India has the most privatized health system in the world with nearly 80% of the outpatient and 60% of the inpatient care provided by private sector. The private sector health infrastructure has been predominantly in the metros and now expanding to Tier 1 and Tier 2 towns. Despite this expansive role of private sector in healthcare delivery the bottom line challenges they face receive only scant attention.
With the advent of quality movement in healthcare in India by NABH over the last decade, hospitals have started the journey on quality improvement and patient outcomes, but this still has a long way to go.
Government and civil society activism is targeting hospitals for their profiteering practices which further adds to the woes of the already bleeding hospital bottom line. Furthermore today’s healthcare consumer is more engaged and involved and this is significant departure from being a passive recipient of care. With very little government intervention healthcare system in India has to be dependent on the private healthcare providers. The health financing mechanism in India is also largely dependent on out of pocket expenses. The health insurance sector is fast growing but still covers only a small section of the population.
With the above scenario providers are cash strapped and large chains are consolidating the provider space with more and more international chains operating in India. The once favourite topic of medical value travel has taken a beating since there was never a consolidated effort towards that gachievingoal either by the government or the private sector. And this concept is relegated to a few centres who can boast of an international clientele and that too in selected cities. In contrast a country like Malaysia who were lagging behind India, embarked on the journey of medical value travel just a few years back and now boasts of almost a million patients within a span of few years. Since there was an effort by the various partners coming together like the tourism industry along with hospitality, government and the private healthcare providers who helped build the medical value travel platform.
Healthcare also has huge amount of data and the usage of data is changing the way healthcare is delivered and consumed. However hospitals are still reluctant to the usage of data derived outcomes. With the concept of smart hospitals emerging hospitals in India are further going to lag behind our other counterparts in the neighbouring countries. Augmented intelligence is emerging as a big trend in the healthcare space and very soon will change dramatically how healthcare functions in India. Despite the break-through potential of data many hospitals still do not have a functional electronic medical records in place.
With the above trends in the healthcare space, providers have now need to be equipped to deal with these challenges. With the day to day firefighting of the issues in the hospitals CEO’s are not providing the right level of importance in addressing these trends for superior patient outcomes and returns to stakeholders. There needs to be a long sighted approach for the hospitals not only able to meet the operating challenges but also to improve their bottom line.
With the myriad of problems and with no answers in place the only way healthcare can sustain in the long run, is to improve efficiency. The efficiency improvement should be at all levels of hierarchy and across all departments. One of the ways of improving efficiency is to go for accreditation.
Accreditation by itself while may look in the beginning to be expensive but in the long run it pays for itself, stringent processes, protocols, policies and clinical pathways, ensures standardized methodology employed across the hospital segments. This and this alone will improve efficiency by about 15% in emerged countries and would be more than 25% in the emerging countries. Studies have shown this improvement. This percentage improvement falls straight into the bottom line. Besides standardized processes and outcome monitoring will enable hospitals to gain from expansion of the insurance sector.
Next is the importance of transparency and communication. A lot of healthcare providers do not communicate appropriately at various levels- Doctor to patient, nurse to patient, admin to patient, doctor to nurse and nurse to nurse and so on and so forth. If transparency and communication is not improved at all levels it is very difficult to improve healthcare and accreditation provides this by having standardized templates of communication whether it is doctors’ orders or nurse’s order and handover takeover communication and an efficient billing process along with time outs during surgery. This standardized template ensures communication is short, precise and complete. Besides the standardized processes and communication reduces the information asymmetry prevalent in hospitals. The recent spate of activism is a consequence of the lack of transparency in hospital operations.
Leadership has a great role to play at all levels if efficiencies are to be improved. Leaders are not only to lead but have to show the way, in one of the hospital while I was entering the ICU, The head nurse insisted on my wearing the gown and mask along with shoe covers but didn’t insist the CEO and the Quality head who was accompanying me in the ICU. This is clear disregard for the process and hence a breach in infection control protocols. Implementation of these processes are crucial for the success of accreditation programs.
In my interactions with many leaders, my first question is “Why do you want to go for accreditation?” Many times the answers I get is, “having an accreditation will help drive brand image and improve patient footfalls. If this is the reason for going for accreditation providers should not even attempt for accreditation as the purpose and intention do not match. The reason for accreditation should be and only “better patient outcomes and quality of care”. All the above are by-products of this purpose.
There is always a general question when the Hospital has achieved NABH as an accreditation why should they go for JCI or any other international accreditation. Process improvement is a continuous process and patient safety should not have various levels. There is either safety or no safety, as we are talking about the patient. So it is important for providers to continuously raise the bar. While NABH will give the providers a point to start and be comparable to hospitals in the country, a JCI will raise the bar will help compare with international hospitals of repute. And both NABH and JCI can co-exist. As 1 year the provider will have NABH audit and the next year JCI. This will ensure complacency is not set in between audits.
The medical value travel will not improve and the bubble will be burst until various stakeholders do not come together to solve the issues, it has to have representation from the Tourism industry, external affairs ministry, health ministry, healthcare providers, policy makers and the patient, unless all of these come together and improve the medical destination travel, this will continue to be in the same state as they are and countries like Malaysia, Vietnam and even Sri Lanka will overtake us in the near future.
Lastly the only way healthcare in India can improve is to bring all the stakeholders together. The 4 Pillars of healthcare or 4 P’s Framework. 1) Policy 2) Provider 3) Payer 4) Public. Unless the 4 P’s come together and work in establishing the right framework, can healthcare become sustainable and cost effective. Engineers will change healthcare forever if physicians don’t embrace futuristic changes.
Published By:- Dr. Prabhu Vinayagam
MBBS, MBA in Marketing & Operations
Former Managing Director of the Joint Commission International – Asia Pacific
Financial Times Asia pacific – most influential person of Asia Pacific in healthcare