a peek into the future of healthcare trends for 2010
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8/8/2019 A Peek Into the Future of Healthcare Trends for 2010
1/1345
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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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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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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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 rana.mehta@technopak.comGulshan Baweja,Associate Director I gulshan.baweja@technopak.comAbhishek Pratap Singh, Principal Consultant I abhishek.singh@technopak.com
Monika Kejriwal, Principal Consultant I monika.kejriwal@technopak.com
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