To move to a more corporate mode of functioning, the Indian Railways is looking for ways to do away with its social sector subsidies of about Rs 30,000 crores a year.
According to sources, it is in talks with two financial institutes to conduct a study on this.
The strategy of a more corporate way of functioning is based on a report by a panel chaired by Bibek Debroy, a member of the NITI Aayog, in 2015. One round of discussion has happened between the National Institute of Public Finance and Policy and Indian Railways officials on how to proceed.
“We are in talks with two financial institutes, regarding a study on ways to reduce or do away with the subsidies. If the railways is a commercial entity, social obligation should not be a baggage for it,” said an official source.
Late last year, Railway Minister Suresh Prabhu had written to his finance counterpart that social sector subsidies should be borne by the ministries concerned. The Indian Railways recovers only 57% on the cost of passenger services; on suburban rail, around 40%.
“Once the reports are submitted, we will approach the finance ministry. The idea is, if we are giving a subsidy to, say, a defence person, it should be absorbed by the ministry concerned,” said the official.
This comes after the Central government merged the Railway Budget with the General Budget, doing away with a 92-year-old tradition. The Debroy panel had recommended this, as a way of easier segregation of the railways’ social responsibility from its operational finances. Another item on Prabhu’s agenda is the government’s clearance to his proposal for a sector regulator, a Rail Development Authority. This entity is to decide on rates and equitable treatment for stakeholder investment in the railways, setting efficiency and performance standards, and dissemination of information.
This comes as the Indian Railways posted its worst operating ratio (money spent to earn every Rs 100) in 16 years, at 96.9 in 2016-’17. This was mainly due to the social burden and implementation of the pay commission report. It has already appointed a foreign consultant to come up with a performance index other than the operating ratio.
“Despite all this, our loading has increased from 1,104 million tonnes in 2015-’16 to 1,109 million tonnes in 2016-’17. We are also giving extra focus on non-fare revenue. The major concern for us is the increasing subsidy burden, while the pay commission impact will also be there in 2017-’18, of about Rs 15,000 crores,” said another official.
Key social service obligations
Non-suburban passenger services: Concessions to various categories of passengers. Senior citizens, students, recipients of gallantry awards and national sports awards, participants of national and state sports tournaments, Shram awardees, war widows, patients suffering from cancer, TB, other serious diseases, handicapped persons, press correspondents, concessions to military personnel the Northeast.
Sub-urban passenger services: Fares of various classes of tickets lower than system costs, season ticket concessions to suburban passengers.
Goods services: Carriage of essential commodities at concessional rates, concessions to postal traffic, military traffic, registered newspapers and magazines, Northeast.
Uneconomic branch lines: Continued operations of uneconomic branch lines
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 cardstohelp 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.