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Diljo Thomas
Manager- Patient care
Aravind Eye Hospital, Madurai
Introduction
Health care, education, judiciary, various government and private-sector institutions must be able to adapt to changing circumstances. Changes in population, service demand, utilization patterns and technologies contribute to new requirements for program delivery, thereby increasing the need for new or renovated facilities. In addition, physical deterioration of buildings, code changes and economic factors, such as energy conservation, contribute to facility obsolescence.
Hospital management is a hard task due to the complexity of the organization, the costly infrastructure, the specialized services offered to different patients and the need for prompt reaction to emergencies.
Interpreting the National Health Policy 2002 from the point of view of governments role in healthcare, suggests that the Government of India has subtly accepted the fact that it does not intend to be an active provider of tertiary care services. In other words, it wants private players to take up the responsibility of offering high-end speciality and super-speciality care. The private sector, it seems, have taken up the challenge and doing a good job of providing advanced healthcare.
But even as the requirement of healthcare is being met on one hand, on the other, unnecessary focus is on glamour rather than just treatment. The zest to produce a world class hospital is the root cause of all problems say experts. Can a middle class, salaried employee afford treatment in such centres?
The corporate bandwagon has recently been focussing on creating facilities that can be called world class and service foreign patients too. But can Indian patients afford it? Naturally hospitals take a long time to get over their debts and breakeven. Low project cost is the key to low pricing which in turn can make healthcare affordable. And low project cost means keeping frills and fancies out.
Apart from cutting corners on building, costs on some services like air conditioning can be kept low by eliminating a central AC. Having a central AC costs nearly Rs 350 per bed/ day. So if occupancy is low this cost could go up. People are not used to AC in their homes so why give them additional luxury and make them pay for it.
Size is another factor that needs to be kept in mind while building a hospital. The number of beds or the size of a hospital does not qualify the infrastructure as good or bad. The golden advice is try to run to full capacity and then expand.
Finally the key to a good facility lies in assessing the right kind of hospital that is required for the Indian market. India requires cost effective solution which should be for masses and not classes. Experts say that though we need buildings that reflect best quality design, this should serve the functionality. Infrastructure should be planned so as to keep the initial cost low. For example, the number of entrances to a hospital building should be minimum to keep security cost low. Too many toilets should not be built because it is costly to create them and even more expensive to maintain toilets.
What is also often forgotten is that good hospital infrastructure comprises not building and interiors but personnel and medical equipment. Patient traffic depends on quality of care in the market.
Bottom-line is that creating good infrastructure is not enough. One has to keep in mind that insurance companies would like to pay as less as possible. If the quality is almost the same, insurance will go to the lower priced.
There should be no doubt that the healthcare personnel are the backbone of the medical industry. Second would be the technical personnel. Only next in line of importance is finance. Just as Vitamin K is essential for human existence, finance is critical for every industry, not just the healthcare industry. Though it might be more so in the healthcare industry because this is one place people are brought to, not out of will but by compulsion. This being the case the issue of money becomes a delicate factor. Though patients are the core of our business it is vital for every hospital to make up and maintain their operating profits. Hospital needs to always take the balance sheets into account. They need to evaluate the cost for each bed and how much that one bed would contribute. Also one needs to keep into account the structural capital in mind. The capital status, for instance, how much money have we taken from banks, needs to be taken into consideration.
Unlike other properties that can be upgraded in terms of room capacity as they develop, hospitals should be built to the optimum capacity, in terms of its number of rooms and other facilities in the same block. This is because one cannot add facilities at a later date as this would only disturb the patients and increase the possibility of an infection.
But before building one must do the market research and understand the market capability. People are the best asset we can provide. We have world class doctors who go abroad to work only because they are unable to exploit their potential here. Finance is important but so are our people. We need to be able to balance between the two to create a world class infrastructure. This would ensure the success of many excellent healthcare institutions that are now dwindling due to lack of finance management.
Create efficient people and world class infrastructure will follow
Hospital management is totally different from managing any other property. Be it hotels or corporate buildings the plan and purpose of their infrastructure is totally different from that of a hospital. The following are some of the tips that hospitals must keep in mind to erect a hospital with an effective infrastructure.
- Location
- Vehicle parking
- Building
- Operation theatre
- Equipment
- Monitoring activity
- Train your staff
- Maintenance
Location
Building a hospital is not an easy job. If there is one thing that the industry agrees on, it is the fact that clients or patients who come to the hospital are not there out of choice. They visit a hospital because they are forced to do so. In this scenario the first thing that would look at before setting up an infrastructure is the location of the hospital. The property must be accessible to people from all walks of life. Unlike certain industries that cater to the rich who can afford their own mode of transportation, hospitals must be accessible to everyone. This location should be one that can be permanent since people associate a hospital with a location.
Vehicle Parking
The second thing that would look at is the space for vehicle parking. Though most of our hospitals are in the main road we try to set up our property where we are also connected to a small lane wherein people can park their vehicle. Setting up our properties in L-roads reduces the trouble for the patients to search for vehicle parking.
Building
Building is another major area that one needs to look at carefully before setting up a hospital. The facility for outpatients must be different from those of the in-patients. Outpatients might bring in infections with them, which might spread to the inpatient that has undergone an operation. Hence an inpatient area must be accessible only to the inpatients. Construct the hospital in a way that the two need not any time have to use the same area.
Operation theatre
Gone are the days when loved ones of the patients waited outside eagerly to know how an operation went on. All our operation theatres have an observation gallery from where attendants can watch and see how the operation proceeds. This way they would know exactly what was happening in the room, which increases the awareness of operations amongst the general public. At present this is being implemented in a few hospitals but as awareness increases patients would look for a hospital that is transparent. So while building a new hospital it is best to build it according to the latest standards and guidelines though you might spend a little more. Another facility that could be included is to be able to talk to those in the observation gallery right from the operation theatre. This further reduces their fear and assuring that the doctor is in touch with them.
Equipment
Remember that a hospital is not a five star hotel. We need 5-star doctors with good surgical skills. People do not come to the hospital for its ambience. They come because of the efficient staff and the equipment handled by them. While it is very important that your hospital is hygienic, clean and comfortable it would be foolish to make it look like a 5-star hotel and hike the prices.
Monitoring activity
Monitor every activity that happens at the hospital. In our hospital we have cameras in the operation theatres and I an able to see what happens in all the four operating theatres. A television is kept in the outpatient area where they can also get a feel of what happens at the hospital. This kind of a transparent atmosphere eases any fear.
Training staff
The patient comes to the hospital as a last resort. When he comes in he does not want to feel dejected further by the attitude of the staff. Hence the staff needs to be trained to be courteous to people. Have a counsellor at the hospital that would be there for the patient both during pre and post operation period. Our post operation counsellor at the hospital dials all the patients who have undergone the operation that particular day to ask them how they feel etc.
Maintenance
Building a hospital is not over with developing infrastructure and starting operations. The success of the property depends on constantly maintaining and updating the facilities. Employ an effective housekeeping department that can constantly maintain the hospital. Appoint microbiologists to test the sterilisation levels. Manage your waste effectively. Dont just burn them or dispose them, as they would only pollute the surrounding areas.
The Indian healthcare industry is keeping up or even moving ahead of the developed world. With a steady increase in population India needs more hospitals. With increase in awareness amongst people these hospitals need to be of world class standards to survive in the industry. What better way to do it than to start efficiently and keep up the standards year in and year out!
Reference:
- Principles of Hospital Administration and Planning B.M. Sakharkar
- Hospitals Planning, Design and Management - A. Katakam, G.D. Kunders, S. Gopinath
- Hospital and Health Services Administration - Principles and Practice - Syed Amin Tabish
- Express Healthcare Management
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