May , 2018
How accountable is India’s healthcare
16:54 pm

Ankita Chakraborty

Much debate is rife about the current status of India’s healthcare. The fast changing lifestyles of a large number of Indian citizens has thrown various health related challenges. Government agencies and healthcare organisations are concerned about healthcare related issues and many proactive measures are being taken to improve the status of Indian healthcare. Healthcare challenges across developed and developing countries are equally present urban as well as rural areas. As far as performance and non-performance of the healthcare sector is concerned, strengthening healthcare policies aimed at catering to patients, budgets and funds, establishing public healthcare facilities, encouraging private participation in developing healthcare facilities, incentivising innovations, and judicious use of IT and telecom in effectively managing and providing high-end healthcare facilities, together plays a fair role in developing the patient-doctor relationship and in trust building.

Performance and healthcare goals

Globally, the healthcare expenditure is rising twice as fast as the overall economic growth.  The global healthcare industry, at the same time, is moving from a volume-based model to a value based business model. This requires the government and the healthcare service providers to shift towards hi-tech infrastructure enabled with sophisticated IT solutions to improve the outcome and efficiency. As building a suitable infrastructure is imperative, focusing on healthcare goals is the need of the hour. Hospitals and healthcare institutions should emphasise on improving operational effectiveness, improve the quality of services in a time bound manner, reduce medication errors, improve clinical effectiveness and financial and administrative performance, reduce re-admissions and work towards enhancing a patient’s satisfaction. To achieve such goals, hospital management and medical staff should work in sync to be at par with the shifting dynamics of the healthcare sector and also be in a position to readily incorporate regulatory changes. The complexity increases given the patient volumes and the various types of patients, increasing supply costs, stringent government compliances, quality requirements, multiple usage of assets and resources and due to scarcity of trained staff.

KPI: However, the non-availability of quality real time data and data analytics does not give the true picture of hospitals’ performance with regard to operational, clinical and financial key performance indicators (KPIs). The KPI review factors like changing the business strategy and policies of the organisation, change in the role of the staff, reducing impact of the external factors, change in the regulatory framework, performance of the staff or the organisation. These KPIs help the government departments including the Ministry of Health and Ministry of Finance to monitor the performance of healthcare resources including the performance of the staff, help to improve the quality of service delivery, and enhances overall efficiency by appropriately allocating and utilising the resources and improving the financial performance of the healthcare facilities.

BSC: Balanced score card (BSC) in hospitals are used to define performance management metrics for hospitals. BSC focuses on facts like patients expecting a high level of service, medical professionals adapting to new clinical demands and research solutions, and administrators focusing on managing resources effectively. This approach enables hospitals to track financial results while simultaneously monitoring progress in building the capabilities and acquiring the intangible assets that they would need for future growth.

Hospital business value: This focuses on operating margin, inventory turnover ratio and on the current ratio of cash in hand. These are good measures of the financial performance of a hospital. For example, for calculation of target or benchmark levels of these metrics, the market can be segmented into hospitals depending upon the bed size, like more than 50 beds, 50-200 beds, 200-500 beds and more than 500 beds. The benchmark levels for each metric can then be calculated using activity based costing.

Hospital employee value: The employee value is measured by employee satisfaction and retention. The relevant KPIs for employer value will be voluntary turnover, productivity in work, absence and presenteeism, number of employee grievances, etc.

Hospital patient value: Patient value can be measured by clinical outcomes and patient satisfaction. It is important to measure the success rate in treatments. Patient satisfaction can be measured by a number of parameters like less waiting time, patient recommendation to others, nurse communication, doctor communication, staff responsiveness, room cleanliness, clear patient discharge instructions, etc.

Hospital learning and growth value: The learning and growth value of the hospital is measured by improvement in quality of its services as well as by offering newer services. It can be measured using reduced or controlled per capita cost of care, investment in skill development, improved existing services, new services offered in last quarter, etc.

According to a KPMG report titled, ‘Healthcare: Reaching out to the masses’, “It has been observed that there is a widespread effort to improve the accessibility of healthcare amenities to every strata of society. The fact that a major part of India is rural cannot be ignored and indispensable services such as healthcare need to be made available to all.”

On the demand and supply analysis front, the KMPG report stated that India rates poorly on even the basic healthcare indicators when benchmarked against not just the developed economies, but also against the other BRIC nations. This can be attributed to the poor healthcare infrastructure reflected in the low bed density ratio, low doctor density ratio, and poor healthcare spending. However, majority of the private hospitals are now gearing up to overcome the healthcare shortage across the country and trying to shed out apprehensions of them being catering to the upper classes. Uttam Bose, CEO, CK Birla Hospitals told BE, “We pride ourselves in providing comprehensive and top healthcare. It is our dedication to consistently provide excellence in medical care with passion, empathy and quality. And even as we innovate to enhance and improve care for our patients, we must not forget the values and traditions, with new innovations of modern medicine on the landscape of Indian healthcare.” ICRA reported that the performance of five listed hospital chains in the country, which together operate more than 20,000 beds, has suffered as a result of regulatory interventions. Nonetheless, the performance and accountability of hospitals is crucial as the sector witnessed a setback in the last few quarters due to multiple governmental policies like demonetisation, price caps on medical devices and the GST.

Government hospitals: a mess?

Data from the National Health Profile 2017 stated that India has a little over one million modern medicine (allopathy) doctors to treat its population of 1.3 billion people. Of these, only around 10% work in the public health sector. Nonetheless, the shortage of health providers and infrastructure is the most acute in rural areas, where catastrophic health expenses push populations the size of United Kingdom into poverty each year.

In a report by Hindustan Times, Baba Raghav Das Medical College Hospital in Gorakhpur, Uttar Pradesh, bodies of the dead being mutilated by dogs in hospital morgues almost every day. People carry home their dead children because the hospital refused them a hearse, and tragedies like the hundreds of infant deaths occur there every hour. This brings to us the questions about the accountability and non-performance of the government hospitals in India, which fails to cater to the basic medical needs of its patients. If asked is it mismanagement and inadequate resources that lead to such crisis – there is no answer to this. Even the shortages of doctors are a matter of concern, as the WHO report, published in 2016, said that 31.4% of those calling themselves allopathic doctors were educated only up to Class 12 and 57.3% doctors did not have a medical qualification.

The recent case in Unnao district in Uttar Pradesh, where a quack infected at least 46 people with HIV also brings forward the sorry state of the healthcare system in the rural India. As a matter of fact, how much trained a quack is, they cannot replace doctors, and India is just not training them enough. There are 462 medical colleges that teach 56,748 doctors and 3,123 institutions that prepare 1,25,764 nurses each year, but with India’s population increasing annually by 26 million, the numbers are too little.

To provide a fair treatment, apart from bringing in high clinical equipment, focus should be made to strengthen traditional systems of medicine, train and qualify doctors and nurses to offer first line of treatment and care.

Uttam Bose, Group CEO CK Birla Hospitals, informed BE about CK Birla group of hospital’s performance and accountability,.

Q.  What is the performance and accountability of the private hospitals currently? How is CK Birla Group working towards that?

Our hospitals are intrinsically bound by three integrated philosophies — clinical excellence, ethical conduct and patient centricity. Maintaining transparency is an essential precondition to achieve our broader health system objectives. We sustain a rigorous performance reporting framework which is immensely critical in providing extensive information to our patients and clients, doctors, para-medics, nurses and our administration staff. Our team continuously engages in effective communication with patients and their families throughout the treatment procedure. We have started a systematic  counselling session with each of our patient’s family before embarking on vital treatment plan. Our multi-disciplinary care plan is always focused on the responses of the patient where we put entire effort in addressing their needs.

Q.  How are you working on trust building mechanisms? What are your views on the  patient-doctor trust issues?

With our meticulously designed  medical care plans we have set a standard procedure by keeping complete patient recovery as the ultimate goal.  Each plan is carefully chosen after an integrated assessment done by our highly-skilled doctors and the expert medical team. Patient-doctor relationship is a constant team effort where continual engagement comes into play. Fundamentally our hospital setting itself is totally based on patient experience where our care plans are vastly successful due to the trust that patients and their families have on us.

Q. Going with the current trend that private hospitals are not fair to the poor and middle class, how is CK Birla Group of hospitals working on this?

CK Birla Hospitals are committed to provide best quality treatment to all sections of society with the most advanced  global technology and highly skilled doctors. We are continuously upgrading the safety and quality of the health system employing state-of-art innovation. We are a trust hospital and our system is modelled as a not for profit organisation. On principle, we keep up robust accountability to the concerned government bodies so that we are perfectly aligned with their policies. Providing affordable quality healthcare to every section of the society is one of our key objectives.

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