In the news: HIV pediatric drug approved, permission for sterilisation in Chhattisgarh, and more

A quick wrap of health news.

Cipla’s new HIV drug approved for registration

On May 25, an expert committee of Central Drugs Control Standard Organisation permitted the Cipla’s registration of HIV drug in a pellet formulation used to treat children with HIV.

The drug regulator’s expert committee conceded that finding patients and suitable institutions for a feasibility study to test the drug would be difficult and that there are ethical issues in conducting such a study in pediatric populations. The committee recommended approval of the product with the condition that National Aids Control Organisation will conduct post-marketing surveillance in the first 100 patients and submit the data.

The lopinavir-ritonavir drug combination is the backbone treatment regimen for HIV positive children below three years of age. The drug combination in pellet form is known to be better than the syrup that was used earlier. The syrup contains 42% alcohol, has to be refrigerated and is often rejected by children because of its bitter taste. Cipla’s product in the pellet formulation has no taste, no alcohol and can be stored at room temperature.

The lopinavir-ritonavir pellets are packaged as micro-tablets inside a capsule that can be opened and mixed with a child’s food. “With more children actually swallowing the medicines, there will be more survivors,” said Paul Lhungdim of the Delhi Network of Positive People. “These innovations represent very important progress in the fight to end AIDS in children.”

The expert committee had rejected Cipla’s application twice earlier on the ground that clinical trials were not conducted.

Registering the drug would have allowed the National AIDS Control Organisation to buy and use the drug to address the problem of frequent stock outs of paediatric HIV medication in the country.

Cipla had conducted clinical trials in Uganda and Kenya and had already been supplying the drug pellets outside India. The company sought a waiver for clinical trials among the Indian paediatric population.

Tribal women still need govt nod for sterilisation

The Chhattisgarh government has amended its 1979 order that said that protected tribal women who are a primarily vulnerable tribal group can seek sterilisation with the permission of the sub-divisional magistrate, the Indian Express reported.

In 1979, the health department of undivided Madhya Pradesh had restricted the sterilisation of members of these Primarily Vulnerable Tribal Groups. The justification at the time was that these vulnerable tribal groups had low health indicators and were in a danger of dying out.

A Public Interest Litigation was filed by Baiga families, one of the seven protected tribes of Chhattisgarh, two public health activists related to Jan Swasthya Sahyog and Jan Swasthya Abhiyan in Chhattisgarh. The PIL contended that the order was passed when the state was following an aggressive target based population policy. The order, the petition said, violated right to life and liberty.

The activists who filed the petition said that the new order is not much different from the old 1979 order, which said that the block development officer can give permission to get the sterilisation procedure done.

“The fact that they still have to ask for permission shows that really nothing has changed,” Sulakshana Nandi of the Jan Swasthya Abhiyan told the Indian Express.

230 swine flu deaths in Maharashtra

Swine flu or H1N1 influenza continues to claim lives in Maharashtra with the death toll touching 230 in June. Between January and December last year, the state had reported 26 deaths.

Officials from the Maharashtra health department observed that the number of deaths have not risen with the pre-monsoon showers. Monsoons are favourable for the transmission of H1N1 infection and officials fear that the monsoons would lead to a further rise in cases and deaths.

“In the last fortnight, we have not seen a rise in cases or deaths,” said Dr Pradeep Awate, in-charge of swine-flu surveillance in Maharashtra. “This means that the virulence of the virus has definitely not increased.”

The current strain in circulation, according to Awate spreads easily in hot climate. Hence, Awate and his colleagues feel that the cases might drop once monsoon hits the state. So far, the state has recorded 1202 cases of swine flu.

Earlier Dr MS Chadha, the influenza group leader at the National Institute of Virology in Pune told that there is a change in the virus. But, she said that that the change “is inconsequential for the clinical severity and transmission of H1N1 virus in circulation in India”.

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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 marketing team and not by the editorial staff.