sood & Rajni Bagga • Annual Report of ESIC New Delhi (1995-96 & 2002-2003) Inserts from 66
  • 67.  Dr. Agarwal (Dr.Agarwal’s eye hospital)  Dr. C.P. Kamle (An international associate of American Institute of Medicine and Hans Finne International.) 67