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First of all, I want to express my all humble thanks to God who is very sensitive about each and every activity of all his men and without whose help, I am unable to accomplish any objective in my life. Who blessed me with an opportunity to get internship training in a world class organization – Narayana Hrudayalaya. Secondly, I am grateful to my prestigious institute that made this learning opportunity a part of our education. I am thankful to Miss Shrabani Basu, Internship Coordinator who not only guided me well but also helped me in finding such a great place for internship. I am also thankful to all the teachers as the knowledge imparted by them enables me to gain knowledge of the organization in the best way. From Narayana Hrudayala, I would like to express my gratitude toward Dr Asha Naik (Medical Superintendent) to take me as intern in the organization. I would like to thanks my immediate supervisor in Narayana Hrudayala Miss Rashmi and HR Head Miss Meneka for assigning me different type of work to give me maximum exposure in minimum assigned internship period from the college. I want to pay gratitude to all persons, who had helped me in completing this internship.
The purpose of this report is to fulfill the internship requirement for the Post Graduate Diploma in Human Resource Management. While I was employed at Narayana Hrudayala as management trainee, I was assigned various jobs which gave me the maximum exposure to the actual work flow. This report summarizes on International Department, Waiting Time in Radiology and Imaging Dept, Waiting time in ECG, Waiting time in Treadmill Test, Market Research work for Business Development, Checking on referral from the doctors for Business Development purpose. The number of child who born in India is large compared to several other countries, so this way the problem with the heart of child also goes higher than any other country. This increases the need of good healthcare. So keeping all this in mind this organization was started with clear mission and vision to take good care of all these problems.
VISION AND MISSION
VISION AFFORDABLE QUALITY HEALTHCARE TO THE MASSES WORLDWIDE In accordance with the vision statement the hospital administration has launched several plans in which the farmers, can afford the good healthcare because of the affordable price. The hospital administration has launched a plan known as “YESHASWINI”. Under this plan any farmer can enroll with a monthly fee of Rs 10/head and they need to fulfill two conditions: 1) need to have a farming land, and they should be the member of any co-operative society. In this plan all the expenses till diagnosis of the disease is levied on the farmers and as the disease is diagnosed and confirmed, after that all the expenses is covered by the hospital like room charges, surgery charges, etc. There is a different insurance plan for school going girls till class Xth which is known as “ ”. In this plan only those girls are covered who are school going girl. In this plan the health of girls are taken care by the doctors who are very experienced at just the negligible cost.
MISSION DREAM AT NARAYANA HRUDAYALAYA IS “A DREAM OF MAKING QUALITY HEALTHCARE AVAILABLE TO THE MASSES WORLDWIDE”.
To make the dream a reality we commit ourselves to:
1) Being a tertiary care referral center for complex medical and surgical problems. 2) Developing a Health City Model, to be replicated nationally and internationally. 3) Excelling as an Education, Training and Research Center in Medical, Paramedical and Allied specialties.
Some call it a temple. Some chose to call it the abode of saints who heal. To some, it's a last chance of survival. But to no one, is this just a hospital. In its genre, Narayana Hrudayalaya may well be one of the biggest hospitals in the world, but the fact that it’s one of the biggest hospitals, with a heart, is becoming legendary. The rich come here for the world's best heart care. The poor come here for the world's kindest care, for no one here is turned away for lack of funds. This was the vision of Dr. Devi Prasad Shetty, who believed that no child should be deprived of the best healthcare, because the parents cannot afford it. Caring with Compassion, this world's largest heart hospital for children, is set to be transformed into the world's biggest health city, with all super-specialities that the medical world offers. It’s a promise of the best healthcare, that brings succour to all, like the divinity of Narayana’s Vishwarupa that greets everyone in the lobby of the hospital. Narayana Hrudayalaya is founded by one of the India’s oldest construction company “Shankar Narayana Construction Company”. Narayana Hrudayalaya group has Narayana Health City at Bangalore covering 25 acres of land and Rabindranath Tagore International Institute of Cardiac Sciences in Kolkata and Rotary Narayana Nethralaya a Super Specialty Eye Hospital. Currently this group’s two-heart hospitals in Bangalore and Kolkata perform about 10% of the heart surgeries done in the country. In Bangalore we have an infrastructure to perform 30 major heart surgeries in a day and in Kolkata 10 major heart surgeries in a day. Narayana Hrudayalaya performs largest number of heart surgeries on children in the World attracting children from 26 countries. The postoperative pediatric cardiac surgical unit has 80 critical care beds to look after children who are undergone heart operations and this is World’s largest Pediatric cardiac surgical Intensive Therapy Unit (ITU). Narayana Hrudayalaya is an academic institution conducting 49 training programmes and is short-listed by the University grant commission for the status of the Deemed University. Four years ago Narayana Hrudayalaya in association with the state government launched a Micro Health Insurance Programme called Yeshaswini, which covers the healthcare of nearly 3 million farmers and is considered as India’s largest Micro Health Insurance Programme for a monthly
premium of 10 rupees. This program now is launched in several other states in consultation with our groups. Narayana Hrudayalaya in association with India’s Space Research Organization runs one of World’s largest Tele-Cardiology programs using ISRO satellite and till date we have treated close to 30,000 heart patients. Asia Heart Foundation, which manages all our activities in Kolkata, runs the primary healthcare of entire Amethi constituency of Uttar Pradesh. Amethi is one of India’s largest MP constituency having 24 Lakh people and this is managed by 16 clinics created by Asia Heart Foundation with Narayana Hrudayalaya where Amethi residents come and see the doctors and get all the medicines entirely free. Currently this programme called ‘Rajeev Gandhi Arogya Yojana’ treats over 50,000 patients per month. This is considered as India’s largest primary healthcare program by the private sector. Narayana Hrudayalaya in association with Mrs. Kiran Mazumdar of Biocon is in the process of launching one of World’s largest cancer hospitals with 1400 beds at Narayana Health City. CONCEPT OF HEALTH CITY: Narayana Health city was Conceptualized six years ago by creating a conglomeration of hospitals in one campus with a 1000 bed heart hospital called Narayana Hrudayalaya, 500 bed orthopedic hospital called Sparsh Hospital, 300 bed eye hospital with the infrastructure to perform 500 cataract surgeries everyday and 1400 bed cancer hospital a joint venture of Narayana Hrudayalaya with Mrs. Kiran Mazumdar of Biocon. Projects in the making are a 500bed Neuro hospital, 500-bed kidney hospital and a women and children hospital. Together they will make a 5000 bed and once the entire health city is commissioned, we believe that the cost of healthcare should come down atleast 50%.
RECOGNIZATION OF OUR ACTIVITIES: Three year ago Harvard Business School chooses Narayana Hrudayalaya as one of their case study and this is one of the most quoted case studies in the healthcare industry.
Four years ago discovery channel made a documentary on Narayana Hrudayalaya, which was broadcasted all over the world. Three years ago Australian broadcasting corporation made a documentary about Narayana Hrudayalaya, which was broadcasted all over the world and especially in Australia during the prime time. Narayana Hrudayalaya’s story is written by Forbes, Readers Digest, and New Scientist and appears in two of the books from the Harvard Business School.
Day 1 as I stepped in the hospital I was interviewed by the panel of HR personnel from the hospital and asked about the project work on which I am willing to work. I informed that as per the guideline from the college I am required to concentrate on the organization structure. As the interview as over I was put under the surveillance of Mr Nithin Aiyappa (General Manager), International Division and told that I need to observe the working of the department and how they can improve the satisfaction of the patient. I continued there for almost a week and half. I started my assignment with understanding the work how patient approach the hospital and response from the hospital. This department is basically concerned about International division only. Mr Aiyappa gave me bundle of files to go through. Those files were having lots of communication which they get from the patients who are abroad and came to know about the hospital from any number of sources. The sources through which they may come to know about the hospital are doctor, who is treating the patient, agents, hospital website. Agents, there are few organizations those have tie ups with the hospital, like Lions Club, and there are few more club who have the tie up with the hospital. Travel Agents are also the source of the information to the patients for the hospital. As they know about the hospital they can E mail, Fax, or Call up the hospital about the problem and with all other queries. As the query start from the entire source they are received by the international division and they are answered by them. Once there query is answered the hospital need to receive the medical record for the patient so that doctor can review it and can get to know about the problem in details. The medical records can be send via Fax, Email, or Post. The doctor then reviews the record and can come to know about the diagnosis and the treatment. If some more record is needed to know about the problem of the patient correctly, then those records are requested. If necessary the tele conference or video conference is made with the concern party. The hospital has one of the biggest tele or video conference centre in the healthcare industry, they have a tie up with Indian Space Research Organization (ISRO).
If the patient is interested to get the treatment in the hospital, they inform the hospital administration. The hospital administration then respond back with the appointment to the patient. The patient needs to send the copy of Visa and Passport to the international division so that pre registration and ID card is made for patient and attendant. The travel plan is also made for the patient. The hospital administration prepare the room as per the diagnosis of the patient, it can be called as customized room preparation. Before the patient arrives at airport all the preparation is made in the hospital. There living arrangement, their visa, coordinating with embassy if there is some problem with the patient to get the visa, they hospital administration assist them there as well. Once the patient arrive at the airport the personnel from hospital, who is fluent with their language, go to receive them and bring them to hospital or the place where they have the accommodation. I have put down all the function in the chart, which on the next page.
PROCESS WORKFLOW IN INTERNATIONAL DIVISION
E-Mail / Fax / Letter from patient/ Dr’s / Agent regarding the problem of the patient Received by Intl. Division
Medical record of the patient is requested through proper Channel Medical records are reviewed by the specialist Dr Recommendation is made to patient on basis of medical record. Diagnosis and Treatment is told. Tele / Video conference is made with patient or concerned party
If patient is interested for treatment in hospital. Appointment is given.
Copy of Visa and Passport is received by Intl Div Pre-Registration is done for the patient Patient arrives at Airport. Representative and hospital receives the Guest. fromattendants & Id card is issued
Travel Plan is prepared as per the appointment Room is prepared (Based on Dx of patient)
This is how the international patients are informed and admitted to the hospital. As the patients are admitted to the hospital, they have attendant with them, so along with the patients, attendants are also need to be taken care off. Taking care of patient and attendants is not a easy task so I was assigned the job that to interview the attendants and let the hospital administration know how they can take good care for the both (patients and attendants). This work is really important for the hospital administration, because a satisfied patient and attendant will return to the native country and when they speak about the hospital this will create an image of hospital in the eye of listener. Not only will the image of hospital, along with hospital the Indian image about the hospitality, healthcare, and tourism will be created. Now a days the concept of medical tourism is really booming. It is not that much affected by the economic slowdown because the simple reason is people can compromise in any of the services like they can stop going out for shopping, will not have lunch of dinner in five star hotel but when it comes to the health they cannot compromise with health. Good health comes on top priority because “Health is Wealth”. If they are not healthy, nothing can be done about it. GROWTH OF MEDICAL TOURISM INDUTRY The countries where medical tourism is being actively promoted include Greece, South Africa, Jordan, India, Malaysia, Philippines and Singapore. India is a recent entrant into medical tourism. According to a study by McKinsey and the Confederation of Indian Industry, medical tourism in India could become a $2.3 billion business by 2012. The report predicts that: "By 2012, if medical tourism were to reach 25 per cent of revenues of private up-market players, up to $2.5 billion will be added to the revenues of these players". The Indian government predicts that India's $17-billion-a-year health-care industry could grow 13 per cent in each of the next six years, boosted by medical tourism, which industry watchers say is growing at 30 per cent annually. In India, hospital like Apollo is the front runner in medical tourism industry. They have so far treated about 95000 of the foreign patients alone. Narayana Hrudayalaya is growing on the rapid pace and attracting large number of international patients.
Another corporate group running a chain of hospitals, Escorts, claims it has doubled its number of overseas patients - from 675 in 2000 to nearly 1,200 this year. Recently, the Ruby Hospital in Kolkata signed a contract with the British insurance company, BUPA. The management hopes to get British patients from the queue in the National Health Services soon. Some estimates say the foreigners account for 10 to 12 percent of all patients in Mumbai hospitals despite roadblocks, poor road infrastructure and absence of uniform quality standards.
Analysts say that as many as 150,000 medical tourists came to India last year. However, the current market for medical tourism in India is mainly limited to patients from the Middle East and South Asian economies. Some claim that the industry would flourish even without Western medical tourists. Afro-Asian people spend as much as $20 billion a year on health care outside their countries - Nigerians alone spend an estimated $1 billion a year. Most of this money would be spent in Europe and America, but it is hoped that this would now be increasingly directed to developing countries with advanced facilities. I started interviewing the attendants with the patients. It was quiet interesting for me to get along with the people who are not from our country. What is their expectation and how do they see the thing around them, how are they affected by the surrounding, and what problems are they facing here and how they can be resolved? All these questions were in my mind before I started the interview. I was really interesting part of my training. Most of the patients were form Middle East Countries, Tanzania, Namibia. They all were happy when I told them that I am doing a patient satisfaction survey for hospital so that the hospital administration can improve the quality for service provided. The most common thing they want to be improved about the food. Learning Outcome: This assignment helped me to increase the inter-personal skill. Since I was talking to the people who are here for the purpose with is concern with health. It was not easy to talk with them because I did not have any idea that what is going on with the patient, with whom they are here, but I found all of the really cool to talk and expressed their ideas. They were really friendly in nature. I am going to summaries it into the points:
Internship Report Patient arrives at Airport. Representative from hospital receives the Guest.
Food and Beverages: They need the kind of food they have at their country, but they do understand that due to health reason the foods cannot be provided to the patients. The attendants can have the food of their liking but they need to travel really far to get those kind of food. As I was told by Mr Aiyappa that the hospital administration is coming up with an idea of food court in future. So this will definitely help out the attendants.
Fun Park: There were huge number of child with the patient, so they want some type of fun park were there child may have some game, drawing activity. If this is not possible they can be provided with the crayon colors and a chart sheet they can do some painting activity in the hospital room itself.
Nursing Practice: One of the attendant told that her daughter was given a injection by a nurse but she was not using any cotton and the blood was coming out so he didn’t felt good about it. If the hospital administration wants to increase the satisfaction of the patient they must have well motivated employee from top to bottom because each one is contributing equally to the patient.
Separate Counter for Foreigners: The foreigner patients are also required to pay the bill, get the receipt, and several other transaction do at the same counter where there is a big queue of the national patient. So if at least one executive is assigned dedicated to foreign patient, they may feel that they are being given extra attention. This will increase the level of satisfaction in them.
The second assignment which I got was to calculate the waiting time for the patient in Radiology Department, Echo Department and Treadmill Test. All these procedures are really common in the hospital because most of the patient who coming for the heart problem, and this is one of the biggest heart hospital, need to undergo these tests. Procedure Done Ultrasound KUB Ultrasound Abdomen Carotid Doppler 15 min 20 min 15 – 20 min
TVS Ultrasound Neck OBG Single Doppler MRI
20 min (each sitting usually takes 3 sitting) 10 min 40 min 25 – 30 min 1 hr – 1:30 hr
Introduction Radiology and Imaging Dept. has 5 Ultrasound Machine, 1 MRI Machine. Normal OPD hrs are between 9 AM to 5 PM. Between this time 8 Dr’s are available in the dept to help out the patient. 1 girl is available to take care of patient who are coming in to get the scans done, she register the patient in the register, send them to scan as the machine is free, after the scan is over and the reports are prepared she deliver the report to the patients. 1 girl is dedicated for typing the report. Number of Employees Doctors Reception Reporting Observations Patient arrive at reception with the Dr’s Order for specific procedure and also with the payment receipt which they have paid to the accounts dept. Patient give the complete record to the reception and the girl at reception register them in the register with the patient id no, Name, Age / Gender, Referring Dr, Procedure to be done, In time, etc. Patient needs the bladder to be filled completely for most scan procedure they are being referred to the Radiology Dept. So the patient needs to drink a lot of water before they feel to urinate. So the patient needs to wait in the reception area till the time they are ready for the scan. Always the priority is given to the 8 1 1
pediatric patient and patient who are feeling the pressure. All the staff are really cooperative with the patients. For In patient, the reception receives the request form with the patient id, name, and all other necessary details as soon as the patient needs one. The reception girl receives the request and registers them into the register. If some emergency case is brought in then the scan is done immediately. Otherwise if the pressure of the OPD patients is less than they are called in and the scan is done. Normally after 3 PM the pressure of out patients are less so that time the in patients are called for the scan. It was observed that on a day 40 – 45 patient come for Scan and 4 – 5 patients come for MRI between Monday to Wednesday and it’s comparatively less on other days. The reception girl also need to make the excel report at the day end. Suggestions 1. Duplication of work: The receptionist need to maintain the register as the patient comes in and then at the day end she need to make the excel report. So if at the starting only the patient can be registered into the computer, her work can be reduced and she can be utilized for some other productive work as reporting. 2. At the time Dr refers the patient to the Radiology dept. they can be well informed that the need to drink lots of fluid before they are good for scan. So that patient can get them self ready before coming to the scan and avoid the waiting time. 2 machines of Ultrasound were observed to be idle for most no. of time. Out of which 1 machine is bed side machine and other machine is normal one. If the patient is well prepared before scan then as soon as they come to the radiology dept. they can be directly taken to the machine without any waiting time if the machine is free. 3. The main cause of waiting time for the patient is because they are not prepared for the scan physically. Observations on ECHO tests are:
1. Some time they come after have sugar test and they need to have the food before they can
give blood for the second time, so they are send to have the food. 2. Patient need to have ECG test as well along with ECHO so they are redirected to ECG if there is less rush.
3. At ground floor there is only one ECHO machine and the procedure itself may take 5 to
20 min. so especially in the morning hours the rush is more and due to the only machine on ground floor the patient waiting time is more.
4. At First Floor (Executive Class), there are 2 machines and the waiting time in executive class patients is comparatively lower than the ground floor OPD. The third assignment which I got was for market research, the hospital administration is planning to give their name to pharmacy and can provide some more numbers of service on the pharmacy other than giving them only medicine. This assignment is a part of business development. In this assignment I was supposed to talk to the customers at pharmacy and the pharmacy owner. This gave me real good exposure with the interpersonal skill. This told me how to interact with a person when the one has no interest in your work, but still you need to make him interested in you objective. I faced several problems whenever I used to approach a person with questionnaire, they are doing nothing, but they were not at all interested in answering my questions. With this situation it was really difficult to get the required number of responses. But the given work was also needed to be completed in time, so I learned to negotiate with the situation in term of time, I didn’t wanted to have extra time from them to get the information required but I walked with them so that they don’t feel that their time is wasted by answering the questions.
The next assignment which I got was to check with the patients who are coming to see the doctors with the referral. The patients who come to the registration counter with the slips from the doctors who were treating the patient previously. The patients don’t understand the difference between referring doctor and the treating doctor. The treating doctor is one who is treating the patient. The patient comes to the hospital for the second opinion and they tell that they have been referred over here. The referring doctor is one who refers the patient to different hospital for further treatment and they get a cut for it. The receptionists who are at the registration counter they don’t clarify with the patient that whether they are in the hospital for the second opinion or they have been referred over here. So I was informed to let them know about this fact and to get to know how to cross question the patient so the registration department get where they have been referred or not.
In the course of total internship program, the main learning was the integration of learning to the work. However the 35 days time was not sufficient to learn most of the things but I tried to grasp best possible thing in that time. I got an exposure to International Division, waiting time calculation, market research, and referral check. Most important thing which I understood was time management. It is very important for one to manage the time because if the time is not managed properly, the work will get accumulated and somewhere there will be a bottle neck situation, which will create big harm to the organization in term of manpower wastage, money wastage, and several other resources will be wasted too. Systematic organization of the work is the way through which the time management can be achieved easily. The employee should be well motivated because the industry like healthcare were time means life or death. Communication between different organizations in another integral part of organization, which keeps all the department of organization informed about what is going on within the organization. So that any organization if they are lagging behind with the work they can pull the work immediately. Business Development an important part of any organization, every organization wants to grow. Any organization needs fresh idea so that they can increase their business keeping in mind that the present services also run smoothly. Innovative ideas are important for the organization so that the organization can be standalone entity in present business world.
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