1.

ORGANIZATIONAL OVERVIEW

1.1. Introduction

National Institute of Cardiovascular Diseases (NICVD) in collaboration with the Government of

Sindh, established in 1963 by Dr. Ali Muhammad Kasim,1 a prominent healthcare institution in

Pakistan. Whereas, it offered its free-of-cost services since 2018. It specializes in cardiovascular

disease prevention, diagnosis, treatment, and rehabilitation, with free-of-cost services. Recognized

by major medical authorities, including the Pakistan Medical and Dental Council (PMDC), the

College of Physicians and Surgeons Pakistan (CPSP), University of Karachi (UoK), and Dow

University of Health Sciences (DUHS), it serves as a leading post-graduate teaching institute. With

over 10,000 employees and a team of qualified professionals, it operates 25 chest pain units and 9

satellite centers, delivering exceptional cardiac care to 2.3 million patients annually.2 It is the

largest facility for cardiac services in Pakistan but also the biggest in the world.3 It is committed to

provide services without discrimination based on financial, cultural, or religious factors.

1.2. Vision

We strive to keep every heart close to ours. We aim to be the premier hospital in Pakistan for the

prevention, diagnosis, treatment and rehabilitation of patients with cardiovascular diseases

regardless of their socioeconomic status.

1.3. Mission

We aspire to be one of the world's leading heart care facilities by adopting a patient-focused

approach that is respectful and sensitive to patient needs and values, acting on the time is muscle

principle to ensure prompt diagnosis and treatment to save and reduce heart damage, providing

convenient access to those with financial constraints to prevent and treat heart related diseases

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 without delay, educating the finest medical professionals of tomorrow in the field of cardiology

and promoting a research-oriented environment to keep abreast with latest updates in cardiology.

1.4. Organizational Hierarchy

Governing
Body

Executive
Director

Chief Operating
Officer

Chief Strategy Head of Cheif Finance Head of Head of

Head of Head of Human Head of Medical
Administration Resource Departments Cheif Auditor Information Head of Stores
Officer Marketing Officer Technology Procurement

Professors &
Managers Managers Managers Managers Managers Managers Managers Managers Managers
Doctors

Assistant Assistant Assistant Assistant Assistant Assistant Assistant

Officers Nursing Staff Officers
Managers Managers Managers Managers Managers Managers Managers

Officers Officers Officers Officers Managers Officers Officers Officers

Clerks Clerks Clerks Officers Technicians Clerks Clerks

Clerks

Organizational Hierarchy: Figure 1

2. EXTERNAL ASSESSMENT

Identification of the external factors affecting NICVD, including opportunities and threats, is

presented in this section.

2.1. Identification of External Opportunities and Threats

Opportunities

➢ Research and innovation to explore new treatment procedures, and preventive measures

➢ Educational institution; by establishing a university that can attract students globally

➢ Prevention and awareness programs to educate the public and promote healthy lifestyles

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➢ Introduction of specialized medical services to cater to other healthcare needs rather than only

cardiac care

➢ Telemedicine services through social media and other relevant sources

➢ International and national collaborations to facilitate knowledge exchange and access to

cutting-edge techniques, raising the standard of cardiac care

➢ Organizational growth to retain its position as a leader in cardiovascular healthcare

Threats

➢ Limited resources including funding constraints

➢ Competition from other healthcare institutions, both public and private

➢ Technological obsolescence

➢ Economic instability and political instability could lead to budget reductions

➢ Rising healthcare costs can lead to financial challenges for both the hospital and patients.

➢ Shortage of skilled healthcare professionals can affect the efficiency of patient care because

of the shift towards abroad for better compensation

➢ Aging infrastructure challenges in delivering efficient and modern healthcare services

➢ Unexpected public health crises and pandemics like corona virus

2.2. Identification of Environmental Factors

The section assesses economic, social, demographic, environmental, political and governmental,

technological and competitive factors.

i. Economic factors

✓ Capital limitations

✓ Cost of medical supplies increased

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ii. Social factors

✓ Public health awareness is equals to none

iii. Demographic factors

✓ Population growth

iv. Political and Governmental factors

✓ Political instability

v. Technological factors

✓ Advancements in medical technology

✓ Advancements of IT sector in government organization

vi. Competitive factors

✓ Competition and ✓ Quality of care is increased

✓ Pricing strategy is stable for NICVD

Through PESTLE analysis and considering other competitive factors, we identified that NICVD

may encounter economic challenges with potential capital limitations and fluctuating medical

supply costs. Political instability adds operational hurdles, while public health awareness remains

low, necessitating targeted initiatives. Demographic factors, particularly population growth,

require strategic resource allocation. However, adapting to advancements in medical technology

and the IT sector, it can navigate the effective technological landscape. In a competitive arena with

hospitals like Karachi Institute of Heart Diseases (KIHD), and Tabba Heart Institute (THI), it can

keep distinguishing itself through offering cost-free healthcare and prioritizing quality.

2.3. Industry Analysis

The healthcare sector in Pakistan faces a deficiency in state-of-the-art solutions compared to more

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developed nations. Typically, hospitals impose substantial charges on patients, creating financial

barriers for a substantial portion of the population due to the country's prevalent poverty and high

unemployment rates. According to the World Bank, the poverty rate in Pakistan is estimated to be

around 37.2%,4 with individuals earning as little as approximately PKR 1000 per day.5

Furthermore, the unemployment rate was recorded at 6.42% in the year 2022.6 Given these

economic challenges, a majority of the population finds it difficult to access services at well-

established medical facilities. However, certain government hospitals and non-government

organization do offer either free or highly affordable treatments. In our analysis, we will delve into

key industrial factors and major competitors, particularly focusing on the provision of free health

services.

2.3.1. Public Needs and Requirements

Public which is basically patients, seeks sufficient accessibility and quality services. Patients

prioritize experienced medical professionals who can provide expert guidance and cure through

cutting-edge technology. A holistic, patient-centric approach is emphasized, recognizing the

importance of addressing not only the physical but also the emotional and psychological aspects

of healthcare. It is notable that some individuals within the public may require free-of-cost services

highlighting the importance of inclusivity and affordability in delivering comprehensive

cardiovascular care.

2.3.2. Competitive Profile Matrix Analysis

In this analysis, we will explore the CPM Matrix for the NICVD, highlighting the most significant

success factors that shape its competitive profile to gain deeper insights into its strategic

management.

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 Competitive Profile Matrix (CPM)
NICVD KIHD THI
Critical Success Factors Weight Rating Score Rating Score Rating Score
Range of Cardiac Services 0.10 4.00 0.40 3.00 0.30 3.00 0.30
Patient Satisfaction 0.10 4.00 0.40 3.00 0.30 4.00 0.40
Technology and Equipment 0.10 4.00 0.40 2.00 0.20 3.00 0.30
Staff Expertise 0.10 4.00 0.40 3.00 0.30 4.00 0.40
Patient Accessibility 0.10 4.00 0.40 2.00 0.20 2.00 0.20
Financial Stability 0.10 4.00 0.40 2.00 0.20 3.00 0.30
Research and Innovation 0.05 3.00 0.15 2.00 0.10 3.00 0.15
Cost Competitiveness 0.10 4.00 0.40 3.00 0.30 2.00 0.20
Capacity and Patient Load 0.05 4.00 0.20 3.00 0.15 3.00 0.15
Post-Treatment 0.10 3.00 0.30 3.00 0.30 3.00 0.30
Awards and Recognitions 0.10 3.00 0.30 2.00 0.20 4.00 0.40
Total 1.00 3.75 2.55 3.10
Competitive Profile Matrix: Table 1

The CPM evaluates NICVD, KIHD, and THI, as industry benchmarks, across vital success factors

in the healthcare industry. NICVD emerges as the head with a score of 3.75, signifying excellence

in a broad spectrum of cardiac services, high patient satisfaction, and strong financial stability.

THI follows closely with a score of 3.10, excelling notably in awards and recognitions. In contrast,

KIHD scores the lowest at 2.55, indicating a comparatively less competitive position against

NICVD. The CPM underscores its strong competitive profile, emphasizing its leadership in critical

success factors that contribute to its dominant position in the healthcare landscape.

3. INTERNAL ASSESSMENT

In this section, we will identify NICVD’s internal strengths and weaknesses.

3.1. Identification of Internal Strengths and Weaknesses

Strengths

➢ Accreditation and recognition from reputable medical authorities ensuring high standards

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➢ Specialization and expertise of skilled and experienced doctors, nurses, and support staff

➢ State-of-the-art facilities with modern infrastructure and advanced medical equipment

➢ Educational and training programs for medical staff to stay updated with advancements

➢ Extensive network all over Sindh

➢ Patient-centric approach for excellence

➢ Strong reputation and trust within the community for quality healthcare services

Weaknesses

➢ Challenges in retaining skilled healthcare professionals

➢ Lack of employees’ recognition and appreciation

➢ Outdated facilities layout

➢ Dependence on external funding, limiting resources for expansion and upgrades

➢ Lack of certain specialized services in other healthcare segments compared to competitors

➢ Long wait times for appointments or procedures impacting patient satisfaction

3.2. Financial Ratios

Due to governmental secrecy policies, accessing detailed financial information about NICVD

proves challenging. Despite this, insights into budget allocation has been derived from available

credible sources. Strong government support, reflected in the budget, has boosted NICVD's

success, enabling its expansion across the Sindh region and differentiation through the provision

of free healthcare services. The allocation likely supports initiatives such as facility expansion,

vendor management, retention of employees, and sustaining the practice of offering free services.

As can be seen in budget allocation: figure 2, the budget increased steadily over the years,

underscoring the sustained government commitment to NICVD's mission and strategic initiatives.

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Rupees in Billions
Budget Allocation for NICVD
14 12 12.5
12 10.2
10 8.9
8
5.8
6
4
2
0
2018-19 2019-20 2020-21 2021-22 2022-23

Budget Allocation: Figure 2

The budget increased steadily over the years, reaching 5.8 billion in 2018-197, 8.9 billion in 2019-

20, 10.2 billion in 2020-218, 12 billion in 2021-22, and 12.5 billion in 2022-23.9 This reflects a

consistent and linear progression in funding, indicating its widespread operations.

3.3. Performance Measures

In 2022, 2.3 million cases were conducted, as compared to 1.9 million in 2021, whereas nearly 10

million cases from 2015 to 2021. It has successfully expanded its network of 9 SCs and over 25

CPUs, showcasing remarkable achievements in the healthcare domain.

Cases in Milloins

12 10 Completed Cardiac Cases

10
8
6
4 1.9 2.3
2
0
2015-21 2021 2022

Completed Cardiac Cases: Figure 3

The success and growth of NICVD are strongly linked to consistent financial support from the

government, enabling investments in infrastructure, medical resources, and outreach programs.

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This financial support has not only elevated its capacity to address cardiovascular health challenges

but also underscores its commitment to inclusive and widespread healthcare accessibility.

3.4. Service Differentiation

NICVD has successfully conducted approximately 140 cases of TAVI, cost ranging from 35 to 40

lakh rupees per case. It has also achieved a remarkable milestone in providing effective treatment

for brain stroke patients, ensuring a potential cure and the possibility of preventing paralysis, if the

patient reaches the hospital within 90 minutes. Whereas, following are some other main core

services:

➢ Free-of-cost cardiovascular care ➢ Extensive network accessibility

➢ State-of-the-art technology

3.5. Value Chain Analysis

NICVD's value chain simply revolves around the achievement of organizational excellence

through patient-centric approach. We have broken down its activities into primary and support

activities to understand how each contributes to its overall value creation. Primary activities cater

to emergency responses, patient admission, free-of-cost, state-of-the-art, and post-procedure

services. Support activities like HRM, SCM, QC, IT, and infrastructure, maintain operational

efficiency and uphold quality standards.

The 360-degree free-of-cost cardiac services provided by NICVD stand out as a significant value

proposition, that surpasses the high charges of reputable private hospitals and outshines the quality

and reliability of other non-government facilities like KIHD. This commitment ensures widespread

access to top-notch cardiac care, aligning with NICVD's mission and positioning it as a leader in

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providing high-quality, affordable services. NICVD has turned its distinctive value chain, centered

on free cardiac services, into a sustained competitive advantage, marked by accessibility,

affordability, and unwavering quality

3.6. SWOT Matrix

Strengths Weaknesses
1. Accreditation and recognition 1. Challenges in retaining skilled
from reputable medical healthcare professionals
authorities

2. Specialization and expertise 2. Lack of employees’ recognition

of skilled and experienced and appreciation
doctors, nurses, and support
staff

3. State-of-the-art facilities with 3. Outdated facilities layout

modern infrastructure and
advanced medical equipment

4. Educational and training 4. Dependence on external funding,

programs for medical staff to limiting resources for expansion
stay updated with and upgrades
advancements

5. Extensive network all over 5. Lack of certain specialized

Sindh services in other healthcare
segments compared to
competitors

6. Patient-centric approach for 6. Long wait times for appointments

excellence or procedures impacting patient
satisfaction

7. Strong reputation and trust

within the community for
quality healthcare services

Opportunities SO Strategies WO Strategies

1. Research and innovation to explore 1. Establish a National Global 1. Modernize facilities at least 1
new treatment procedures, and Medical Education Hub center a year
preventive measures (S1, S4, O2) (W3, O7)

2. Educational institution; by 2. Provide financial and non- 2. Diversify specialized services

establishing a university that can financial benefits to achieve like Nephrology, Oncology,
attract students globally organizational growth in Neurology
long-run (W5, O4)
(S2, O7)

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3. Prevention and awareness 3. Public health education for
programs to educate the public and societal concern
promote healthy lifestyles (S6, O3)

4. Introduction of specialized medical

services to cater to other healthcare
needs rather than only cardiac care

5. Telemedicine services through

social media and other relevant
sources

6. International and national

collaborations

7. Organizational growth to retain its

position as a leader in
cardiovascular healthcare

Threats ST Strategies WT Strategies

1. Limited resources including 1. Ensure technological
funding constraints advancements for state-of-
the-art healthcare facilities
(S3, T3)
1. Mitigate outdated facilities and
financial challenges amidst
political instability for enhanced
healthcare resilience
(W3, T1, T4)

2. Competition from other healthcare 2. Optimize facilities amid 2. Strategize financial independence
institutions, both public and private funding constraints to overcome resource constraints
(S3, T1) in healthcare expansion
(W4, T1)

3. Technological obsolescence 3. Strengthen medical expertise 3. Enhance specialized healthcare

amidst budgetary Challenges services to mitigate competition
(S4, T4) challenges
(W5, T2)

4. Economic instability and political 4. Optimizing reach and 4.
instability could lead to budget addressing infrastructure
reductions challenges for strong
healthcare delivery
(S5, T7)
Address workforce challenges
through recognition and retention
initiatives
(W1, W2, T6)

5. Rising healthcare costs can lead to

financial challenges for both the
hospital and patients.

6. Shortage of skilled healthcare

professionals

7. Aging infrastructure challenges in

delivering efficient and modern
healthcare services

SWOT Matrix for NICVD: Table 2

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3.7. BCG Matrix

BCG Matrix for NICVD Karachi Region: Figure 4

In our effort to optimize healthcare service distribution in Karachi, we have employed the BCG

Matrix framework to categorize districts based on their current performance and potential for

growth, as can be seen in BCG Matrix for Karachi Region: Figure 5. This analysis aims to inform

resource allocation strategies for sustainable development.

➢ Stars: Karachi South District

✓ Due to its flourishing infrastructure and efficient service availability.

➢ Question Marks: Malir District, Korangi District, Orangi District

✓ These areas show potential but currently face challenges in service availability.

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➢ Cash Cows: Executive-Charged Clinical Services

✓ These services demonstrate a stable and somehow profitable performance, generating

reliable revenue platform.

➢ Dogs: Manual Health Records

✓ Lower priority due to technological advancements

This BCG Matrix analysis provides us guidance to our decisions to maximize impact and

sustainability in healthcare service provision across Karachi. However, regular reassessments will

be crucial to adapt our strategies in response to changing dynamics and emerging opportunities in

the healthcare landscape.

4. STRATEGY PLANNING FRAMEWORK

Strategic management is a critical process that sets the foundation for the future direction and

success of any organization. In this case, NICVD needs to establish clear long-term objectives.

These below objectives should be aligned with its vision and mission.

4.1. Long-term Objectives

➢ Strategic alliances with companies to gain access to advanced treatments and technologies

➢ Introduce comprehensive public health education and preventive measures and awareness

initiatives

➢ Introduction and expansion of telemedicine services by leveraging digital platforms for

outreach

➢ Financial independence and sustainability via diverse funding and public-private partnerships,

less reliance on government funds

➢ Expand network for increased accessibility

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➢ Prioritize quality care with improved patient outcomes and satisfaction

➢ Strengthen educational sector by establishing a specialized university to attract global students

These long-term objectives collectively highlight excellence and innovation in cardiovascular care

to aim dedication to staying at the front of cardiovascular healthcare.

4.2. Alternate Strategies

In addition to the strategies defined in the initial strategy formulation, NICVD can consider the

following alternate strategies to address its challenges and avail opportunities effectively:

➢ Global healthcare hub positioning, by establishing national and international collaborations

➢ Continuous modernization and expansion by annual facility modernization and diversification

into specialized healthcare

➢ Enhancing specialized healthcare services, diversify into critical healthcare segments, and

strengthen medical expertise, innovative healthcare services to stay competitive

➢ Mitigating outdated facilities and financial challenges, align modernization with political

stability

➢ Staff development to enhance their skills and knowledge, recognition and retention initiatives

for workforce challenges to ensure high-quality patient and employee care

4.3. Choosing Particular Strategies to Pursue

The choice of specific strategies is based on a thorough analysis of internal capabilities, resource

availability and a genuine assessment of external opportunities and threats. Below listed strategies

to consider initially could be:

➢ Vertical integration – by taking control over KIHD, with the help of government

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➢ Market penetration and development – to expand network for increased accessibility all over

Pakistan

➢ Related diversification – by enhancing specialized healthcare services, diversify into critical

healthcare segments, and strengthen medical expertise, innovative healthcare services to stay

competitive

➢ Horizontal integration – by strategic alliances with companies to gain access to advanced

treatments and technologies

These abovementioned versatile strategies address various aspects. By following these diverse

strategic objectives, NICVD can further stabilize its role in cardiovascular care, delivering

comprehensive and holistic healthcare services to its diverse patient population while contributing

to broader healthcare advancements.

5. OPERATIONAL PLANNING

Effective strategy formulation ensures that the envisioned goals and objectives of an organization

are decoded into action. It provides a roadmap for the allocation of resources, sets priorities and

guides decision-making at all levels of the organization.

5.1. Annual Objectives

Following are the potential SMART annual objectives that NICVD could consider to align with

its long-term objectives:

➢ Financial sustainability and reducing dependency on government funding

➢ Continuous process of advance technology integration

➢ Staff development and well-being to improve their skills and knowledge

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➢ Financial sustainability and reducing dependency on government funding

➢ Quality of care and cure in improving patient satisfaction year over year

These objectives contain a broader scale of areas, ensuring its continued growth and impact,

allowing NICVD to adapt to changing circumstances to maintain its commitment to heart health.

5.2. Policies

Policies play a significant role in strategy management because they provide guidelines and rules

for decision-making and behavior within the organization. In this case, we might consider the

following policy areas for effective strategy execution:

➢ Financial policies to ensure transparent resource management, including allocation of funds

and financial controls

➢ Quality of care policies emphasizing patient care protocols, safety measures and quality control

➢ Human resource policies in employee motivation, recruitment, retention, training, performance

evaluations and career development

➢ Research and innovation policies provides clarity on research activities

➢ Educational policies in collaborations with universities to the integration of innovative

technologies and practices.

5.3. Employee Motivation

Employees are the most important assets of any organization; therefore, employee motivation is

essential for successful strategy management. Following are some approaches to motivate

employees:

➢ Recognition and rewarding employees for their exceptional contributions

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➢ Training and development initiatives to enhance their skills and knowledge

➢ Involvement and empowerment in decision-making processes to heighten engagement

➢ Performance-based incentives to act as a strong motivator for employees

➢ Work-life balance to contribute the overall employee motivation

5.4. Allocation of Resources

In the strategic domain of the NICVD, effective resource allocation stands as a prerequisite for the

success. To execute strategies, it must strategically allocate its resources.

➢ Financial Resources should be allocated carefully to support the expansion of facilities, to pro-

cure cutting-edge medical equipment and encourage ongoing free-of-cost services, and R&D

programs

➢ Human Resources, another invaluable asset, need to be precisely, assuring that individuals

possessing the required skills are placed in significant roles, enhancing efficiency and expertise

within the organization

6. CONCLUSION

NICVD stands as a milestone in cardiac healthcare landscape in Pakistan, especially in Sindh,

providing unparalleled cardiovascular care since its establishment in 1963. The following findings

and recommendations are discussed in this section.

6.1. Key Findings

➢ NICVD is specialized in cardiovascular care, together with technological advancements,

positions it as a leader in the field

➢ Its strong belief that services have to be reached beyond socioeconomic barriers

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➢ Economic challenges, political instability, and resource constraints pose challenges

➢ It is distinctive in free cardiac care, extensive network, through government support that

strengthens its position.

6.2. Recommendations

➢ Explore opportunities to introduce specialized medical services beyond cardiac care, for

broader healthcare needs

➢ Implement initiatives to recognize and appreciate employees, to foster a positive work

environment

➢ Sustain efforts in staying technologically advanced innovations, and ensure seamless

integration of IT solutions for efficient operations

➢ Expand public awareness programs to educate communities on cardiovascular health,

prevention, and healthy lifestyles

➢ Explore opportunities for financial sustainability, considering potential economic challenges,

and diversify funding sources for long-term stability

Execution of these recommendations, can further establish its position as a dominating institution,

ensuring the continued exceptional cardiac care, fostering innovation, and positively impacting the

healthcare landscape in Pakistan.

7. REFERENCES

1
History, (n.d.). Retrieved November 23, 2023, NICVD Website
2
About Us, (n.d.). Retrieved November 23, 2023, NICVD Website
3
M. Waqar Bhatti, January 11, 2019, 'NICVD now world's largest facility for cardiac surgeries,

primary PCIs', The News International

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4
World Bank. (2023, April). 'Poverty & Equity Brief, Pakistan, South Asia'
5
Times of India. (2023, September 24). 'Nearly 40% of Pakistan's Population Now Living Below

Poverty Line: World Bank'. Times of India Website

6
World Bank. (n.d.). Unemployment Rate in Pakistan
7
Budget Analysis 2018-19, Finance Department, Government of Sindh
8
Kalbe Ali, June 13, 2020, 'Budget 2020-21: Govt allocates Rs14bn for three Karachi hospitals',

Dawn
9
Express Tribune, Jan 11, 2022, 'Opposition leader stands with protesting NICVD workers'

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