The Aga Khan University

Hospital

History and Introduction to Hospital:

The word "hospital" comes from the Latin "hospes" which refers to

either a visitor or the host who receives the visitor. From "hospes"

came the Latin "hospitalia", an apartment for strangers or guests, and

the Medieval Latin "hospitale" and the Old French "hospital." It crossed

the Channel in the 14th century and in England began a shift in the

15th century to mean a home for the elderly or infirm or a home for

the down-and-out. Hospital is an institution or the organization for the

treatment, care, and cures of the sick and wounded, for the study of

disease, and for the training of physicians (teaching hospitals), nurses,

and allied health care personnel.

What is the importance of Hospital Management?

The answer to this question is simply that supervisors and managers of

hospitals must not only have vocational, technical knowledge about

hospitals and treatment, but also should have three types of

knowledge, about contemporary management and its functions and

principles. The work module of any job is based on two pillars, namely

technical work and management work.

What is to be managed in Hospital?

Like other organizations and institution, hospitals or any healthcare

facility passes through the following stages or in other words they need

the management of below sections for the smooth running of their

organizations, but the hospitals are very complex in its nature.

• Operations (actions)

• Finance (money and resources),

• Personnel (human relations)

• Information (needed information for wise decisions)

• Time (you’re own and that of others)

According to the Project Definition: “A project is a sequence, set or

series of unique, complex and connected activities, having one goal or

purpose to be completed with time frame, allocated budget and

according to its specification, now we can say the leading, controlling,

organizing and planning of all these activities is called project

management. Now we can say it easily, that a hospital or any

healthcare facility is a project in its nature, therefore; applying the rule

of project management will be no far away from it.

Each of these five elements mentioned, must be managed by any

person, who has its own set of principles and guidelines to follow. For

instance, when it comes to managing people, the teachings of

Industrial Psychology become pertinent. For operations, the teachings

of Operations Management as a subject become important. So, in

analyzing these five elements, it also becomes evident that the

teachings of Financial Management, Information Management and

Time Management, are also important for the other three elements.

Concisely, for a hospital manager it is compulsory to have the sound

knowledge of Operations Management, Financial Management,

Information Management, Human Resources Management, Time

Management and Communication. For the lower level jobs at hospitals

and healthcare facilities, the principles of Supervision can become a

starting point for teaching or studying the principles of management. A

person in one of the lowest level jobs found at employers must also

plan, organize and control work, even if it is just to clean an office or

do some washing in one of the departments of the hospital. Top

Management members of the hospitals such as Chief Executive Officer,

Financial Manager etc, must be able to plan, organize, control and lead

the wards and departments with a focus on understanding and

influencing the environment, setting the strategy and gaining

commitment, planning, implementing and monitoring strategies and

evaluating and improving fitness. The Top Management must therefore

have high capabilities with regard to human relations inwards and

outwards, strategic planning, team building, leadership, and

negotiation and fitness management. Middle Management members

must be able to plan, organize, control and lead departments and

sections with a focus on assistance upwards for application of scientific

methods and assistance downwards for application of scientific

methods. They must have the same capabilities as Senior Managers as

well as Supervisory Managers and also be good at interviewing

techniques, goal achievement, conflict handling tactics and project

management. supervisory Management members must also be able to

plan, organize, control and lead sections, units and individuals with a

focus on operations, finance, people, information and time. Lack of

Management skills in employer or employees at every hierarchy level

of the hospital or healthcare facility can be detrimental. Lack of

Management skills can lead to poor fitness, lack of improvement, low

profit, decisions making, disheartening of employees, lower

productivity, and jeopardize your organization. Therefore, it is

obligatory that hospital managers should have the updated and

cotemporary knowledge of Management. In below sections, you will

read more about hospital management, that how to manage hospitals

or any healthcare facility in order to achieve the intended objectives to

meet the organizational goals.

Concept of Productivity in the context of hospital:

As we are discussing regarding the concept of Productivity in the

context of a hospital, so we must know that every organization

whether it is Profitable or non-profitable, governmental or non-

governmental needs and uses different resources, which is classified in

many groups:

• Manpower/Labor/Task Force

• Material/ Raw Material

• Money/Cash/Budget

• Machinery/Equipment

The effective and appropriate usage and utilization of the above-

mentioned factors or resources shows and determines the

organization’s effectiveness. For example if it is a profitable

organization, its benefits and advantages are increased, while in case

of other organizations, its costs are reduced and diminished, therefore

the reliance on private sectors and donors or government grants and

aids or itself the fee for its services are diminished.

The effective and valuable usage/utilization/consumption of the

resources or assets is important and significant for every organization

or association, whether it is public or private. Hospitals are not

including in the row of except ness, they should be included. Actually,

Health care organizations or hospitals need to give more and more

concentration and attentiveness to good and better management and

execution because of the shortage of resources. Usually the health

related organizations are short of resources, bearing in mind the

demands for services placed onthem.5It is useful at this phase to

comprise how management and productivity concepts as well as

techniques are related to the health field. There is mistaken idea that

modern management and productivity concepts and techniques are

concerns to profit- making institutions and manufacturing

organizations only.

Productivity or Output, in simplest terms, is the relationship or bond

between the resources used and results produced. In shorter terms the

productivity is the ratio or difference between Input and output.

Input + Output=Productivity.

The effective usage of inputs will ultimately increase or affect the

output or productivity. So it means that we must give more

concentration for the effective usage of inputs or resources, we must

allocate all our resources in a better way in order to achieve our goals

and objectives. So for the improvement and enhancement of the

productivity it is so important to have qualified and well trained and

skilled staff, by this way they utilize and use the resources and raw

material in good manner. This is the responsibility of the organization

to conduct seminars, workshops and trainings for their employees.

Equipment:

As it is obvious and more apparent that most hospital or health

facilities have expensive equipment remains out of the order or

inventory list because of the insufficiency of the engineering

department, improper maintenance, defective service contracts and so

on. The expensive and costly equipment is under utilized because

often the users do no have a clear understanding of the capital cost of

the equipment or machinery and the bond between these costs,

capacity utilization and a fee charged from the patients. It is important

to improve and enhance the quality of medical services without

incensement in fees and other charges. And it is also possible to

increase the quality of services without increasing the fee by improving

the utilization and usage of the existing equipments and machinery.

Thus the engineering department of the hospital or health facility is the

most and critical department, because they are mostly involved in the

maintenance and repairing the equipments and machinery, as it is

usual in my hospital there is no proper system of the maintenance. A

planned and scheduled maintenance can reduce the chance of

breakdown and damage in of machinery and

Deterioration in normal routine hospital activities. All the staff of the

hospital must be understand about the usage and operation of

electrical/mechanical appliances and equipments. By this way, we can

prevent the breakdown the equipment.

Personnel Matters:

Almost all the staff who is working in the engineering department they

are not satisfied from their works due to their small salaries, wage of

disparities and lack of opportunities for development and so on. It is a

clear fact that the engineering department is so neglected, so they

hospital management should in take all these concerns regarding the

engineering department, their problems should be solved in a better

way for the betterment of hospital services.

Space:

Space is also playing a dominant role in the productivity of hospitals,

as we have seen some of the hospital have so small space while other

has a plenty of space. Example of the poor use of space, and defective

layouts of equipment causing unnecessary movements of personnel

and hospital staff, patients and materials. For the better planning of

hospitals we need a coordinated thinking of medical specialists,

engineers and architects specializing in the hospital field.

Funds:

In most hospitals and health facilities the financial and costing system

are usually weak. The particular income or surpluses and the expenses

of various departments are not separately analyzed nor the different

costs fixed. As a result the related medical and other staff has no idea

and concept of the financial management and its implications of the

resources at their disposal, or the relationship between costs and the

fees for various resources. It is obvious that financial management

becomes very critical to the productivity of hospitals. Public hospitals

in general need a financial advisor who can advise the management on

its spending policies; this will help cost reduction which is so vital.

Many of the health related institutions suffer from the unfavorable and

unpleasant ratio of administrative and actual healthcare expenditure.

Material:

It is clear fact that the good material management can be use to

diminish operating costs for the time it is somehow been neglected in

hospitals and other facilities, so it is most important to take

inconsideration the vitality of the material management in order to

achieve the goals and objectives of the hospital. As it is indicated in

previous surveys, that 40 to 50 percent of the annual budget of the

hospital are spending on material used.

Hospitals must adapt the ways and methods to streamline and make

more efficient their procurement, consumption and utilization control,

inventory and records control, storage and dissemination and service

organization.

The following factors have a big role in the effectiveness of

materials

• The items that are needed urgently should be provided.

• Use the money in such a way that the cost of storage is reduced to a

minimum.

• Handle the items and equipments with the least loss in storage and

management.

In order to achieve the above mentioned objectives when need to have

a good and stabilized policy decisions. However we have to put the

short term polices for the time being to run our work.

Personnel:

As it is a clear fact and I mean it is obvious to all of us that hospital

totally and almost always on human resources/Man Power, the

numbers of human resources usually higher than in other

organizations. So in a result the quality of the services in hospital

totally depends on the quality of their human resources and man

power. So for that the management is very crucial in this stage.

Actually, the staff or personnel productivity (output) is quite low in

many hospitals. It is a big problem that the staff is not assigning in a

specific hours of work but not with wholehearted commitment. So they

show insufficient commitment to their tasks, to the care for the

patients, and towards creativity in finding solutions to institutional

problems. Regarding the capacity, building and training of the staff and

personnel hospitals infrequently sponsor staff and personnel to

external training program. But in large hospitals the training can take

place in house with the help of professionals organizations, so these

trainings should be conducted periodically so that the employees and

staff make aware from the new changes in technology and techniques.

It is so vital for the hospitals to train their staff qualitatively and

quantitatively. The trainings by up gradation of staff and personnel

skills can help in the improvement of staff productivity.

INTRODUCTION

The Aga Khan University Hospital, Karachi (AKUH) was established in

1985 as the primary teaching site of the Aga Khan University’s (AKU)

Faculty of Health Sciences. Founded by His Highness the Aga Khan, the

hospital provides a broad range of secondary and tertiary care,

including diagnosis of disease and team management of patient care.

The hospital’s multidisciplinary approach to diagnosis and care ensures

a continuum of safe and high quality care for patients - with all

services under one roof.

The hospital promotes the Aga Khan University's objective of

promoting human welfare in general, and the welfare of the people of

Pakistan in particular, by disseminating knowledge and providing

instruction, training, research, and service in the health sciences. Aga

Khan University is Pakistan's largest private medical institute and

hospital

The Hospital is part of the Aga Khan University (AKU) in Karachi,

Pakistan. Chartered as the country’s first private international

university in 1983, AKU’s objective is to promote human welfare by

disseminating knowledge and providing instruction, training, research

and services in health sciences, education and other disciplines. AKU is

a non-denominational institution open to all on merit, and admissions

to its academic programmers are needs blind. The University places

special emphasis on the development of women. Through its high

academic standards, programmers relevant to the needs of developing

societies, its work as a dialogue partner with government on issues of

health and education policy, and its delivery of critical social services,

AKU has had a national impact in Pakistan.

With the launch of academic programmers in East Africa, the United

Kingdom, Syria and Afghanistan, AKU has now established itself as an

international institution at ten sites in seven countries. AKU’s Faculty of

Health Sciences, comprising a Medical College and a School of Nursing,

is located on the same campus in Karachi as Aga Khan University

Hospital (AKUH). The Institute for Educational Development (AKUIED) is

situated at another campus in Karachi, while the Institute for the Study

of Muslim Civilizations (AKU-ISMC) is based in London. With the

development of AKU-IED and AKU-ISMC, along with the planning of a

Faculty of Arts and Sciences, AKU has moved towards becoming a

comprehensive university.

Aga Khan Health Services

The Hospital and primary medical centers are part of the Aga Khan

Health Services, which is one of the most comprehensive private not-

for-profit health care systems in the developing world. It includes 325

health centers, dispensaries, hospitals, diagnostic centers and

community health outlets. Building on the Ismailia Community's health

care efforts in the first half of the 20th century, Aga Khan Hospital

Services (AKHS) now provides primary health care and curative

medical care in India, Pakistan, Kenya, Tanzania, and Syria. It includes

5 general hospitals, 7 maternity homes/hospitals and 187 health

centers/dispensaries. The first institution in the Aga Khan Health

Service, Pakistan (AKHS, P) was a 42-bed maternity hospital - formerly

known as the Janbai Maternity Home, which opened in Karachi in 1924.

Today, while maintaining that early focus on maternal and child health,

AKHS, P also offers services that range from primary health care to

diagnostic services and curative care. Its 164 health centers, seven

hospitals, maternity home, two medical centers, physiotherapy unit

and seven community dental units reach over 581,000 people in rural

and urban Sindh, Punjab and Frontier, Northern Areas and Chitral. As

the largest not-for-profit private health care system in Pakistan, its goal

is to supplement the Government's efforts in health care provision,

especially in the areas of maternal and child health and primary health

care.

Aga Khan Health Service, Pakistan also operates six diagnostic centers

with the consultant services and laboratory facilities in different parts

of Pakistan. AKHS, P manages over 1000 employees, around 4000

dedicated volunteers, over 1500 Trained Birth Attendants (TBAs) and

Community Health Workers (CHWs) working in different regions of

AKHS, P.

Healthcare Activities of the Aga Khan Development

Network

AKHS activities are conducted in concert with other health-related

activities of the Aga Khan Development Network (AKDN). The overall

aim is to raise the health status of people in East Africa and elsewhere

in the developing world. Emphasis, in current projects, is on

strengthening health systems development.

The Aga Khan Foundation (AKF), with branches in Kenya, Tanzania, and

Uganda, works with a variety of grantees, including AKHS, to improve

the health of vulnerable population groups, especially mothers and

children, and promote health services development on the national

and regional levels.

AKF and AKHS have been joined in their work in health care in East

Africa by the Aga Khan University's Faculty of Health Sciences, which

offers accredited professional training, especially for nurses, and

conducts a variety of research programs focused on the health

problems of developing nations. The AKDN aims to assist countries in

the building of effective, sustainable health systems linking different

kinds of services and levels of care.

SERVICES OF AGA KHAN HOSPITAL AND UNIVERSITY:

Aga khan hospital is one of the biggest hospitals of Pakistan, offering

several kinds of services. These services include:

LABORATORY SERVICES:

Clinical laboratories provide a complete array of routine and

specialized services. The services are related to all six branches of

laboratory/pathology including hematology, blood bank, clinical

chemistry, clinical microbiology, histopathology, cytopathology and

molecular pathology. Over 800 routine and specialized tests such as

general biochemical profiles, enzyme profiles, endocrine assays,

karyotyping, flow cytometry and HLA typing are available along with

several other special tests, which are not available elsewhere in

Pakistan.

Laboratory testing is also provided for the diagnosis and management

of hematological disorders such as anemia and thrombolytic disorders.

Diagnostic microbiological services include the determination and

identification of bacteria, fungi, viruses and parasites. Serologic tests

are also available for various bacterial, viral, fungal and protozoa

diseases. Histopathological and cytopathological services have all the

specialized procedures and techniques, such as immunoperoxidase,

immunofluorescence, muscle enzymes, histochemical and flow

cytometry techniques to enhance diagnostic accuracy. Services for fine

needle aspiration and pap smear are also available. A team of full-time

consultants and technologists with extensive training and experience is

committed to keeping the clinical laboratory at the cutting edge of

technology.

Laboratory services are provided through a well-equipped, highly

automated and professionally run facility, providing 24-hour service

seven days a week, including holidays, by a team of full-time

histopathologists, hematologists, chemical pathologists, molecular

pathologists and microbiologists. The services offer routine and special

clinical chemistry, hematology, blood transfusion, microbiology,

immunology, surgical pathology, cytology and molecular pathology.

Specialized sections of the laboratory include Endocrine Laboratory,

Cytogenetic, Fluorescence In Situ Hybridization (FISH) including

Pathvysion and Aneuvysion, Aspiration Cytology including Fine Needle

Aspiration (FNA), Frozen Sections, Therapeutic Drug Monitoring and

Molecular Pathology. Accuracy and precision of tests are maintained by

strict internal and external quality control procedures.

AKUH's clinical laboratory participates in various quality assurance

programs and is well known for its accuracy and precision of testing.

To date, the Hospital has a network of approximately 200 laboratory

specimen collection units in all major cities of Pakistan and performs

over 7 million tests annually. AKUH also receives pathological

specimens from UAE.

The Department of Pathology and Microbiology serves the clinical

laboratory network of the Hospital. The laboratory is one of the first

laboratories in the world to receive ISO Certification and Joint

Commission International Accreditation (JCIA). The Department also

publishes a regular pathology newsletter that provides an update on

new procedures and tests in the clinical laboratories.

Cardiopulmonary Diagnostic Services

The Cardiopulmonary Diagnostic Services at Aga Khan University

Hospital is the largest diagnostic centre of its kind in the region. Since

1985, the Non-invasive Cardiopulmonary services has expanded and

evolved into a very sophisticated laboratory, providing the latest

diagnostic facilities in the evaluation of adult and pediatric patients

with heart and lung diseases.

The laboratory’s core is the Echocardiography section and is staffed

with highly competent technologists and cardiac fellows on rotation.

There are four sophisticated color Doppler echocardiography

machines. Over 6,000 examinations are performed annually to

evaluate the structure and function of the heart muscles and valves in

detail, minimizing the need for invasive testing. Eight different echo

modalities are performed: (i) Adult Tran thoracic (ii) Transoesophageal

(iii) Dobutamine Stress (iv) Contrast (v) Fontal (vi) Pediatric (vii)

Interventional and (viii) Intraoperative.

The major aim of the Cardiopulmonary Lab is accuracy of results with

promptness of service.

Services

The Cardiopulmonary Diagnostic Laboratory is located on the ground

floor of the Nazerali-Walji Building and consists of the following five

sections:

I) Pulmonary Function Test (PFT)

The PFT laboratory offers services for:

1. Spirometry

2. Bronchodilator Reversibility

3. Lung Volumes and Transfer Factor (these tests provide a

comprehensive assessment of diseases of the lungs and airways)

4. MIP/MEP (Maximal Inspiratory/Expiratory Pressures), to measure

muscle strength

5. Pulmonary Rehabilitation Programme

In addition, facilities for Pulse Oximetry and the six-minute Walk Test

are also available.

II) Diagnostic ECG

Services offered include:

1. Resting Electrocardiograms (ECG)

2. Stress/Exercise Tolerance Testing (ETT)

3. Ambulatory Blood Pressure Monitoring (ABP)

III) Arrhythmia Evaluation

Services offered include:

1. AmbulatoryECG(Holter)Monitoring

A Holter monitor is a 24-hour portable electrocardiogram monitor

for the detection of heart rhythm problems, ischemia or frequent

unexplained episodes of palpitation or syncope.

2. Head-upTiltTest(HUT)

This is a tool for the work-up of syncope. Currently, we are the

only institution offering this test in Karachi. For neurocardiogenic

syncope (vasovagal), this remains the gold standard of diagnosis.

3. PacemakerFollow-upCheck

Aga khan hospital also offer a pacemaker clinic under the

supervision of Board Certified Heart Rhythm Specialists. This is a

unique service for patients with permanent pacemakers and ICDs

in place. For such patients, regular check-ups are important to

ensure a smooth and trouble-free service. This service is also

offered to patients who had pacemakers implanted at other

hospitals.

IV) Echocardiography

Services offered are:

1. AdultEchocardiogram

Echos are performed on state-of-the-art equipment by highly

trained technologists and reported by experienced cardiologists.

Echo provides structural and functional information of the heart:

i.e. systolic and diastolic function of the ventricles, morphology

and function of the valves, etc. Echo is therefore mandatory for

patients with heart failure and suspected valvular and congenital

heart disease.

2. PaediatricEchocardiogram

Paediatric studies are performed by paediatric cardiologists.

3. FoetalEchocardiogram

Echo is performed during pregnancy to assess any congenital

abnormalities in the foetus in high-risk patients. Early diagnosis

and treatment of these abnormalities may be life-saving. This

test requires highly-skilled paediatric cardiologists, technologists

and state-of-the-art equipment which are available in our

laboratory.

4. Trans-oesophageal-Echocardiogram(TEE)

TEE provides excellent cardiac images and can be used to

visualise left atrial appendage, inter-atrial septum thoracic aorta,

metallic prosthetic valves, small vegetations and complications

of endocarditis. These are indicated in patients with sub-optimal

images of transthoracic echo, suspected ASD, endocarditis,

dissection of aorta, assessment of cardiac source of embolus and

metallic prosthesis, etc.

5. StressEchocardiogram

Stress echocardiogram is a valuable tool in the assessment of

coronary artery disease and the viability of damaged heart

muscles. Its results are equivalent to information obtained from

thallium scan. If the patients can exercise, Treadmill Stress Echo

(TSE) is performed which also provides information on functional

capacity. If the patient cannot exercise or a myocardial viability

assessment is required, then Dobutamine Stress Echo (DSE) is

performed. Stress echo is a safe test in stable patients.

V) Nuclear Cardiology

Nuclear cardiology has established its unparalleled role in helping both

diagnose and prognosticate patients with heart disease. Nuclear

cardiology is a special type of X-ray procedure that uses very small

amounts of radioactive material to diagnose heart disease. Nuclear

cardiology procedure is safe, and the amount of radiation exposure is

no greater than a common chest X-ray. It is highly effective in

determining the degree of blood flow to the heart muscle and in

detecting the presence of arterial blockages in the heart. In addition,

this test also helps a doctor to decide the extent of risk and the best

way of treatment. Imaging is performed on a state-of-the-art dual-head

gamma camera which is designed to meet the high-throughput and

high-quality demands of the most progressive cardiology practices. A

nuclear cardiology test usually consists of taking two sets of pictures of

the heart; one following stress (via exercise or injection), and the other

during a resting phase. The patient receives one or two injections of

radioactive material at different time intervals. The entire test takes

about five to six hours.

We offer the following studies:

1. Exercise treadmill myocardial perfusion imaging using Thallium

201

2. Exercise treadmill myocardial perfusion imaging using

Tetrofosmin

3. Dipyridamole (Persantin) myocardial perfusion imaging using

Thallium 201

4. Dipyridamole (Persantin) myocardial perfusion imaging using

Tetrofosmin

5. Dobutamine myocardial perfusion imaging using Thallium 201

6. Dobutamine myocardial perfusion imaging using Tetrofosmin

7. Resting myocardial perfusion imaging studies for chest pain

evaluation

8. Dual isotope studies

9. Gated imaging studies to estimate left ventricular function. This

unique service enables determination of blood flow to the heart

as well as cardiac function in one test

VI) Off-site Non-invasive Services

Transthoracic Echocardiogram, Holter monitoring, Ambulatory BP

monitoring and ECG services ate also offered at Clifton Medical

Services.

All specialised tests are conducted under direct supervision of highly

trained cardiologists, pulmonologists, and a team of skilled technicians.

Except for the ECG, all specialised tests require prior appointment.

Home Physiotherapy Services

To increase convenience and accessibility for its

patients, Aga Khan University Hospital (AKUH) offers

Home Physiotherapy Services. Now you can save time

and inconvenience of traveling by utilising the same

high-quality service available at the Hospital in the

comfort of your home. The service is available in almost

all areas of Karachi . To avail services, please call our

Coordinator for Home Physiotherapy Services at Tel:

+92 21 3486 1531 and 3486 1532 or 3493 0051 Ext. 1531/1532

(Monday to Saturday).

Home Health Nursing Care Services

AKUH offers skilled, trained and dependable professional nursing staff

through the Home Health Nursing Care program. The services can be

availed on an hourly or daily

basis.

Inpatient Services

AKUH provides comprehensive

inpatient services in almost all

major disciplines of medicine

and surgery. There are 15

inpatient units with a total capacity of 563 beds . This includes 55 c

critical care beds of ICU, CICU, CCU and NICU. The average length of

inpatient stay at AKUH is the lowest in the city; i.e. 3.4 days . All

inpatients are routed through either the Emergency Medicine Section

or the outpatient services.

Facilities offered in nursing units are: five-bedded general wards, two-

bedded semi-private rooms and single-bedded private rooms and

limited VIP private rooms in the Private Wing. Most of the nursing units

have a five-bedded Special Care Unit (SCU) for patients who need close

monitoring and supervision. The major strength of the inpatient service

lies in its highly dedicated team of professionals comprising medical

consultants, fellows, residents, trained and competent nurses and

other paramedical staff who provide high-quality health care through a

collaborative effort together with a broad range of state-of-the-art

equipment to give the best possible diagnosis and treatment options.

Being a teaching Hospital affiliated with Aga Khan University's Faculty

of Health Sciences, the clinical ward rounds are typically medical

education oriented. Senior residents are available to patients round-

the-clock.

All inpatient services have a unique system of prescribing drugs

through Physician Order Entry (POE). Each floor has a operational

nursing station equipped with network computer systems for accessing

a patient's investigation results and medical records, unit receptionists,

nursing staff and residents. 

 Urgent Care Services (UCS)

UCS provide treatment for a condition that requires prompt

attention but does not pose an immediate, serious health threat.

Ear infections and sprained ankles are examples of conditions

that Urgent Care staff can treat.

The service caters to medical problems that are not emergencies

but need to be seen the same day.

Patients with critical, serious or life-threatening illnesses/injuries

will be transferred to the emergency of AKUH at Stadium Road in

a fully equipped ambulance staffed by a physician.

Pharmacy

Pharmacy services are operated under the supervision of graduate

pharmacists who provide complete information related to drugs and

their usage. All drugs are stored at a controlled temperature to

maintain their validity and efficacy. Pharmacy services have the facility

to prepare special drug formulations for patients if requested by their

doctors.

Radiology

Radiology services (general radiography, orthopentomogram (OPG)

and ultrasound with color Doppler, small parts and endo-cavitory

probes) are provided under the supervision of qualified radiologists. In

case of special procedures, such as MRI, CT and Nuclear Medicine, our

staff would provide assistance in taking appointments from AKUH's

main radiology facility on the Stadium Road campus.

Cardiopulmonary Diagnostic Services

Accurate and reliable cardiopulmonary diagnostic services are

extremely important for early

diagnosis of heart diseases.

Diagnostic services include

Electrocardiography (ECG),

Echocardiogram

(transthoracic), Holter

monitoring and Ambulatory

Blood Pressure monitoring. Procedures/ tests are performed reported

by credentialed cardiologists.

Physiotherapy Services

Physiotherapy services are available for

Orthopedic, Rheumatic, Neurological and

Pediatrics conditions by skilled

Physiotherapists. Physiotherapy Services

also provides services for rehabilitation of

traumatic and sports related injuries.

Hospital Services

Whether you want to offer your employees hospitalization coverage,

laboratory testing, vaccination, annual health screening, pre-

employment screening, drug testing or you need a regular physician at

your Hospital site, Aga Khan University Hospital (AKUH), Karachi has

the expertise to address all your Hospital health care needs. Top cadre

local and multinational corporations in almost all industries utilize our

Hospital health services. AKUH, Karachi is also the first choice for

foreign consulates and foreign companies recruiting from Pakistan.

Utilize our twenty years of experience in providing Hospital health

services to discover a high quality, cost-effective health care option for

your employees.

Hospital Registration Process

Pre-employment Screening Services

Vaccination Services

Executive Clinic Services

Hospital Health Awareness Programs

Hospital Patient Business Services Department

Hospital Registration Process

As part of the Hospital registration process, our Hospital clients are

requested to sign a Memorandum of Understanding (MOU), which

outlines the roles and responsibilities of the corporation and the

Hospital. A refundable deposit is required as part of the Hospital

registration process to provide credit facility for both inpatient and

outpatient services.

The treatment at AKUH, Karachi is cost-effective due to its shorter

average length of stay of 3.6 days owing to a number of quality control

measures introduced for the first time in Pakistan, such as infection

control, peer review committees and adherence to international best

practices. Other measures such as billing of pharmacy on the basis of

consumption, that is, the patient or the employer is charged only for

the actual quantity of medicines consumed contribute towards

considerable savings in medical expenses. To date, Aga Khan Hospital

also finalizes agreements with more than 160 state owned and

multinational organizations

Pre-employment Screening Services

The practical and economic costs to your business caused by health-

related work fitness issues can be devastating. Pre-employment health

assessment enables you to identify if the applicant is fit for the specific

job, or if there are any underlying health issues which need to be

investigated.

AKUH, Karachi offers various standardized health-screening packages

and also offers the flexibility to design a health assessment package

based on the individual needs of your organization. More than 60

national and multinational companies including companies recruiting

employees for foreign countries trust AKUH, Karachi for their pre-

employment health screening needs.

Vaccination Services

Vaccination services are available for all vaccinations included in the

National Expanded Program of Immunization (EPI) as well as other

communicable diseases for which vaccination is recommended, such

as Pneumonia, Flu, Meningitis, Chickenpox, Rubella, Hepatitis A,

Hepatitis B, Typhoid, Rabies and others. Vaccination services for some

vaccines can also be availed at your Hospital site.

Executive Clinic Services

Keeping in mind the pressure at office and at home, the Executive

Clinic offers a number of time-efficient yet comprehensive check-up

programs. Details of these programs can be found in the Executive

Clinic brochure.

Hospital Health Awareness Programs

For a nation where treatment of disease is relatively expensive,

Hospital health awareness programs have proved to be an excellent

way to increase awareness of preventive health measures and early

diagnosis of health problems in employees. The Marketing Department

of AKUH assists its Hospital clients in organizing health awareness

guest lectures at both the Hospital site and at AKUH, Stadium Road.

The program consists of a presentation on a health topic by an AKUH

credentialed faculty followed by a question and answer session.

Numerous organizations have benefited from this preventive health

service.

The Emergency Department at Aga Khan University Hospital, Karachi is

visited by approximately 60,000 patients annually, of which more than

40% are admitted to the hospital.   Our Department serves not only

patients from Karachi, but also receives patients from other areas of

Pakistan.

Keeping in view the increasing load on the emergency services, the

expansion plan for these services is underway. The new building of the

University Hospital Emergency Services became functional on October

22, 2008. This building is part of the expansion plan for the current

emergency services in the hospital, which is expected to be completed

by the end of 2009. After the completion of this expansion, the

Emergency Room at Aga Khan University Hospital, Karachi will consist

of 51 beds over an area of 26,700 square feet.

Our highly skilled trauma team of Emergency and Trauma Care trained

physicians and nurses provide treatment around the clock, seven days

a week. At present, the fully equipped Emergency Room is operating

with 27 beds, with a Triage Desk and Fast Track System to ensure

prompt medical attention for all patients.

The Department is organized into the following major patient care

areas:

Triage Bay: 3-bed area for rapid initial assessment of patients

and taking decisions regarding level of care required

Resuscitation Area: Two beds for patients with life-threatening

conditions requiring resuscitation

Critical Care Area: 7-bed area for patients who require critical

care

Non-Critical Care Area: 10-bed area for patients who require

'work up' by the department or other specialty teams

Operating Area: Two beds for patients requiring minor

interventions

Fast Track Clinics: 3-bed area for providing speedy treatment

to patients with minor illness

Clinical Faculty

Executive Clinic

Minor fleeting complaints, seemingly insignificant, are frequently

ignored. A routine examination at the Executive Clinic provides you

with an opportunity to reassure yourself about your good health and

discuss ways to remain healthy. The major benefit of a health

evaluation program is to give information about the status of your

current health – the dos and don'ts. During the examination, potential

problems might be detected and these would be less harmful if treated

at early stages. In case a follow-up with specialists is required,

necessary appointments will be arranged, which are not included in

these packages.

To meet the growing demand for quality health care services as well as

to enhance patients experience, we are pleased to inform you that the

Executive Clinic is now located in the Nazerali Walji Building.

To suit different individual preferences, two packages have been

developed. You can select the one that

better serves your needs.

Executive Clinic (Package A) -

Outpatient Package

Special Executive Clinic (Package

B) - Day Care Package

Executive Clinic (Package A) -

Clifton Medical Service

Faculty Schedule

Package Prices

Timings

Canceling / Rescheduling Appointments

Brochure

Neurophysiology Services

Located in the main Consulting Clinic (CC) and Ward D1,

Neurophysiology Services uses state-of-the-art equipment to aid in the

diagnosis and treatment of diseases of the brain, spinal cord, nerves,

neuromuscular junctions and muscles. Well-trained and qualified

technologists perform routine procedures under the direct supervision

of consultant neurologists.

The service offers Electroencephalography (EEG), Prolonged EEG

(PEEG), Sleep deprived EEG (SDE), Sphenoid EEG, Video EEG

Monitoring (VEEG), Polysomnography (PSG), Split night

Polysomnography (SPSG), CPAP / BiPAP Titration Service, Multiple

Sleep Latency Test (MSLT), Electromyography (EMG), Nerve

Conduction Studies (NCS), Single Fibre EMG, Evoked Potential Studies

(EPS), including Brainstem Auditory Evoked Potential (BAEP), Visual

Evoked Potential (VEP), Somatosensory Evoked Potential (SSEP) and

Electroretinography (ERG).

In addition, Autonomic Testing

including Sympathetic Skin

Response (SSR) and R-R

Interval, Diaphragmatic EMG,

EMG guided Botox services,

Pelvic floor EMG and NCS and

Intraoperative SSEP Monitoring

are also performed.

Unique services like Intra-operative Monitoring (IOM),

Electrocorticography (EcorG), Tran cranial Magnetic Stimulation (TMS),

Tran cranial Doppler Studies (TCD) and Quantitative Sensory Testing

(QST) are also available. Epilepsy Monitoring Unit is the upcoming

project in 2009.

Physiotherapy and Rehabilitation Services

The Department of Physiotherapy provides comprehensive inpatient

and outpatient services to assist adults and children in overcoming

physical, neurological and cognitive impairments, disabilities and

handicaps. All Physiotherapists work with an interdisciplinary team to

restore physical functions, relieve pain and minimize the psychological,

social and vocational efforts of disability.

The services offered include cardiac rehabilitation program, orthotic

and prosthetic clinic, pediatric rehabilitation, musculoskeletal

rehabilitation, general orthopedic conditions, neuro-rehabilitation,

lumbar and cervical tractions, chest physiotherapy, hydrotherapy, gait

training, treatment of pain through Transcutaneous Electrical Nerve

Stimulator (TENS), laser and other electrotherapeutic modalities. The

section is planning to start geriatric and rheumatology rehabilitation

program.

Off-site Physiotherapy Clinics and Home

Physiotherapy Services

In response to the growing demand from patients and consultants from

within and outside AKUH, the Physiotherapy the Physiotherapy

Department has started home- physiotherapy services and off-site

physiotherapy clinics located at Clifton Medical Services and at Aga

Khan Diagnostic and Day Care Surgery Centre, Karimabad.

Highly qualified physiotherapists equipped with sophisticated

modalities treat neurological, neuromuscular, musculoskeletal and

cardiopulmonary disorders, and assure high-quality services.

AKUH Physiotherapy Department also provides feedback to referring

consultants, enabling them to assess the status of their patients and to

plan their future treatment accordingly. All these services are available

from Mondays to Saturdays from 8:30 AM to 6:00 PM.

Advanced Rehabilitation Services at Aga Khan University Sports and

Rehabilitation Centre provide quality multidisciplinary outpatient

rehabilitation by a skilled rehab team using the latest equipments, a

wide range of therapeutic exercises and a multitude of modalities to

help patients return to an active and healthy lifestyle.

Services offered are

Fitness Screening through Microfit fitness evaluation system

Fitness Weight reduction program

Orthopedic rehabilitation program

Neurological rehabilitation program

Cardiac rehabilitation program

Risk factor modification program

Pulmonary rehabilitation program

Sports Injury Clinic

Aga Khan University Hospital, Karachi provides a broad range of latest

and technically advanced diagnostics and therapeutic services. Over

the years, the hospital has developed a health care network, which

covers all areas of Karachi through Off-site Medical Centers, Home

Health Services and Clinical Laboratory Network.

Kindly visit above links for details regarding services offered by AKUH.

In case you are unable to find the service, you would like to avail,

please contact the Hospital Information Desk.

Special Services

Special services include various facilities that provide specialized

medical care for specific clinical problems. Special services use a

problem-oriented approach with inputs from various clinical experts

and specialized training of the persons providing the service.

The various special services available are:

Angiography Suite/Cardiac Catheterization Laboratory

Bone Marrow Transplant Clinic

Breast Clinic

Endoscopy Suite

Family Planning Clinic

Foeto-Maternal Clinic

Gynae-Oncology Clinic

Heart Clinics

Infertility Clinic

Intensive Care Services

Lithotripsy Clinic

Menopause Clinic

Metabolic Bone Disease Clinic

Nutrition Care Clinic

Oncology Day Care

Operating Room

Pediatric Sub-Specialty Clinic

Pain Clinic

Parkinson's Disease and Movement Disorder Clinic

Pre-operative Anesthesia Assessment Clinic

Psychiatric Day Care Service

Sleep Well Clinic

Speech Therapy Clinic

Sports Injury Clinic

Surgical Day Care Unit

Uro-Gynaecology Clinic

Support Services

In addition to clinical and diagnostic services, the institution offers

various supportive and administrative services that help in providing

quality care to the patients. These services may benefit all the

referring physicians in getting access to information in areas of

relevant interest and addressing various non-clinical issues related to

the care of their patients at AKUH.

The following are included in Support Services:

1. AKUNET Services

2. Conference Secretariat

3. Department of Continuing Professional Education

4. Health Information Management Services (Medical Records)

5. Marketing Department

6. Patient Business Services Department

7. Patients Complaint Handling Services

8. Patients Welfare Services

9. Physician Referral System Coordinator

Consulting Clinics

Aga Khan University Hospital (AKUH) provides outpatient consultation

service to over 600,000 patients a year. Clinics are located at AKUH,

Stadium Road, at Clifton Medical Services (CMS) and Off-site Medical

Centers. The service comprises of:

Consulting Clinics: Specialists' clinics from different sub-

specialties of Anesthesia, Family Medicine, Medicine, Obstetrics

and Gynecology, Pediatrics, Psychiatry, Radiation Oncology and

Surgery. Please visit Consulting Clinics Schedule link (top right).

Executive Clinic: Annual health check-up programs, which help

in timely diagnosis of medical problems.

Community Health Centre: Primarily offers low-cost Family

Medicine general walk-in clinics. A limited number of specialty

clinics are also available. The centre also offers

immunization/vaccination, minor surgical procedures such as

circumcision, pre-employment health check-ups and screening

Women's Services

Maternity

Aga Khan University Hospital, Nairobi (AKUH, N), Maternity Services is

accredited by the Royal College of Obstetrics and Gynecology, United

Kingdom. The service provides quality care at an affordable price,

offering would-be mothers a comfortable environment through each

stage of their pregnancy

Qualified nurses and midwives, a team of resident doctors under the

stewardship of senior obstetrics and gynecology consultants cater to

both the mother and child’s needs.

LDR

LDR consolidates the process of Labor, Delivery and Recovery process

in one room saving mothers the inconvenience of being moved from

room to room at various stages of labor. The unit offers an opportunity

for mothers to deliver in an environment in which they feel nurtured,

comfortable and their privacy and preferences respected. The first of

its kind in East Africa, and located at the prestigious Princess Zahra

Pavilion, the unit is the answer to many expressed needs of women in

maternity care; privacy, comfort, and choice. This addresses the

psychosocial needs of the family.

The LDR concept encourages natural childbirth and allows the mother

the option of remaining with family members and friends. The concept

is enhanced by the use of a special bed, which allows the mother to

deliver in any position of her choice in a state-of-the-art room. There is

round the clock monitoring of the mother during the birthing process

by an Obstetrician and mid-wives.

Lamaze

Lamaze is a method of childbirth preparation based on proven

scientific methods to provide a positive experience for the expectant

mother. Recognized internationally, the program is a popular method

of childbirth education and preparation. Couples are encouraged to

attend the six-week program which includes exercises, relaxation and

breathing techniques, labor and delivery experience, nutrition,

sexuality and coping skills for the postpartum period.

Maternity-Ward

The ward has a bed capacity of 25. It has state-of-the-art delivery

rooms with piped oxygen, neo-natal resuscitation units, comfortable

delivery couches and electronic external foetal monitoring devices. The

ward has:

12 ward beds;

8 semi-private rooms;

3 private rooms with television and telephone facilities;

2 private rooms specifically for monitoring high risk expectant

mothers.

UPCOMING SERVICES‘HOSPITAL FITNESS’

Regular activity has a number of proven, positive health effects,

especially on heart health. Vigorous exercise strengthens the heart as

a pump, making it a larger, more efficient muscle. Even moderate

activity can boost HDL ('good') cholesterol, aid the circulatory system,

and lower blood pressure and blood fats. All these effects translate into

reduced risk for heart disease, heart attack, and stroke.  

Exercise can also offer other benefits, including strengthened muscles,

increased flexibility, and stronger bones, which can help ward off the

bone-thinning condition called osteoporosis.

Regular activity also promises mental-health benefits, like relieving

stress and anxiety. It can help you sleep better and renew your energy.

If exercise could be bottled, it would be a best-selling potion at the

local pharmacy.

The reasons for inactivity are not hard to figure out. Most of us have

jobs where we sit most of the time, so chances are limited to be

physically active at work. We also rely heavily on modern, laborsaving

devices - cars, appliances, and power tools - to spare us manual effort.

But there's another reason why many people, especially the

overweight, avoid activity. Check out the firm, supple bodies shown

exercising on television or on magazine covers. They give the

impression that exercise is sweaty, strenuous work best reserved for

the young, super-fit, and athletic. However, the latest research is

proving that picture false: Benefits can be gained even from low-

intensity activity, like gardening.

Situation Analysis

The business model has been well received and marketing is especially

important to maintain growth and market penetration. In addition to

offering fitness facilities for hospital patients, its main activity is the

creation and implementation of wellness programs. The basic market

need is the permanent fitness of the patients that can be achieved

through long-term wellness programs.

Market Summary

Hospital Fitness possesses good information about the market and

knows a great deal about the common attributes of the prized and

loyal customers. This information will be leveraged to better

understand who is served, their specific needs, and how Hospital

Fitness can better communicate with them.

Market Analysis

2003 2004 2005 2006 2007

Potential

Customers

Grow

thCAGR

Hospital Employees 35% 9,87613,33

3

18,00

0

24,30

0

32,80

5

35.00

%

Patients 15% 5,924 6,813 7,835 9,01010,36

2

15.00

%

Other 0% 0 0 0 0 00.00

%

Total28.57

%

15,80

0

20,14

6

25,83

5

33,31

0

43,16

7

28.57

%

Market Demographics

The profile for Hospital Fitness' customer consists of the following

geographic, demographic, and behavior factors:

Geographies

The immediate geographic target is the city of Karachi.

A 35-mile radius is in need of the services. .

Demographic

71%:29% male: female.

The individual income range is 38,000-75,000.

67% of the customers are single, 33% are married.

Behavior Factors

Recognize the need to have physical activity in their lives.

Have in Hospital some sort of exercise program in their daily/

weekly routine for the last several years.

Market Needs

Hospital Fitness is providing their customers with a health care cost

management program for hospital employees that will increase

employee productivity and decrease overall business costs. Hospital

Fitness seeks to fulfill the following benefits that are important to their

customers:

Customization- HF will offer a totally customized solution for each

department as well as each employee within the company.

Convenience- Customers will not use the service if it is not

convenient. HF recognizes this and strives to make their services

as convenient as possible for the targeted customer groups.

Results-orientated strategy- HF will need to improve hospitals’

bottom line in order to attract and maintain customers. While HF

will strive to address all of the customer's needs.

Market Trends

There have been two significant market trends in the last five years.

Increased usage of fitness facilities on behalf of individuals.

Exercising and "working out" has become a more mainstream

activity in lives over the last decade. Five to ten years ago, there

were widespread reports about an impeding health crisis,

obesity. The poor diet is not the only factor however more and

more people are going to the gym after work or are incorporating

some sort of outdoor activity into their daily routine.

The incorporation of fitness memberships within the "basket of

benefits," a part of the total compensation package.

SWOT Analysis

The following SWOT analysis captures the key strengths and

weaknesses within the company, and describes the opportunities and

threats facing HF.

Strengths

Results-orientated approach to attracting and maintaining

customers.

A well-researched, detailed health wellness program that is long-

term in focus.

Intensively trained staff.

Weaknesses

High costs associated with customized, personal service.

The inability to work on a high volume business model.

The costs of attracting a large Hospital client.

Opportunities

Participation within a growing market.

The large increase in clients that follows with the acceptance of

HF's program by hospital employees.

The ability to leverage future quantitative analysis that supports

the contention that long-term wellness programs have a

significant, positive impact on a hospital’s bottom line.

Threats

Lack of immunity to an economic downturn.

A change in society where the individual begins to take far more

responsibility for his/her health maintenance.

Competition

The three main competitors for Hospital Fitness are:

YMCA-market is lower-income families and/or students who want

accessibility and affordability of fitness facilities.

General Gyms-services are targeted toward those motivated and

dedicated individuals who workout five to seven times per week.

Better Bodies-aimed at casual fitness-seekers who do not

workout with a high intensity but still desire the status and

recognition.

Service Offering

Hospital Fitness provides wellness strategies/programs to businesses in

Karachi. A wellness strategy is a long-term effort, combining both

health-promotion and exercise-related activities designed to facilitate

positive lifestyle changes in members of a hospital’s work force.

Hospital Fitness will work with a hospital's senior management to help

it develop a mission statement for its wellness program.

Finally, Hospital Fitness will furnish employee progress reports to

senior management with which to carry out the incentive program and

generally monitor changes in the behavior of its work force.

Keys to Success

Hospital Fitness' keys to success are:

Marketing services to patients and other individuals.

Recruitment of experienced managerial talent.

Dedication and hard work of the founders.

Raising productivity.

Lowering overall costs.

Mission

Hospital Fitness is a health service that helps hospital employees and

patients attain one of the greatest gifts of all--that of good health.

Personal gains, such as improved self-esteem and self-motivation,

combined with measurable benefits will create tremendous advantages

for both the employer and the employee.

Marketing Objectives

1. Generate a 10% yearly increase in sales.

2. Increase market penetration every quarter.

3. Continue to cultivate HF's image as the premier long-term

wellness program provider.

Financial Objectives

1. Decrease customer acquisition costs by 4% every two quarters.

2. Lower the cost of service delivery by 1% a quarter.

3. Holding spending, as a percentage of sales, at a steady rate.

Target Markets

The market for Hospital fitness is not particularly segmented, as

potential customers include all hospital employees

Hospital Fitness, however, segments its services for individual patients.

Hospital Fitness works with senior management to develop mission

statements and provide incentive plans, and with employees to design

personalized health and fitness programs.

The targeted customers are Hospital employees and patients.

Positioning

Hospital Fitness will position them selves as the most effective

wellness strategy and program developer. This positioning will be

supported by statistics indicating an increase in worker productivity

and a decrease in business operation expenses from the

implementation of Hospital wellness programs.

Strategy Pyramids

The single objective is to position HF as the most proficient wellness

program provider in the Seattle area. The marketing strategy will seek

to develop customer awareness regarding the services offered,

develop the customer base, and work toward building customer

loyalty.

The message that HF seeks to announce is that they can have a

dramatic effect on the bottom line. This message will be

communicated through various methods. The first method will be the

production and disbursement of printed materials. The printed

materials will describe all of the services offered and will give

prospective customers some insight into HF's past successes.

HF will also rely on presentations to hospital's HR departments. These

presentations will allow HF to personally address any concerns or

"pains" that hospitals have and indicate how a wellness program/

strategy can help service their needs.

HF will also rely on advertisements in the hospital Journal of Karachi for

increasing visibility and interest in HF's services among Seattle-based

companies. Lastly, Hospital Fitness will use a website as a source for

disseminating information.

Marketing Mix

Hospital Fitness' marketing mix is comprised of the following

approaches to pricing, distribution, advertising and promotion, and

customer service.

Pricing- Prices for using Hospital Fitness' services are comparable

to those of higher-end fitness centers. An employee choosing to

utilize a Hospital Fitness center will pay a 400 monthly fee. For

each employee enrolled in the general wellness program,

regardless of whether or not they use the fitness facility, the

hospital will pay 150 annually. The prices reflect the quality of

the equipment and service.

Distribution- This will occur both at the company's worksite as

well as at HF's facilities.

Advertising and Promotion- Printed material, presentations,

advertising in industry specific journals and a comprehensive

website will be used.

Customer Service- Hospital Fitness will operate on the principle

that it is imperative to achieve total customer satisfaction if the

business is going to succeed.

Marketing Research

Two types of market research were used when HF was collecting

market research. The first type of research was focus groups. The

focus groups were collections of seven to nine people who were asked

a series of predetermined questions with the responses recorded and

discussed among the group members. In addition to the pre-

established questions, there was a free-flow discussion format toward

the end of the focus group that provided flexibility in allowing the

participants to share information and insight with HF.

Additionally, questionnaires were used to collect market information

from perspective customers. The questionnaires were submitted to a

total of 10 HR professionals. The response rate was 100%, higher than

expected. The validity and usefulness of the questionnaire was

ensured by utilizing a graduate statistics student to develop the

questionnaire. Overall, both forms of primary market research were

insightful for providing this research confirmed many already held

assumptions as well as introduced several valuable perspectives that

HF was not yet privy to.

Financials

This section will offer a financial overview of Hospital Fitness as it

relates to the marketing activities. HF will address Break-even Analysis,

sales forecasts, expense forecasts, and how they link to the marketing

strategy.

Break-even Analysis

The break-even analysis indicates that $16,667 will be needed to reach

the break-even point.

Monthly Revenue Break-

even$10,101

Assumptions:

Average Percent Variable Cost 10%

Estimated Monthly Fixed Cost $10,000

Sales Forecast

Please refer to the following chart and graph to illustrate the sales

forecasts.

Sales Monthly

Sales 2003 2004 2005

Hospital Employees $298,783 $389,776 $455,678

Patients $242,077 $288,739 $333,890

Total Sales $540,860 $678,515 $789,568

Direct Cost of Sales 2003 2004 2005

Hospital Employees $29,878 $38,978 $45,568

Manufacturing

Employees$24,208 $28,874 $33,389

Subtotal Direct Cost

of Sales$54,086 $67,852 $78,957

Expense Forecast

Marketing Expense Budget

2003 2004 2005

Pamphlet Production $1,000 $1,200 $1,400

Website Production/Maintenance

$9,200 $8,000 $8,000

Other $9,250 $12,000 $14,000

------------ ------------ ------------

Total Sales and Marketing Expenses

$19,450 $21,200 $23,400

Percent of Sales 3.60% 3.12% 2.96%

The expenses forecast will be used as a tool to keep the department

on target and provide indicators when modification or corrections are

needed for the implementation and maintenance of the market plan.

The marketing expenses will be high during the first quarter of

operation, a quarter when there is increased usage of fitness facilities.

The expenses will settle a bit during the second and third quarter. The

expenses will rise during the fourth quarter, the quarter when HR

budgets are typically submitted/reviewed.

Monthly Expense Budget

Controls

The purpose of Hospital Fitness' marketing plan is to serve as a guide

for the organization. The following areas will be monitored to gauge

fitness:

Revenue- monthly and annual.

Expenses- monthly and annual.

Customer satisfaction.

Wellness program effectiveness within each company.

Implementation

The following milestones identify the key marketing plan programs. It

is important to accomplish each one on time an on budget.

AdvertisingStart Date

End Date

BudgetManage

rDepart

ment

Advertising Campaign #1

1/1/2003

6/30/2003

$3,750 WITMarketi

ng

Advertising Campaign #2

7/1/2003

12/30/2003

$5,500 WITMarketi

ng

Total Advertising Budget

$9,250

PRStart Date

End Date

BudgetManage

rDepart

ment

Pamphlet Completion

1/1/2003

3/1/2003 $1,000 JWTMarketi

ng

Total PR Budget $1,000

Direct MarketingStart Date

End Date

BudgetManage

rDepart

ment

Marketing Plan Completion

1/1/2003

2/1/2003 $0 JWTMarketi

ng

Total Direct Marketing Budget

$0

Web DevelopmentStart Date

End Date

BudgetManage

rDepart

ment

Website Completion 1/1/200 3/15/200 $9,200 JWT Marketi

3 3 ng

Total Web Development Budget

$9,200

Totals $19,450

Contingency Planning

Difficulties and Risks

Problems developing a sufficiently large client base.

Significant economic downturns.

Worst Case Risks Include

Determining that the business can no longer support itself.

Having to liquidate equipment to cover liabilities.

Conclusion

Organizations should take a comprehensive look at their fitness

management system and have very objective goals that are tied to

strategic initiatives and the fitness management process.  Successful

organizations have learned the secret to this and while not always

perfect, a constant striving to improve the process can help

organizations reach their Vision. An effective fitness management

process sets the foundation for rewarding excellence.