Building Resilience ANNUAL REPORT 2019-20 Contents 02 04 Strengthening Clinical the Framework Highlights 06 08 Operational Chairman’s 35-116 Highlights Message STATUTORY REPORTS 35 Management Discussion and Analysis 43 Board’s Report 62 CSR Report 71 Corporate Governance Report 10 12 87 Business Responsibility Report CEO’s Clinical Insight Review 117-269 23 25 FINANCIAL STATEMENTS Collegiums for Patient Safety Managing Clinical Care Initiatives 118 Standalone Financial Statements 193 Consolidated Financial Statements 27 29 Clinical Board of To view this report online, please visit: www.narayanahealth.org Research Directors Our Mission The Company’s mission is to deliver high-quality, affordable healthcare services to the broader population in India. Annual Report 2019-20 Company Overview Statutory Reports Financial Statements Strengthening the Framework Over the last three years, the healthcare industry in India has been going through a period of consolidation. Addition of new bed capacity has slowed down across the country. Hospital systems are focussed on ramping up occupancies within existing hospitals. This trend is mirrored at NH as well. 02 Narayana Hrudayalaya Limited We have focussed on consolidating operations across all our hospitals; building on existing strengths while streamlining non-core units or departments. We are also in the process of adding capacities at existing hospitals that have a track record of clinical and operational excellence. Rather than focussing on bed count, we have upgraded our equipment because the best-in-class clinical care requires the best-in-class medical technology. We constantly work with our doctors to help them deliver the best quality of care and have added world-class clinical talent to our best performing departments. NH rolled out an NH launched its in-house Hospital Information System (HIS) in-house Hospital platform – ATHMA this year. This marks a major milestone in our journey as a hospital group. For the first time, we have a product Information System that is custom-built to the needs of our clinical teams. Simple, fast and robust, this platform helps us provide a seamless experience to all involved – doctors, nurses, administrative staff (HIS) platform and most importantly, patients. ATHMA this year. We have also focussed significant efforts in building our in- house Business and Clinical Intelligence platform – MEDHA. This marks a major This platform provides real-time and accurate inputs on the various operational and clinical metrics that we track, thus helping clinical and business leaders at all levels in the milestone in our organisation take better informed and quicker decisions. journey as a digitally- All these initiatives are steps that the organisation has taken to build the foundation for the next phase of growth. This will enabled healthcare prepare us for a situation where regulatory requirements are increasing, patient expectations are continuously evolving and employee engagement needs to keep pace with the needs of a group. 21st century workplace. 03 Annual Report 2019-20 Company Overview Statutory Reports Financial Statements Clinical Highlights Narayana Multispeciality Hospital, Ahmedabad performed minimally invasive Transcatheter 01 Mitral Valve Replacement - Mitral Valve in Valve Procedure (TMVR-Mitral VIV) eliminating the need for conventional open-heart surgery. Narayana Institute of Cardiac Sciences, Bengaluru successfully performed the world’s first 02 Patent Ductus Arteriosus (PDA) stenting and the southern region’s first thoracopagus surgery on a conjoined-twin with a single heart. Narayana Multispeciality Hospital, Barasat performed the first-ever successful minimally 03 invasive aortic valve replacement through swell right thoracotomy in East India. Narayana Multispeciality Hospital, Raipur successfully performed the first ever Thoracic 04 Endovascular Aortic Repair (Tevar) surgery in Chhattisgarh. 04 Narayana Hrudayalaya Limited In a rare case, a 70-year-old patient suffering from a medial sided knee degeneration was 05 treated through unicondylar knee replacement at Narayana Superspecialty Hospital, Gurugram. A sickle cell patient having atrophic muscles, fixed joints in a contracted position and thus being 06 bedridden for 11 years was successfully treated at Dharamshila Narayana Superspecialty Hospital, Delhi. Narayana Multispeciality Hospital, Jaipur successfully performed cardiac surgery on a 2-year-old child suffering from multiple congenital heart defects. VSD (hole in the heart) 07 coupled with situs inversus (congenital condition in which major visceral organs are reversed from their normal positions) made this surgery quite complex and rare. Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata successfully conducted a one of its kind cardiac intervention in Eastern India using a 28 mm Atrial Septal 08 Defect (ASD) device. It is a rare case as for the first time, Ventricular Septal Rupture (VSR) closure with ASD device was performed in East India. Mazumdar Shaw Medical Centre, Bengaluru successfully treated a 3-year-old patient suffering 09 from Desmoid Fibromatosis, a rare form of tumour in the jaw. It is only the 3rd such case reported in the world so far. Mazumdar Shaw Medical Centre, Bengaluru successfully treated a rare case of nasal tumour 10 with intracranial extension. It is among the very few cases ever reported. In a rare case, gastrointestinal tumour which accounts for less than 1% of all tumour cases 11 was removed at Narayana Superspeciality Hospital, Guwahati. Sahyadri Narayana Multispeciality Hospital, Shimoga successfully treated a patient suffering 12 from Osteochondritis dissecans, a rare bone-joint disorder, this is the first such case performed in central Karnataka. 05 Annual Report 2019-20 Company Overview Statutory Reports Financial Statements Operational Highlights Continuing our impressive track record in harnessing a robust SRCC Children’s Hospital, Mumbai organ transplant programme, completed 1,000 paediatric cardiac SRCC Children’s Hospital, Mumbai surgeries since its inception strengthening performed 9 Transplants (BMT). facility’s position as a top-notch medical destination for paediatric treatment. The Liver Transplant Programme Health City Cayman saw significant traction in Islands through its tie-up Foundation stone laid for FY 2019-20; the team with Doctor’s Hospital at setting up a comprehensive performed over 45 Cases Bahamas conducted the first Radiation Centre at with hugely successful surgery at Bahamas. Health City results. Cayman Islands. ATHMA, our in-house developed Hospital Information System (HIS), has gone live Along with the HIS, a Radiology Information in over 50% of our Group Hospitals. A System (RIS), Customer Relationship groupwide roll-out to be completed in India Management (CRM), Appointment Management and Cayman Islands by Dec 2020. System, Claims Management, Personnel File Embarked on the process to Management and Learning Management get certified for ISO 27001 System (LMS) rolled out across NH. (Information Security Standard). PBS News Hour, Company signed a USA telecasted a 3-year contract to ECG and ECHO machines documentary on HCCI deploy and manage undergoing integration – “How the Cayman NH’s Proprietary Data with PACS; real-time data Islands could become Intelligence Platform acquisition will enable 13% a new healthcare – MEDHA for a Pan- development of destination”, reaching India Hospital Group. AI solutions in out to an audience of at Cardiac Screening least 2.5 million. and Monitoring. 06 Narayana Hrudayalaya Limited Our Core Values are represented by I Care I nnovation and Efficiency Compassionate Care A ccountability to all our Stakeholders R espect for All E xcellence as a Culture 07 Annual Report 2019-20 Company Overview Statutory Reports Financial Statements Chairman’s Message COVID-19 has changed the world forever. The existing healthcare model was only beneficial to a small percentage of the world’s population and the rest of the world barely managed to survive on the remaining scraps. This pandemic has brought the deficiencies of global health care delivery to the forefront and exposed the soft underbelly of every country’s healthcare delivery system. Some scientists are predicting that COVID-like pandemics will keep repeating themselves. India has one of the most fragile healthcare systems and we will not be able to survive another pandemic. The time has come for us to work with the government to build a healthcare system that is more robust, more equitable, and financially viable. These are my suggestions. Address the Supply Shortage There is no reliable database of the number of doctors and nurses actively practicing in India. Out of the 10 lakh doctors registered with the Medical Council of India, 1 lakh doctors actually practice in the USA, 40,000 practice in the UK, and we have no idea how many of the rest are even alive or still practicing medicine. The National Medical Commission must create an active database and use it as the basis for a Strategic Roadmap for Health. India should aim to become the world’s largest producer of trained Dear Shareholders, doctors, nurses, and medical technicians. If we train 50 lakh I spend half my day seeing patients and performing surgeries healthcare workers from small towns across India, they will be on children and adults with complex heart conditions. I love able to earn a minimum of US$ 100 billion in remittances every operating and when I go to sleep at night, I dream about different year.