epidemic threat

Almost 3.5 lakh Indians died of diabetes in 2015

Diabetes may soon be a bigger problem than TB, HIV and malaria together, say endocrinologists.

With a genetic predisposition brought to the fore by changing lifestyles, deaths due to diabetes increased 50% in India between 2005 and 2015, and is now the seventh most common cause of death in the country, up from the 11th rank in 2005, according to data published by the Global Burden of Disease.

Ischemic heart disease continues to be the highest cause of death, followed by chronic obstructive pulmonary disease, cerebrovascular disease, lower respiratory infection, diarrhoeal diseases and tuberculosis.

In 2015, 346,000 people died of diabetes, which caused 3.3% of all deaths that year, with an annual increase of 2.7% from 1990, according to the Global Burden of Disease study.

Nearly 26 people die of diabetes per 100,000 population; diabetes is also one of the top causes of disability and accounts for 2.4% of the disability adjusted life years lost (sum of years lost due to disability or premature death due to the disease).

There are 69.1 million people with diabetes in India, the second highest number in the world after China, which has 109 million people with diabetes. Of these, 36 million cases remain undiagnosed, according to this 2015 Diabetes Atlas released by the International Diabetes Federation. Nearly nine percent in the age group of 20-79 have diabetes.

The figures are alarming since diabetes is a chronic disease that not just affects the pancreas’ ability to produce insulin but affects the entire body. Complications caused due to diabetes include heart disease, stroke, kidney failure, vision loss and neuropathy or nerve damage leading to leg amputation.

Unlike other countries, where a majority of people with diabetes are over 60 years old, the prevalence in India is among the 40-59 years age group, affecting productivity of the population.

“Diabetes strikes Indians a decade earlier than the world,” Anoop Misra, chairman, Fortis Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, told IndiaSpend. “This causes reduced productivity, increased absenteeism in working population and gives more time for complications to arise.”

Blame genes and changing lifestyles

Indians are especially predisposed to diabetes due to social and genetic reasons. Peculiar genetic composition of Indians known as "Asian Indian Phenotype" makes them appear thin but with fat depositions around their internal organs.

It makes them prone to greater abdominal fat, insulin resistance, higher levels of bad fat and increased chances of suffering from diabetes and coronary artery disease.

Lifestyle changes with reduced physical activity and carbohydrate-rich diets, along with environmental factors, are increasing India’s diabetes burden, IndiaSpend reported in June 2015.

Cost of diabetes

It is estimated that diabetes patients in urban areas spend Rs 10,000 and patients in rural areas spend Rs 6,260 every year on treatment, according to a 2013 study published by The Association of Physicians of India.

Since most of the healthcare cost is borne out of pocket in India, those in lower economic groups have to bear the greatest burden. Urban poor spend as much as 34% while rural poor spend 27% of their income on diabetes treatment, the study found.

India is predicted to have 123 million diabetes cases aged between 20 and 79 by 2040, according to estimates by the International Diabetes Federation. “We need a national campaign on the level of pulse polio to tackle diabetes, it is soon going to be a problem bigger than TB, HIV and malaria together,” Misra said.

Even though diabetes features in the National Health Mission’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke for district-level intervention to prevent non-communicable diseases, it needs to do more to screen, create awareness and monitor and treat the disease to stem the tide.

We welcome your comments at letters@scroll.in.
Sponsored Content BY 

What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.