Gurrit K Sethi, Hospital Chief Operating Officer, Care Hospitals

The answer to our healthcare expense woes can ultimately come from smart hospitals and smart care along with the new tech based care options that support preventive care, early detection and outside of hospital care curriculum using connected devices setup on a strong healthcare physical and digital platform.

Smart is an often-used word today with varied and interlinked meanings. Who would have ever thought of smart hospitals a few years ago? And yet this term is today fast becoming the key to delivering smart care.

“Seamless service made available alongwith the right tools and technology” is what I came up with when I first heard of this term. A good hospital has expectations from the patients rooted in impeccable service delivery, medical as well as non-medical. ‘Impeccable’ here would represent timeliness, quality, foolproof approach, hassle free care, and above all, safety. The ‘impeccable’ aspects of healthcare are a multitude of things and very different from all other industries. Hence also that the tools and technology come in varied shapes and forms to support both medical and non-medical aspects. And much more, as we strive to provide better connectivity and care within and outside the realms of hospital buildings.

In one of my previous articles, I wrote about communication and Information (C&I) as being the backbone of service delivery. A smartly designed hospital combines with smart devices and tools across the spectrum of different services enabling a smooth physical flow of patients and related activities alongside the not so visible flow of information and communication. This is not just about a smart building that offers all facilities in a ‘coherent to service manner’, but also combining the physical aspects with smart equipment, tools, devices, programmes etc. From entry of patient, as well as staff, to exit and after —encompassing the medical as well as non-medical bits. The smart here embraces hospital buildings, smart software, smart medical equipment, smart non-medical equipment, smart healthcare devices, and most importantly, smart teams!!

Smart buildings entail much more than a beautiful design. These buildings look more deeply at patient and staff movements ergonomically, well designed storage, service areas, waiting areas and as well as patient areas also the space available for attendants and visitors. When a patient enters the premises, where does he or she go for the first point-of-contact that is the reception areas?Are the reception areas convenient for different categories of patients like the handicapped and elderly? Is there enough waiting space to offer areas for passing time, eating spaces, educational areas, nursing pre-checks, entry to the doctors’ clinics, support desks etc.? And the list goes on. On the in-patient side, areas need more focussed designing and detailing. Operation theatres (OTs) and cathlabs need close access places; waiting areas for attendants in waiting while their near and dear go through the procedures; the doctors need to inform them, take consents etc. These places also need a good sterile connect to the critical care units.

While these things sound simple, many a hospital are created out of makeshift arrangements using buildings made for other uses. One sees very many ‘good looking’ hospitals but only when you start organising the services does one realise the hazards, such as, a poorly placed nursing station takes away the watchful eyes of the nurses from the patients, open stairways and multiple entries and exits can at times become safety hazards, and poorly designed waiting areas can be another menace. Entering into the care zones, life can be way better when the spaces are designed keeping staff ergonomics in mind. Many hospitals get built without the mindfulness of the work flow thus increasing the operations costs in turn pushing up costs of the care offered. In fact, some of these costs may not even be easily visible.

The patient service gets defined by a plethora of tools today. Starting with call receiving to booking of services, enabling patient reminders, taking advanced deposits, billing and queuing at out-patient department (OPDs) are the first indicators of a satisfactory patient experience of any facility. Today, there are a plethora of tools available to enable these services. A point to note is that these can help better plan service delivery, reduce the drop-out rates, and help pick up signs of dissatisfaction early on so that service recovery can kick in on time. These are an important smart tools to welcome patients into the system. Good customer relationship management (CRM) and Electronic Medical Record (EMR) systems are an important and critical tool to know your patients better, for record keeping, and better care.

This is followed by the medical care itself, which gets defined not only by the skill of the attending physicians, nurses, technicians, and a plethora of medical and para-medical staff, but also by the quality of the equipment, tools, software support such as clinical decision support, various medical keys etc. available to them. The technical definition of the investigative and diagnostic equipment underlines the explorative results and the precision that will help pin-pointing the diagnosis. This diagnosis, in turn, supports the smart physician to speed the patients’ recovery. It is again smart tech tools that support the analysis of treatment outcomes and further research of more and better treatment modalities. The beginning of the treatment also depends on the speed of availability of drugs and medicines. It is virtually impossible to store all the different types of medicines, injectables and consumables available. Also, what with the new brands hitting the market every now and then. The hospital has to create a formulary and stock items based on this. The maintenance of stocks and the to and fro information of the requirements for each patient again is managed by smart logistic systems.

Today, smart care also defines the availability of care across difficult terrains. New age modalities such as telemedicine, video consultation options and even E-ICUs have created anenormous opportunity to cut through challenges of scarcity of medical personnel in remote and far flung areas. The doctors can be consulted over a video call, reports shown etc. This technological advancement alone can help various governments and health organisations to scale their challenges with comparative ease. As these are evolving, the policies and regulations need to evolve as well to support them and to take advantage of these in a meaningful manner.

Alongside all this, to build a smart hospital offering smart care, one also needs to apply lean tools to see that there is no waste in the system as well in other areas, especially in manpower, and in movement and deployment of different types of resources. The manpower resources need to be smart as well, and well trained.

Having worked across a few projects there are many interesting stories to tell.

An upcoming luxury unit, bogged down by luxurious spending, struggled to keep track of where and how the resources were deployed across materials and manpower. While the initial capex spend was mind-boggling, more incredible was the operational spend. There was simply luxury everywhere, even in the minds of employees! With a bit of process re-engineering along-with a home-grown super basic reporting system, the team was able to better the gross earnings by introducing smart spend and smart analysis. This was achieved by reducing spends as well as enhancing the top line in a leaner manner. The effects showed in the bottomline within weeks in a high single digit number.

Another hospital, running fullfledged teams up and down and at times, helter-skelter to ensure smiles on the patients faces was actually doing a good job. However, when one got the teams into a room for a workshop designed to help identify workplace issues, there came out a plethora of events and things that they faced daily which were very much avoidable. And, if avoided, they would improve the patient experience by many notches. Along the journey of re-engineering, the team not only made their own lives easier but pushed up the customer satisfaction scores by couple of points as well as reducing the cost of care by a few percentage points. This also slowly helped change the case mix towards better business profitability.

One may think that creating a smart hospital is an expensive affair. Indeed, in the beginning it is. However, it is also mindful spending, ensuring overall better quality, better patient experience, satisfied work place experience, skilled staff offering a service with a smile, and, most definitely, lower day-to-day operational spend. Operational spends also depend on the service levels you lay out for your target audience — be it the 5-star luxury or the more economic fuss-free model, this gives a value for service all the way.

While this sounds amazing, let me also leave you with a warning! For green field projects this is much easier to achieve, not easy though. What is difficult is the change management which needs to be ‘managed’ in a brown field taking this up. For all the green and black belts, finding the solution is the easiest, it is the implementation which is the devil! The key to success is also governed by this devil. Make sure that the top management team is on board with all the solutions proposed. And post implementation, please do remember that this is a journey. You would need the right tools and teams to continue in the right direction especially in the VUCA world!

For those listening, it is never too late to get started now and you will be amazed to see how this churns up care at a much better value for all stakeholders! Value for care and value for investment of money and skill!

--Issue 46--

Author Bio

Gurrit K Sethi

Gurrit K Sethi, Hospital Chief Operating Officer, Care Hospitals; Strategic Advisor for Global Health Services, Global Strategic Analysis,contributes to healthcare by helping providers build and better business efficiencies and concept development, also strives to contribute socially through the Swiss Foundation, Global Challenges Forumas Strategic Advisor, throughconception of sustainable health initiatives. She started her career from the shop floor working her way up to lead and set up different healthcare businesses.

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