a peek into the future of healthcare trends for 2010

8/8/2019 A Peek Into the Future of Healthcare Trends for 2010

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A Peek

into the

Future of

Healthcare:

Trends

for 2010

An Overview 46

PublicPrivate Partnership:Search for an IngeniousModel in India 47

Single Speciality DeliveryModels: Single Speciality toSingle Procedural Hospitals 48

Diagnostic Centres:Unbundlingfrom theTraditional Setting 49

Low-cost Healthcare DeliveryModels: Increasing Penetration 50

Healthcare System:Staying Connected to YourPatient 51

Integrated Medicine:Leveraging the InherentStrengths 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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| Volume 03perspectivel 1l

| A Peek into the Future of Healthcare: Trends for 201046

We initiated providing informed insight into the healthcare market in India through quarterly feature asHealth Outlook in 2007. Most of the earlier trends* that we predicted are shaping todays healthcareindustry in India.

Some of these trends (Exhibit 1) will have a major impact in the healthcare marketplace in the future.

The coming decade will shape the future of the healthcare industry with innovations in technology, financingand 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, retailclinics, 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 willgain 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 healthcare system that provides more individualised care without necessarily increasing costs. Healthcare willbecome increasingly personalised with the development and delivery of new treatments tailor-made topatients needs as far as possible.

New financing schemes and partnership modes will be developed to make healthcare more accessibleand 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 deathscaused by heart disease, stroke and diabetes. Overall improvements in health and a 20 per cent reductionin Disability Adjusted Life Years (DALYs) over the next decade would translate into a gain of national incomeof over US$ 100 billion per year, 2020 onwards.

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

An Overview

Secondary Care Hospitals:Unleashing the new potential in

smaller towns

Five year tax holiday has provided further impetus to the growth of hospitals outside the metros.Both existing & upcoming healthcare providers are already investing or announcing future plans forsetting up secondary care hospitals in tier-II and tier-III cities.

Health Insurance: The changingscenario

Voluntary health insurance has seen a phenomenal growth over the past few years and is expected to grow further with the entry of new players and innovative products. The shift in the role ofGovernment 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

Corporatisation of Medical EducationCorporate entities will be allowed in field of medical education in future to address huge shortageand improve quality of health workforce. This will lead to growth of Academic Medical Centers inIndia.

Med-polis : The emerging healthcare

cities

Health cities could change the way healthcare delivery, medical education, research anddevelopment is conducted in India. A growing number of players including Medanta, Narayana

Hrudyalaya, Reliance, Care Hospitals are looking for set up health cities.

Infusion of Private EquityHealthcare sector has emerged as one of the preferred sectors for investments by private equityand further growth is expected given the huge potential of the sector .

Exhibit 1:Trends Impacting Healthcare in India

*The 2007-2010 trends as detailed on page 57


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47A Peek into the Future of Healthcare: Trends for 2010 |

01Public-Private Partnership (PPP) models have provedto be a successful tool in the infrastructure sectorlike national highways, power, transport, airports and

seaports. The Central and State Government is nowincreasingly pursuing this model to bridge the equityand accessibility gap prevalent in the countryshealthcare. PPPs would usher in private sectorexpertise along with efficiencies in operation andmaintenance, thus leading to improved healthcareservice delivery to the masses. PPP in healthcaredelivery can facilitate the creation of new capacity aswell as improve efficiency in the existing facilities. As of now, there is preponderance of non-institutionalthan institutional PPP. The emergence of epidemics like H1N1 swine flu, HIV, etc., also saw the Governmentrecognising PPP engagements to combat the epidemics. However, it is imminent that such cooperationcan extend far beyond national emergencies and public health provisions.

With the advent of national schemes like Rashtriya Swastya Bima Yojana (RSBY), the Government isincreasingly taking on the role of insurer providing a substantial patient base for private providers. Thereseems 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

Public-Private Partnership:Search for an IngeniousModel in India

Exhibit 2: PPP Models

State PPP Model

Karnataka Karuna Trust; Yashaswini Scheme

Tamil Nadu Mobile health services

Andhra Pradesh Aarogyasri

West Bengal Mobile health services

Madhya Pradesh Community outreach program

Rajasthan Contracting in public hospitals

Gujarat Chiranjeevi Project

Exhibit 3: PublicPrivate Partnership Options

Primary HealthCentre District Hospital

Single SpecialtyHospital

MultispecialtyHospital

Academic MedicalCentre

Management contract

Private player/NGOundertaking themanagement andoperation of PHC.

Goverment pays aportion of the runningcost.

Design, build andoperate

In addition to thedesign, build and fulloperation of thehospital, the privateplayer can deliver allclinical services.

The Goverment paysannual fixed servicepayment for deliveryof all services.

The Governmentprovides land,building andimmovable.

The private playerhires manpower,pays salaries andprovides medicalservices.

The Governmentprovides land,infrastructure atconcessional rates.

The private playerprovides medicalservices to peoplebelow poverty line(BPL) within the cityand the region atsubsidsedrates.

The possible modelscould be jointownership modelinvolving strategicpartnership,bothfinancial and technicalor pure managementmodel with no equityinvolvement

Tlype

ofcollaboration

Possible

Player

Organised Providers/Technology Providers

Physician Group PracticeOrganised Providers

Physician Group PracticeOrganised Providers/Technology Providers

Physician Group PracticeOrganised Providers/Technology Providers

NGO OrganizedProviders


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

02Single speciality hospitals are a small but rapidly growing genre among todays hospitals in India. Thegrowing number of speciality centres and hospitals signals a move towards maturity of the healthcareindustry with an increasing complexity of business and consumer affordability.

What sets these hospitals apart is their focus on onesingle speciality or service line. Whether it is high-end disciplines such as oncology or neighbourhoodspecialities such as ophthalmology and day-caresurgery, they are growing by sticking to their corestrength. While there have always been stand-alonespeciality clinics or hospitals run by doctors, theseproviders are moving towards corporate set-upoffering the same precision of quality care in multiplelocations.

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 areoffered in a multi speciality hospital format. The low-risk speciality models require low capital expenditureand have comparatively low operating costs as in-patient stay is rarely required for day procedures. Thisminimises the need for support infrastructure and offers easy replication. Consumers expect convenienceand 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 andoperating 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 intier-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 asShouldice Hospital, Canada - that focus on conducting surgeries only for abdominal hernias.

Single Speciality DeliveryModels: Single Speciality toSingle Procedural Hospitals

Cost efficiency due to higher volumes

Provide higher quality care due to greater specialization

Easily attract human resource

Economies of scale and scope

Ease of operation

Increase consumer satisfaction

Competitive pricing and increased choice for consumer

Exhibit 4: Advantages of Single Speciality Models

18% Women & Children( US$ 5422 Mn)

17%

9%

3%

53%

Cardiology ( US$ 4889 Mn)

Oncology ( US$ 2667 Mn)

Ophthalmology

( US$ 947 Mn)Others ( US$ 15542 Mn)

Future

2000

Single ProcedralHospital

Specialitycentre1980

Teritary CareHospital1950

MultispecialityHospital1900

TeachingHospital1500 - 1800 AD

1500- 1800 AD

400 - 100 BC

General Hospital &Nursing Homes

Military & Slave

Hospital

Religious InpatientHomes

Exhibit 5: Evolution of Hospitals Exhibit 6: Break-up of Speciality-wise Market


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Traditionally, diagnostic centres have been part of hospitals and physician offices. The marketplace isevolving, with diagnostic centres operating as stand-alone entities. In the future, diagnostic services will beoffered 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 essentialelement in the delivery of healthcare services. Physicians use lab tests and radiology procedures to assistin the diagnosis, evaluation, monitoring and treatment of medical conditions.

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 organisedplayers who have a good presence in the metros. Unfortunately, the good quality diagnostic services areinaccessible in rural areas. Despite current business challenges, the diagnostic marketplace will continueto 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 specialisedtests. These advances are spurring interest in and demand for personalised medicine which relies ondiagnostic and prognostic testing.

Consumers and insurers increasingly recognise the value of diagnostics as a means to improve healthand 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 diagnosisand treatment.

There are new opportunities arising in infectious disease testing, molecular oncology andpharmacogenomics.

03Diagnostic Centres:Unbundling from theTraditional Setting

Exhibit 7: Diagnostic Centers: Services

PathologyHaematologyBiochemistry

Microbiology & Infectious DiseasesHistopathology

Immunology & Radio ImmunoassayGene Testing

Radiology & ImagingPET CT

MRICT

UltrasoundMammography

X Ray

Speciality DiagnosticsCardiologyNeurologyOncology

(Services offered based on

local market needs)

Exhibit 9:

Growth of Diagnostic Market in India

Exhibit 8:

Diagnostic Centres: Moving Closer to the Patient

0

2

4

6

8

1

3

7

CAGR2

0%

2010 2015 2020

US$ in Billion

Hospital & physicianoffice labs

Stand alone labs &diagnostic centers

Retail outlet pharmacytesting centers

Home based testingpoint of care testing


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04Over the years, most healthcare providers weredeveloped keeping in mind the metro markets. Butnow, metros with developed healthcare infrastructure

and rising competition have reached a saturationlevel serving a certain socio-economic segment ofthe population. The healthcare providers have nowstarted realising that they cannot serve all segmentsof population through high-cost structures. To servedifferent consumer segments such as lower middleincome, urban poor and rural population, they needto develop low-cost healthcare delivery models.Low capital intensive models will ensure viability ofthe project and expand the healthcare providersreach in different geographies and consumer segments. There are some hotel brands such as Taj thatare operating luxury as well as budget hotels (Ginger), thus serving different consumer segments withappropriate services.

There is much that can be done to reduce healthcare costs without reducing the quality of care. To reduceinitial capital cost for setting up low-cost healthcare facilities, land can be bought on the outskirts ratherthan in the centre of town to reduce the overall land cost. The overall built-up area per bed can be reducedto reduce per-bed cost. Similarly, rather than buying the latest medical equipment, appropriate technologyneeds 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-conditioningsolutions.

The low-cost models will have a lower cost of operation. The tariff for the services will be low as comparedto 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.

Low-cost HealthcareDelivery Models:Increasing Penetration

Secondary care with basic and a few super specialties

100 beds

15-20 ICU beds

3-4 operation theatres

Endoscopy

Health check-up services

Lab, radiology and blood bank services

Fully equipped ambulance services

Exhibit 10:

Low-cost Secondary Care Hospital Services

ParametersCurrent Secondary Care 100-

bed HospitalLow-cost Secondary

Care 100-bed HospitalRemarks

Floor space per bed(sq. ft.)

1,000 - 1,200 700 - 800Optimising space allocation without compromising onfunctionality

Building cost(US$ /sq.ft)

63 - 73 42 - 50Reducing building cost by value engineering, choice ofmaterial cost based on project vision and model

Equipment cost(US$ /bed)

42,000 - 52,000 21,000 - 31,000

Reducing equipment cost by deploying appropriate technol-ogy in diagnostic and laboratory services. Further reductioncan be brought about by group purchasing and outsourcingof certain services.

Total cost(US$ /bed)

105,000 - 110,000 52,000 - 62,500

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


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05Traditionally, 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 economiesof scale. With increasing accessibility to insurance and rising consumer awareness, healthcare providerswill offer the entire gamut of services across the value chain, including primary, secondary and tertiaryservices to attract patients into the healthcare system right from the entry point. The primary and secondaryhealthcare formats will act as feeders to tertiary care hospitals. The integrated healthcare provider will beable to negotiate contracts with insurance companies and equipment vendors.

Characteristics of the Healthcare System

Develop integrated healthcare delivery modelaround core hospital business

Offer a broad spectrum of services across thevalue chain in the most cost-effective manner

The hospitals have high volume and high marginspeciality services

Out-patient services are an integral component ofthe healthcare system to increase attractiveness topatients

Ability to negotiate service contracts with purchasersof group health care services

Implement advanced health information technologyto improve the quality and convenience ofservices

Achieve price efficiencies through group

purchasing

Build cost savings by sharing of support and otherservices

Healthcare System:Staying Connected to YourPatient

Hospital Corporation of America, US

166 hospitals including 160 general acute care hospitals, 5psychiatric hospitals, 1 rehabilitation hospital

104 free-standing ambulatory surgery centres

49 free-standing diagnostic treatment facilities, and 74 provider-based imaging facilities

Comprehensive rehabilitation and physical therapy centres

Netcare, South Africa

120 hospitals

Primary care community care centres offering GPs, dental,pharma, pathology and imaging services

120 retail pharmacy outlets

Diagnostics: 6 main laboratories, 215 collection centre depotsand 120 radiology centres

Ancillary Healthcare Business: 41 dialysis centres, 14 travel

clinics, 7 radiotherapy/oncology centres, emergency medicalservices

Exhibit 12: Leading Healthcare Networks

Components of the Healthcare SystemExhibit 13:

Common ITInfrastructureandServices

SharingofSupportServices,GoupPurchasing

EmergencyServices

Day CareSurgeryCentres

Pharmacies

DiagnosticServicesHospitals

As

CoreServices

SpecialityServices


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06Integrated medicine is a new paradigm in health care that focuses on the synergy and deployment of thebest 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.

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 andmodern 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 traditionalmedicine into the general health service system. The purpose of integrated medicine is not simply toyield a better understanding of differing practices, but primarily to promote the best care for patients byintelligently selecting the best route to health and wellness.

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

An approach to harmonising activities between modern and traditional medicine will promote a clearerunderstanding of the strengths and weaknesses of each, and encourage the provision of the besttherapeutic option for patients.

Integrated Medicine:Leveraging the InherentStrengths

Yoga & Naturopathy (US$ 11 Mn)

3%

71%

19%

7%

Unani & Siddha (US$ 22 Mn)

Homeopathy (US$ 58 Mn)

Ayurveda (US$ 222 Mn)

US$ Mn

Exhibit 14: Components of Integrated Medicine Exhibit 15: Market Size of Integrated Medicine

ModernMedicine

Ayurveda

Unani &Siddha

Yoga &Naturopathy

Homeopathy

Widest array of options available to patients(One in threeadults in the United States used at least one complementary oralternative medical therapy (CAM))

Provides an opportunity to combine the best of bothconventional medicine and complementary alternativemedicine.

Provides cost-effective treatment options

Results in better patient outcomes, measured in terms of

symptom relief, functional status and patient satisfaction

Focus on holistic health and well-being

The hospital was founded on the principles of patient-centred care andevidence-based medicine. The patient is provided with evaluations thatare holistic and involve a conference of five on-site experts: MedicalDoctors (MD) specialising in internal and preventive medicine, a NursePractitioner, and two Naturopathic Physicians with expertise in a widearray of natural, complementary and alternative therapies.

Treatment approaches available at the IMC include internal medicine,naturopathic medicine, preventive medicine, nutritional counselling,nutritional supplements, nutriceuticals, herbal medicine, acupuncture,

craniosacral therapy, therapeutic touch, homeopathy, intravenousmicronutrients, relaxation therapies, as well as refer rals to counselors,

trauma therapists (EMDR), and chiropractors.

Exhibit 16: Exhibit 17:Advantages of Integrated Medicine

Integrative Medicine Centre at GriffinHospital, Connecticut USA


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Technology is seen as one of the three importantdrivers of increasing healthcare accessibility.Selection and adoption of appropriate technology

often makes a critical difference in the success ofhealthcare reform and reengineering. It has thecapability to revolutionise the way healthcare isdelivered.

However adopting and implementing technologyin healthcare forms a significant area of cost inhealthcare projects. It is estimated that almost 30-40 per cent of the project cost is allocated to medicaltechnology including both medical devices and information technology. Therefore, it is imperative to deviseways 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 careand 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. Forexample, the Active Technology Partnership (ATP) initiative of GE enables the provider to control theirequipment budget over a long period of time while managing technology obsolescence through plannedequipment renewals.

07Technology Partnerships:Arresting the Rising Cost

Reducing the cost of medical technology research and

development

Encouraging indigenous production of medical devices

Devising innovative ways of dealing with obsolescence

Testing the new and upcoming business models of technologyservices

Exhibit 18:

Novel Ways to Rationalise Technology Cost

Exhibit 19: Innovative Options in Healthcare Technology

Company Model Differentiating Factor

Health Hiway

Pay-per-use Model

Software As A service (SaaS) model wherein the vendor setsup an IT infrastructure in hospitals, looks after the completemaintenance, training and effective implementation of the mod-ules and the provider has to pay some annual fee only for therequired modules within the hospital.

The model allows easy adoption of technologyand helps save on the cost of fur ther developmentand upgrading of solutions.

Innovative pricing mechanisms based on asubscription model .

YOS Technologies

Pay-per-use Model

Provides record management and hospital management soft-ware to hospitals along with value-added services like smar tcards and patient portal.

Smart card issued by the hospital acts as Hospital

ID card which stores patient health information,eliminating the need to carry bulky medical files.

The card is also linked to the record managementand hospital management software of YOS,enabling ready retrieval of required records andthus reducing patient wait time.

GE

Active TechnologyPartnership Solution

The ATP program is individually tailored to the hospital needs,both at an organisational and depar tmental level.

Enables the provider to control their equipmentbudget over a long period of time while managing technology obsolescence through plannedequipment renewals.


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08Healthcare providers and administrators todayare under constant pressure to meet the ever-increasing customer expectation and stay ahead

in the competitive race. Operations optimisationin hospitals can enable hospitals to provide world-class services with a finite set of resources and cansignificantly impact competitive strengths, enhancingthe 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 feltthat automated support can only help the organisation to a certain level of process management. The keyto 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-consumingprocedure. However, the associated benefits of operations optimisation far outweigh the difficulties. Thereare reports of a number of benefits associated with the introduction of techniques like queuing, clinicalpathways, standard operating protocol and integrated care pathways. These include reduction in thelength of stay in hospital, reduction of costs in patient care, improved patient outcome, improved quality oflife, reduced complications, increased patient satisfaction with service, improved communication betweenstaff, and reduction in time spent by health staff on paperwork.

Operations Optimisation:Measuring Performance

Variability methodology

Queuing theory

Scheduling and forecasting

Simulation modeling

DMAIC

Exhibit 21:

Tools for Operations Optimisation in Hospitals

Service Quality Clinical Outcomes Commercials

Shorter waiting time

Increased patientsatisfaction

Lower ALOS

Reduction in the trendof re-admission

Increased sales and

revenue

Exhibit 20: Performance Parameters

30%

20%

40%

53%

Increase inmedicine

availability atcustomer end

Increase inOPD pharmacy

revenue

Savings ininventory

Reduction inlead time

Exhibit 22:

Note: Results indicated for a leading hospital in India

Benefit Analysis of Operations Optimisation ofa Leading Hospital in India


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09With the rise in patient awareness and a subsequent surge in hospitals going for accreditation-whichimposes a mandate to take greater accountability for patient safety and risk reduction, there is a renewedfocus 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 andagenda for addressing medical error in health care.

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

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

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

The Indian Confederation for Healthcare Accreditation (ICHA), a non-profit organisation consisting of variousassociations, aims to spell out clear-cut healthcare standards, train employees of hospitals, nursing homesand clinics in spotting medical errors and adverse reactions as well as encourage them to report the samein order to create a database.

Patient Safety:A Renewed Focus

Estimates of as many as 44,000 to 98,000 people die inUS hospitals each year as the result of problems in patientsafety.

Every hour, 10 Americans die in a hospital due to avoidableerrors; another 50 are disabled.

Implementing computer physician order entry

Having full-time doctors and nurses certified in critical care

Implementing a patient safety compliance checklist

Encouraging adverse event reporting

Robust infection control mechanism

Exhibit 23: Exhibit 24:Patient Safety Facts

What Steps Can a Hospital Take toImprove Patient Safety?

Source: To Err is Human: Building a Safer Health System,Institute of Medicine report, 1999.

Exhibit 25:

WHOs Proposed High 5s Project to Facilitate Implementation and

Evaluation of Standardised Patient Safety Solutions

Managing ConcentratedInjectable Medicines

Assuring MedicationAccuracy at Transitions

in Care

Communication DuringPatient Care Handovers

Improved Hand Hygieneto Prevent Health Care-

Associated Infections

Performance of CorrectProcedure at Correct Body

Site


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10Healthcare design has undergone an incredible change over the last few years. The emergence ofambulatory 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 beadmitted overnight.

Some design implications for ambulatory care centres are:

Need to emphasize more on providing structured spaces along with aesthetic appeal to achieve efficiencyin design.

Reduced travel time and distance between clinical areas and offices results in cost-effectiveness andbetter services.

Standardisation of spaces such as the operating rooms, recovery and treatment rooms helps achievefunctional 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 ofequipment required for individual units.

The ambulatory care hospitals are intended to serve patients who have not undergone complex surgeriesand are able to walk; nevertheless facilities must incorporate measures for handicapped and patientsunder slight sedation.

Healthcare Design:Alternative Care Settings

Larger number of units of care at significantly lower costper unit

Faster construction

Less complicated planning

Improved quality of care

Cosmetic and facial surgery centres

Endoscopy centres

Ophthalmology practices

Laser eye surgery centres

Centres for oral and maxillofacial surgery

Exhibit 26: Exhibit 27:Advantages of Ambulatory Care Settings Ambulatory Surgery Centres

Exhibit 28:

Parameter Ambulatory Care Hospital In-patient Hospital

Space Requirement*40,00060,000 sq. ft(typical size of facility)

100,000 sq. ft(100-bed facility)

Standardisation of space Works more effectively Less efficient due to specific individual requirements

Need for support infrastructureReduced requirement for facilities such as dietaryand linen

Full support services required

Space Implications: Ambulatory Vs. In-patient Environment

*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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2007 2008 2009 2010

The private sector takes the leadAcademic Medical Centres:Delivering excellence in care,education & research

PublicPrivate Partnerships: Thecurrent imperative

PublicPrivate Partnership: Searchfor an ingenious model in India

Health Insurance: Increasingaccessibility

Healthcare Consumerism in India:Rising awareness and spend

Corporatisation of MedicalEducation:The impact

Single Speciality Delivery Models:Single Speciality to SingleProcedural Hospitals

Standardisation: Need foruniformity

Newer Formats of Healthcare

Delivery: Taking healthcare closerto the consumer

Medpolis: The emerginghealthcare cities

Diagnostic Centres: Unbundlingfrom the traditional setting

The Empowered Indian PatientHealthcare REITS: Addressing thereal-estate challenge

Secondary Care Hospitals:Unleashing the potential in smallertowns

Low-cost Healthcare DeliveryModels: Increasing penetration

Manpower: Reversing the braindrain

Private Equity: The race for valuedeals

Designing Cost-effectiveInfrastructure: A green approach

Healthcare System: Stayingconnected to your patient

Technology Takes Centrestage Clinical Trials: Making inroadsNewer Partnerships: Catalysinggrowth of healthcare delivery

Integrated Medicine: Leveragingthe inherent strengths

PublicPrivate Partnership: Theway ahead

Emergency Evacuation Services:Building a network for India

Appropriate Technology:Optimising healthcare delivery

Technology Partnerships:Arresting the rising cost

Medical Value Travel: Hype andreality

Healthcare Architecture: Thebusiness of design

Lean Thinking: Improving thebottom line

Operations Optimisation:Measuring performance

Special Economic Zones Healthcare Outsourcing: Providersfocus on their core competence

Clinical Protocols : Standardizingcare

Patient Safety: A renewed focus

Infusion of Private EquityMedical Device Innovation :Involving providers and physicians

Health Insurance: The changingscenario

Healthcare Design: Alternativecare settings

Exhibit 30: Ten Trends 20072010

ReceptionRegistration

WaitingConsents Lab Work

Anesthetic Assessmment

Change(Accompanied By Relative)

Patient to Prep/Hold(Relative to Surgical Waiting)

Day Care Bed(Relative joins)

SpecialProcedure

Endoscopy

OperatingRoom

Post-OP

Recovery

Discharge Follow upScheduling

Follow up OPVisits

Nurse Station

Typical Patient Flow in Surgical Ambulatory Care SettingExhibit 29:

Authors

Dr. Rana Mehta, Vice President I [email protected] Baweja,Associate Director I [email protected] Pratap Singh, Principal Consultant I [email protected]

Monika Kejriwal, Principal Consultant I [email protected]

a peek into the future of healthcare trends for 2010

Documents