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CASE STUDY ON 
EXPANSION AND ESTABLISHMENT OF 
PATIENT CARE HOSPITALS 
IN BIHAR, CHHATTISGARH, JHARKHAND AND 
MADHYA PRADESH 
SUBMITTED BY 
SHUBHENDU CHAKRAVORTY
Preface 
like, Life Expectancy, Under Five Mortality Rate, Adult Mortality Rate and others well below the global and in some cases 
regional average. While the Government is recalibrating its approach to lay more focus on Healthcare; factors like diversity, 
administrative structure and vast geography makes the task more challenging. This presents a perfect case for a Public- 
Private Collaboration to develop wherein the Private Sector can supplement the efforts of the Government with focused 
intervention 
The total Health Expenditure, including the Private Healthcare Systems today stand at close to 4% of the GDP which 
is a further case in point for more such participations. The fast changing economic scenario of the country along with 
rising aspirations of the people, both financially and socially, further develop a constructive environment for sustainable 
intervention of the Private initiators. However, fast paced development often also creates disparity and inequitable 
distribution of resources, which leaves the population venerable. While healthcare in India is expanding rapidly in the 
metropolitans and urban centers, the rural and remote areas are still as dependent on Government services as they were 
decades back. The dwindling health indicators of India are largely from these dark pockets of the country which even 
today await a sustainable model of healthcare, which has till now been elusive and an expensive 
The Government of India has articulated its long term goal in the Twelfth Five Year Plan of achieving ‘Universal Health 
Coverage’. While the Government will lead the journey over the next decades, the private sector shall be presented with 
opportunities to intervene with newer business models, especially, for the rising sections of the Society 
In such dichotomy, innovation can step in and provide long lasting solutions which are both sustainable and expandable. 
Patient Care aims to present a model of low cost-high quality Healthcare which, drawing on its key focuses, sustains 
healthcare centers in states with particularly poor healthcare indicators in comparison to the national average and reduce 
the inequity in healthcare access in the country 
1.20% of the GDP in India is utilized for Public Health Expenditure. This in a country which has the key health indicators 
. 
. 
. 
. 
PATIENT CARE HOSPITALS 
SEPTEMBER, 2014 
Page 2
The Case Study 
Patient Care is presently operating 50 low cost-high 
quality Hospitals in Patna, Bihar in and around the city 
slums and now intends to expand the Hospital Model 
into other states with similar health indicators. A total 
of five hundred Hospitals shall be established in phases 
across the states of Bihar, Chhattisgarh, Jharkhand and 
Madhya Pradesh. This case study attempts to provide 
blueprint for the expansion plan and its implementation. 
Disclaimer: All the data used in this Case Study is 
authentic and has been reffered to from various 
Government and Non-Government sources. Please refer 
to the Bibliography at the end for further details. 
Page 3
Contents 
Page 4 
Cornerstones of our Philosophy 
Proposed Expansion Model 
Focus Area Strategies 
Innovation 
Locations 
Timeframe 
Work Plan 
Management Structure 
Hospital Management Information System 
Anticipated Challenges 
Bibliography 
05 
06-07 
08 
09-10 
11-16 
17-18 
19-20 
21-22 
23 
24 
25
Cornerstones of Our Philosophy 
The cornerstones of the expansion journey for Patient Care from a chain of fifty successful Hospitals in Patna to becoming 
a network of over five hundred hospitals in the four key states shall be the following. 
Equitable Access 
to 
Quality Healthcare 
High Quality 
Healthcare 
Community 
Ownership Innovative Ideas 
Low Cost 
Healthcare 
One of the founding Objectives of Patient Care to make access to quality Healthcare equitable and delink it from the 
beneficiaries Social or Financial Status. 
Equitable Access to Quality Healthcare 
A pre-requisite to meet our overall objective of making healthcare access more equitable, low cost healthcare shall 
be achieved through rigorous utilization of assets, leveraging Information Technology and constant monitoring of 
operating expenses to ensure sustainability. 
Low Cost Healthcare 
One of the prime focuses of Patient Care is to ensure that the Quality of Healthcare is consistent with the acceptable 
industry standards. Stringent control over the quality of healthcare shall be maintained and all the Hospitals since 
inception shall follow the Pre-Assessment Guidelines of National Accreditation Board for Hospitals and Healthcare 
Providers (NABH) and seek accreditation within 3 years of operation. 
High Quality Healthcare 
It is imperative that participants or beneficiaries are transformed into stakeholders for long term sustainability of the 
Hospitals. Patient Care shall lead extensive outreach initiatives with community involvement in the geographical areas 
around the hospitals. 
Community Ownership 
Innovative Ideas 
Focus shall be on developing innovative ideas which shall bridge the gap between technology and the patients which 
can initiate a social impact and further strengthen the economic model of the Hospitals. 
Page 5
Proposed Expansion Models 
Three expansion models have been proposed with the Key Highlights and Drawbacks 
MODEL A 
PROFIT 
NOT 
MAXIMIZED 
MODEL B 
COMMUNITY 
AS 
STAKEHOLDERS 
MODEL C 
GRATIS OPD 
AND 
SUBSIDIZED 
TREATMENT 
MODEL A 
PROFIT NOT MAXIMIZED 
This model proposes establishment of ‘for Profit’ Hospitals which focuses on providing services on lowest possible costs 
without maximizing the Profits. 
Key Highlights 
Specialized provision for Maternal and Pediatric Care. This will ensure a narrow focus in health care and directly 
address the major challenges of reducing the Maternal Mortality Rate, Child Mortality Rate and the Child 
Nourishment Ratio. The specific focus will also enable alignment of medical equipments and thereby contribute 
significantly in streamlining the operating costs. 
Partnership with the Government on various Health Services extension schemes like Janani Suraksha Yojna.s 
Sustainable. A for Profit venture shall ensure sustainability of the Hospital while covering costs and not maximizing 
profits. s 
Drawbacks 
Exclusion. Of the most venerable section of the Society which may be financially unable to even afford the lower 
prices of the Services.s 
Fluctuating External Factors. Like manpower cost, operational costs etc. may force the pricing to remain dynamic 
which may affect the sustainability.s 
The Internal Cross-Subsidization Model. Highly depends on the demography and financial strength on the region. 
Unless the area is both financially and socially diverse this model may not be sustainable.s 
Healthcare Activism and Community Outreach. May be non-compatible into the priority focus areas of the model.s 
Page 6
MODEL B 
COMMUNITY AS STAKEHOLDERS (FOR PROFIT)s 
The key element of this model is to develop the participating Community as Stakeholders contributing to of the Hospitals. The Hospitals shall be established on non-return profit franchise model wherein the 5-6 Village Panchayats could jointly pool in resources to contribute to the logistical expenses of the establishment of the Hospital and certain defined overhead costs of sustaining it while Patient Care shall contribute the medical infrastructure, Hospital management, manpower and all other aspects. Therefore, the service cost of the Hospitals can be significantly subsidized for the patients. All income from the Hospital shall be the rights of Patient Care while the subsidized services to the village residents shall be thePanchayat’s advantage. s 
Key Highlights 
Broader Base for Social Inclusion. This model shall include a broader base of the lower income population andthus further expanding the social base.s 
Community Ownership. With deep involvement of the Community, the ownership and interest in its sustenanceshall be much higher.s 
Health Activism. This model is compatible with the ideas of Health Activism and provides a chance to developcollaborations.s 
Community Outreach. The key element of the Marketing Strategy shall be to introduce various initiatives betweentargeting communities.s 
Partnership with the Government on various Health Services extension schemes like Janani Suraksha Yojna.s 
Drawbacks 
Village Panchayat Dynamics shall directly affect the functioning of the Hospital.s 
The Social Dynamics of the villages shall become more significant as the Villages shall be contributory partners.s 
The Income shall be on sustenance basis and any upgradation of medical equipments shall be Patient Care’sresponsibility. s 
The Most Venerable Section may still remain out of bounds for the Hospital owing to social dynamics, servicecosts or other factors.s 
MODEL C 
GRATIS OPD AND SUBSIDIZED TREATMENT 
The Hospital shall fully function on the funding available from external financial sources. The Out Patient Department shall function gratis; treating the patients without costs while having a layered service cost for admitted treatment which shallhelp the Hospital to break even within a targeted span.s 
Key Highlights 
Total Inclusion. The objective of total inclusion may be achieved as access to preliminary quality healthcare shallbe delinked from financial resources.s 
Layered Service Costs. Higher social income groups could utilize the layered services which could expand thecustomer base of the Hospital.s 
Health Activism. This model is compatible with the ideas of Health Activism and provides a chance to developcollaborations.s 
Community Outreach. The key element of the Marketing Strategy shall be to introduce various initiatives betweentargeting communities.s 
Drawbacks 
The Model is entirely based on external funding which will be unsustainable and unstable.p 
Expansion or Upgradation shall be based on the funding available and thus render the model dependent.s 
Page 7
Focus Area Strategies 
Patient Care Hospitals shall have a three prong approach which shall focus on Maternal Care, Pediatric Care and Out 
Patients.s 
MOTHER AND CHILD 
Maternal and Pediatric Health are most 
venerable with the key health indicators 
indicating critical attention needed in these 
areas especially in central-eastern India where 
the population does not have immediate access 
to quality healthcare. Patient Care attempts to 
step into this void to develop specialized care 
for maternal and pediatric care.s 
OUTREACH 
Patient Care shall depart from the 
usual strategy of awaiting patients and 
reach out to Communities (Women and 
Children) partnering with institutions like 
Schools, Anganwadis, Mahila Kendras 
and conduct awareness workshops and 
other Outreach Activities.s 
OUT PATIENT DEPARTMENT 
This shall further objective of maximized 
inclusion and provide common healthcare 
facility to the residents. Patient Care shall 
collaborate with nearby multi-specialty 
hospitals for referral of patients under 
mandatory admission to EWS (Economically 
Weaker Section) patients and with other 
Government Hospitals.s 
56 48 UNDER FIVE 
MORTALITY RATE 
PER 1,000 
LIVE BIRTHS 
India Average Global Average 
Only about52%Patients having 
diagnosed for any kind of Chronic Illness in Bihar, 
Chhattisgarh, Jharkhand and Madhya Pradesh are 
getting Regular Treatment.s 
ONE 
TWO 
THREE 
54is the Average Infant Mortality Rate 
is the Average Infant Mortality Rate in the four Focus 
states of Bihar, Chhattisgarh, Jharkhand and Madhya 
Pradesh. S 
While the National Average is .s 44 
Page 8
Innovation 
OPERATIONAL 
STANDARDIZATION OF PROCESSES 
All operational processes shall be centralized and standardized. For instance, procurement shall be made 
through the dual channel of Central and Local Procurement. While infrastructural material shall be procured 
centrally, operational material shall be procured locally. s 
LOW CAPITAL EXPENDITURE MODEL 
The Hospitals shall be developed to be ‘No-Frills’ hospitals. A series of measures will be taken to implement 
the low capital expenditure model including seeking a long-term lease of the land, restricted spending on the 
non-necessary fixtures like Air Conditioners etc., Streamlined design and utilization of space etc.s 
INTERNAL CROSS-SUBSIDIZATION 
Layering of the accommodation being provided in the Hospital with Private wards available at market prices.s 
CLUSTER APPROACH 
To better utilize resources and create a common pool of central resources for a District the cluster approach 
shall be adopted in establishing the hospitals which shall further intensify healthcare access and streamline 
utilization of resources. s 
OUTREACH 
EMERGENCY RESPONSE MECHANISM 
This mechanism seeks to address the emergency requirements of the villages in 10kms. or more of the Hospital 
at any time of the day. The average Telephone/Mobile Density in the urban areas of Bihar, Chhattisgarh, 
Jharkhand and Madhya Pradesh is 73.65% while in Rural areas it is 39.40% .s 
SERVICES 
A community plan could be proposed which provides emergency response service of a semi-equipped 
ambulance for providing initial treatment, transport to the Hospital and services of a trained medical 
practitioner. This would essentially link the villages beyond the catchment area to the Hospital and increase 
the customer base.s 
COMMUNITY SCHEME 
This scheme could be implemented at a community level to pool in resources and minimize costs which would 
mean that this service can be opted for by a village or a significant % of the village and not individual persons.s 
COSTING 
The objective being to provide an emergency response mechanism to those beyond the catchment area of 
the Hospital the costing could be to cover the operational and sustenance cost than the establishment cost. 
A model costing is presented for reference:s 
Average Households per Village 
Average No. of Personsper Household 
Total Persons per Village 
Subscription to Emergency Response Mechanism Scheme 
Service Cost 
Per Household Cost per Month 
Per Vilage Cost per Month 
Note: All Data has been reffered from Annual Health Survey Factsheet, 2010-11 
300 
04 
1200 
50% 
Re1 
Rs. 120 per Household per Month 
Rs. 18,000 per Village per Month 
Households range from 150-2000 homes 
Persons 
Persons 
Per Person per Day 
Page 9
SCHOOL HEALTHCARE OUTREACH PROGRAMME 
Healthcare with the aim of wellness is not practiced in India generally, primarily due to immense strain on existing resources which prioritize treatment of chronic diseases. The average percentage of Children attending School in the targeted four states is 87.75% in Rural areas and 91.55% in Urban areas . Patient Careshall attempt to launch a School Healthcare Outreach Programme which shall have the following objectives:s 
-Ascertaining the Health Status and identifying children with health deficiencies ranging from minor to critical 
-Screening for deficiencies, diseases and disabilities 
-Conducting Vaccination Drives 
-Providing Training on First Aid 
HEALTH PROBLEMS IN SCHOOL CHILDREN 
The health problems of school children vary from one place to another. However, the main emphasis will fall inthe following categories:s 
-Malnutrition 
-Infectious Diseases 
-Intestinal Parasites 
-Diseases of Skin, Eye and Ear 
-Dental carries 
COMMUNITY VOLUNTEERING 
The School Healthcare Outreach Programme shall be implemented on the ground under the supervision of the trained medical practitioner by a team of Volunteers from the villages who shall be provided adequate trainingand given know-how.s 
Eventually a cadre of part time Volunteers shall be built who shall act as a link to the village and further act asHealth Change Agents in their villages and implement the various social initiatives of the Hospital over time.s 
Page 10
Locations 
One of the cornerstones of our Philosophy is to provide equitable access to healthcare and delink it from the beneficiaries 
Social or Financial status. This is the central guiding principal while the locations of the Hospitals have been proposed.s 
All data being presented below is original and has been referred from the Annual Health Survey Factsheet, 2010-11 
conducted by the Office of the Registrar General and Census Commissioner, India.s 
METHODOLOGY 
A three step method has been followed to identify locations for the Hospitals. The locations have been limited to the 
Districts of the States.s 
STEP 1 
PROFILING THE HEALTH STATUS OF THE STATES, DISTRICT WISE 
The Annual Health Survey Factsheet profiles all the District of the State across 152 Parameters in 29 Categories (Annexure 
1). A statistical comparison on 25 Parameters across 7 Categories has been drawn of the four Target States of Bihar, 
Chhattisgarh, Jharkhand and Madhya Pradesh which is presented below:s 
Page 11
Page 12
STEP 2 
IDENTIFICATION OF THE CRITICAL DISTRICTS IN THE STATES 
In the second step the most critical districts on more than 4 and 3 parameters are identified and assigned Zone A (CapitalCity, except Bihar), Zone B and Zone C respectively.d 
The State Capitals (excluding Patna in Bihar) have been marked as Zone A and have been identified for the inaugural intervention in the State. The critical Districts of the State(s) categorized in Zone B for higher Critical Districts and ZoneC for Medium Critical Districts in order of their health indicators.s 
BIHAR 
Page 13
CHHATTISGARH 
Page 14
JHARKHAND 
Page 15
MADHYA PRADESH 
STEP 3 
SHORTLISTED DISTRICT RATIO 
BIHAR 
CHHATTISGARH 
JHARKHAND 
MADHYA PRADESH 
Page 16
Timeframe 
The Hospitals which have been categorized in three Categories shall be launched in separately in the same sequence as 
detailed below:s 
RATIO 
The following Ratio has been proposed for establishment of the Hospitals:s 
ZONE A: INAUGURAL INITIATIVE IN THE STATE 
Each state Capital has been included in Zone A irrespective of the Social Indicators since the inaugural intervention in 
the state shall be a replicated model of the cluster Hospitals close to the Slums in Patna. The inaugural initiative shall 
establish itself as the pilot project in the State and provide Patient Care an opportunity to understand the State dynamics 
and develop further collaborations.s 
Number of Hospitals 
Cluster Hospitals are opened in the City Slums, 10 
surrounding areas and in the residential areas of the Lower 
Income Group.s 
Incubation Period 
Two years is the incubation period of each Hospital to break 
even.s 
Launch Month 
March 2015 
ZONE B: HIGHER CRITICAL DISTRICTS 
Half i.e. 50% of the allocated Hospitals shall be established in the higher critical districts of the State in cluster of 10 
Hospitals. s 
Number of Hospitals 
Hospitals in clusters of 10 are opened in each of the Zone 
B Districts.s 
Incubation Period 
Three years is the incubation period of each Hospital to 
break even.s 
Launch Month 
October 2015 
Page 17
ZONE C: MEDIUM CRITICAL DISTRICTS 
A total of 40% of the allocated Hospitals shall be established in the higher critical districts of the State in cluster of 10Hospitals.s 
Number of Hospitals 
Incubation Period 
Three years is the incubation period of each Hospital tobreak even.s 
Launch Month 
May 2016 
Hospitals in clusters of 09 are opened in each of the ZoneC Districts.s 
Page 18
Work Plan 
The Expansion Project shall be conceived and implemented by the Project Management Team which shall oversee all 
aspects including Strategic, Planning and Implementation.s 
OBJECTIVES OF THE PROJECT MANAGEMENT TEAM 
The Objectives of the Project Managment Team shall be:s 
Need Assesment 
Review of Existing Facilities 
Role of the Patient Care Hospitals in the local 
context 
Deciphering any specific local dynamics 
Implementation of the Project 
COMPONENT OF PROJECT MANAGEMENT 
Feasibility Study 
Identification of the Break Even Period and Expense 
Model 
Commissioning 
Strategic Planning 
FEASIBILITY STUDY 
Data Collection 
Demographic Pattern 
Need Assessment 
Transport and Communication 
Site Selection 
Environmental Study 
Village and Panchayat Dynamics 
Market Cost Analysis 
DATA COLLECTION 
Demographic Data 
Geographic Data 
Analysis of the Utilization of Present Healthcare 
Facilities 
Disease Pattern 
Existing Facilities and User Feedback 
SITE SELECTION 
Availibility of adequate land as per the size of the 
Hospital 
Approach Raod 
Suitable Soil Condition 
Suitable Drainage System for Disposals 
ENVIRONMENTAL STUDY 
Moderate Climate 
Non-existance of any Waste Dumpyard in the 
vicinity 
Away from the Main Road and Heavy Traffic flow 
PHASE 1: PLANNING 
NEED ASSESSMENT 
Type of Healthcare already existing - Preventive, 
Rehabilitation, General Care, Special Care etc.s 
Economic Status and Source of Earning 
Motivation for Utilization of Private services by 
people 
Housing, Education and Awareness among the 
people 
CONNECTIVITY 
Access from the main centers of the City, Village 
Availability of Private Taxis and other means of 
Transport 
Easy access to Transmission Towers for 
uninterrupted communication 
.. 
...... 
... 
.. 
.... 
. 
... 
... 
.. 
. 
.. 
. 
. 
... 
.... 
. 
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PHASE 2: STRUCTURAL IMPLEMENTATION 
LAND SCOUTING 
The Project Management Team shall, based on the Reseach parameters as mentioned in Phase 1 shall scout for the Landand seek a Long-Term Lease from the owner.s 
RESOURCE ALLOCATION 
An estimated Resources Allocation Chart detailing the Financial and Operational Resource requirements for theincubation perriod shall be prepared for implementation.s 
EQUIPMENT & OTHER ITEM SOURCING 
The Central Procurement Team shall take over all the Procurement requirements and start negotiations with theVendors.s 
STRATEGIC PLANNING 
The Project Management Team taking into account the various Factors from the analysis reports obtained in Phase1 plan for the following aspects:s 
Staffing 
Medical Doctors, Techinical Staff, Nursing Staff, Administrative Staff etc.s 
Machinary Equipments 
Priority Equipment, Heavy Equipment, Investigation Machines, Instruments, Drugs and Disposables, Furniture, Linen, Other Items 
. 
. 
COMMISSIONING 
Aspects like refurbishing of the Premises, Recruitment ofStaff etc.s 
PHASE 3: INCUBATION PERIOD 
The Project Management Team shall be responsible for Monitoring of the Project through the incubation period for requirements like liaison with other Units and any other requirements. During this period the Project Management Team shall handover the Operational Responsibilities of the Hospital to the local team and exit day-to-day Operations within adefined period of time.s 
Page 20
Management Structure 
Patient Care operates thorugh three layer Management and Reporting Structure of Central, State and Unit Level teams 
working in tandem.s 
CENTRAL TEAM 
The Cenral Team is madated to oversee the strategic direction, overall implenetation and monitoring of the Units and to 
ensure that the cornorstone of the Groups philosophy is rigorously followed. The Central Team shall primarily facilitate 
and enable the State and Unit Level Teams and work through the following departments:s 
VISION & PLANNING 
Often operating as a think tank, this team shall be responsible 
for envisaging the vision of the organization. The team would 
be involved in strategic planning of the broader vision of 
the organization. s 
PROJECT MANAGEMENT 
This team shall be responsible for implementation of 
different projects undertaken by the organization. The 
project team has a complete overview of the requirements 
of the different projects and works towards its completion. 
s 
CENTRAL PROCUREMENT 
The Central Procurement Team shall be responsible for all 
the major, centre-related procurements for all its hospitals. 
This shall bring in standardization and uniformity. s 
EQUIPMENT & INFORMATION TECHNOLOGY 
This team shall be responsible for carrying out research on 
the new forms of medical equipment available. The team shall 
also be responsible for assessing the needs of every hospital 
and recommending the suitable medical equipment. They 
would also find ways of integrating information technology 
with the hospital requirements for better implementation of 
the Low Cost-High Quality model.s 
LEGAL & COMPLIANCE 
Responsible for all legal matters, audit, submission of 
documents etc. Weekly and monthly reports would be 
compiled and sent. s 
HUMAN RESOURCE AND TRAINING 
Responsible for all the staff members of all the centres of 
this hospital. This team would be involved in not only hiring 
and recuditruitment, but also in providing necessary support 
to all the staff members as well through workshops. s 
ADMINISTRATION & GOVERNMENT LIAISON 
This team would be responsible for overall administration of 
the Group and shall look into matters of government liaison 
at the central level. It shall stay in touch with government 
offices, health officers etc.s 
MANAGEMENT INFORMATION SYSTEMS 
The MIS team is crucial in any organization. This team 
shall monitor and analyze data being recorded at the Unit 
Level and be responsible for the overall management of the 
integrated Hospital Management Information System.s 
QUALITY CONTROL & AUDIT 
The quality control team needs to ensure that all the hospital 
are following the given’s guidelines and procedures. It may 
conduct special check on hospitals from time to time, which 
may be informed to the hospital or otherwise. s 
FINANCE MANAGEMENT 
This team looks into the financial aspects of the organization. 
Budgeting, analyzing financial data, bringing out financial 
advisory and notifications falls into their purview.s 
MARKETING & COMMUNICATION 
This team is in charge of both internal and external 
communication. Through marketing, they generate grants 
and funds while the communication team sets internal 
communication processes and also organizes outreach 
campaigns in schools and villages. s 
Page 21
STATE TEAM 
The State Team shall be the coordinating unit between the Central and the Local Unit. The State Team shall be a compact team of professionals functioning under a State Programme Manager to monitor the functioning of the Hospitals within the State, Monitor the Strategic Intervention of Patient Care in the State, Porject the State Expansion Plans and coordinate withthe State Government for collaborations and partnership. The State Team shall work through the following Departments:s 
STATE MANAGEMENT TEAM 
The State Management team is responsible for heading the state units of the organization. It is responsible for theactivities of all the hospitals in a particular state. s 
STATE PROCUREMENT 
The state procurement department shall procure according to the requirements of the hospitals of the state and mandategiven by the Central Procurement Department. s 
MONITORING 
The Monitoring team would be monitoring the working of different people in the company. Continous monitoring, providing feedback review and evaluation would hel[p thehospital keep a check on itself and evolve. s 
GOVERNMENT LIAISON 
Coordinate with the State Government for Collaborations and Partnerships in the State. Monitor the State Health Policy and work on the areas of expansion for Patient Care’sintervention in the State.s 
HOSPITAL TEAM 
The Local Unit of the Patient Care Group, the Hospital Team shall be the on-ground team. The Medical and Operational Roles of the Team shall be segregated distinctly for better implementation. The Hospital Team shall work through thefollowing Departments:s 
MEDICAL SERVICES 
OUT PATIENT DEPARTMENT 
The Out Patient Department, meant to provide immediatemedical care and attention. s 
MATERNAL CARE 
One of the main wings of the hospital, this will be responsible for providing maternal medical care, which shall be one ofthe Key Strategies of the Hospitals..s 
PEDIATRIC CARE 
Our focus remains women and children. This departmentprovides medical attention to children. s 
EMERGENCY RESPONSE MECHANISM 
A unique initiative of this hospital, people in this department, work to provide access to immediate medical care tovillagers living in remote corners. s 
COMMUNITY OUTREACH 
This department heads community outreach initiatives like taking healthcare to the schools, addressing sanitationissues with people etc. s 
NURSING & SUPPORT SERVICES 
This department consists of the Nurses and Support Staffwho work across departments to provide their services.s 
ORGANIZATIONAL SERVICES 
HOSPITAL ADMINISTRATION 
Responsible for the overall working of the hospital, this team looks after day to day administration needs includingScheduling etc. and MIS requirements for the hospital.s 
MARKETING & PUBLIC RELATIONS 
As a subordinate group of the main marketing team, this team is responsible for setting up collaborations with localinterested partners and formulate Outreach Activities.s 
QUALITY MANAGEMENT 
Working as a subordinate Group of the Central Team, this team shall be responsible for Quality Adherance and Auditat the local Unit level.s 
FINANCIAL MANAGEMENT 
This group shall be responsible for the Financial Managmentof the Hospital.s 
Page 22 
7
Hospital Information Managemeng System 
Record Management and Reporting of the Hospitals shall be through an integrated Hospital Information Management 
System which shall link all the Hospitals to the Cenral and State Teams. The HMIS shall provide layered access to the data 
being generated for various purposes.s 
The local Hospital Unit shall be responsible for Data Entry into HMIS and its local management while the Central and State 
Teams shall be repsonsible for Data retrieval and analysis.s 
DATA ACCESS AND RETRIEVAL 
PRIMARY MODULE: MEDICAL SERVICCES 
Patient Administration, which includes:s 
Registration 
Admission 
Tereatment Records 
Discharge 
Tracking of Patients 
Programmes, whcih includes:s 
Maternal Care Patient Profiling 
Pediatric Care Patient Profiling 
Emergency Response Mechanism 
Scheduling, whcih includes:s 
Doctor Schedule 
Nurse and Support Staff Duty Roster 
Procurement, which includes:s 
Tracking of consumable Medical Iteams for 
Procurement purposes 
SECONDARY MODULE: HOSPITAL ADMINISTRATION 
Performance Analysis 
This module shall compile and analyze performance reports 
of the various units based on common factors like footfall 
etc. This module shall also have an integrated Feedback 
System for recording response of the Users.s 
Fixed Asset and Inventory Management 
This module shall manage the Fixed Assets and Inventory of 
the Hospital as per the Statutory requirement .s 
Profiling: User Demographics and Disease Database 
This module shall profile the Users and provide insight 
into the profile and prefrences of the returning Users. 
Additionally, the Module shall maintain a central database 
of the Diseases being diagnosed.s 
REPORT MANAGEMENT AND UTILIZATION 
The Reports being generated thorugh the above mentioned modules of the Integrated Hospital Information Management 
shall be utilized for various Strategic Decionmakings, Compliences, Doner Requirement and any other requirements.s 
Page 23
Anticipated Challenges 
Since the Hospitals are envisaged to be Local Intervention Units in the Healthcare Delivery Mechanism in India, it is 
anticipated that these Units will function in close coordination with the Village/City level institutions. Therein lies the 
Challenges, some of which have been articulated below:s 
SOCIAL AND VILLAGE LEVEL SUPPORT AND ACCEPTANCE 
The Hospital will have to consciously to work in developing Trust of the Community which shall be the core factor for 
sustenance and positive intervention. Community Outreach and long term goals to develop General Health aspects of the 
Community shall assist in developing mutual trust and respect.s 
RECRUITMENT OF QUALIFIED DOCTORS 
The Hospital will have to recruit on a larger and central level to inspire qualified Doctors to serve in remote locations which 
may not be the nerve centers of medical traffic but pockets which require dedicationa and sustained intervention.s 
SUCCESS OF THE FINANCIAL MODEL 
The Hospital will have to extensively reach out to the local Community and the Government to collaborate on Health 
Schemes etc. to ensure that the Financial Model is sustained.s 
BALANCING THE VILLAGE DYNAMICS 
Since the Hospital will work closely with the Village Panchayats, Opinion Makers and other Village Institutions, it is 
imperative that a fine balance is maintained in the existing dynamics of these institutions and remain focussed on the 
primary objective of providing low cost healthcare. s 
FOCUS 
It is also imperative that the Focuses identified are taken forward without any new dimensions being added so that these 
focuses are given time and resources.s 
ACCEPTING THE EXISTING SITUATION 
While working with the Community, the Hospital staff will have to accept the sitution on the the grond as it is which at times 
may be difficult to comprehend. It is essential that the culture, priorities and difficulties of the Users are understood in 
detail after commencement of operations.s 
These are a few of the major Challenges anticipated during implementation of the Project . There shall be many more 
Challenges which shall have to be dealt with once the Project has been initiated.s 
ADHERING THE TIMELINE 
This being a Mega-Project of implementation of 500 Hospitals in 4 States, one of the important Challenges shall be to 
maintain the Timeline of the lanuch of these Hospitals. The flow of funds and a dedicated team at various levels will have 
to ensure timely monitoring of activities to anticipate any hurdles slowing down the pace.s 
Page 24
Bibliography 
The following sources were referred for the purpose of the Case Study:s 
Website of Ministry of Health and Family Welfare, Government of India 
Website of Department of Health of the States of Bihar, Chhattisgarh, Jharkhand and Madhya Pradesh 
Apollo Hospitals Case Study 
Bio-IT and Healthcare in India, Deptment of Biotechnology, Government of India 
Delivering World Class Healthcare Today, Harward Business Review 
Enhancing access to Healthcare through Innovation, PricewaterhouseCoopers Private Limited 
Good Health at Low Cost 25 Years On, General Briefing 
Good Health at Low Cost 25 Years On, Tamil Nadu Success Story 
Healthcare in Developing Countries, A Presentation 
Healthcare in India, Vision 2020: Issues and Prospects by R. Srinivisan 
High Level Report on Universal Healthcare in India, Planning Commission, Government of India 
Human Resource requirements for Healthcare Industry, National Skill Development Council 
India Healthcare, McKinsey & Co.s 
Medical Technology Industry in India, Deloitte 
New Horizons in Indian Healthcare, Parthenon Group 
Providing Low Cost, High Quality Healthcare: LifeSpring: A piece by Anant Kumar 
Quintegra Hospital Information Management System 
Smile on Wheel Programme Brochure 
BCTA,LifeSpring, Case Study 
Innovative Pro-Poor Healthcare Financing and Delivery Models 
LifeSpring Backgrounder 
STATISTICS 
Census, Key Findings- 2001&2011 
Key Health Indicators for India, World Bank 
India Health Profile, WHO 
Census District-Level Household and Facility Health Survey 
Annual Health Survey Factsheet 2012-13 
Annual Health Survey Factsheet 2010-11 
Various other related Websites, Blogs and other Online Resource Material.s 
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Case study on establishing low cost hospitals in 4 states with low health indicators

  • 1. CASE STUDY ON EXPANSION AND ESTABLISHMENT OF PATIENT CARE HOSPITALS IN BIHAR, CHHATTISGARH, JHARKHAND AND MADHYA PRADESH SUBMITTED BY SHUBHENDU CHAKRAVORTY
  • 2. Preface like, Life Expectancy, Under Five Mortality Rate, Adult Mortality Rate and others well below the global and in some cases regional average. While the Government is recalibrating its approach to lay more focus on Healthcare; factors like diversity, administrative structure and vast geography makes the task more challenging. This presents a perfect case for a Public- Private Collaboration to develop wherein the Private Sector can supplement the efforts of the Government with focused intervention The total Health Expenditure, including the Private Healthcare Systems today stand at close to 4% of the GDP which is a further case in point for more such participations. The fast changing economic scenario of the country along with rising aspirations of the people, both financially and socially, further develop a constructive environment for sustainable intervention of the Private initiators. However, fast paced development often also creates disparity and inequitable distribution of resources, which leaves the population venerable. While healthcare in India is expanding rapidly in the metropolitans and urban centers, the rural and remote areas are still as dependent on Government services as they were decades back. The dwindling health indicators of India are largely from these dark pockets of the country which even today await a sustainable model of healthcare, which has till now been elusive and an expensive The Government of India has articulated its long term goal in the Twelfth Five Year Plan of achieving ‘Universal Health Coverage’. While the Government will lead the journey over the next decades, the private sector shall be presented with opportunities to intervene with newer business models, especially, for the rising sections of the Society In such dichotomy, innovation can step in and provide long lasting solutions which are both sustainable and expandable. Patient Care aims to present a model of low cost-high quality Healthcare which, drawing on its key focuses, sustains healthcare centers in states with particularly poor healthcare indicators in comparison to the national average and reduce the inequity in healthcare access in the country 1.20% of the GDP in India is utilized for Public Health Expenditure. This in a country which has the key health indicators . . . . PATIENT CARE HOSPITALS SEPTEMBER, 2014 Page 2
  • 3. The Case Study Patient Care is presently operating 50 low cost-high quality Hospitals in Patna, Bihar in and around the city slums and now intends to expand the Hospital Model into other states with similar health indicators. A total of five hundred Hospitals shall be established in phases across the states of Bihar, Chhattisgarh, Jharkhand and Madhya Pradesh. This case study attempts to provide blueprint for the expansion plan and its implementation. Disclaimer: All the data used in this Case Study is authentic and has been reffered to from various Government and Non-Government sources. Please refer to the Bibliography at the end for further details. Page 3
  • 4. Contents Page 4 Cornerstones of our Philosophy Proposed Expansion Model Focus Area Strategies Innovation Locations Timeframe Work Plan Management Structure Hospital Management Information System Anticipated Challenges Bibliography 05 06-07 08 09-10 11-16 17-18 19-20 21-22 23 24 25
  • 5. Cornerstones of Our Philosophy The cornerstones of the expansion journey for Patient Care from a chain of fifty successful Hospitals in Patna to becoming a network of over five hundred hospitals in the four key states shall be the following. Equitable Access to Quality Healthcare High Quality Healthcare Community Ownership Innovative Ideas Low Cost Healthcare One of the founding Objectives of Patient Care to make access to quality Healthcare equitable and delink it from the beneficiaries Social or Financial Status. Equitable Access to Quality Healthcare A pre-requisite to meet our overall objective of making healthcare access more equitable, low cost healthcare shall be achieved through rigorous utilization of assets, leveraging Information Technology and constant monitoring of operating expenses to ensure sustainability. Low Cost Healthcare One of the prime focuses of Patient Care is to ensure that the Quality of Healthcare is consistent with the acceptable industry standards. Stringent control over the quality of healthcare shall be maintained and all the Hospitals since inception shall follow the Pre-Assessment Guidelines of National Accreditation Board for Hospitals and Healthcare Providers (NABH) and seek accreditation within 3 years of operation. High Quality Healthcare It is imperative that participants or beneficiaries are transformed into stakeholders for long term sustainability of the Hospitals. Patient Care shall lead extensive outreach initiatives with community involvement in the geographical areas around the hospitals. Community Ownership Innovative Ideas Focus shall be on developing innovative ideas which shall bridge the gap between technology and the patients which can initiate a social impact and further strengthen the economic model of the Hospitals. Page 5
  • 6. Proposed Expansion Models Three expansion models have been proposed with the Key Highlights and Drawbacks MODEL A PROFIT NOT MAXIMIZED MODEL B COMMUNITY AS STAKEHOLDERS MODEL C GRATIS OPD AND SUBSIDIZED TREATMENT MODEL A PROFIT NOT MAXIMIZED This model proposes establishment of ‘for Profit’ Hospitals which focuses on providing services on lowest possible costs without maximizing the Profits. Key Highlights Specialized provision for Maternal and Pediatric Care. This will ensure a narrow focus in health care and directly address the major challenges of reducing the Maternal Mortality Rate, Child Mortality Rate and the Child Nourishment Ratio. The specific focus will also enable alignment of medical equipments and thereby contribute significantly in streamlining the operating costs. Partnership with the Government on various Health Services extension schemes like Janani Suraksha Yojna.s Sustainable. A for Profit venture shall ensure sustainability of the Hospital while covering costs and not maximizing profits. s Drawbacks Exclusion. Of the most venerable section of the Society which may be financially unable to even afford the lower prices of the Services.s Fluctuating External Factors. Like manpower cost, operational costs etc. may force the pricing to remain dynamic which may affect the sustainability.s The Internal Cross-Subsidization Model. Highly depends on the demography and financial strength on the region. Unless the area is both financially and socially diverse this model may not be sustainable.s Healthcare Activism and Community Outreach. May be non-compatible into the priority focus areas of the model.s Page 6
  • 7. MODEL B COMMUNITY AS STAKEHOLDERS (FOR PROFIT)s The key element of this model is to develop the participating Community as Stakeholders contributing to of the Hospitals. The Hospitals shall be established on non-return profit franchise model wherein the 5-6 Village Panchayats could jointly pool in resources to contribute to the logistical expenses of the establishment of the Hospital and certain defined overhead costs of sustaining it while Patient Care shall contribute the medical infrastructure, Hospital management, manpower and all other aspects. Therefore, the service cost of the Hospitals can be significantly subsidized for the patients. All income from the Hospital shall be the rights of Patient Care while the subsidized services to the village residents shall be thePanchayat’s advantage. s Key Highlights Broader Base for Social Inclusion. This model shall include a broader base of the lower income population andthus further expanding the social base.s Community Ownership. With deep involvement of the Community, the ownership and interest in its sustenanceshall be much higher.s Health Activism. This model is compatible with the ideas of Health Activism and provides a chance to developcollaborations.s Community Outreach. The key element of the Marketing Strategy shall be to introduce various initiatives betweentargeting communities.s Partnership with the Government on various Health Services extension schemes like Janani Suraksha Yojna.s Drawbacks Village Panchayat Dynamics shall directly affect the functioning of the Hospital.s The Social Dynamics of the villages shall become more significant as the Villages shall be contributory partners.s The Income shall be on sustenance basis and any upgradation of medical equipments shall be Patient Care’sresponsibility. s The Most Venerable Section may still remain out of bounds for the Hospital owing to social dynamics, servicecosts or other factors.s MODEL C GRATIS OPD AND SUBSIDIZED TREATMENT The Hospital shall fully function on the funding available from external financial sources. The Out Patient Department shall function gratis; treating the patients without costs while having a layered service cost for admitted treatment which shallhelp the Hospital to break even within a targeted span.s Key Highlights Total Inclusion. The objective of total inclusion may be achieved as access to preliminary quality healthcare shallbe delinked from financial resources.s Layered Service Costs. Higher social income groups could utilize the layered services which could expand thecustomer base of the Hospital.s Health Activism. This model is compatible with the ideas of Health Activism and provides a chance to developcollaborations.s Community Outreach. The key element of the Marketing Strategy shall be to introduce various initiatives betweentargeting communities.s Drawbacks The Model is entirely based on external funding which will be unsustainable and unstable.p Expansion or Upgradation shall be based on the funding available and thus render the model dependent.s Page 7
  • 8. Focus Area Strategies Patient Care Hospitals shall have a three prong approach which shall focus on Maternal Care, Pediatric Care and Out Patients.s MOTHER AND CHILD Maternal and Pediatric Health are most venerable with the key health indicators indicating critical attention needed in these areas especially in central-eastern India where the population does not have immediate access to quality healthcare. Patient Care attempts to step into this void to develop specialized care for maternal and pediatric care.s OUTREACH Patient Care shall depart from the usual strategy of awaiting patients and reach out to Communities (Women and Children) partnering with institutions like Schools, Anganwadis, Mahila Kendras and conduct awareness workshops and other Outreach Activities.s OUT PATIENT DEPARTMENT This shall further objective of maximized inclusion and provide common healthcare facility to the residents. Patient Care shall collaborate with nearby multi-specialty hospitals for referral of patients under mandatory admission to EWS (Economically Weaker Section) patients and with other Government Hospitals.s 56 48 UNDER FIVE MORTALITY RATE PER 1,000 LIVE BIRTHS India Average Global Average Only about52%Patients having diagnosed for any kind of Chronic Illness in Bihar, Chhattisgarh, Jharkhand and Madhya Pradesh are getting Regular Treatment.s ONE TWO THREE 54is the Average Infant Mortality Rate is the Average Infant Mortality Rate in the four Focus states of Bihar, Chhattisgarh, Jharkhand and Madhya Pradesh. S While the National Average is .s 44 Page 8
  • 9. Innovation OPERATIONAL STANDARDIZATION OF PROCESSES All operational processes shall be centralized and standardized. For instance, procurement shall be made through the dual channel of Central and Local Procurement. While infrastructural material shall be procured centrally, operational material shall be procured locally. s LOW CAPITAL EXPENDITURE MODEL The Hospitals shall be developed to be ‘No-Frills’ hospitals. A series of measures will be taken to implement the low capital expenditure model including seeking a long-term lease of the land, restricted spending on the non-necessary fixtures like Air Conditioners etc., Streamlined design and utilization of space etc.s INTERNAL CROSS-SUBSIDIZATION Layering of the accommodation being provided in the Hospital with Private wards available at market prices.s CLUSTER APPROACH To better utilize resources and create a common pool of central resources for a District the cluster approach shall be adopted in establishing the hospitals which shall further intensify healthcare access and streamline utilization of resources. s OUTREACH EMERGENCY RESPONSE MECHANISM This mechanism seeks to address the emergency requirements of the villages in 10kms. or more of the Hospital at any time of the day. The average Telephone/Mobile Density in the urban areas of Bihar, Chhattisgarh, Jharkhand and Madhya Pradesh is 73.65% while in Rural areas it is 39.40% .s SERVICES A community plan could be proposed which provides emergency response service of a semi-equipped ambulance for providing initial treatment, transport to the Hospital and services of a trained medical practitioner. This would essentially link the villages beyond the catchment area to the Hospital and increase the customer base.s COMMUNITY SCHEME This scheme could be implemented at a community level to pool in resources and minimize costs which would mean that this service can be opted for by a village or a significant % of the village and not individual persons.s COSTING The objective being to provide an emergency response mechanism to those beyond the catchment area of the Hospital the costing could be to cover the operational and sustenance cost than the establishment cost. A model costing is presented for reference:s Average Households per Village Average No. of Personsper Household Total Persons per Village Subscription to Emergency Response Mechanism Scheme Service Cost Per Household Cost per Month Per Vilage Cost per Month Note: All Data has been reffered from Annual Health Survey Factsheet, 2010-11 300 04 1200 50% Re1 Rs. 120 per Household per Month Rs. 18,000 per Village per Month Households range from 150-2000 homes Persons Persons Per Person per Day Page 9
  • 10. SCHOOL HEALTHCARE OUTREACH PROGRAMME Healthcare with the aim of wellness is not practiced in India generally, primarily due to immense strain on existing resources which prioritize treatment of chronic diseases. The average percentage of Children attending School in the targeted four states is 87.75% in Rural areas and 91.55% in Urban areas . Patient Careshall attempt to launch a School Healthcare Outreach Programme which shall have the following objectives:s -Ascertaining the Health Status and identifying children with health deficiencies ranging from minor to critical -Screening for deficiencies, diseases and disabilities -Conducting Vaccination Drives -Providing Training on First Aid HEALTH PROBLEMS IN SCHOOL CHILDREN The health problems of school children vary from one place to another. However, the main emphasis will fall inthe following categories:s -Malnutrition -Infectious Diseases -Intestinal Parasites -Diseases of Skin, Eye and Ear -Dental carries COMMUNITY VOLUNTEERING The School Healthcare Outreach Programme shall be implemented on the ground under the supervision of the trained medical practitioner by a team of Volunteers from the villages who shall be provided adequate trainingand given know-how.s Eventually a cadre of part time Volunteers shall be built who shall act as a link to the village and further act asHealth Change Agents in their villages and implement the various social initiatives of the Hospital over time.s Page 10
  • 11. Locations One of the cornerstones of our Philosophy is to provide equitable access to healthcare and delink it from the beneficiaries Social or Financial status. This is the central guiding principal while the locations of the Hospitals have been proposed.s All data being presented below is original and has been referred from the Annual Health Survey Factsheet, 2010-11 conducted by the Office of the Registrar General and Census Commissioner, India.s METHODOLOGY A three step method has been followed to identify locations for the Hospitals. The locations have been limited to the Districts of the States.s STEP 1 PROFILING THE HEALTH STATUS OF THE STATES, DISTRICT WISE The Annual Health Survey Factsheet profiles all the District of the State across 152 Parameters in 29 Categories (Annexure 1). A statistical comparison on 25 Parameters across 7 Categories has been drawn of the four Target States of Bihar, Chhattisgarh, Jharkhand and Madhya Pradesh which is presented below:s Page 11
  • 13. STEP 2 IDENTIFICATION OF THE CRITICAL DISTRICTS IN THE STATES In the second step the most critical districts on more than 4 and 3 parameters are identified and assigned Zone A (CapitalCity, except Bihar), Zone B and Zone C respectively.d The State Capitals (excluding Patna in Bihar) have been marked as Zone A and have been identified for the inaugural intervention in the State. The critical Districts of the State(s) categorized in Zone B for higher Critical Districts and ZoneC for Medium Critical Districts in order of their health indicators.s BIHAR Page 13
  • 16. MADHYA PRADESH STEP 3 SHORTLISTED DISTRICT RATIO BIHAR CHHATTISGARH JHARKHAND MADHYA PRADESH Page 16
  • 17. Timeframe The Hospitals which have been categorized in three Categories shall be launched in separately in the same sequence as detailed below:s RATIO The following Ratio has been proposed for establishment of the Hospitals:s ZONE A: INAUGURAL INITIATIVE IN THE STATE Each state Capital has been included in Zone A irrespective of the Social Indicators since the inaugural intervention in the state shall be a replicated model of the cluster Hospitals close to the Slums in Patna. The inaugural initiative shall establish itself as the pilot project in the State and provide Patient Care an opportunity to understand the State dynamics and develop further collaborations.s Number of Hospitals Cluster Hospitals are opened in the City Slums, 10 surrounding areas and in the residential areas of the Lower Income Group.s Incubation Period Two years is the incubation period of each Hospital to break even.s Launch Month March 2015 ZONE B: HIGHER CRITICAL DISTRICTS Half i.e. 50% of the allocated Hospitals shall be established in the higher critical districts of the State in cluster of 10 Hospitals. s Number of Hospitals Hospitals in clusters of 10 are opened in each of the Zone B Districts.s Incubation Period Three years is the incubation period of each Hospital to break even.s Launch Month October 2015 Page 17
  • 18. ZONE C: MEDIUM CRITICAL DISTRICTS A total of 40% of the allocated Hospitals shall be established in the higher critical districts of the State in cluster of 10Hospitals.s Number of Hospitals Incubation Period Three years is the incubation period of each Hospital tobreak even.s Launch Month May 2016 Hospitals in clusters of 09 are opened in each of the ZoneC Districts.s Page 18
  • 19. Work Plan The Expansion Project shall be conceived and implemented by the Project Management Team which shall oversee all aspects including Strategic, Planning and Implementation.s OBJECTIVES OF THE PROJECT MANAGEMENT TEAM The Objectives of the Project Managment Team shall be:s Need Assesment Review of Existing Facilities Role of the Patient Care Hospitals in the local context Deciphering any specific local dynamics Implementation of the Project COMPONENT OF PROJECT MANAGEMENT Feasibility Study Identification of the Break Even Period and Expense Model Commissioning Strategic Planning FEASIBILITY STUDY Data Collection Demographic Pattern Need Assessment Transport and Communication Site Selection Environmental Study Village and Panchayat Dynamics Market Cost Analysis DATA COLLECTION Demographic Data Geographic Data Analysis of the Utilization of Present Healthcare Facilities Disease Pattern Existing Facilities and User Feedback SITE SELECTION Availibility of adequate land as per the size of the Hospital Approach Raod Suitable Soil Condition Suitable Drainage System for Disposals ENVIRONMENTAL STUDY Moderate Climate Non-existance of any Waste Dumpyard in the vicinity Away from the Main Road and Heavy Traffic flow PHASE 1: PLANNING NEED ASSESSMENT Type of Healthcare already existing - Preventive, Rehabilitation, General Care, Special Care etc.s Economic Status and Source of Earning Motivation for Utilization of Private services by people Housing, Education and Awareness among the people CONNECTIVITY Access from the main centers of the City, Village Availability of Private Taxis and other means of Transport Easy access to Transmission Towers for uninterrupted communication .. ...... ... .. .... . ... ... .. . .. . . ... .... . Page 19
  • 20. PHASE 2: STRUCTURAL IMPLEMENTATION LAND SCOUTING The Project Management Team shall, based on the Reseach parameters as mentioned in Phase 1 shall scout for the Landand seek a Long-Term Lease from the owner.s RESOURCE ALLOCATION An estimated Resources Allocation Chart detailing the Financial and Operational Resource requirements for theincubation perriod shall be prepared for implementation.s EQUIPMENT & OTHER ITEM SOURCING The Central Procurement Team shall take over all the Procurement requirements and start negotiations with theVendors.s STRATEGIC PLANNING The Project Management Team taking into account the various Factors from the analysis reports obtained in Phase1 plan for the following aspects:s Staffing Medical Doctors, Techinical Staff, Nursing Staff, Administrative Staff etc.s Machinary Equipments Priority Equipment, Heavy Equipment, Investigation Machines, Instruments, Drugs and Disposables, Furniture, Linen, Other Items . . COMMISSIONING Aspects like refurbishing of the Premises, Recruitment ofStaff etc.s PHASE 3: INCUBATION PERIOD The Project Management Team shall be responsible for Monitoring of the Project through the incubation period for requirements like liaison with other Units and any other requirements. During this period the Project Management Team shall handover the Operational Responsibilities of the Hospital to the local team and exit day-to-day Operations within adefined period of time.s Page 20
  • 21. Management Structure Patient Care operates thorugh three layer Management and Reporting Structure of Central, State and Unit Level teams working in tandem.s CENTRAL TEAM The Cenral Team is madated to oversee the strategic direction, overall implenetation and monitoring of the Units and to ensure that the cornorstone of the Groups philosophy is rigorously followed. The Central Team shall primarily facilitate and enable the State and Unit Level Teams and work through the following departments:s VISION & PLANNING Often operating as a think tank, this team shall be responsible for envisaging the vision of the organization. The team would be involved in strategic planning of the broader vision of the organization. s PROJECT MANAGEMENT This team shall be responsible for implementation of different projects undertaken by the organization. The project team has a complete overview of the requirements of the different projects and works towards its completion. s CENTRAL PROCUREMENT The Central Procurement Team shall be responsible for all the major, centre-related procurements for all its hospitals. This shall bring in standardization and uniformity. s EQUIPMENT & INFORMATION TECHNOLOGY This team shall be responsible for carrying out research on the new forms of medical equipment available. The team shall also be responsible for assessing the needs of every hospital and recommending the suitable medical equipment. They would also find ways of integrating information technology with the hospital requirements for better implementation of the Low Cost-High Quality model.s LEGAL & COMPLIANCE Responsible for all legal matters, audit, submission of documents etc. Weekly and monthly reports would be compiled and sent. s HUMAN RESOURCE AND TRAINING Responsible for all the staff members of all the centres of this hospital. This team would be involved in not only hiring and recuditruitment, but also in providing necessary support to all the staff members as well through workshops. s ADMINISTRATION & GOVERNMENT LIAISON This team would be responsible for overall administration of the Group and shall look into matters of government liaison at the central level. It shall stay in touch with government offices, health officers etc.s MANAGEMENT INFORMATION SYSTEMS The MIS team is crucial in any organization. This team shall monitor and analyze data being recorded at the Unit Level and be responsible for the overall management of the integrated Hospital Management Information System.s QUALITY CONTROL & AUDIT The quality control team needs to ensure that all the hospital are following the given’s guidelines and procedures. It may conduct special check on hospitals from time to time, which may be informed to the hospital or otherwise. s FINANCE MANAGEMENT This team looks into the financial aspects of the organization. Budgeting, analyzing financial data, bringing out financial advisory and notifications falls into their purview.s MARKETING & COMMUNICATION This team is in charge of both internal and external communication. Through marketing, they generate grants and funds while the communication team sets internal communication processes and also organizes outreach campaigns in schools and villages. s Page 21
  • 22. STATE TEAM The State Team shall be the coordinating unit between the Central and the Local Unit. The State Team shall be a compact team of professionals functioning under a State Programme Manager to monitor the functioning of the Hospitals within the State, Monitor the Strategic Intervention of Patient Care in the State, Porject the State Expansion Plans and coordinate withthe State Government for collaborations and partnership. The State Team shall work through the following Departments:s STATE MANAGEMENT TEAM The State Management team is responsible for heading the state units of the organization. It is responsible for theactivities of all the hospitals in a particular state. s STATE PROCUREMENT The state procurement department shall procure according to the requirements of the hospitals of the state and mandategiven by the Central Procurement Department. s MONITORING The Monitoring team would be monitoring the working of different people in the company. Continous monitoring, providing feedback review and evaluation would hel[p thehospital keep a check on itself and evolve. s GOVERNMENT LIAISON Coordinate with the State Government for Collaborations and Partnerships in the State. Monitor the State Health Policy and work on the areas of expansion for Patient Care’sintervention in the State.s HOSPITAL TEAM The Local Unit of the Patient Care Group, the Hospital Team shall be the on-ground team. The Medical and Operational Roles of the Team shall be segregated distinctly for better implementation. The Hospital Team shall work through thefollowing Departments:s MEDICAL SERVICES OUT PATIENT DEPARTMENT The Out Patient Department, meant to provide immediatemedical care and attention. s MATERNAL CARE One of the main wings of the hospital, this will be responsible for providing maternal medical care, which shall be one ofthe Key Strategies of the Hospitals..s PEDIATRIC CARE Our focus remains women and children. This departmentprovides medical attention to children. s EMERGENCY RESPONSE MECHANISM A unique initiative of this hospital, people in this department, work to provide access to immediate medical care tovillagers living in remote corners. s COMMUNITY OUTREACH This department heads community outreach initiatives like taking healthcare to the schools, addressing sanitationissues with people etc. s NURSING & SUPPORT SERVICES This department consists of the Nurses and Support Staffwho work across departments to provide their services.s ORGANIZATIONAL SERVICES HOSPITAL ADMINISTRATION Responsible for the overall working of the hospital, this team looks after day to day administration needs includingScheduling etc. and MIS requirements for the hospital.s MARKETING & PUBLIC RELATIONS As a subordinate group of the main marketing team, this team is responsible for setting up collaborations with localinterested partners and formulate Outreach Activities.s QUALITY MANAGEMENT Working as a subordinate Group of the Central Team, this team shall be responsible for Quality Adherance and Auditat the local Unit level.s FINANCIAL MANAGEMENT This group shall be responsible for the Financial Managmentof the Hospital.s Page 22 7
  • 23. Hospital Information Managemeng System Record Management and Reporting of the Hospitals shall be through an integrated Hospital Information Management System which shall link all the Hospitals to the Cenral and State Teams. The HMIS shall provide layered access to the data being generated for various purposes.s The local Hospital Unit shall be responsible for Data Entry into HMIS and its local management while the Central and State Teams shall be repsonsible for Data retrieval and analysis.s DATA ACCESS AND RETRIEVAL PRIMARY MODULE: MEDICAL SERVICCES Patient Administration, which includes:s Registration Admission Tereatment Records Discharge Tracking of Patients Programmes, whcih includes:s Maternal Care Patient Profiling Pediatric Care Patient Profiling Emergency Response Mechanism Scheduling, whcih includes:s Doctor Schedule Nurse and Support Staff Duty Roster Procurement, which includes:s Tracking of consumable Medical Iteams for Procurement purposes SECONDARY MODULE: HOSPITAL ADMINISTRATION Performance Analysis This module shall compile and analyze performance reports of the various units based on common factors like footfall etc. This module shall also have an integrated Feedback System for recording response of the Users.s Fixed Asset and Inventory Management This module shall manage the Fixed Assets and Inventory of the Hospital as per the Statutory requirement .s Profiling: User Demographics and Disease Database This module shall profile the Users and provide insight into the profile and prefrences of the returning Users. Additionally, the Module shall maintain a central database of the Diseases being diagnosed.s REPORT MANAGEMENT AND UTILIZATION The Reports being generated thorugh the above mentioned modules of the Integrated Hospital Information Management shall be utilized for various Strategic Decionmakings, Compliences, Doner Requirement and any other requirements.s Page 23
  • 24. Anticipated Challenges Since the Hospitals are envisaged to be Local Intervention Units in the Healthcare Delivery Mechanism in India, it is anticipated that these Units will function in close coordination with the Village/City level institutions. Therein lies the Challenges, some of which have been articulated below:s SOCIAL AND VILLAGE LEVEL SUPPORT AND ACCEPTANCE The Hospital will have to consciously to work in developing Trust of the Community which shall be the core factor for sustenance and positive intervention. Community Outreach and long term goals to develop General Health aspects of the Community shall assist in developing mutual trust and respect.s RECRUITMENT OF QUALIFIED DOCTORS The Hospital will have to recruit on a larger and central level to inspire qualified Doctors to serve in remote locations which may not be the nerve centers of medical traffic but pockets which require dedicationa and sustained intervention.s SUCCESS OF THE FINANCIAL MODEL The Hospital will have to extensively reach out to the local Community and the Government to collaborate on Health Schemes etc. to ensure that the Financial Model is sustained.s BALANCING THE VILLAGE DYNAMICS Since the Hospital will work closely with the Village Panchayats, Opinion Makers and other Village Institutions, it is imperative that a fine balance is maintained in the existing dynamics of these institutions and remain focussed on the primary objective of providing low cost healthcare. s FOCUS It is also imperative that the Focuses identified are taken forward without any new dimensions being added so that these focuses are given time and resources.s ACCEPTING THE EXISTING SITUATION While working with the Community, the Hospital staff will have to accept the sitution on the the grond as it is which at times may be difficult to comprehend. It is essential that the culture, priorities and difficulties of the Users are understood in detail after commencement of operations.s These are a few of the major Challenges anticipated during implementation of the Project . There shall be many more Challenges which shall have to be dealt with once the Project has been initiated.s ADHERING THE TIMELINE This being a Mega-Project of implementation of 500 Hospitals in 4 States, one of the important Challenges shall be to maintain the Timeline of the lanuch of these Hospitals. The flow of funds and a dedicated team at various levels will have to ensure timely monitoring of activities to anticipate any hurdles slowing down the pace.s Page 24
  • 25. Bibliography The following sources were referred for the purpose of the Case Study:s Website of Ministry of Health and Family Welfare, Government of India Website of Department of Health of the States of Bihar, Chhattisgarh, Jharkhand and Madhya Pradesh Apollo Hospitals Case Study Bio-IT and Healthcare in India, Deptment of Biotechnology, Government of India Delivering World Class Healthcare Today, Harward Business Review Enhancing access to Healthcare through Innovation, PricewaterhouseCoopers Private Limited Good Health at Low Cost 25 Years On, General Briefing Good Health at Low Cost 25 Years On, Tamil Nadu Success Story Healthcare in Developing Countries, A Presentation Healthcare in India, Vision 2020: Issues and Prospects by R. Srinivisan High Level Report on Universal Healthcare in India, Planning Commission, Government of India Human Resource requirements for Healthcare Industry, National Skill Development Council India Healthcare, McKinsey & Co.s Medical Technology Industry in India, Deloitte New Horizons in Indian Healthcare, Parthenon Group Providing Low Cost, High Quality Healthcare: LifeSpring: A piece by Anant Kumar Quintegra Hospital Information Management System Smile on Wheel Programme Brochure BCTA,LifeSpring, Case Study Innovative Pro-Poor Healthcare Financing and Delivery Models LifeSpring Backgrounder STATISTICS Census, Key Findings- 2001&2011 Key Health Indicators for India, World Bank India Health Profile, WHO Census District-Level Household and Facility Health Survey Annual Health Survey Factsheet 2012-13 Annual Health Survey Factsheet 2010-11 Various other related Websites, Blogs and other Online Resource Material.s Page 25