While the phrase "New Normal"is doing rounds, here is one view. Identify the New Abnormal in healthcare system and address them. New Normal evolves...

1. The New Abnormal in Healthcare
Is it Disruption or Opportunity ?

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Abnormal defined
not normal, average, typical, or usual; deviating from a standard:
Not normal, average, typical, or usual; deviating from a standard
Synonyms for “Abnormal”
Aberrant, Anomalous, Atypical, Bizarre, exceptional, Extraordinary, irregular,
odd, peculiar, strange, uncommon, unexpected, unnatural, unusual, weird,
odd, Peculiar, strange, uncommon, unexpected, unnatural, unusual weird.
There is a new phrase doing rounds in industry “The New Normal”.
The new Normal is either achieved or adapted to, whereas the New
Abnormal needs to be analysed, tackled and mitigated.
For the Health system it would be worthwhile to identify the New Abnormal

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Identifying the New Abnormal in
Health Sector
Post the Pandemic and Beyond

4. IdentifyingtheNewAbnormalPost thePandemicand
Beyond Demand side
Abnormals
Supply Side
Abnormals
Economic
Abnormals
Social Abnormals
Changing health
seeking
behaviour
Barriers to
accessibility for
service seekers
Uncertainty Fear
psychosis poor
investment
climate
Distancing,
Panic, introvert
society mental
health issues
Global
Abnormals
Isolation,
localisation, multi
polar world

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Change in Health seeking Behaviour: Patients not seeking immediate
medical help for fear of being labelled as Covid case and subsequent
isolation/quarantine, getting socially outcast or Police action.
Drift towards easier alternatives: Inclination towards towards alternative
medicine and even quacks.
Fear of Contracting infection: Wilful distancing from health care
institutions for fear of contracting Covid
Heath Care Facility appear formidable: Intimidation by strict gate
keeping, over clad staff, indemnity paperwork for Covid is the new abnormal
and not normal.
Identifying the New Abnormal Post the Pandemic
and Beyond
Demand Side Abnormals

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Economic Turbulence: Uncertainty in trade, jobs, vocation further shrinks
demands in all segments including healthcare. Elective procedures in
Orthopaedics, Plastic surgery, Cosmetic, Gynaecology, and even Cardiac
sciences avoided either due to fear psychosis or economic reasons.
Demand for Health Finance Mechanism : There could be more reliance on
demand side funding such as health insurance and Government schemes.
Covid overshadows NCDs: Procrastination for Health checks and regular
follow up check up leading to adverse impact on Chronic conditions.
Identifying the New Abnormal Post the Pandemic
and Beyond:
Demand side Abnormals, ctd....

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Panic & confusion among Doctors & Healthcare workers: Absenteeism,
avoidance, over suspicion is the new abnormal behaviour.
All time low Doctor patient connect: Doctor patient relationship due to no
touch practice, barrier practice indiscriminate suspicion of Covid is the new
Abnormal.
Turning away patients: Spurt in referrals to Government hospital from Private
hospitals is again a new abnormal.
Patient centricity: Cost, caution and caregiver protection Overtaking patient
well being is new abnormal.
PPE all over: PPE overshadows General health & lifestyle products is the New
Abnormal.
Digital marketing: loads of live streaming and webinars for marketing is the
new abnormal.
Identifying the New Abnormal Post the Pandemic
and Beyond:
Supply Side Abnormals

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Community fencing: Sudden Colonization in community dwellings
(villages, semi urban housing and multi storied complexes) assuming control
over exit and entry. New abnormal colonization of communities.
Humanity challenged: Insensitivity & mindless victimization of Covid
suspects, recovered patients, Healthcare workers.
Domestic conflicts: Joint families at brink of break up due to effects of
lockdown which has exposed space constraints and internal conflicts.
Home is new office: Abnormal demand for working privacy at home.
Mental Health issues: Lack of de stressing and recreational avenues are
diverting people to new hobbies, showcasing latest talents. But many with no
means to steam out are prone to stress disorders. Abnormal rise in sub clinical
and clinical mental health issues is the new abnormal.
Identifying the New Abnormal Post the Pandemic
and Beyond:
Societal Abnormals

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Lowest rung worst affected: Suddenly the country realises the presence of such
vast unorganized workforce hidden in the maize of urban economic activity.
Nowhere to go they braved long journeys with no access to healthcare and later
could be a public health challenge.
Impending doomsday: Economic shutdown may trigger a negative vicious circle.
Small and medium health care enterprises might shut down.
The Swadeshi Call: Likelihood of control on imports and can impact repair and
maintenance of imported equipment.
There will be demand for low cost treatment packages and less demand for
high end rooms. Will adversely affect Average Revenue per Occupied Beds.
Stock prices in healthcare crashing. Poor investment climate in the sector.
Identifying the New Abnormal Post the Pandemic
and Beyond
Economic Abnormals

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From Globalisation to localization: There is a new world order with highly
developed nations busy fighting Pandemic, they will have little or no control on world
economy.
Mostly Local patients will subscribe. Tourism and medical value travel worst hit
and impact long term financial models of hospitals in Metros.
Pharmaceutical sector: Pharmaceutical sector will have capital crunch due to weak
investments .R&D will be hit.
Boon for Diagnostics: Diagnostic chains including MNCs will continue to sustain as
the distancing doctors will rely more on tests than clinical judgement.
IT can connect globally but can help a little: Telemedicine & AI is one option. Can
bridge the gap to some extent.
Identifying the New Abnormal Post the Pandemic
and Beyond:
Global Abnormals

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Tackling
The New Abnormal Post the
Pandemic and Beyond:
Few Suggestions

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BCC (Behaviour Change Communication) : Needs a lot of attention from public
health communication experts. While the media has been showing “Corona Meter”
with excitement very little is being done to allày undue fears.
Accessibility to be improved. The Private Health Care need to reach out to
communities with novel products like home health care, virtual connect, 24X7 help
lines.
Community Nurses : Need to develop a cadre of Community Nurses who can do
home visits and identify Non Covid emergencies. (Concept exists in many countries)
Reach out facilitate & Schedule : All follow up chronic cases to be called up and
given fixed appointment in batches. Local patients must be offered home collection
sample.Their hospital exposure can be shortened.
Need to address affordability concerns. Assured medical packages is a good
option.
Tackling the New Demand Side Abnormals.

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Need for Coping Strategy : From lowest to highest qualified, display fear of
unknown, unprecedented and some times not so rationale outlook to Covid
pandemic.They need a coping behaviour.
Online Training : Coping Behaviour modules for online learning should be
immediately launched by premier institutions such as Indian Institute of Behavioural
& Allied Sciences
The virtual medium is flooded with live streams and webinars but very little efforts
seen in addressing the workforce stress and training on coping strategy.
The views on pre testing for Covid before all clinical intervention are strictly Urban
and the huge network of CHC, PHC Talluka Hospitals are often forgotten that they do
not have such luxury.
Patient centric approach needs full emphasis. Covid or Non Covid, all patients need
same empathy.
Tackling the New Supply Side Abnormals.

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Research needed on Social apathy: Social scientists and thinkers need initiate short
term study/ research in this area. Mass media intervention urgently needed to educate
masses on empathy, victimization prevention.
Govt Officers need Training: Orientation also needed in Government administration
as there has been ugly incidences of use of excessive force on care givers and
suspected/confirmed cases.This is counter productive.
Proper Use of Masks: Mask and social distancing needs specific mass media
campaign. People touch the masks, take it away while talking. Mass education is the
only answer.Very little is seen onTV screens.
Learning Lessons from HIV Experience: HIV was a big stigma, but with multi
pronged communication approach this has been mitigated in community as well as
health care facilities.
Focus on MMR, IMR, Malnutrition, NCDs. This is a real red flag if neglected under
shadow of Covid pandemic.
Tackling the New Societal Abnormals

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Organise the unorganized : A firm data base on unorganized migrant labourer
with skill sets and arranging their employment through employment exchange is
first step towards limited economic security coupled with other welfare schemes.
Labourer Clinics: Create Shram Kalyan clinics for accessibility and Shramik health
card linked to digital data base and DHI is one such initiative..
Aid to Health MSME: The Government has opened up multiple avenues for
boosting economy. However there is a strong case for providing relief packages to
hospitals who are participating in Government schemes by tax relief, power subsidy
etc.
Rework on business model: Hospitals must Rework on the annual
budgets and work on low margin high volume principle.
Policy Support Needed. Restoration of investment in Health sector needs
government policy support. Pvt Health sector is asset and not adversary.
Tackling the New Economic Abnormals

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Great Indian Opportunity: Reorganize the international patient services through
inter - Governmental tie ups and processes.
Human Resource Global Shortage: New world order will also cause talent drain
to middle east countries. Specially for young specialists and Nurses. The Human
resources in health needs correct mapping. Short term fellowships and training will
create a pool of Resident doctors. Fresh Nurses to be groomed through hospital
finishing school for absorption as experienced nurses will be scarce.
Active participation in Drug trials, drug discovery to be eased out. India
needs to be the next drug discovery hub. Regulatory delays have been
detrimental to this segment. Policy review and easing out will attract
investments. International collaborations will be needed.
Tackling the New Global Abnormals

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To tackle the New Abnormal multi pronged approach could be considered.
BCC for public and Healthcare workers to be planned. Inclulcate a coping
behaviour for long term implications.
Private Sector to come forward with accessibility improvement plan like
Community Nursing, Proper scheduling, safe practices, assured service
packages.
Government and Private sector to be complimentary. Unilateral decisions
of take over, sealing, closure, criminalization needs to be addressed
through collaborative approach and dialogues.
Public Health system to review its outlook interms to health care to large
unorganized labour force. This workforce must be dealt thorugh data
gathering, skilling, job opportunities and access to primary health care with
Shramik clinics and sharmic health cards.
Tackling the New Abnormal ......Summary of
Suggestions

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Human resource in health needs a rennovated training and skilling with
short term role based training programs and combat the talent drain to other
countries.
Facilitative approach to Pharma and device sector and cut down regulatory
delays for reesearch and development can bring investments.
Focus on MMR, IMR Malnutrition and NCDs to be urgently restored.
Government officers also need training and orientation for a long term
perspective.
Overall, the Abnormals need to be addressed and mitigated. New
Normal will evolve on its own
Tackling the New Abnormal ......Summary

19. THANK YOU
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The views, thoughts, and opinions expressed in the text belong solely to the author, and not
necessarily to the author's employer, organization, committee or other group or individual.
Discussions, opinions suggestions and criticism are welcome.
Dr Sajal Sen, MBBS, MHA (AIIMS) MMS (Osmania)