2. Public Health Infrastructure is below WHO norms
Rajasthan 2849 46778 68548 0.68
Tamil Nadu 2507 99435 72147 1.38
Madhya Pradesh 465 31106 72627 0.43
Uttar Pradesh 4683 66700 199812 0.33
Gujarat 2245 29402 60440 0.49
Karnataka 2842 70474 61095 1.15
India 41245 825234 1210855 0.68
States
Total
Hospitals
- Govt
Total
Beds
Govt
Population
(000)
Govt Hospital
Beds per
1000 people WHO
Guideline
3.5
Source : Central Bureau of Health Intelligence
3. IMR (Infant Mortality Rate) & MMR (Maternal
Mortality Rate) disparate across States
Male Female
Rajasthan 2.4 32 67.2 71.6 67 113
Tamil Nadu 1.4 13 70.1 74.0 24 54
Madhya Pradesh 2.6 43 65.2 68.5 75 173
Uttar Pradesh 2.7 38 65.4 67.6 75 167
Gujarat 2.0 23 68.9 73.1 49 57
Karnataka 1.6 19 68.7 72.1 40 69
India 2.0 28 68.4 71.5 50.9 97
States
Life expectancy at
Birth
Total Fertility
Rate
Infant Mortality
Rate(per 1000
births)
Under 5
Mortality
per 1000
live
births
Maternal
Mortality
Rate(per
100,000 live
births)
Source : Central Bureau of Health Intelligence
4. Government Initiatives
• Overall Government Spend in Healthcare was 2,26,000 Crores
in FY2020 - around 1.5 % of GDP
• Ayushman Bharath
• Addressing Primary Health Care – Health & Wellness
Centers
• PM JAY – 5 lakhs coverage for inpatient for around 100
Million Citizens
• Digital Health
• Health Registry, Health Exchange, PHR
• India led the world in Covid Vaccination
5. Shifting Disease Burden
• Transition from Communicable to Non-Communicable Diseases (NCDs):
• Communicable Diseases Control: Progress in controlling infectious diseases such
as malaria, tuberculosis, and certain vaccine-preventable illnesses
• Improved healthcare interventions
• vaccination programs
• public health initiatives.
• Rise in Non-Communicable Diseases(NCDs): Cardiovascular diseases, diabetes,
cancer, respiratory illnesses, and mental health disorders.
• Aging Population: The population of elderly individuals in India is growing.
With aging comes an increased susceptibility to chronic health conditions,
contributing to the rise in NCDs.
• Urbanization and Lifestyle Changes: Urban areas witness lifestyle shifts
characterized by unhealthy diets, reduced physical activity, stress, pollution
exposure, and other risk factors associated with NCDs.
• Increasing Focus on Preventive care is a must
6. The Healthcare Imperatives
•Major spend through personal
finances (53% Out of Pocket)
•Limited health insurance and other
risk pooling measures
•Additional cost on
transport/lodging reaching
healthcare destinations
•Gaps in infrastructure
•Cutting edge medical protocols
•Initial and continuous training
•Regulations enforcement
•Achieving Millennium Development
Goals (MDG)
7. Healthcare System is Complex
Patients, Family
Members
Healthcare Providers:
•Hospitals (Public &
Private)
•Clinics & Healthcare
Centers
•Diagnostic Laboratories
•Home Healthcare
Pharmaceuticals:
• Manufacturers
• Retailers
Healthcare Payers:
•Insurance
•Government Schemes
Healthcare
Professionals :
• Doctors
• Nurses
• Paramedics
Regulators :
• Government
• Regulatory
Bodies
Education :
• Medical,
Dental,
Nursing
Colleges
• Training
Medical
Equipment &
Consumables
• Manufacturer
s
• Retailers
8. Important to improve Healthcare Efficiency
Patients
Reduce wait times –
O/P and I/P
Improve outcomes
Reduce cost to the
patient
Providers
More patient
throughput
Better utilization of
assets improve
profitability
Better outcomes will
improve reputation
Healthcare
Professionals
Focus on clinical rather
than administrative
overheads
Reduce work
overloads
Public Health
Better Utilization of
Funds
More Coverage of
patients
9. Illustrative Examples – Outpatients(O/P)
Huge wait times for doctors in many hospital in-spite of appointments
Wait times for diagnostic procedures like CT/MRI
Wait times at pharmacies; stockouts at pharmacies
Wait times for reports leading to poor satisfaction
A patient/family member – no unified journey – can be sent from one counter to another leading to longer
times, frustration
10. Challenges
A lot of time goes in first time
registration (Fill it before you
come to the hospital)
Many Doctors are not
employees/full-time in
hospitals – they have limited
slots for seeing patients
When you are referred to go to
another doctor in a different
specialty – you may not get a
slot immediately
When you are referred to get a
scan – already there is a queue
No Sharing of health records
across the system
EMR is not very prevalent – so
Doctors still write out the
prescriptions
• Imagine if the prescription is digitally
sent to the pharmacy and by the time
you reach the pharmacy – it is ready to
be picked up
11. Appointment Management for O/P……….. 1/2
Implemented an
appointment and
queuing
management system
Got access to the
doctor calendars of
each department of
each hospital in the
system
Set-up a centralized
call center and also
introduced online
appointment system
Introduced
reminders for
appointments
Tracked data on
adherence to
appointment
schedules
12. Appointment Management for O/P……….. 2/2
Improved patient satisfaction – wait times reduced
Reduced crowding and smoother flow of patient footfalls
Patterns on appointments – which departments, which days of week, preferred time-slots etc – new concepts
like evening O/P clinics could be launched
Data gave visibility on where we had to get additional doctors for O/P
Better utilization of O/P consultation rooms
13. Illustrative Examples – In Patients(I/P)
Waiting for a bed for
admission
Operation Theater
Usage
Waiting for Discharge
14. Discharge Process ………………….. 1/2
It can take many
hours for the
patient to get
discharged after
the Doctor gives
the OK
More than 1
doctor involved
– everybody
needs to sign off
Any extra drugs
& other hospital
items needs to
be returned to
Pharmacy
If the patient is
under an
insurance policy
– the complete
patient file
needs to be sent
to the
insurer/TPA
A lot of duplicate
work happens at
both ends of the
chain – because
of health records
not being
standardized/dig
ital
The
TPA/Insurance
company needs
to cross check
15. Discharge Process ………………….. 2/2
IMPLEMENT A
SOFTWARE TOOL
TO MONITOR THE
DISCHARGE
ACTIVITIES
SHOWCASE
WHERE EACH
DISCHARGE IS
STUCK
HAVE HOURLY
MEETINGS TO
TAKE STOCK OF
ALL DISCHARGES
HAVE TEAM
MEMBERS TO
ADDRESS THE
POINTS WHERE
THEY ARE STUCK
IDENTIFY BIGGEST
CHOKE POINTS
AND COME UP
WITH LONGER
TERM SOLUTIONS
SIGNIFICANT
REDUCTION IN
DISCHARGE
TIMELINES AND
IMPROVING
PATIENT
SATISFACTION,
BED
UTILIZATION(NEW
ER PATIENTS) ETC
16. Modern Work Management Practices is a need of the hour in
Healthcare
Patient Experience
Admissions to Discharge
Healthcare Claim Processing
Post discharge care
Chronic Disease Management
Operations
Increase utilization of Beds, OR, Labs,
OP Consultation rooms
Lab Test & Result Proceasing
Improve procurement, warehousing
especially in Pharmacy
Clinical
ER Triage
Access to Longitudinal Health
Records(across providers)
Precision Medicine
AI assisted diagnostics and care
17. Structural
Changes
India is implementing PHR – Personal Health Records thru
ABHA
Increasing adoption of EMR
Creation of claims exchange to improve data visibility across
providers and payers
Increase of health insurance
Newer digital healthcare players are removing information
asymmetry and forcing established players to become efficient
Patient advocacy is increasing and there is demand for more
efficient and affordable healthcare
18. Conclusion
• There is a huge opportunity for improving
efficiency in Healthcare
• Come up with ideas on how Kanban can be
used in Healthcare
• Look for opportunities to implement them in
Public as well as Private healthcare
Overview of challenges: Highlight key challenges faced in the Indian healthcare sector (e.g., accessibility, affordability, resource constraints).
Statistics and data: Use impactful visuals to showcase statistics illustrating the existing inefficiencie
Engaging opening: Share a thought-provoking statistic or a personal anecdote related to healthcare inefficiencies in India.
Set the stage: Discuss the importance of efficient healthcare systems for better patient outcomes and overall societal well-being.
Define objectives: Discuss the specific objectives and goals aimed at enhancing healthcare efficiency.
Link objectives to audience interest: Explain how achieving these goals can positively impact both healthcare providers and patients.
Technology Integration: Explore the role of technology (EHRs, telemedicine, AI, etc.) in streamlining processes and improving healthcare delivery.
Process Optimization: Discuss methods for optimizing workflows, reducing wait times, and enhancing resource utilization.
Government Initiatives: Highlight key government programs, policies, or reforms aimed at improving healthcare efficiencies.
Real-life examples: Present case studies showcasing successful implementations of efficiency strategies in Indian healthcare settings.
Impact and outcomes: Discuss measurable outcomes, such as improved patient care, cost reduction, or enhanced access.
Real-life examples: Present case studies showcasing successful implementations of efficiency strategies in Indian healthcare settings.
Impact and outcomes: Discuss measurable outcomes, such as improved patient care, cost reduction, or enhanced access.
Technology Integration: Explore the role of technology (EHRs, telemedicine, AI, etc.) in streamlining processes and improving healthcare delivery.
Process Optimization: Discuss methods for optimizing workflows, reducing wait times, and enhancing resource utilization.
Government Initiatives: Highlight key government programs, policies, or reforms aimed at improving healthcare efficiencies.
Real-life examples: Present case studies showcasing successful implementations of efficiency strategies in Indian healthcare settings.
Impact and outcomes: Discuss measurable outcomes, such as improved patient care, cost reduction, or enhanced access.
Visualizing the Discharge Workflow: Create a Kanban board that represents the stages of the discharge process, starting from the decision to discharge to the actual departure of the patient. Stages might include "Discharge Order Received," "Medication Review," "Preparation for Departure," "Documentation," and "Patient Departure."
Work in Progress (WIP) Limits: Establish WIP limits for each stage of the discharge process. For example, limit the number of patients being reviewed for discharge simultaneously or the number of patients in the documentation phase. This prevents congestion and ensures a smooth flow of patients through the process.
Patient Cards: Each patient due for discharge is represented by a card on the Kanban board. Information on the card may include the patient's name, room number, discharge status, pending tasks, and any special requirements.
Status Updates and Transparency: Hospital staff responsible for different stages of the discharge process update the Kanban board as tasks are completed and patients move through each stage. This allows for real-time visibility into the progress of patient discharge for all involved stakeholders.
Coordination and Communication: Kanban promotes collaboration among staff members involved in the discharge process. It facilitates communication regarding patient readiness, pending tasks, and any special considerations that need to be addressed before discharge.
Continuous Improvement: Regularly review the discharge process using the Kanban board. Identify bottlenecks or areas causing delays and brainstorm solutions to improve the flow. Encourage feedback from staff involved in the discharge process to implement improvements.
Integration with Electronic Health Records (EHR): Integrate the Kanban system with the hospital's electronic health records or information systems. This integration allows for easy access to patient information, reducing manual efforts in updating the board and ensuring accuracy in patient status updates.
Metrics and Performance Tracking: Measure key metrics such as discharge times, turnaround times for specific stages, patient satisfaction post-discharge, and any other relevant KPIs. Analyze this data to identify areas for further enhancement.
Implementing Kanban in the discharge process can lead to a more organized, efficient, and patient-centered approach. It helps in reducing discharge delays, improving communication among staff members, enhancing patient experience, and ensuring a smoother transition for patients leaving the hospital.
Addressing barriers: Acknowledge potential challenges and discuss strategies for overcoming them (e.g., funding, infrastructure limitations, resistance to change).
Lessons learned: Share insights from challenges faced and how they can be valuable for future initiative
Empowerment and action: Encourage audience involvement by suggesting actionable steps they can take to contribute to healthcare efficiency improvements.
Inspiring conclusion: Summarize key points, leaving the audience with a strong and motivational closing statement.