I was surprised when my colleague showed me an e-mail speaking of the good hospitality we had rendered on that day. The AGM of JSL, his wife and their little daughter had come to our hospital for a health check-up. In spite of their delayed arrival, we scheduled them in the respective diagnostic areas and completed their tests and doctor consultation within the stipulated time.
Had we not planned well, at the instant of their arrival, the timely execution of their tests and reports would not have been possible. Despite the scorching heat, space constraints and other adverse circumstances, the couple was extremely happy and stated that CARE Hospitals was their preferred destination for a health check-up. They did not face any problem during their stay at the hospital from 11 am to 4:30 pm. This was a big relief for them as earlier they had an unpleasant experience in another hospital.
Providing good hospitality and receiving a positive feedback is inspirational. A study has shown that most satisfied customers not only increase our business, more importantly, their admiring feedback also boosts our morale. The absence of a good patient culture, weak communication and lack of an empathetic and sincere attitude are a barrier between patients and the hospital staff. Research has shown that patients’ dissatisfaction is an administrative and system related issue. We have to enforce good parameters like punctuality, social interaction and teamwork, by which we will be judged. Our commitment is to provide care that people trust.
Varun Bhargava (VB) came to Sevagram in 1969. He belonged to the first batch of MGIMS. Four years later, he graduated from MGIMS, went to PGI, Chandigarh to earn his MD (Medicine) and established a highly successful practice in Nagpur. His 100-bed hospital — driven by ethics and science — evokes a level of respect and admiration that doctors yearn to have.
When VB was a medical student, Babulalji Ganvir (BG) — a young man in his late twenties — ran a gourmet restaurant in Sevagram. Medical students, eternally hungry, would fill their stomachs with the samosas, kachoris and aloo bondas that came from BG’s frying pans. His canteen served as a hub of social interactions and juicy gossip, where students would share their ecstasies and agonies. Students, and the faculty, would frequent his place for the delicious food available at a throwaway price. And they loved him because he never bothered to track who paid what. Students, coming from small towns, villages and poor families, often ran out of money. BG was a one-stop, 24×7, Sevagram ATM for them. He would happily take care of their financial worries — paying for their tickets, transport, fees, tuitions, hostel rents and mess bills. Never wanting the borrower to feel awkward, he seldom asked for the money back. If he got what was his due, he felt happy. And if he didn’t, he’d simply shrug it off.
Four decades rolled by. Varun Bhargava got tied to his Nagpur hospital; BG was happy running a small shop in Sevagram. In his seventies now, the frail old man began to have angina. He stopped cycling. His chest would ache when he walked a few blocks from his home to the Sevagram square.
BG was admitted to MGIMS. His ECG looked ominous. His clogged coronary arteries no longer quenched his parched myocardium. The doctors tried everything they could, but he looked, and sounded, serious. The doctors chose to transfer him to VB’s hospital in Nagpur.
BG lay on one of the ICU beds in VB’s hospital. Blissfully oblivious that the Sevagram man was in his hospital, VB chanced to see BG when he was on the ICU rounds. He immediately went down memory lane. He recalled the aroma of the aloo bondas, still fresh in his nostrils. He was able to put BG’s name to the face. He asked his team to treat BG as a special guest, arranged for his angioplasty and ensured that BG not only received tender loving care but also did not have to pay a single penny for the procedure.
It was a rare sight. The doctor and the patient were teary-eyed. Tears — symbolic of genuine gratitude, respect and mutual admiration. The passage of time couldn’t diminish their mutual love and affection.
BG was overwhelmed with emotions: VB had not forgotten him after four decades. And VB thanked destiny for giving him a chance to repay his old debt!
Dr SP Kalantri, MD, MPH is Director Professor of Medicine at MGIMS and Medical Superintendent of Kasturba Hospital, Wardha, Maharashtra. http://www.sp.kalantri.co.in
CARE Raipur conducted an orientation program on the occasion of 10 successful renal transplants, wherein the patients were felicitated by Chief Minister of Chhattisgarh, Dr Raman Singh. He congratulated the in-house team of doctors Dr Ajay Parashar, Dr P K Choudhary, Dr P Agnihotri and Dr Ashish Sharma for their achievements, which made the state proud.
Patient/attendant engagement programs are being organized at COPC by Ms Sowjanya Kandru, FHA with support from Mr Amit Kapoor, DGM (Operations). The focus is on spreading awareness about various disease conditions, symptoms, treatment options and promoting good health among patients. Patients and attendants aired their questions and doubts, which were well answered by the specialist for the benefit of all present.
Some of the topics covered during the past quarter were: ‘Causes & Treatment of Joint Pains’ by Dr Veda Prakash, Consultant, Orthopedics; ‘Glaucoma — Silent Stealer of Sight’ by Dr G V S Prasad, HoD Ophthalmology; ‘Common Eye Emergencies’ by Dr Radhika Bhupathiraju, Consultant, Ophthalmology; ‘Health Check-ups & Benefits’ by Dr Anil Kotamreddy, Consultant, Wellness; ‘Common Skin Infections’ by Dr Swapna Priya, Consultant, Dermatology; ‘Common Dental Problems’ by Dr Sreenivas Akula, HoD, ‘Dentistry and Osteoporosis’ by Dr Avinash Kumar Mishra, Consultant, Orthopedics.
Around 40-50 patients and families attended each session with many of them following up with consultations with the doctors.
“It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm” – Florence Nightingale
Here’s raising a cheer to the revolutionary who put modern nursing in the forefront! To her we owe our gratitude; to her and all those hundreds and thousands of kind men and women who took up nursing.
The meticulous and dedicated care that our nurses offer is often overlooked or taken for granted. But it’s time to give a pat to our unsung heroes who make healthcare and the hospital the warm welcoming place it is today.
It all started with the courageous Florence Nightingale. Born on May 12, 1820, she took up nursing as a profession at a time when it was considered an undignified occupation, hospitals were just a breeding ground for diseases and it was unconventional for a woman to work. However, our tender nurse changed the course of healthcare history and nursing by breaking stereotypes at that time. She stood as a beacon and harbinger of a new beginning for all those aspiring to become diligent nurses later.
How often do we recognize and realize the work put in by our nurses? It’s they who take care, diligently, of the progress of the patient. Like a mother on a constant watch, they cater to every need of the patient. Always on their toes, they know what might go wrong and whom to call in an emergency. They know the ins and outs of a hospital, they treat each other and patients like family and are vital to the efficient functioning of our doctors, who depend upon these hardworking souls.
Being a nurse is as much a noble profession as being a doctor. To them we are thankful — for standing by our side and standing strong in every step our hospital has taken. And the next time you are at a hospital, give a smile, strike up a conversation and thank your nurses for you know they were there for you.
Novo Nordisk Haemophilia Foundation (NNHF) funds development programmes that improve access to care for people with haemophilia and allied bleeding disorders in developing countries.
The “Laboratory Coagulation Workshop’’ by Dr Angus McCraw, Royal Free Hospital, London, UK is one such programme. He has conducted such courses in India for four years, along with Ms Pura Lawler from Haemophilia Centre, Royal Free Hospital, London, UK, in partnership with leading diagnostic company Werfen (Instrumentation Laboratory).
Conducted in association with CARE Hospitals, Hyderabad under the guidance of Dr Shanthi Naidu, HoD, Laboratory Medicine, the course (March 15-18) offered laboratory technologists and clinical pathologists from India and the neighbouring countries an opportunity to broaden their knowledge in diagnostic tests and improve diagnosis of bleeding disorders.
After the training, the participants can train others in their own hospitals and country in the protocol of these diagnostic tests, thereby helping haemophilia patients with proper diagnosis and treatment.
CARE Hospitals, the Indian chain, has just been bought by the private equity group, Abraaj, in a deal that is rumoured to value the enterprise at 1,850 crores INR (US$273m). Here we speak to CARE’s CEO, Dilip Jose, about future plans and how he expects CARE to function within Abraaj’s international network.
HN: The press release circulated in the wake of the Abraaj deal said that CARE will focus on providing accessible and affordable care in underserved cities throughout India. But when we spoke previously you said that no chain can restrict itself to one element of the pyramid. You have to address all demand segments. So will you continue with a mixed strategy?
Jose: We can work both ways. We have sharing wards in our hospitals, but we also have suites. All of our hospitals address different price points. What changes is the proportion of luxury and cheaper beds in each hospital and this depends on location. So, for example, our new hospital in Hyderabad, which will open next April, has a higher proportion of sharing rooms. That is because it’s in a micro market, which requires more affordable care. We need to tailor for that. But even in the smaller towns, there will be some patients who want a luxury suite. We are also entering into some new areas like liver transplants – at the pilot stage – and oncology for the first time in a comprehensive manner. These are more high-end procedures and both these programmes have the support of Abraaj. Having said all that, there is definitely a Tier 2 focus.
HN: We hear that revenue per bed in the smaller towns is a quarter of that in the metros at around 2m INR (US$30,000) per annum. Must it be difficult to grow your margins with those kinds of patients?
Jose: I would say that it’s closer to 2.5m INR (US$37,000) and that’s exclusively for secondary care. It’s higher for tertiary. But the cost structures in lower-tier towns are very different as well and the number of beds we have in the cheaper categories may be fewer.
HN: Do you subsidise some patients or are they all profitable?
Jose: Even the cheaper patients contribute to gross margins, so it’s not really true that we are cross-subsidising them.
HN: So when you look at your revenue streams, during the autumn you said that 67% was OOP and around 5-6% came through the social health insurance schemes. What direction do you expect these to move in?
Jose: As we grow the OOP and the SHI components may come marginally down on a proportion of revenue basis. We would expect to see more growth in the PHI component. We are also growing our outpatient segment as we do more procedures on an ambulatory basis and insurers will now pay for it.
HN: How many beds are now operational?
Jose: We have 2,500 running now and that should grow to 3,000 in April. We have 800 in Hyderabad and the rest are in tier 2 cities. With the fresh investments, we will build two more hospitals. One in Visakhapatnam and one in Nagpur. They will both be around 240-250 beds and should cost about 100 crore INR (US$14m) each.
HN: There is a lot of speculation about how CARE will fit into Abraaj’s wider network. One possibility is that CARE doctors and managers could be used across Abraaj hospitals in the Middle East and Africa. Another is that patients will be brought to India for treatment. Which strategy do you expect to pursue?
Jose: We are looking at both options. The short-term option may be medical tourism. That is the clear nearer term option. But it would have to be in quite specific clinical areas, mostly elective, like liver transplants, for example, and it would have to be in Hyderabad.
We could take patients from high disease burden markets in Africa without impacting our ability to treat Indian patients or pursue our tier 2 strategy.
HN: And with regards to bringing CARE staff out of India, you are actually one of the larger groups that have not made moves abroad yet, so do you think it would be a challenge?
Jose: It would be a challenge, yes. But we have a lot of expertise in running hospitals at a low cost and that is valuable. We would take it one hospital at a time.
HN: Analysts told us that because you don’t own many of your hospitals you could face rental increases. What do your lease contracts look like?
Jose: We have 16 hospitals. Two are asset light, ten are on a long-term lease of 20 years or more and four are owned. All of the four new hospitals we intend to open in the next few years will be owned.
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“Values create the foundation of every successful organization, and all the choices we make in life are influenced by what we value most.”
This statement has been iterated to the point of being a cliché, but exactly what is it that drives a value-driven institution and how do the values trickle down to make it a sustainable, value-based organisation in the long run? This is a question which has no single answer. More often than not when discussing value driven organisations the question of ‘how’ overshadows the question of ‘what’.
So what are these values that we are talking about? They are a set of thoughts, principles, beliefs or the moral fibre upon which an organisation is based and which need to be nurtured for the growth and sustenance of the organization, so that it remains anchored to its founding principles. In broader terms, it may be compared to the constitution that was created for a country to be run or governed by — the constitution is the value system for the country.
Increasingly, the founder members of an organization, in the healthcare or non healthcare sector, discuss the principles or values on which the organisation was founded to assess whether the system has strengthened those values or, in some cases, diluted them. In most successfully run organisations, it is seen that the system in place has strengthened the value systems on which they were founded.
For example, Infosys has remained very committed to the value system of integrity, loyalty and an employee-centric organization. These have been strengthened even when the management changed some years back. Similarly, the Indigo airlines’ value system is rooted in the best service experience at affordable costs, which made it the market leader in seat share. It continues to be the most profitable airline in India and second on the run of profitable quarters, globally.
So how have successful organisations been able to sustain their value systems and create strong beliefs in them to prosper? Some methods of doing this are:
Leading by example: You don’t only talk the talk but walk the talk. That’s how the top management delivers — by doing everything, whether visible or not, according to the value system of the organization.
Breaking it down to the lowermost employee: Graduating from the jargon mode and making sense of the value system to the lower most employee is essential. After all, it is in the beliefs of the people more than the people themselves.
Freedom to make mistakes: The value system only exists and grows when there is transparency and the employees feel free to take independent decisions to support the value system. That is only possible when there is empowerment and freedom for employees in favour of customer delight/engagement.
Engage positively: Continuous positive engagement from the management towards its employees is one of the key ways to drill down the value system and understand the gaps.
Continuity of thoughts: The value-based system is not a cross-sectional event but a longitudinal event comprising of long and continuous efforts over a period of time. This means that creating a value-based system is not a one-day effort but it requires a very long standing belief of the top management in the values, while making efforts to nurture, preserve and implement them.
Setting standards and taking tough decisions: “What if we spend time on training people and they leave” will always be juggled against “what if we don’t and then they stay?” The accepted practice is to provide sufficient time and space to a person entering the system to evolve into the value system and, later, consider what to do if the person does not evolve or accept those values. The decision to retain or to let the individual loose is a tricky one for the management to ensure continuity of the value system for future generations. Eventually, some tough decisions may have to be taken to sustain the value system for long-term organizational growth.
Value systems are worked out, delivered and driven by the people in the organisation and, in that sense, values are the sum of the individual parts. This drives a sense of belonging. That belonging to the system is the reason why many people stay in the system, report adverse events and think of the organisational good over the individual good. One of the simpler methods to instill and continue value systems in the enterprise is to connect the “individual“ to the “system” and bring them together as one.
– Saurabh Bose, Project Commissioning Team for CARE’s new hospitals in Hi-tech City and Bhubaneswar.
Often, people ask us what is the meaning behind our tagline “To Provide Care that People Trust”, which is also our purpose statement. Well, simply put, trust means a firm belief in the reliability, truth or ability of someone or something. And at CARE, we believe that every patient should have a firm belief in our services and feel reassured that they can rely on our doctors for their good health.
Through the tagline we reiterate our intention to provide healthcare services according to the people’s needs and aspire to be trusted by them for a lifetime for being excellent, efficient, safe and affordable while keeping them healthy.
Our vision statement “To be a trusted, people-centric, integrated healthcare system as a model for global health” also talks about trust. Unless we trust each other, it is difficult for a people-centric brand to survive. Especially in an industry like healthcare where life altering decisions are made every minute, trust within our team members and in every patient-doctor relationship is mandatory.
Hence, CARE places the highest priority and focus on trust. We trust our team and, hence, we provide services and healthcare facilities that you can trust.
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