In the news: Scientists find high levels of drug resistant bugs in poultry farms in Punjab and more

A wrap of health news over the past week.

Drug-resistant bugs in chickens

Scientists have found high levels of antibiotic-resistant bacteria in chickens raised for both meat and eggs in poultry farms in Punjab. The findings raise health concerns for human beings that consume poultry products and point to the indiscriminate use of antibiotics to promote the growth of birds in poultry farms.

The research was led by the Centre for Disease Dynamics, Economics and Policy, headquartered in the US, and was conducted in 2014. The study, published in the journal Environmental Health Perspectives last week, was conducted to understand drug resistance on farms in India.

The study was conducted in 18 poultry farms in six districts of Punjab. Samples of 530 birds were taken. The scientists isolated e-coli bacteria from these samples and tested them for resistance to a range of antibiotics routinely used to treat humans. Two-thirds of these farms reported using antibiotics for growth promotion (to increase weight of the animal), the study found.

The chickens were found resistant to some important and commonly used drugs such as ampicillin and ciproflaxin. The World Health Organisation has classified as these as drugs that should be available at all times for patients with basic infections.

“Overuse of antibiotics in animal farms endangers us all as it multiplies drug resistance in the environment,” said Ramanan Laxminarayan, the study’s lead author and the director of Centre for Disease Dynamics, Economics and Policy. “Punjab is one of the leading states in India in poultry farming. It is critical that we take measures to end the use of antibiotics for growth promotion in animal breeding practices.”

The press release issued by the Centre for Disease Dynamics, Economics and Policy said that the farms using antibiotics as growth promoters were three times more likely to report multi-drug resistant bacteria than those who did not use growth promoters. Meat producing farms had twice the rates of antibiotic resistance as compared to egg producing farms, as well as higher rates of multi-drug resistance.

Maharashtra revokes ban on pan masala

The Maharashtra Food and Drug Administration has decided not to renew the ban on pan masala this year.

Pan masala (scented areca nut or flavoured supari) is a known carcinogenic and had been banned in the state for the last five years.

Maharashtra was the first state to ban the sale of gutkha and pan masala in 2012 as per the Food Safety and Standards (Prohibition and Restrictions on sales) Regulations, 2011, which prohibits the use of tobacco and nicotine as ingredients in any food products. Pan masala without tobacco, though legal under the Regulations, was banned using a special power given to the FDA commissioner.

Since 2012, the ban has been renewed every year. However, on July 17, the state’s Food and Drug Administration renewed the ban on gutkha, but not on scented areca nut. The order said the government has formed a single-member committee to take decision on banning pan masala , till when its sale will be allowed.

Public health experts expressed disappointment over the decision. “World Health Organisation and several studies in India have proven beyond doubt that pan masala causes serious health hazards including mouth and throat cancer ,” said Dr Pankaj Chaturvedi, a head and neck surgeon from Tata Memorial Hospital, Mumbai.

Last year, the Supreme Court ordered all the states and union territories ban the manufacturing and sale of gutkha and pan masala with tobacco. The Union health ministry also wrote to all state governments, directing them to follow the Supreme Court’s diktat.

WHO cautions about rising drug resistance to HIV treatment

In a report published last week, the World Health Organisation said that in six out of 11 countries surveyed in Africa, Asia and Latin America, more than 10% of those who started on antiretroviral therapy for treatment of HIV had a strain of the virus that was resistant to some of the widely used HIV medicines. The six countries are Argentina, Guatemala, Namibia, Nicaragua, Uganda and Zimbabwe.

HIV drug resistance develops when people do not adhere to a prescribed treatment plan, often because they do not have consistent access to quality treatment and care. has reported on repeated stock outs of medicines in the country that may result in drug resistance. Such patients need to be put on more antibiotics.

India has yet not undertaken an HIV drug resistance survey, which is recommended by the World Health Organisation, DNA reported.

So far, 26 countries have completed or are implementing national surveys to check drug-resistance levels among HIV patients, based on WHO’s guidance.

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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.