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A Peek

into the
Future of
Healthcare:
Trends
for 2010
An Overview 46

Public–Private Partnership:
Search for an Ingenious
Model in India 47

Single Speciality Delivery


Models: Single Speciality to
Single Procedural Hospitals 48

Diagnostic Centres:Unbundling
from theTraditional Setting 49

Low-cost Healthcare Delivery


Models: Increasing Penetration 50

Healthcare System:
Staying Connected to Your
Patient 51

Integrated Medicine:
Leveraging the Inherent
Strengths 52

Technology Partnerships:
Arresting the Rising Cost 53

Operations Optimisation:
Measuring Performance 54

Patient Safety:
A Renewed Focus 55

Healthcare Design:
Alternative Care Settings 56

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An Overview

We initiated providing informed insight into the healthcare market in India through quarterly feature as
‘Health Outlook’ in 2007. Most of the earlier trends* that we predicted are shaping today’s healthcare
industry in India.

Some of these trends (Exhibit 1) will have a major impact in the healthcare marketplace in the future.
Exhibit 1:
Trends Impacting Healthcare in India

Secondary Care Hospitals: Five year tax holiday has provided further impetus to the growth of hospitals outside the metros.
Unleashing the new potential in Both existing & upcoming healthcare providers are already investing or announcing future plans for
smaller towns setting up secondary care hospitals in tier-II and tier-III cities.

Voluntary health insurance has seen a phenomenal growth over the past few years and is expected
Health Insurance: The changing to grow further with the entry of new players and innovative products. The shift in the role of
scenario Government from delivery to the financing of care with launch of Rashtriya Swasthya Bima Yojana
(RSBY) is expected to cover 60 million Below Poverty Line families by 2020

Corporate entities will be allowed in field of medical education in future to address huge shortage
Corporatisation of Medical Education and improve quality of health workforce. This will lead to growth of Academic Medical Centers in
India.

Health cities could change the way healthcare delivery, medical education, research and
Med-polis : The emerging healthcare development is conducted in India. A growing number of players including Medanta, Narayana
cities Hrudyalaya, Reliance, Care Hospitals are looking for set up health cities.

Healthcare sector has emerged as one of the preferred sectors for investments by private equity
Infusion of Private Equity
and further growth is expected given the huge potential of the sector .

The coming decade will shape the future of the healthcare industry with innovations in technology, financing
and delivery models. While hospitals will continue to be the mainstay of treatment for episodic acute care,
there will be a fundamental shift in the nature, mode and means of delivery of care. Speciality centres, retail
clinics, diagnostic centres and wellness centres with simplified processes and focus will improve quality,
service and convenience for the consumer. With rising lifestyle diseases, preventive and chronic care will
gain more importance and play a major role in addressing medical needs.

Advances in technology and medical research will make it possible to envision an entirely new health
care system that provides more individualised care without necessarily increasing costs. Healthcare will
become increasingly personalised with the development and delivery of new treatments tailor-made to
patients’ needs as far as possible.

New financing schemes and partnership modes will be developed to make healthcare more accessible
and affordable. This transformation is already evident and shall continue to grow.

The country will loose national income of US$ 236 billion over the next 10 years due to premature deaths
caused by heart disease, stroke and diabetes. Overall improvements in health and a 20 per cent reduction
in Disability Adjusted Life Years (DALYs) over the next decade would translate into a gain of national income
of over US$ 100 billion per year, 2020 onwards.

This edition continues to focus on and attract attention towards the newer trends, which range from
innovative business models to logical integration possibilities.

*The 2007-2010 trends as detailed on page 57

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Public-Private Partnership:
Search for an Ingenious
Model in India 01
Public-Private Partnership (PPP) models have proved Exhibit 2: PPP Models
to be a successful tool in the infrastructure sector State PPP Model
like national highways, power, transport, airports and Karnataka Karuna Trust; Yashaswini Scheme
seaports. The Central and State Government is now
Tamil Nadu Mobile health services
increasingly pursuing this model to bridge the equity
and accessibility gap prevalent in the country’s Andhra Pradesh Aarogyasri
healthcare. PPPs would usher in private sector West Bengal Mobile health services
expertise along with efficiencies in operation and Madhya Pradesh Community outreach program
maintenance, thus leading to improved healthcare Rajasthan Contracting in public hospitals
service delivery to the masses. PPP in healthcare Gujarat Chiranjeevi Project
delivery can facilitate the creation of new capacity as
well as improve efficiency in the existing facilities. As of now, there is preponderance of non-institutional
than institutional PPP. The emergence of epidemics like H1N1 swine flu, HIV, etc., also saw the Government
recognising PPP engagements to combat the epidemics. However, it is imminent that such cooperation
can extend far beyond national emergencies and public health provisions.

With the advent of national schemes like Rashtriya Swastya Bima Yojana (RSBY), the Government is
increasingly taking on the role of insurer providing a substantial patient base for private providers. There
seems to be a search for an ideal PPP model for healthcare, which continues to be elusive.

Key Success Factors for PPP


• Political Commitment and enabling legislation
• Need for clear policy and legal framework for PPP
• A strong control mechanism to undertake efficient oversight and dispute resolution procedures
• Careful design of the contract with appropriate risk apportionment
• Defining an ‘acceptable rate of return’ for the private sector
Exhibit 3: Public–Private Partnership Options
Primary Health District Hospital Single Specialty Multispecialty Academic Medical
Centre Hospital Hospital Centre
Management contract Design, build and The Government The Government The possible models
Tlype of collaboration

operate provides land, provides land, could be joint


Private player/NGO
building and infrastructure at ownership model
undertaking the In addition to the
immovable. concessional rates. involving strategic
management and design, build and full
partnership,both
operation of PHC. operation of the The private player The private player
financial and technical
hospital, the private hires manpower, provides medical
Goverment pays a or pure management
player can deliver all pays salaries and services to people
portion of the running model with no equity
clinical services. provides medical below poverty line
cost. involvement
services. (BPL) within the city
The Goverment pays
and the region at
annual fixed service
subsidsed
payment for delivery
rates.
of all services.
Possible
Player

Physician Group Practice Physician Group Practice


NGO Organized Organised Providers/ Physician Group Practice
Organised Providers/ Organised Providers/
Providers Technology Providers Organised Providers
Technology Providers Technology Providers

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Single Speciality Delivery


Models: Single Speciality to
Single Procedural Hospitals 02
Single speciality hospitals are a small but rapidly growing genre among today’s hospitals in India. The
growing number of speciality centres and hospitals signals a move towards maturity of the healthcare
industry with an increasing complexity of business and consumer affordability.
Exhibit 4:
Advantages of Single Speciality Models
What sets these hospitals apart is their focus on one
single speciality or service line. Whether it is high- • Cost efficiency due to higher volumes
end disciplines such as oncology or neighbourhood • Provide higher quality care due to greater specialization
specialities such as ophthalmology and day-care
• Easily attract human resource
surgery, they are growing by sticking to their core
strength. While there have always been stand-alone • Economies of scale and scope
speciality clinics or hospitals run by doctors, these • Ease of operation
providers are moving towards corporate set-up • Increase consumer satisfaction
offering the same precision of quality care in multiple • Competitive pricing and increased choice for consumer
locations.

Speciality hospital formats range from low-risk speciality including eye care, dermatology, mother and child
to high-end speciality including cardiology, cancer and transplant medicine. The mid-level specialities are
offered in a multi speciality hospital format. The low-risk speciality models require low capital expenditure
and have comparatively low operating costs as in-patient stay is rarely required for day procedures. This
minimises the need for support infrastructure and offers easy replication. Consumers expect convenience
and are not willing to travel too far for such speciality services.

On the other hand, high-risk speciality models require a high level of expertise, capital investment and
operating cost due to the complexity of procedures and specialised equipment.

These speciality centres have been spurred by rising affordability and healthcare awareness. Currently,
speciality centres are operating in mature markets and there is a huge opportunity to offer such services in
tier-II and tier-III cities. The speciality models have become favourite investment options for private equity
firms. In future, the single speciality hospitals will transition into single procedural hospitals - such as
Shouldice Hospital, Canada - that focus on conducting surgeries only for abdominal hernias.

Exhibit 5: Exhibit 6:
Evolution of Hospitals Future Break-up of Speciality-wise Market
Single Procedral
2000 Hospital
Speciality
1980 centre
Teritary Care
1950 Hospital
Multispeciality 18% Women & Children
1900 Hospital ( US$ 5422 Mn)
Teaching
1500 - 1800 AD Hospital Cardiology ( US$ 4889 Mn)
General Hospital &
Nursing Homes 53% 17% Oncology ( US$ 2667 Mn)
1500- 1800 AD Ophthalmology
Military & Slave
Hospital ( US$ 947 Mn)
400 - 100 BC Others ( US$ 15542 Mn)
Religious Inpatient 9%
Homes
3%

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Diagnostic Centres:
Unbundling from the
Traditional Setting 03
Traditionally, diagnostic centres have been part of hospitals and physician offices. The marketplace is
evolving, with diagnostic centres operating as stand-alone entities. In the future, diagnostic services will be
offered at retail outlets, pharmacies and at home (personalised testing).

Diagnostic test results impact more than 70 per cent of healthcare decisions and thus form an essential
element in the delivery of healthcare services. Physicians use lab tests and radiology procedures to assist
in the diagnosis, evaluation, monitoring and treatment of medical conditions.
Exhibit 7: Diagnostic Centers: Services
Pathology Radiology & Imaging Speciality Diagnostics
Haematology PET CT Cardiology
Biochemistry MRI Neurology
Microbiology & Infectious Diseases CT Oncology
Histopathology Ultrasound (Services offered based on
Immunology & Radio Immunoassay Mammography local market needs)
Gene Testing X Ray

The Indian market for diagnostics is worth US$ 1.1 billion, and constitutes 4 per cent of the overall healthcare
delivery market. Currently the marketplace has several hundred smaller players with a handful of organised
players who have a good presence in the metros. Unfortunately, the good quality diagnostic services are
inaccessible in rural areas. Despite current business challenges, the diagnostic marketplace will continue
to grow due to some of the key trends, such as:
• The growing and ageing population will increase demand for diagnostics testing.
• Continuing research and development in area of genomics is expected to yield new and specialised
tests. These advances are spurring interest in and demand for personalised medicine which relies on
diagnostic and prognostic testing.
• Consumers and insurers increasingly recognise the value of diagnostics as a means to improve health
and reduce the overall cost of healthcare through early detection and prevention.
• Organised players offer consumers increasing convenience and access to quality diagnostic services.
• Point-of-care testing will enable solutions that improve care to the patients by enabling faster diagnosis
and treatment.
• There are new opportunities arising in infectious disease testing, molecular oncology and
pharmacogenomics.
Exhibit 8: Exhibit 9:
Diagnostic Centres: Moving Closer to the Patient Growth of Diagnostic Market in India
Home based testing 8
US$ in Billion
point of care testing
6
Retail outlet pharmacy % 7
testing centers R 20
4 CAG
Stand alone labs & 2
diagnostic centers 3
Hospital & physician 1
office labs 0
2010 2015 2020

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Low-cost Healthcare
Delivery Models:
Increasing Penetration 04
Over the years, most healthcare providers were Exhibit 10:
developed keeping in mind the metro markets. But Low-cost Secondary Care Hospital Services
now, metros with developed healthcare infrastructure
• Secondary care with basic and a few super specialties
and rising competition have reached a saturation
• 100 beds
level serving a certain socio-economic segment of
the population. The healthcare providers have now • 15-20 ICU beds
started realising that they cannot serve all segments • 3-4 operation theatres
of population through high-cost structures. To serve • Endoscopy
different consumer segments such as lower middle • Health check-up services
income, urban poor and rural population, they need
• Lab, radiology and blood bank services
to develop low-cost healthcare delivery models.
• Fully equipped ambulance services
Low capital intensive models will ensure viability of
the project and expand the healthcare providers’
reach in different geographies and consumer segments. There are some hotel brands such as Taj that
are operating luxury as well as budget hotels (Ginger), thus serving different consumer segments with
appropriate services.

There is much that can be done to reduce healthcare costs without reducing the quality of care. To reduce
initial capital cost for setting up low-cost healthcare facilities, land can be bought on the outskirts rather
than in the centre of town to reduce the overall land cost. The overall built-up area per bed can be reduced
to reduce per-bed cost. Similarly, rather than buying the latest medical equipment, appropriate technology
needs to be deployed. Usage of good quality indigenous medical equipments can be promoted. Also,
outsourcing or third party arrangements can be evaluated for diagnostic and other support services. Air-
conditioning can be considered just for special rooms and areas instead of full building air-conditioning
solutions.

The low-cost models will have a lower cost of operation. The tariff for the services will be low as compared
to that offered in high cost hospitals. Initially, such models will feature in secondary care space and later
graduate to tertiary care speciality and super speciality based on local market needs.

Exhibit 11: Reinventing the Value Chain: Low-cost Models


Current Secondary Care 100- Low-cost Secondary
Parameters Remarks
bed Hospital Care 100-bed Hospital
Floor space per bed Optimising space allocation without compromising on
1,000 - 1,200 700 - 800
(sq. ft.) functionality
Building cost Reducing building cost by value engineering, choice of
63 - 73 42 - 50
(US$ /sq.ft) material cost based on project vision and model
Reducing equipment cost by deploying appropriate technol-
Equipment cost ogy in diagnostic and laboratory services. Further reduction
42,000 - 52,000 21,000 - 31,000
(US$ /bed) can be brought about by group purchasing and outsourcing
of certain services.
Total cost
105,000 - 110,000 52,000 - 62,500
(US$ /bed)

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Healthcare System:
Staying Connected to Your
Patient 05
Traditionally, healthcare providers have been offering in-patient services in the geographies they serve.
With the evolving healthcare marketplace, major organised healthcare providers such as Apollo Hospitals,
Fortis Healthcare operating in tertiary care space are diversifying apart from their core hospital business
to include retail pharmacies, clinics and other services to serve patients better and to achieve economies
of scale. With increasing accessibility to insurance and rising consumer awareness, healthcare providers
will offer the entire gamut of services across the value chain, including primary, secondary and tertiary
services to attract patients into the healthcare system right from the entry point. The primary and secondary
healthcare formats will act as feeders to tertiary care hospitals. The integrated healthcare provider will be
able to negotiate contracts with insurance companies and equipment vendors.

Characteristics of the Healthcare System Exhibit 12:


Leading Healthcare Networks
• Develop integrated healthcare delivery model
Hospital Corporation of America, US
around core ‘hospital’ business
• 166 hospitals including 160 general acute care hospitals, 5
• Offer a broad spectrum of services across the psychiatric hospitals, 1 rehabilitation hospital
value chain in the most cost-effective manner • 104 free-standing ambulatory surgery centres
• The hospitals have high volume and high margin • 49 free-standing diagnostic treatment facilities, and 74 provider-
speciality services based imaging facilities
• Comprehensive rehabilitation and physical therapy centres
• Out-patient services are an integral component of
the healthcare system to increase attractiveness to
Netcare, South Africa
patients
• 120 hospitals
• Ability to negotiate service contracts with purchasers
• Primary care community care centres offering GPs, dental,
of group health care services pharma, pathology and imaging services
• Implement advanced health information technology • 120 retail pharmacy outlets
to improve the quality and convenience of • Diagnostics: 6 main laboratories, 215 collection centre depots
services and 120 radiology centres
• Achieve price efficiencies through group • Ancillary Healthcare Business: 41 dialysis centres, 14 travel
clinics, 7 radiotherapy/oncology centres, emergency medical
purchasing
services
• Build cost savings by sharing of support and other
services

Exhibit 13: Components of the Healthcare System

Common IT Infrastructure and Services

Diagnostic
Hospitals Services
Emergency As Day Care
Services Surgery
Core Speciality Centres
Pharmacies Services Services

Sharing of Support Services, Goup Purchasing

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Integrated Medicine:
Leveraging the Inherent
Strengths 06
Integrated medicine is a new paradigm in health care that focuses on the synergy and deployment of the
best aspects of diverse systems of medicine including modern medicine, Homeopathy, Siddha, Unani,
Yoga and Naturopathy in the best interest of the patients and the community.
Exhibit 14: Exhibit 15:
Components of Integrated Medicine Market Size of Integrated Medicine

Ayurveda
7% 3%
US$ Mn
19% Yoga & Naturopathy (US$ 11 Mn)
Yoga & Modern Unani & Siddha (US$ 22 Mn)
Medicine Homeopathy
Naturopathy
Homeopathy (US$ 58 Mn)
71% Ayurveda (US$ 222 Mn)

Unani &
Siddha

The increasing public demand for traditional medicine use has led to considerable interest among policy-
makers, health administrators and medical doctors on the possibilities of bringing together traditional and
modern medicine. Traditional medicine looks at health, disease and causes of diseases in a different way.
The integration of traditional medicine with modern medicine may mean the incorporation of traditional
medicine into the general health service system. The purpose of integrated medicine is not simply to
yield a better understanding of differing practices, but primarily to promote the best care for patients by
intelligently selecting the best route to health and wellness.

Surveys and other sources of evidence indicate that traditional medical practices are frequently utilised
in the management of chronic diseases. Traditional medicine presents a low-cost alternative for rural and
semi-urban areas where modern medicine is inaccessible.

An approach to harmonising activities between modern and traditional medicine will promote a clearer
understanding of the strengths and weaknesses of each, and encourage the provision of the best
therapeutic option for patients.
Integrative Medicine Centre at Griffin
Exhibit 16: Exhibit 17:
Advantages of Integrated Medicine Hospital, Connecticut USA
• Widest array of options available to patients(One in three • The hospital was founded on the principles of patient-centred care and
adults in the United States used at least one complementary or evidence-based medicine. The patient is provided with evaluations that
alternative medical therapy (CAM)) are holistic and involve a conference of five on-site experts: Medical
Doctors (MD) specialising in internal and preventive medicine, a Nurse
• Provides an opportunity to combine the ‘best’ of both
Practitioner, and two Naturopathic Physicians with expertise in a wide
conventional medicine and complementary alternative
array of natural, complementary and alternative therapies.
medicine.
• Treatment approaches available at the IMC include internal medicine,
• Provides cost-effective treatment options
naturopathic medicine, preventive medicine, nutritional counselling,
• Results in better patient outcomes, measured in terms of nutritional supplements, nutriceuticals, herbal medicine, acupuncture,
symptom relief, functional status and patient satisfaction craniosacral therapy, therapeutic touch, homeopathy, intravenous
• Focus on holistic health and well-being micronutrients, relaxation therapies, as well as referrals to counselors,
trauma therapists (EMDR), and chiropractors.

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Technology Partnerships:
Arresting the Rising Cost 07
Technology is seen as one of the three important Exhibit 18:
drivers of increasing healthcare accessibility. Novel Ways to Rationalise Technology Cost
Selection and adoption of appropriate technology
often makes a critical difference in the success of • Reducing the cost of medical technology research and
development
healthcare reform and reengineering. It has the
capability to revolutionise the way healthcare is • Encouraging indigenous production of medical devices
delivered. • Devising innovative ways of dealing with obsolescence
• Testing the new and upcoming business models of technology
However adopting and implementing technology services
in healthcare forms a significant area of cost in
healthcare projects. It is estimated that almost 30-40 per cent of the project cost is allocated to medical
technology including both medical devices and information technology. Therefore, it is imperative to devise
ways to rationalise this cost by adopting some innovative methods.

Top medical technology companies like GE, Philips and Siemens-in their effort to lower the costs of care
and improve the quality of outcomes-have been using innovation as a main tool. These companies come
up with a slew of products endeavouring to bring down cost while upgrading the level of technology. For
example, the Active Technology Partnership (ATP) initiative of GE enables the provider to control their
equipment budget over a long period of time while managing technology obsolescence through planned
equipment renewals.
Exhibit 19: Innovative Options in Healthcare Technology
Company Model Differentiating Factor

Software As A service (SaaS) model wherein the vendor sets • The model allows easy adoption of technology
Health Hiway up an IT infrastructure in hospitals, looks after the complete and helps save on the cost of further development
maintenance, training and effective implementation of the mod- and upgrading of solutions.
Pay-per-use Model ules and the provider has to pay some annual fee only for the • Innovative pricing mechanisms based on a
required modules within the hospital. subscription model .
• Smart card issued by the hospital acts as Hospital
ID card which stores patient health information,
YOS Technologies eliminating the need to carry bulky medical files.
Provides record management and hospital management soft-
ware to hospitals along with value-added services like smart • The card is also linked to the record management
Pay-per-use Model
cards and patient portal. and hospital management software of YOS,
enabling ready retrieval of required records and
thus reducing patient wait time.
GE • Enables the provider to control their equipment
The ATP program is individually tailored to the hospital needs, budget over a long period of time while managing
Active Technology both at an organisational and departmental level. technology obsolescence through planned
Partnership Solution equipment renewals.

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Operations Optimisation:
Measuring Performance 08
Healthcare providers and administrators today Exhibit 20: Performance Parameters
are under constant pressure to meet the ever- Service Quality Clinical Outcomes Commercials
increasing customer expectation and stay ahead
Shorter waiting time Lower ALOS Increased sales and
in the competitive race. Operations optimisation revenue
Increased patient Reduction in the trend
in hospitals can enable hospitals to provide world-
satisfaction of re-admission
class services with a finite set of resources and can
significantly impact competitive strengths, enhancing
the business performance of the organisation.

By definition, operations optimisation relates to appropriate workforce management, quality management,


planning and control, sound clinical processes and outcome performance.

Although many healthcare providers rely mainly on technology to optimise service delivery, it is largely felt
that automated support can only help the organisation to a certain level of process management. The key
to any real improvement lies with better understanding of process workflow and tackling the bottlenecks.
While staff performance also plays a very important role, it is process design and management-or lack of
it-that needs to be tackled on a priority basis.

Introducing and implementing operations optimisation techniques is a complex and time-consuming


procedure. However, the associated benefits of operations optimisation far outweigh the difficulties. There
are reports of a number of benefits associated with the introduction of techniques like queuing, clinical
pathways, standard operating protocol and integrated care pathways. These include reduction in the
length of stay in hospital, reduction of costs in patient care, improved patient outcome, improved quality of
life, reduced complications, increased patient satisfaction with service, improved communication between
staff, and reduction in time spent by health staff on paperwork.

Exhibit 21: Exhibit 22:


Tools for Operations Optimisation in Hospitals Benefit Analysis of Operations Optimisation of
a Leading Hospital in India

• Variability methodology 53%

• Queuing theory 40%


• Scheduling and forecasting 30%
20%
• Simulation modeling
• DMAIC Increase in Increase in Savings in Reduction in
medicine OPD pharmacy inventory lead time
availability at revenue
customer end
Note: Results indicated for a leading hospital in India

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Patient Safety:
A Renewed Focus 09
With the rise in patient awareness and a subsequent surge in hospitals going for accreditation-which
imposes a mandate to take greater accountability for patient safety and risk reduction, there is a renewed
focus on patient safety amongst the care-givers. Furthermore, the new legislation and governmental
programmes, like Consumer Protection Acts, etc. have given healthcare entities a clear mandate and
agenda for addressing medical error in health care.

In fact, the intent of statements of principle by the healthcare professional is perfectly aligned with the
goal of patient safety. The maxim in the Hippocratic oath ‘do no harm’ is intended to guide the ethical
sensibilities of physicians.

The first step towards achieving these safety goals would be imbibing and crystallising a culture of safety
within the organisation. Encouraging an open and non-punitive environment goes a long way in enhancing
patient safety.

The Indian healthcare industry, too, is moving towards acquiring patient safety goals. Hospitals are using
technologies like RFID, Computerised Physician Order Entry, etc.

The Indian Confederation for Healthcare Accreditation (ICHA), a non-profit organisation consisting of various
associations, aims to spell out clear-cut healthcare standards, train employees of hospitals, nursing homes
and clinics in spotting medical errors and adverse reactions as well as encourage them to report the same
in order to create a database.
What Steps Can a Hospital Take to
Exhibit 23: Exhibit 24:
Patient Safety Facts Improve Patient Safety?

• Estimates of as many as 44,000 to 98,000 people die in • Implementing computer physician order entry
US hospitals each year as the result of problems in patient
• Having full-time doctors and nurses certified in critical care
safety.
• Implementing a patient safety compliance checklist
• Every hour, 10 Americans die in a hospital due to avoidable
errors; another 50 are disabled. • Encouraging adverse event reporting
• Robust infection control mechanism

Source: To Err is Human: Building a Safer Health System,


Institute of Medicine report, 1999.

WHO’s Proposed High 5s Project to Facilitate Implementation and


Exhibit 25: Evaluation of Standardised Patient Safety Solutions

Assuring Medication Improved Hand Hygiene Performance of Correct


Managing Concentrated Communication During
Accuracy at Transitions to Prevent Health Care- Procedure at Correct Body
Injectable Medicines Patient Care Handovers
in Care Associated Infections Site

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Healthcare Design:
Alternative Care Settings 10
Healthcare design has undergone an incredible change over the last few years. The emergence of
ambulatory care services has transformed the way healthcare facilities are programmed and configured.
Due to faster procedures and fewer in-patient stays, ambulatory care centres are able to deliver care in
less intensive settings, covering a wide range of health care services for patients who do not need to be
admitted overnight.

Some design implications for ambulatory care centres are:


• Need to emphasize more on providing structured spaces along with aesthetic appeal to achieve efficiency
in design.
• Reduced travel time and distance between clinical areas and offices results in cost-effectiveness and
better services.
• Standardisation of spaces such as the operating rooms, recovery and treatment rooms helps achieve
functional efficiency.
• These facilities have more potential to incorporate natural light and ventilation due to factors such as
narrower floor plates.
• A single service core surrounded by operating/treatment/recovery rooms reduces the amount of
equipment required for individual units.

The ambulatory care hospitals are intended to serve patients who have not undergone complex surgeries
and are able to walk; nevertheless facilities must incorporate measures for handicapped and patients
under slight sedation.
Exhibit 26: Advantages of Ambulatory Care Settings Exhibit 27:
Ambulatory Surgery Centres

• Larger number of units of care at significantly lower cost • Cosmetic and facial surgery centres
per unit
• Endoscopy centres
• Faster construction
• Ophthalmology practices
• Less complicated planning
• Laser eye surgery centres
• Improved quality of care
• Centres for oral and maxillofacial surgery

Exhibit 28: Space Implications: Ambulatory Vs. In-patient Environment


Parameter Ambulatory Care Hospital In-patient Hospital
40,000–60,000 sq. ft 100,000 sq. ft
Space Requirement*
(typical size of facility) (100-bed facility)
Standardisation of space Works more effectively Less efficient due to specific individual requirements
Reduced requirement for facilities such as dietary
Need for support infrastructure Full support services required
and linen
*The size of a typical and well designed ambulatory care facility is significantly less than that of an inpatient hospital for similar patient volumes/ workloads.

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Exhibit 29: Typical Patient Flow in Surgical Ambulatory Care Setting

Reception
Registration Consents Lab Work
Waiting Anesthetic Assessmment
Special
Procedure
Patient to Prep/Hold Change
(Relative to Surgical Waiting) (Accompanied By Relative)

Endoscopy
Nurse Station

Day Care Bed


Operating (Relative joins)
Room Discharge Follow up Follow up OP
Scheduling Visits
Post-OP
Recovery

Exhibit 30: Ten Trends 2007–2010


2007 2008 2009 2010
Academic Medical Centres:
Public–Private Partnerships: The Public–Private Partnership: Search
The private sector takes the lead Delivering excellence in care,
current imperative for an ingenious model in India
education & research
Single Speciality Delivery Models:
Health Insurance: Increasing Healthcare Consumerism in India: Corporatisation of Medical
Single Speciality to Single
accessibility Rising awareness and spend Education:The impact
Procedural Hospitals
Newer Formats of Healthcare
Standardisation: Need for Medpolis: The emerging Diagnostic Centres: Unbundling
Delivery: Taking healthcare closer
uniformity healthcare cities from the traditional setting
to the consumer
Secondary Care Hospitals:
Healthcare REITS: Addressing the Low-cost Healthcare Delivery
The Empowered Indian Patient Unleashing the potential in smaller
real-estate challenge Models: Increasing penetration
towns
Manpower: Reversing the brain Private Equity: The race for value Designing Cost-effective Healthcare System: Staying
drain deals Infrastructure: A green approach connected to your patient
Newer Partnerships: Catalysing Integrated Medicine: Leveraging
Technology Takes Centrestage Clinical Trials: Making inroads
growth of healthcare delivery the inherent strengths
Public–Private Partnership: The Emergency Evacuation Services: Appropriate Technology: Technology Partnerships:
way ahead Building a network for India Optimising healthcare delivery Arresting the rising cost
Medical Value Travel: Hype and Healthcare Architecture: The Lean Thinking: Improving the Operations Optimisation:
reality business of design bottom line Measuring performance
Healthcare Outsourcing: Providers Clinical Protocols : Standardizing
Special Economic Zones Patient Safety: A renewed focus
focus on their core competence care
Medical Device Innovation : Health Insurance: The changing Healthcare Design: Alternative
Infusion of Private Equity
Involving providers and physicians scenario care settings

Authors
Dr. Rana Mehta, Vice President I rana.mehta@technopak.com
Gulshan Baweja, Associate Director I gulshan.baweja@technopak.com
Abhishek Pratap Singh, Principal Consultant I abhishek.singh@technopak.com
Monika Kejriwal, Principal Consultant I monika.kejriwal@technopak.com

A Peek into the Future of Healthcare: Trends for 2010 | 57