1. 1. OPERATIONS
• Competitive Analysis
• Benchmarking financial Analysis
• Supply chain Analysis
• Future Scope and recommendations
2. OPERATIONS
Product and services
Fortis Healthcare (India) is engaged in providing the latest in internationally recognised
medical care to patients with a variety of ailments and medical conditions.
Their Network consists of Super Speciality Hospital Hubs that concentrate on one
or more specialities. These hospitals are interconnected to a larger network of multi
speciality hospitals that ensures patient access to expert care for any speciality.
This unique network architecture provides expert care to their patients and a level of
confidence in receiving the latest medicine has to offer.
Corporate Services
Healthy employees contribute to a healthy business! The healthcare delivery services in
their top hospitals are specially designed to suit employee needs. All patient records are
accessible at all their hospitals across India so that employees can access healthcare
services at the centre most convenient to them, choosing from a wide network of their
group hospitals.
Fortis offers a wide range of products and services to suit the company's needs.
1. OPD Services - Fortis network of top hospitals in North India offer special packages
to corporate employees and their dependants on the OPD facilities listed below:
• Doctor consultations
• Pathological investigations
• Radiological
diagnostics such as X-Rays, CT Scan, MRI, Ultrasound,
Mammography
• Non-invasive cardiology like ECG, Echo, TMT, Holter etc.
• Neurology investigations such as EEG, EMG etc.
• Physiotherapy
2. In-patient Admissions (IPD-related services) - Employees of empanelled

2. corporates are given special offers on all multi- specialty procedures/surgeries and on
room rent.*
3. Ambulance Facility - This facility can be availed of in times of emergency.
Dependants of members may also be eligible for these facilities.
4. Health Awareness Lectures/ Workshops – Awareness workshops and sessions
are organized by eminent faculty members on diverse topics at various hospital units
as well as the Corporate premises with the intention of promoting a sense of well-being
and fitness among corporate personnel.
5. Executive Health Checkups
6. Health Check Camps
7. Blood Donation Camps
*conditions apply
List of Empanelled Institutions
The Fortis Group is empanelled with a number of top corporates and multinational
companies (MNCs), Public Sector Units (PSUs), Government Bodies/ Institutions,
Ministries under the Government of India, Insurance Companies and Third Party
Administrators (TPAs). Many of these clients have chosen Fortis has their preferred
healthcare provider. The employees of these empanelled clients are given special offers
on Preventive Health Check- up programmes, multi-specialty procedures/surgeries and
medical management services. This facility can be availed of in times of emergency
wherever and whenever needed. All dependants of employees at the empanelled
organization may also be eligible for these facilities
Fortis Operational Management and Structure
The Fortis hospital network was based on a “hub and spoke” model with
multispecialty “spoke” hospitals providing comprehensive health care services and “hub”
hospitals with sub specialty services in one or more areas. This model helped Fortis
provide comprehensive health care services from within its own network to a large
geographical area. To make optimal use of the intra-network referral model, the number
of patients referred for surgeries from within the network versus those who came from
outside were constantly monitored.
Fortis’ hospital services prices were among the highest in India. Fortis justified thehigher
prices by noting its large investments in infrastructure, equipment, nursing facilities,
and prominent doctors with high salaries. The price of procedures at subspecialty
hospitals was higher than the “spoke” hospitals. Fortis bundled services at hospitals
as “Packages,” a single charge for a range of services associated with a diagnosis,
including examinations, common tests, room charges and procedure costs.

3. Fortis refined many hospital protocols imported from the west for the Indian market. For
example, a typical Indian patient checked in accompanied by three to four attendants
and this number sometimes grew to 10 to 20 for patients from rural backgrounds. Fortis
ensured that the higher number of patient attendants was factored in hospital design
and workflows. It also accommodated cultural practices which varied dramatically
across the country. The hospitals provisioned for prayer rooms for different communities
at different sites.
Fortis’ Human Resource Policies
Fortis considered the recruitment and retention of highly skilled doctors, nurses and
other personnel its top priority. The staff at hospitals operated and managed by Fortis
was compensated by the respective hospital owners. At its owned hospitals, Fortis hired
reputed physicians at above-market salaries to access the patient roster and increase
the company’s standing in the industry. Cultural fit was also used as selection criterion
in the interview process.
All specialists and most general practitioners were compensated on a salary plus
incentive basis. They worked across the network hospitals, depending on demand. The
physicians who practiced exclusively within the Fortis network earned a guaranteed
income and had predictable working hours. They could also provide better continuum of
care to patients, and had more time for resource development and research. Although
Fortis paid more in salary costs during the initial years, it hoped to lower personnel
costs in the future as physicians’ practices expanded.
Fortis outsourced housekeeping, security, grounds maintenance and various other
medical support services.
In most cases, Fortis replaced the physician-led management of acquired hospitals
with professional managers. This practice sometimes disturbed the power structure
within the hospitals, creating friction between physicians and managers. A senior
cardiologist at the recently acquired Escorts heart hospital remarked, “Fortis’
management is generating ill-will amongst the physicians, some of whom are the best
in the country. They overrule the decisions of senior surgeons and introduce policies
without consulting the physicians.” To address such concerns, the Human Resources
departments of Fortis group hospitals focused on balancing business requirements
with the motivational concerns of the physicians. Compensation of physicians varied
significantly, depending on seniority, specialty, reputation and demand for their services.
Fortis had developed a formula to calculate the variable component of salary, which
factored success rate of various procedures, patient referrals, and rapport with patients,
administrative responsibilities and publications. Though Fortis encouraged physicians
to conduct research, it had not developed a clear model to compensate for the time.
The physicians in non-core specialty areas, such as dentistry and ophthalmology,
and in multi-specialty practices, were permitted to maintain their own separate private
practices and to consult at other hospitals. They were compensated on a fee-for-service
or revenuesharing basis.

4. Fortis’ salaries were considerably higher than the national average. The salaries of the
most senior consultants ranged from US$100,000 to US$600,000. In comparison the
salaries for a physician trained in internal medicine in an average Indian hospital were in
the range of US$10,000–US$15,000 post residency and for specialists with fellowship
training in medical sub-specialties in the range of US$12,000–US$20,000. The hospitals
expected the high-paying physicians to generate revenues to justify their pay packages.
Marketing and Branding
Under the guiding hand of Ranbaxy, Fortis understood the importance of creating a
specific and strong brand identity. Fortis hoped that its message of quality would help
overcome the controversy between private primary care practices in the community and
hospitals around kickbacks for referrals. The patient referral system in India was similar
to other countries and relied on referrals from the family doctor to specialists or directly
to a hospital if the patients
needed a procedure.
Patients frequently conferred with friends, family members and other doctors before
they chose a hospital. Those who were Internet savvy read about their condition
and identified the best physicians and hospitals. To aid in physician retention, Fortis
conducted Continuing Medical Education (CME) programs. It reimbursed the physicians
for any participation fees but did not
compensate them for the time spent on non-clinical activities. In 2006, Fortis physicians
participated in over 400 CMEs.
Competition
The major competitors of Fortis were the for-profit hospitals in North India, including
the nationwide chain of Apollo hospitals, and regional operators like Max Healthcare.
Fortis also competed with hospitals owned by government agencies or nonprofit trusts,
such as the Post Graduate Institute, All Indian Institute of Medical Sciences, and
hospitals affiliated with medical schools. As Fortis expanded into the rest of India,
it expected to face competition from established local players. A large number of
private hospital groups from Singapore, United States and Australia were also planning
hospitals in India.
With a growing demand for health care services by local Indian population, most market
participants felt that there was enough room for growth by addressing the domestic
market. To build a national brand, the hospitals jointly created the “Indian Health Care
Federation” whose agenda was to establish national benchmarks by sharing clinical
outcomes information among all the member hospitals.
Competitive Analysis:

5. Corporate Strategy
The corporate strategy of the Fortis is based on steady expansion in the new markets.
It has adopted a strategy of market development where the business seeks to sell its
existing products into new markets.
There are many possible ways of approaching this strategy; Fortis has adopted the
strategy of Mergers
And Acquisitions which are explained below:
Mergers and Acquisitions
According to Wall Street Journal, Fortis Healthcare was in process of buying 10
hospitals in India, for 9.09 billion rupees ($187 million). And this move was a part of
overall strategy of Fortis healthcare to expand rapidly in the hospital chain sector. These
acquisitions will get Fortis to mark of 38 hospitals with capacity of 52,000 beds across
India.
In addition to this 10 additional hospitals were added after the Wockhardt’s deal.
International Partnership
Fortis Healthcare is affiliated with some of the world’s best in the fields of infrastructure,
technology, and medical treatments to deliver world class healthcare services in the
region.
It continuously strives to provide the hassle-free healthcare services to patients from all
over the world. In order to make treatments seamless, over the years Fortis Healthcare
has developed alliance with the top-notch global service providers in the fields of

6. healthcare, insurance, medical tourism, travel, and other sectors. Which include likes
of, Aetna, Bupa, Cigna,GMCserviceetc. The alliance with international partners ensures
seamless healthcare coverage for members patients while living, studying or travelling
throughout India and in the Asia-pacific region. Thus ensuring a larger network of
hospital will be there to support its customer base. The alliance with the service provider
facilitates timely access to world-class healthcare 17 services, medical expertise, and
other healthcare related services. This is how Fortis meets its quality service goals.
Benchmarking financial Analysis
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Supply chain Analysis
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Future Scope and recommendations:
Future prospectus evaluation:
Fortis is relatively new entrant in healthcare industry. However, in addition to
hospital business, they have also entered into retail pharmacy business and also
entering into old age home business. Over a five period of time, the growth in the

7. super specialty hospital business are likely to stagnant therefore, it will be like
a cash cow of BCG matrix. The cash generated thru’ cash cow will be used for
developing old age home which is relatively new and high growth product (Star
in BCG matrix). The hospitals which are not able to generate cash (even though
other hospitals are growing) will be like problem child and it would be better to
sold those hospitals and invest in Star. Being a relatively new player, there is no
dog in their portfolio. The details of various phases on life cycle of product and
BCG matrix are show below:
Recommendations:

8. •
More Focus required on Organic Growth
• Too much focus on specialty
• Market extension in tire 2 and 3 cities
• Smaller Hospitals
More Recommendations & Suggestions:
Some Suggestions for improving the position of the Fortis hospitals
1. The general perception that large hospitals, with high bed-occupancy rate, are
profitable, is misleading. Global experience shows that hospital with more than
250 beds don‟t do well. Many Indian hospitals are following the US healthcare
industry, by decreasing the average length of stay of patients and increasing patient
turnover. US research shows that 80% of the revenues form a patient comes in the
first 72 hours post- admission. Hospitals generate a lot of revenues from General
Inspection, because the patient turnover is very high. A large percent of revenues
come from specialized services like operations and surgeries. It is because of
these reasons that many corporates are planning for a small 100 beds specialized
hospitals, which caters to specific diseases like cardiac, cosmetic surgery, neurology
etc. Research shows that there exist a lot of space for super-specialized hospitals
with 100-150 beds, which generate revenues equivalent to large 500 bed general
hospital. Typically large hospitals with approximately 500 bed capacity takes about
9-10 years to break even whereas super-specialty hospitals with about 100 beds
take about 6-7 years to break even. Therefore, going in for super-speciality hospitals

9. seems to be a more viable option today.

10. 2. Hospitals could also generate revenues from medicines if they are supplying them
in-house. Some hospitals make it mandatory for the patients to buy medicines
from the hospital‟s chemist shop. A margin of 15-20 % can be charged for such
medicinal supplies. Though many hospitals run by Trusts do not earn this way, but
new entrants or corporates for whom private healthcare sector is a direct extension
of their line of business ( eg. Pharma companies), can generate good returns from
medicine supply.
3. Health Plan packages can be provided by hospitals to family and corporate. For
example Family Health Plan Services (FHP), a subsidiary of Apollo Hospitals does
health management of employees of its clients. With a wide net work of Hospitals
and Healthcare providers countrywide, and a tie -up with General Insurance
Corporation of India, FHP offers a range of services to employees and dependants,
such as Preventive Healthcare, Corporate Counseling, welfare Programmes,
Claims Administration, Patient-care Coordination and so on. So FHP's healthcare
packages, optimize the benefits while keeping the cost under control.
4. Apart from preventive healthcare, stress management programs could be provided.
For example „Effective Stress Management Programme‟ offered by Wockhardt
Hospital. This programme provides a medical perspective of stress and is conducted
by a medical professional. The programme includes a series of one-to-one sessions,
with a clinical Psychologist highlighting the factors responsible for inducing stress,
and the methodologies, which can be adopted to cope with this phenomenon
practically.
5. Hospitals can become integrated healthcare systems i.e. when medicines, food
services, laundry and linen etc will become "purchased" services. These third-party
operations will increase the profit margins.
6. Mergers could be used for synergy of skills - i.e. to help the merged organisations
benefit from one another's individual strengths by applying them across the board.
It also helps them to make joint investments in branding or information technology
and also to react effectively to the changed market forces. Alternatively hospitals
can go in for Group Purchases, as in USA. The buying power of large GPOs in
USA like Premier, VHA / UHC and AmeriNet gives them the clout to exert price
pressure on suppliers, particularly for products in lower demand. And as GPOs
have consolidated, manufacturers have offered bigger discounts to hang on to their
contracts. So there exists a lot of supply management opportunity, which will affect
spending productivity.
OPERATIONS (IT CAN BE CONSIDERED AS AN EXAMPLE)

11. Fortis Hospital Mohali
Fortis Hospital, Mohali has three sub-facilities on one campus: (i) a super-specialty
cardiac center quipped to provide advanced cardiac treatments for all forms of heart
disease (ii) a general multi-speciality hospital and (iii) the Fortis Inn Rehabilitation
Centre designed to provide “step-down” care to outstation patients. It currently has 9
operating theatres and 215 beds and has capacity for up to 300 beds. Fortis Hospital,
Mohali together with FHL’s satellite centre contributed 84% of the Company’s total
operating income for the financial year 2007-08. The hospital has recorded an overall
growth of 12%, achieving operating revenue of Rs. 133.01 crores as against Rs. 118.75
crores in the previous year.
Multi-specialties like Obstetrics and Gynecology were well established during the year.
1018 Cardiac Surgeries (CTVs), 1353 Angioplasties (PTCAs) and 3172 Angiographies
(CAGs) were conducted during the year.
Fortis Hospital, Amritsar
Fortis Hospital, Amritsar is a multi-speciality facility with 37 beds. It serves as a “spoke”
hospital for Fortis Hospital, Mohali and has a tele-link connecting it to that hospital. The
facility is currently equipped
with 2 operating theatres, endoscopic suite, a labour room, a nursery and a 24-hour
emergency room. It is also supported by a fully equipped intensive care unit with
ventilators. Fortis Hospital, Amritsar contributed 2.57% of the Company’s total operating
income for the financial year 2007-08.
SUBSIDIARIES
As on 31st
March, 2008, your Company had four direct subsidiaries viz. Escorts Heart Institute
And Research Centre Limited, International Hospital Limited, Fortis Hospotel Limited
(erstwhile Oscar Bio-Tech
Private Limited) and Hiranandani Healthcare Private Limited and four step down
subsidiaries viz. Escorts Hospital And Research Centre Limited, Escorts Heart And
Super Speciality Hospital Limited, Escorts Heart Centre Limited and Escorts Heart And
Super Speciality Institute Limited.
A Statement pursuant to Section 212 of the Companies Act, 1956, relating to subsidiary
companies is attached to the accounts. In terms of approval granted by the Central
Government under Section 212(8) of the Companies Act, 1956, the audited accounts
of the subsidiary companies are not attached to this Annual Report. However, the

12. consolidated accounts prepared in accordance with Accounting Standard 21 of the
Institute of Chartered Accountants of India presented in this Annual Report includes the
financial information of subsidiary companies.
The copy of the annual report of the subsidiary companies will be made available
to shareholders on request and will be kept for inspection by any shareholder at the
registered office and corporate office of your company and its subsidiary companies.