If Narendra Modi wants to boost India’s economy, he could start with improving road and rail safety

One estimate is that road accidents alone cost about 3% of India’s gross domestic product every year.

When somebody dies an untimely death, how can the loss to the economy be computed? One way is to work out the number of productive years that person might have lived, and the likely value of work that person would have done through those years. After adding up that amount, a Net Present Value – a tool financial analysts use to measure the future cost and success of projects – can be calculated.

Net Present Value is calculated like compound interest in reverse. Just as you can say that Rs 100 will compound to Rs 161 over five years at an interest rate of 10%, you can reverse the calculation and say that a sum of Rs 161 accumulated over five years would be equivalent to Rs 100 now, if you assume an interest rate (it is called a “discount rate” in Net Present Value) of 10%.

So, for example, assume a 25-year-old dies in an accident. We may reasonably assume that this person would have gone on to work till the age of 60, or for 35 years. Based on the skill and education levels of the deceased person, a rough estimate of how much that person would have earned over their working life could be calculated. We can then adjust for likely inflation and industry growth rates to arrive at a Net Present Value.

Obviously this is a crude method. It is based on long- term assumptions that will contain large error factors. For instance, it cannot be used to make a decent estimate for an outlier like an artist, or even a lawyer, who might earn vast sums at age 75. It cannot estimate the loss in the case of a successful sportsman whose career might end at the age of 35. In the case of a criminal, there may actually be a long-term gain, not loss.

When dealing with large numbers, however, this method can be used to derive an averaged value of likely loss.

Around 1.5 lakh Indians die every year in road accidents. Another 25,000 die in rail-related accidents. Those are large numbers and they can be averaged by assuming that the unfortunate people who died would have earned close to the per capita income and would have seen their earnings grow at around the same rate as per capita.

Of course, each such accident also leads to other losses. If train services are interrupted, or a road is blocked by an accident, there are economic losses. If vehicles are damaged, there are costs of repairs. If people are injured, there are medical costs and loss of earnings. Plus there are the unquantifiable emotional costs of the loss where friends and family are concerned.

Impact on GDP

The average Indian accident victim is under 30 and therefore has over 30 years of productive life ahead of them. The economy and per capita income has grown at fairly high rates in the past 25 years and it is expected to continue growing at a reasonable clip. So the assumed growth of that lost productivity compounded across three decades would be high.

One estimate is that road accidents alone cost about 3% of India’s gross domestic product on an annual basis. Rail accidents would cost an additional amount. The estimate of loss seems high. It possibly is. However, this estimate was made by a respectable body and it has been unofficially endorsed by former senior bureaucrats.

It is the United Nations Economic and Social Commission for Asia and the Pacific that has said: “The Indian economy takes a 3% hit to GDP [gross domestic product] every year due to road traffic accidents, which is over $58,000 million in terms of value.”

To put that figure in perspective, India’s central tax collections, direct and indirect, amount to 12% of its gross domestic product.

Accidents are very largely caused by human error, deliberate flouting of safety rules, poor design of roads and from poorly maintained rail infrastructure that is being stressed way beyond its capacity. There is scope for a dramatic reduction in the country’s accident rates.

Terrible rail safety record

No nation has anywhere near as terrible a rail safety record as India. A very large number of deaths occur when people crossing tracks are hit by trains. Another common problem is people falling off trains. According to the National Crime Records Bureau, 25,006 people died and 3,882 were injured in a total of 28,360 railway accidents across the country in 2014. The leading cause of deaths was falls from trains or the collision of trains with people on the tracks. These together accounted for 13,542 deaths. Other causes mentioned included other collisions (99 deaths), derailments (59), explosion/fire (32).

The Union Ministry of Road Transport and Highways publishes an annual handbook of traffic accidents. According to this handbook, in 2015, 1,46,133 people died in road accidents across India and 4.94 lakhs were injured. Of these, a total of 51,204 persons were killed in road accidents on National Highways. Another 39,352 deaths occurred on state highways. As many as 93% of road accident victims are under 65, with about 86% between 15 years and 65 years of age.

The World Health Organisation claims road accidents are the 10th-highest cause of deaths in India. Hence the assumption of high economic loss compounded over decades seems reasonable.

The Ministry of Road Transport and Highways says the single largest cause of fatal accidents was speeding (43% in 2013). Other major causes included overloading (21%), intoxication (4.6%) and load-protrusion (7%). I assume the ministry has a method for assigning causes, when for example, an intoxicated driver kills somebody while speeding in an overloaded vehicle. Driver error accounted for 78% of accidents, mechanical defects accounted for under 2%. About 9% of victims were pedestrians while two-wheelers (28.5%) and cyclists (3.5%) also suffered.

(Photo credit: Reuters).
(Photo credit: Reuters).

Low-hanging fruit

Improving safety on roads and in the rail system would appear to be relatively low hanging fruit in terms of policy. Better licensing systems for drivers, better road design, more stringent checks on weight carried and protrusions, better rail safety standards including controlling the movement of commuters across tracks, and rebuilding of rail infrastructure would seem to be the order of the day.

But for some reason, a focus on safety has never been considered politically worthwhile. It occasionally hits the headlines when there is a bad accident but there is a steady attrition rate of 450 deaths per day that are scarcely mentioned.

I cannot recall a single political campaign at any level – from the municipal level to the Lok Sabha – which have mentioned road and rail safety as a central issue. I am sure that there must have been some mentions but it is not an issue that seems to excite much political attention. For instance, it has never even been mentioned in Maan Ki Baat – the prime minister’s radio programme nor has it been a topic of debate on TV programmes. This lackadaisical attitude suggests that road and rail safety has never been a hot button issue for civil society. Until that attitude changes, there will not be policy focus on this issue.

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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.