Dr M Veera Prasad, MD (HA), DNB

DIRECTOR
Santhiram Medical College & Hospital
NANDYAL (AP)
India: the potential hub
 India to emerge as a Health Care hub
 India requires 600,000 to 700,000 additional beds;
about 300000 doctors & about 600000 nurses n
paramedics by 2020
 The overall Indian healthcare market is worth around
US$ 100 billion and is expected to grow to US$ 280
billion by 2020, a Compound Annual Growth Rate
(CAGR) of 22.9 per cent (ref # Deloitte Touche
Tohmatsu India report)
 Investment opportunity of US$ 25-30 billion per year
Govt initiatives
 Pro-active government
 Ease policies to promote health care
 Many PPP intiatives to promote haelth care
 Reduced excise & customs duty
 Universal Community Health Insurance for BPL
 Encouraging pvt sector to expand hospitals
 Coverage for Govt employees, CHGS, ESI, PSUs
in private hospitals
 More medical Colleges to establish to produce
specialists/ super specialists and paramedics
 PPP concept for Medical Colleges
Health gap
 India requires 600,000 to 700,000 additional beds;
about 300000 doctors & about 600000 nurses n
paramedics by 2020
 Total medical colleges---436
 Total UG seats….52,103
 Total PG seats…. (excluding DNB)… 23,686 (MD-13,137;
MS- 6,735; Diplomas-3,810
 Many more medical colleges to come to cope up the
staff-gap
 Recent relaxation of MCI for some country’s medical
graduates
 Budget 2017-18 mentions to add 5ooo PGs every year
Market research
 A thorough market research or business intelligence is
the crucial step before planning for a medical college
 A deep study on health care facilities available in new
proposed place, their business and place for new
comer are to be analyzed
 Availability of doctors, especially faculty
 Any nearby government medical college
 What are other private medical colleges in that district
 Connectivity
 Infra structure of town/city
 HA to lead the show
Challenges for HA- funding
 Own funding
 Identifying an appropriate, like-minded partner, if it is
a JV
 Or for a merger /acquisition
 If a own unit, discussions with potential
investors/doctors
 Identifying a PE funder
 PPP with government
 Proper documentation for MoU / Agreements
Challenges for HA- MCI guidelines
 MCI minimum standards criteria book is like a ‘bible’
 Infrastructure
 Staffing
 Equipment & furniture
 Documentation
 Yearly enhancement planning
 Academic schedules & planning
 Faculty & their research papers
 ‘biometric attendance’
 Plans for PG courses in future
Challenges for HA- how to initiate
 To follow the Minimum Standards criteria, as
prescribed by MCI
 College for 100 OR 150 UG seats
 Green field OR partially brown field
 To have a 300 bed running hospital, for three years
before applying to MCI
 Later this hospital shall be incorporated in to teaching
hospital, with yearly expansion
 To identify a special architect
 To develop a project team
Challenges for HA- how to initiate
 Applying to state government for a medical college
 State govt inspection by appropriate authority
 Application for EC
 Inspection by Govt Officials with DME
 EC sanctioned
 Applying for Health University
 Health University inspection
 Applying for MCI with all required documents & BG
 LOI & LOP inspections by MCI
 Permission accorded by Central Govt
 Health University affiliation inspection before admitting
Challenges for HA- time lines
 Target for UG student intake……2021
 Running 300 bed general hospital from 2017
 Submission of application to MCI before 31st Aug 2020
 LoI inspection in and around Dec’20 OR Jan’21
 LoP inspection in and around March ’21 OR Apr 21
 No deficiencies----direct sanction
 Small deficiencies---submission of compliance
 Big deficiencies-----better luck next time
Challenges for HA- MCI inspections
 Yearly renewal inspections
 Inspections are ‘surprise’
 Minimum 1200 OPD per day
 Minimum 75% bed occupancy in each department
 Adequately equipped areas
 Minimum number of tests in labs & radiology
 Running of UHC & RHC
 Faculty Identification Forms- proper data
 Supports for faculty eligibility
Challenges for HA- project
management
 Nearly 1 M sft requirement for contruction
 Planning for a project team
 Involvement in the project management right from
planning with hospital architect & promoter (s)
 Execution with contractors by preparing BOQs,
commissioning and then operating.
 Operations management
 Planning and implementing efficient supply chain
management
 Following timelines…..inspections should not fail
Challenges for HA- statutorys
 Obtaining all licenses & legal obligations
 Radiology as per AERB
 Hospital Registration
 Fire NOC
 PCPNDT
 PCB & MoU with CTF
 Pharmacy running licenses
 Blood Bank valid license
 HR licenses
 Financial statutes
Challenges for HA- legal & statutes
 Legal compliance
 Following statutes
 Obtaining all licenses
 Union-related issues
 Labour issues compliance
 Financial related compliance
Challenges for HA- recruitment
 Identifying good doctors and roping in for ‘star
professors’ is a challenge
 Because majority of the colleges are in rural areas,
obtaining qualified & experienced staff is an issue,
especially of Doctors & nurses
 Training them is a challenge
 Recruitment of staff as per MCI guidelines
 Faculty will have ‘some sort of immunity’ by MCI
Challenges for HA- equipment
 Equipment plan as per MCI
 Hi-end Bio medical equipment to be ordered and site
should be ready
 Oragnising finances/LC
 Appropriate licenses from authorities before arrival of
the equipment
 Blood bank licenses
 Necessary trainings
 To be ready for commission
Challenges for HA- technology
 Project Management software
 Implementation of HIS
 Software for students management
 Newer gadgets in patient care
 Training of staff
 e-library
 Paper less office-EHR/EMR
 digitalization
 Biometrics for students and staff
 Website management in lines with MCI
Challenges for HA- commissioning
 Pre-launch activities
 Trainings done
 Licenses ready for operations & tariff fixed
 Launching activities- soft launch- walk thru
 Equipment, wards, staff ready
 Labs, diagnostics equipped
 Accessories ready
 Review of operations
 Post launch activities-Regular CMEs/Health
talks/Health camps
Challenges for HA- medical education
 Excellence in academics
 Making availability teaching material (clinical)
 Monitoring academics & exams and evaluation
 Training on simulators
 Teaching on UHS & MCI guidelines
 Promoting research and publications
 Faculty development programmes
 Guest lectures/zonal CMEs
 e-learning
Challenges for HA: college
 Establishing pre-clinical; para clinical depts.
 Labs, museums
 Lecture halls; demonstration rooms
 Central library & departmental libraries
 Animal house
 Research & academics
 College council room
 Exam hall
 Doctor is aTEACHER
Challenge of medical college doctor
(teacher)
Challenges for HA: hospital
 Patient safety
 Quality care
 Health Care Associated infections
 Clinical classes in hospital and monitoring
 Training of staff and students
 Maintaining adequate OP & IP- ‘always ready hospital’
for surprise MCI inspections
 Conferences/ workshops
 Faculty management
 Customer satisfaction (patient/student/doctors)
 Self sustainable hsopital
Challenges for HA- accreditation
 Providing Quality Care in a Teaching Hospital is a
Challenge
 Right from planning itself, accreditation criteriae to be
kept in mind
 NABH/JCI etc
 Documentation can be started before commissioning
the hospital
 Trainings on SOPs can be started before launching
 Challenge to get accreditation at the earliest
 Sub-standard staff
Challenges for HA- financial viability
 Getting financial viability is a big challenge
 Only fees from students for college
 ‘Need to provide ‘almost free’ treatment
 No ‘paying category’ patients
 Top-line (revenue) is very less
 Doctors salaries are high & Other over heads too
 Minimum wages to nurses and paramedics, bleeds on
P&L
 Gestation period is high
 Judicious use of resources
 ‘Paying Block’?
Challenges for HA- future plans
 100/150 UG seats college is eligible for enhancement to
200/250 after 10 years
 So initial plans itself should have the ‘future’ ideas
 PG courses can be started after 6th year
 Super specialty courses can be started in 9th year
 Para medical courses
 Nursing courses
 Dental college
 Though MCI suggests minimum 20 acres in rural area,
we need to procure a minimum of 50 acres
Different challenges: Medical College
Hospital Vs Corporate Hospital
Medical College Hospital Corporate Hospital
Infrastructure Huge Not so huge
Areas Very strict (measurable in Sq No rules
Mtrs)
Timelines As per MCI No regulation
OP & IP Regulated No regulation
Staffing Regulated No regulated
Departments Can not be closed Can be
Customers Students & patients Patients
Type of Rx General Sophisticated
Top line Very less Reasonably good
Profitability Loss, if Hospital persae Profitable, if run good
Overheads High Reasonable
Different challenges: Medical College
Hospital Vs Corporate Hospital
Medical College Hospital Corporate Hospital
Focus Seat centric Patient centric
Financial Not monitored P&L is highly monitored
Orientation Academic and treatment Treatment (& academic, if
DNB)
Chain Usually solitary Can go to chain, if brand
established
Driving force Students Patients
Inspections Periodically & surprise No inspections (few)
Accountability To MCI; UHS; students to share holders
For Quality No much emphasis Highly conscious
Doctors Two extremes & casual Middle level & target oriented
Documentation Huge & regulated Not so important
Lets all accept Challenges to lead for SUCCESS
There are many challenges for establishing &
running a medical college…..but in spite of
challenges……
 Dr M Veera Prasad
+91 9494 30 3535
drveera2007@gmail.com