year in review

2017 in review: These three stories from the year show India’s apathy towards public healthcare

Lack of transparency and accountability in the healthcare system rarely elicits outrage.

The Gorakhpur tragedy

It is nearly five months since more than 50 people died over just a few days in the Baba Raghav Das Medical College and Hospital in Gorakhpur, Uttar Pradesh. Several doctors at the state-run hospital were arrested after an enquiry found that at least some of the patients had died for lack of oxygen. It is not known, however, if the facilities at the hospital have improved since and whether measures have been taken to ensure that a similar tragedy does not occur.

Twenty three children and eight adults died in the hospital on August 10. The deaths coincided with reports that the oxygen supply had been cut because the hospital administration had failed to pay the supplier. By the next day, the death toll rose to 34 children and 18 adults.

Although the state government initially denied the deaths had anything to do with the shortage of oxygen, subsequent investigations found otherwise, and several doctors, hospital administrators and the oxygen supplier were arrested. But what of the hospital itself? It is the largest tertiary hospital in eastern Uttar Pradesh. Severely ill patients come from neighbouring districts and states, and even from Nepal. The hospital is overburdened and under-equipped.

As Scroll.in found in August, the neonatal intensive care unit has 40 beds, but accommodates over 100 children at any given time. Two or three children are crammed into a bed, increasing the risk of infection. Many children brought to the hospital are admitted with encephalitis, which is endemic in eastern Uttar Pradesh.

But even after the tragedy in August, almost nothing about public healthcare in Gorakhpur, and Uttar Pradesh generally, appears to have been fixed.

A man holds pictures of his twins who died in Baba Raghav Das Medical College, Gorakhpur, on August 10 Photo credit: Menaka Rao
A man holds pictures of his twins who died in Baba Raghav Das Medical College, Gorakhpur, on August 10 Photo credit: Menaka Rao

The Zika cover-up

On May 26, the World Health Organisation issued a statement that India’s Ministry of Health and Family Welfare had reported three laboratory-confirmed cases of Zika in Ahmedabad, Gujarat, 10 days earlier.

This came as a surprise to most people in India, including health officials in Ahmedabad who found out about the cases from the WHO announcement. The health ministry subsequently put out a press release saying it had not made the information public because it did not want to cause panic. Moreover, even while carrying out surveillance for Zika, health officials had said the exercise was for malaria control.

Health activists criticised the government’s handling of the situation. Instead of issuing warnings about the risk of infection and advisories about how people in the affected area might protect themselves, they pointed out, the government chose to suppress important public health information.

Residents of Bapunagar where Zika was detected had no idea how to protect themselves from the infection. Photo credit: Priyanka Vora
Residents of Bapunagar where Zika was detected had no idea how to protect themselves from the infection. Photo credit: Priyanka Vora

Pitting public health against national interest

In April this year, the Ministry of Home Affairs barred the health advocacy organisation Public Health Foundation of India from receiving foreign funding by revoking its registration under the Foreign Contribution Regulation Act. Among the grounds for the ban, the ministry cited the organisation’s work on tobacco control.

The foundation is a public-private initiative that provides technical support to the health ministry on public health matters. The irony of the home ministry’s action was that the foundation had been running anti-tobacco programmes at the behest of the health ministry since 2010. In June this year, Health Minister JP Nadda even accepted a WHO award for tobacco-control initiatives.

In October 2016, the government had cancelled the Foreign Contribution Regulation Act licence of the Institute of Public Health in Bengaluru and the Voluntary Health Association of Assam, without citing specific reasons. Both organisations have done considerable work on tobacco control. While the home ministry claimed to be acting in the interests of tobacco farmers and bidi makers, it would appear it was actually protecting the interests of the influential tobacco industry. While appearing to act in national interest, the home ministry has, in fact, been imperilling India’s health.

A farmer with oral cancer who has quit chewing tobacco and wants to quit growing it but cannot. Photo credit: Menaka Rao
A farmer with oral cancer who has quit chewing tobacco and wants to quit growing it but cannot. Photo credit: Menaka Rao
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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.

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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.