Bombay Hospital, Indore
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March 20, 2013 BOMBAY HOSPITAL, INDORE FINAL REPORT 1 INTRODUCTION BOMBAY HOSPITAL Bombay Hospital was established over five decades ago, in 1952, as a result of the enormous philanthropy displayed by Shri Rameshwardas Birla, Founder Chairman of the Bombay Hospital Trust. It began as a 440 bed hospital whose objective was, in its founder’s words, “to render the same level of service to the poor that the rich would get in a good hospital.” Today, the hospital has grown to house over 830 beds, some of the country’s most advanced diagnostic & surgical equipment, and offers a comprehensive range of specialized medical services. The objective however, remains unchanged, which is why 33% of the patients treated are in the general ward and pay only for their medicines and consumables. The free OPD at the hospital successfully treats in excess of 1, 00,000 patients each year. It is on this sound foundation that the hospital has based its pursuit of excellence in every field of medical specialization. This has seen fruition in the form of the Medical Research Centre now known as the M P Birla Medical Centre. The Bombay Hospital presently ranks among the finest multi-specialty tertiary level medical centers in the country. The internationally renowned panel of doctors and consultants in every field of specialization have, at their disposal, cutting-edge equipment. Supported by a highly trained and professional nursing staff Vision: “To render the same level of service to the poor that the rich will get in a good hospital” Mission “Bombay Hospital shall provide the best possible medical treatment, delivered most efficiently, in the shortest possible time, at minimum cost, to all sections of the society, irrespective of caste, creed or religion.” INDUSTRIAL VISIT TEAMS . BUSINESS PROCESS IMPROVEMENT – GROUP 58 . CUSTOMER RELATIONSHIP MANAGEMENT – GROUP 59 . COMMUNICATION OF STRATEGY TO THE PEOPLE – GROUP 60 A firm is managed when the different parts of functions to maximize the collective effort and not individual ones. In our analysis we have mentioned them separately but worked together which was instrumental in pulling the veil off certain intricate yet noteworthy aspects of running a business in healthcare industry. Hence we begin by analyzing the industry. BOMBAY HOSPITAL, INDORE | 2 Growth factors of the healthcare delivery market To be able to design a proper strategy in the healthcare industry it is important for us to understand the key factors of growth. We would need to address the problems on these parameters. The major factors for growth in the healthcare delivery market would be: Increasing health awareness Rising income Change in levels disease profile Growth in Healthcare Industry Health Change in insurance demographics coverage Medical tourism Change in demographics As the population and the life expectancy is expected to grow, we expect a higher health coverage in India. The India population is expected to grow from around 1.2 billion in 2011-2012 to around 1.5 billion by 2026. The current number of beds per 10,000 persons is 9 while the global median is 24 beds per 10,000 persons. Thus the aging and increasing population along with the deficit of number of beds is an opportunity which hospitals must harness and if backed with a proper strategy, it must try to expand aggressively in this domain. These are the projections of the population growth of the Indian population and as we can see, the total population of India tends to increase to 1.55 billion by the year 2026. This opens up more opportunities for the healthcare sector and a program of expansion is highly recommended for the healthcare industry. Currently there are around 11 Lakh beds and by 2017 we would need 72000 more beds if we need to maintain a mere 9 beds per 10,000 people. BOMBAY HOSPITAL, INDORE | 3 Since the life expectancy is increasing, the proportion of population above 60 years is on the rise and is expected to rise over 12 percent by the year 2026; currently the level is at around 8 per cent. This would increase the requirement for the healthcare delivery for the senior citizens. This is a demographics that we need to look at for a greater coverage of the healthcare in the years that are to come. BOMBAY HOSPITAL, INDORE | 4 Quality healthcare through rising income levels Although healthcare should not be considered to be discretionary expense, in India the high-quality healthcare facilities are not affordable to a major section of India’s population. The next 5 years show that those who fall in the lowest income bracket – below Rs 1 lakh per annum – and this is expected to fall from 56 per cent to 41 per cent by 2016-17. While the share of the households in the income bracket of Rs 2-5 lakhs is expected to increase up to 31 per cent in 2016-17 and indicates the rising disposable income. Thus increasing the purchasing power which in turn stimulates the growth of the industry. Health awareness rise to boost hospitalization With the new literacy initiatives at work we can expect the awareness level of the disease to increase and that would increase the awareness of preventive and curative healthcare. This would increase the demand for the healthcare services. Primary research data indicate that this rise will be from the current 83 percent in 2011-12 to a stronger 88 per cent in the year 2016-17. Lifestyle diseases increase The illness caused due to improper lifestyle habits are increasing rapidly in India. These habits are shown to be more in the higher income level groups and thus we can expect the increasing income bracket groups to exhibit a higher need for the hospitalization needs. Those who are in the 5 lakhs and above income bracket are expected to have a share in lifestyle diseases of 5 per cent by 2016-17 from the current 3 per cent in the year 2011-12. Demands in the areas associated with cardiac ailments, diabetes and oncology can be expected to rise in the coming years. BOMBAY HOSPITAL, INDORE | 5 Health coverage increase to increase demand WHO’s World health statistics show that over 86 per cent of India’s private healthcare expenditure is incurred through out of wallet expenditure for of India’s population only 5 per cent subscribes to health insurance. The increasing penetration due to hospitals and increasing rates of hospitalization are due to increase. The health checkups which is a compulsory part of health insurance coverage are expected to lead to an increase in the healthcare industry. Medical tourism in India Over the years the medical tourism industry has increased and India is a major destination for the health tourism. Associated Chambers of Commerce and Industry of India (ASSOCHAM) the number of medical tourists visiting India are due to increase to 32 lakh per annum by 2015; the current figures stand at 8.5 lakh tourists per year. Due to lower healthcare costs in India it has become extremely lucrative for those living in developed countries tend to come to India to get treated. India offers many advanced medical facilities in areas of cardiology, joint replacement, ophthalmology, urology, organ transplant and orthopedics. These are the critical factors which would attract more tourists to India. As we can see the future prospects of the Indian Medical Industry looks bright and has a lot of potential for rapid growth. Hospitals should take this in to account while devising their long-term strategy. Such aggressive expansion would need bolstering facilities and investments to maintain the quality of the healthcare provided. BOMBAY HOSPITAL, INDORE | 6 BUSINESS PROCESS IMPROVEMENT Identification and removal of bottleneck in the discharge process The procedure of discharging a typical self pay patient may take as long as six hours, and this proves to be strenuous to the recovering individual as well as to the members of his/her family. As a result, the hospital has been experiencing heightened frequency of complaints by both patients and the members of their families. Additionally, the lengthy discharging process limits the bed capacity thereby making it difficult to admit new patients. This is detrimental to the society and, besides, it ends up decreasing the amount of revenue making it difficult to grow or acquire new technologies. The most time consuming processes are: returning of medicines and processing of discharge papers. The Principle Bottlenecks that Lead to Delayed Discharge The first bottleneck among those that undermine the optimal operation in this hospital is the delayed commencement of the discharging process. This is attributable to the failure of the management to create care plans with clearly spelt out lengths of stay as well as projected date of discharge. It is common to find the discharging process being set off unpredictably, in fact, just after the consultant declares the patient to be fit for discharge. This happens during the routine rounds, and it proves to be intriguing as the discharge was evidently unforeseen or, at least, predictable. Secondly, an additional challenge during discharge is experienced during the completion of the patients’ discharge cards. This happens because most of these cards are handwritten, and the process of filling them begins just after the consultant has a signoff during the day of discharge. Furthermore, there are instances when, even after being approved for discharge, the patient is delayed at the facility since the relevant signatories cannot be traced in time. Some consultants, for instance, delay signing of the discharge cards; and these results into a situation where the cards are unnecessarily held in an office or two. BOMBAY HOSPITAL, INDORE | 7 Likewise, there is a delay in the preparation of the final bill which is occasioned by tendency of the wards delay until the billing files have increased to a certain number before they are forwarded for processing at the billing counter.