pqm final hardcopy wasim

8/2/2019 PQM Final Hardcopy Wasim

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S.Y.BMS

(2011-2012)

K.C. College

SUBMITTED TO:

ASSOCIATE PROFESSOR

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Mr Vikram Shrotri

Group Members:

Rohit Ahuja (01)

Nipul Jain

Anand Rawal (37)

Wasim Shaikh (50)

Neel Poudel

Venugopal Maniar (68)

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Acknowledgement

We are pleased to submit this project on Productivity and quality

management in hospital sector and would like to thank everyone who

has been involved in the success of this research work; more specifically

we would like to acknowledge the following people:

We would like to particularly like to thank our Professor Mr. Vikram

Shrotri for granting us the opportunity to work on this project. The

brainstorming sessions with her gave us enormous information on the

Adverse effects of reality shows and her constant support also helped us a

lot to acquire necessary equipments from time to time.

We offer our heartfelt thanks to Ms. Manju Nichani (Principal Of

K.C.College) and Mr. Kailash Chandak (HOD BMS Department) for his

enthusiasm & contribution towards our project. Her sessions enhanced our

knowledge about the mounting and the specifications of the IC helped us

to establish a suitable framework of this project.

We would like to express our gratitude towards Kishinchand Chellaram

College for approving our Productivity and quality management in

hospital sector project and providing us with various facilities in the

institute.

We would also like to thank the entire Teaching and Non-Teaching Staff

for being a strong backbone to us in time of need and providing us all the

information needed for the project.

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We finally would like to mention a special thanks to our Families and

Friends for their direct and indirect support and for helping throughout the

year.

CONTENTS

1. Introduction.(06)2. SWOT analysis.(10)3. PESTLE analysis......(12)4. PORTERS model........................(14)5. Case study.(18)6. Computer application...........................(14)

7. Conclusion............................(13)

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INTRODUCTION

The Indian healthcare delivery market is estimated at US$ 18.7 billion and

employs over four million people, making it one of the largest service sectors in

the economy today. Total national healthcare spending reached 5.2% of

GDP, or US $34.9 billion in 2004 and is expected to rise to 5.5% of

GDP, or US $60.9 billion by 2009. The sector comprises of many segments,

which include hospitals, medical infrastructure, medical devices, clinical trials,outsourcing, telemedicine, and health insurance, to name some. The industry

has grown at about 13 per cent annually in recent years and is expected to grow

at 15 per cent per year over the next four to five years. According to a recent

study, the industry will account for 6.1 percent of GDP by 2012 and is projected

to provide employment to around 9 million people.

A striking feature of Indias healthcare system is the significant and growing

role of the private sector in healthcare delivery and total healthcare

expenditures. Public health expenditure accounts for less than 1 percent of GDP

compared to 3 percent of GDP for developing countries and 5 percent for high

income countries. The private healthcare sector in India accounts for over 75

percent of total healthcare expenditure in the country and is one of the largest in

the world. Indias healthcare sector, however, falls well below international

benchmarks for physical infrastructure and manpower, and even falls below the

standards existing in comparable developing countries. It is estimated that over

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a million beds have to be added to attain this 1.85 ratio, which translates into a

total investment of $78 billion (Rs. 350,830 crores) in health infrastructure. An

additional 800,000 physicians are required over the next 10 years, which

translates into huge investments in training facilities and equipment. In order toreach even 50-75 percent of the present levels of other developing countries, the

sector will require an estimated investment of $20-30 billion.

Thus, Indias healthcare sector needs to scale up considerably in terms of the

availability and quality of its physical infrastructure as well as human resources.

Given the growing demand, the emergence of reputed private players, and the

huge investment needs in the healthcare sector, in recent years, there has been

growing interest among foreign players and non resident Indians to enter the

Indian healthcare market. There is also growing interest among domestic andinternational financial institutions, private equity funds, venture capitalists, and

banks to explore investment opportunities across a wide range of segments.

This study examines the status of foreign financing (foreign direct investment-

FDI as well as other forms of foreign fund inflows) in one of the key segments

of the healthcare sector, i.e., in hospitals. It also analyses the implications of

such financing for the hospital segment and for the overall healthcare system.

Status and prospects for foreign investment in hospitals in India

The study indicates that the foreign investment policy is very liberal for

hospitals. Since January 2000, FDI is permitted up to 100 percent under the

automatic route in hospitals in India.

3Controlling stake is also permitted in hospitals for foreign investors. FIPB

approval is only required for foreign investors with prior technical

collaboration, but allowed upto 100 percent. Current regulations also permit

other forms of capital mobilization, such as through ADRs and GDRs, upto 49

percent, which are treated as FDI. FII as well as private equity funding over a

certain stake are also permitted under FDI route. In addition, FIIs and private

equity funds can individually purchase upto 10 percent and collectively upto 24

percent of the paid-up share capital of the company, through open offers or

private placement, or through the stock exchange. Proprietary funds, foreign

individuals and foreign corporates can register as a sub-account and invest

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8. Lilavati Hospital, Mumbai.

9. P.D.Hinduja National Hospital, Mumbai.

9. Sankara Nethralaya, Chennai.

9. Escorts Heart Institute and Research Centre, Delhi.

10. LV Prasad Eye Institute, Hyderabad.

10. Jaslok Hospital, Mumbai.

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SWOT ANALYSIS OF HOSPITAL SECTOR

Strengths :

Cost effective: healthcare services are usually cost effective as there is

no margin for errors. It is one of the biggest strengths of the hospital

sector.

Competitive workforce: In India, many skilled doctors emerge every

year. In fact, India is ranked second in the number of qualified doctors in

the whole world.

Emerging R & D sector: Hospital sector has an emerging R & D sector

in which they work on developing low cost drugs to help in the

development of the country.

Medical tourism : Medical tourism (also called medical travel, health

tourism or global healthcare) is a term initially coined by travel

agencies and the mass media to describe the rapidly-growing practice of

travelling across international borders to obtain health care. as thehospital sector has an international reach, medical tourism is given

importance as healthcare services are availed from medical tourism.

Weaknesses :

High cost of technology : the technology that helps in health care

usually involves high cost which in turn becomes a weakness.

Price discrimination

Incompetent public sector: the public sector which forms part of the

hospital sector is usually incompetent and cannot contribute much as the

private sector.

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Oppurtunities :

Policy makeover : sometimes the policies are made by the government

to suit the hospital sector which gives them an opportunity to develop

themselves and help people better.

Use of IT : the use of IT is a big opportunity for the hospital sector as it

makes the work easier as people can avail of the services they couldnt

before.

Medical tourism : as explained above medical tourism also provides anopportunity for the hospital sector to gain invaluable experience and

advancement.

International reach : as the hospital sector has an international reach it

provides an opportunity to integrate globally so that via integration the

hospital sector of the developing countries can be helped by the ones of

developed countries.

Threats :

Burgeoning population : the ever increasing population of the country is

a major threat for the hospital sector of any country.

Ill monitored system : the improper monitoring of the hospitals remains

a major threat. The sector should be properly monitored to avoid lapses

which can be damaging.

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Pest Analysis:

Political

The government is reducing its hold on subsidies.There are particular pressure groups which tend to have an influence ongovernment hospitalsThe cost ofmedicines also tends to affect hospitals besides affecting the pharmaceutical industriesRelationships between neighboring countries also affect the hospital sector.

Economic Analysis:Increase in income would lead to an increase in the standard of living.Thus peoples lifestyles changes and health is better understood. Thus there is aroom for specialized treatment, doctors, and hospitalsGovernment has made loans easily available and thus people with limitedmeans could avail better/specialized treatment

Social Environment Analysis:

Medical facilities have increased since there is more awareness of healthcareamong the populationCertain percentages of beds have to be kept for poor people. E.g. in Bombay20% of beds has to be kept reserved for poor people.Look after the needs of local poor people.Open counseling and relief centers.Teach hygiene, sanitation among the poor masses.Safe disposal of hospitals wastes like used injection needles, waste blood etc.and taking due care of environment.Spreading awareness about various diseases through campaigns

and free medical checkups.

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Technological Environment Analysis:

Breakthrough innovation in the field of specialized equipmentCommunication has managed to bridge the gap between places located at longdistancesTest tube babiesMobility of medical servicesMobile phones, credit cards (for payment purposes) etc have made doctors andmedical facilities easily available.

Legislation

The hospital sector has less regulatory and legislative restrictions. There is also

a growing culture of litigation in many countries. The evolution of the internetis also stretching the legislative boundaries with patients demanding more

rights in their healthcare programmes.

Environmental

There is a growing environmental agenda and the key stake holders are now

becoming more aware of the need for businesses to be more proactive in this

field. There is also an opportunity to incorporate it within their Corporate Social

Responsibility programmes. And reduce the hazardous waste which is causeddue to syringes, needles, IV-sets etc.

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Porters five forces

1. Threat of new competition.

2. Threat of substitute services.

3. Bargaining power of customers (buyers).

4. Bargaining power of suppliers.

5. Intensity of competitive rivalry.

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In detail we will study them as follows:

Threat of new competition;

In every industry they have to face the Threat of new Competition in their ownoperating environment.Profitable markets that yield high returns will attractnew firms. This results in many new entrants, which eventually will decrease

profitability for all firms in the industry.

In this Threats are from both organized as well as unorganized sector, inorganized sector new ventures are entering in the competition like Reliancehealthcare, Hindujas, Sahara group etc. are joining the existing players likeApollo, Fortis, Primal healthcare etc. Finance is not a problem for these groups,neither the economic scale as in India the Hospital sector lies under hugeuntapped markets.

In urban areas, unorganized pharma retail is facing a competition from chainslike Apollo healthcare.

This same factor is applicable for pathology centers in India.

Threat of substitute services;

The existence of services outside of the realm of the common servicesboundaries increases thepropensityof customers to switch to alternatives.

Substitute or alternative healthcare services include;

Not for profit base hospital; this thing depends on where, how, what type of

hospital it is. Is it working on medium or high bases as per the location and

treatments carried out there?

Public hospitals which are owned by government and services provided are free

of cost i.e. municipal hospitals.

Day care hospitals, they are the clinics and family doctors who manage them

for regular activities such as treating patients for cold, fever, chough etc and

also for dressing wounds and giving injections. Technology as a major

substitute as it is obtains only in private hospitals and special treatments for

cancer, HIV, etc.

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Bargaining power of customers;

The bargaining power of customers is also described as the market of outputs:

the ability of customers to put the firm under pressure, which also affects the

customer's sensitivity to price changes.

The hospital sector as a whole is relatively unaffected by customer power in the

sense that the sector is composed of all of the hospitals involved in providing

healthcare services. Whether the economy is good or bad , whether the prices of

medicines are high or low, does not affect the choices of customers to consume

(or not to consume) healthcare treatments.

Bargaining power of customers is only when it is concern for a treatment in

overseas hospitals and any specialization.High quality treatment is available at a fraction of the cost, in comparison to

western countries. And thus makes India an ideal healthcare destination for

highly specialized medical care.

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Bargaining power of suppliers;

The bargaining power of suppliers is also described as the market of inputs.

Suppliers of raw materials, components, labor, and services (such as expertise)to the firm can be a source of power over the firm, when there are few

substitutes. Suppliers may refuse to work with the firm, or, e.g., charge

excessively high prices for unique resources.

In hospital sector healthcare services are provided by (doctors, nurse,

management staff), pharmaceuticals companies, equipment manufacturer,

insurance provider, government. All play equal role in bargaining power of

supplier as the only hope left with customer.

Intensity of competitive rivalry;

For most industries, the intensity of competitive rivalry is the major

determinant of the competitiveness of the industry. The competitive rivalry is

very intense, especially in biotech/drug discovery and insurance industries.

Pharmaceuticals companies are continuously competing with each other to be

the 1st one to create a drug that can effectively treat a disease. Most of the

companies invest a huge amount in R&D departments to come up with neweffective drug, but only a company can reap profit of a new life saving drug as

it would create a patent for its own invention. There is a massive rivalry in the

insurance companies as any patient or customer will buy only one or two

medical insurance for himself not more than that.

Hospital face less competitive rivalry because usually there are only few or one

hospital in a particular area and so if anyone how is extremely sick will be

brought to the nearest hospital. Hospital also cost the same price (and most of

them is covered under insurance), so there is no price competition between

hospitals and so very little competitive rivalry.

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CASE STUDY:

New pneumonia jab at state govt hospitals soon

Preetha T SSource: TNN | Feb 11, 2012, 05.39AM IST

KOCHI: Kerala could soon roll out pneumococcal vaccine through the national

immunisation programme. In public health sector, Kerala would be the first

state in India to introduce this vaccine that protects infants from pneumonia, a

disease that killed 3.71 lakh children in India in 2008, according to the latest

World Health Organization report. The disease also accounts for 23% of deathsamong infants under five in the country.

Though the vaccine is now available in the private sector, it reaches only 40%

of the target population. The price of Rs 3,000 for a shot also makes it an

optional vaccine for many. India's National Technical Advisory Group on

Immunisation (NTAGI) has already given its nod to the implementation of this

new generation vaccine in the country. Since Kerala has the highest percentage

of vaccination, on a par with developed countries, it would be the first, like in

the case of Pentavalent vaccine, to bring the new vaccine to the government

health sector.

"NTAGI has recommended the introduction of the vaccine in the country, and

Kerala has the chance to be the first state to implement the programme," said Dr

Chandrakant Lahariya, WHO's focal person for routine immunization and new

vaccines. "We have not yet been informed about the vaccine's launch in Kerala.

But, usually the information comes to us in the final stage,"said Dr N Sreedhar,

state immunization officer.

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Too many gadgets: Are our doctors distracted?

Source:ET, Newyork, 15 Dec, 2011, 09.10AM IST.

Hospitals and doctors' offices, hoping to curb medical error, have invested

heavily to put computers, smartphones and other devices into the hands of

medical staff for instant access to patient data, drug information and case

studies.

But like many cures, this solution has come with an unintended side effect:

Doctors and nurses can be focused on the screen and not the patient, even

during moments of critical care. And they are not always doing work; examples

include a neurosurgeon making personal calls during an operation, a nurse

checking airfares during surgery and a poll showing that half of technicians

running bypass machines had admitted texting during a procedure.

This phenomenon has set off an intensifying discussion at hospitals and medical

schools about a problem perhaps best described as "distracted doctoring." In

response, some hospitals have begun limiting the use of devices in critical

settings, while schools have started reminding medical students to focus on

patients instead of gadgets, even as the students are being given more devices.

"You walk around the hospital, and what you see is not funny," said Dr. Peter J.

Papadakos, an anesthesiologist and director of critical care at the University of

Rochester Medical Center in upstate New York, who added that he had seen

nurses, doctors and other staff members glued to their phones, computers and

iPads.

"You justify carrying devices around the hospital to do medical records," hesaid. ``But you can surf the Internet or do Facebook, and sometimes, for

whatever reason, Facebook is more tempting.

"My gut feeling is lives are in danger," said Papadakos, who recently published

an article on "electronic distraction" in Anesthesiology News, a journal. "We're

not educating people about the problem, and it's getting worse."

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Research on the subject is beginning to emerge. A peer-reviewed survey of 439

medical technicians published this year in Perfusion, a journal about cardio-

pulmonary bypass surgery, found that 55 percent of technicians who monitor

bypass machines acknowledged to researchers that they had talked oncellphones during heart surgery. Half said they had texted while in surgery.

About 40 percent said they believed talking on the phone during surgeryto be

"always an unsafe practice." About half said the same about texting. The study's

authors concluded, "Such distractions have the potential to be disastrous."

By many accounts, the technology has helped reduce medical error by, for

example, providing instant access to patient data or prescription details.

Dr. Peter W. Carmel, president of the American Medical Association, a

physicians group, said technology "offers great potential in health care," but he

added that doctors' first priority should be with the patient.

Indeed, doctors and nurses face growing pressures to listen carefully to patients,

provide customer service and show empathy as they look for subtle cues that

might explain an illness.

"The computer has become a good place to get a result, communicate withother people," said Abraham Verghese, a doctor and professor at the Stanford

University Medical Center and a best-selling medical writer. "In the interest of

preventing medical error, it's a good friend."

At the same time, he said, the wealth of data on the screen - what he frequently

refers to as the "iPatient" - gets all the attention."The iPatient is getting

wonderful care across America," Verghese said. "The real patient wonders,

'Where is everybody?".It is hard to know the precise impact that distracteddoctoring has on patient care, because it is hard to measure. But at least one

example puts the risks in sharp relief.

Scott J. Eldredge, a medical malpractice lawyer in Denver, recently represented

a patient who was left partly paralyzed after surgery. The neurosurgeon was

distracted during the operation, using a wireless headset to talk on his

cellphone, Eldredge said.

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"He was making personal calls," Eldredge said, at least 10 of them to family

and business associates, according to phone records.His client's case was settled

before a lawsuit was filed so there are no court records, like the name of the

patient, doctor or hospital involved. Eldredge, citing the agreement, declined toprovide further details.Others describe multitasking as relatively commonplace.

"I've seen texting among people I'm supervising in the OR," said Dr. Stephen

Luczycki, an anesthesiologist and medical director in one of the surgical

intensive care units at Yale-New Haven Hospital.He said he had also seen

young anesthesiologists using the operating room computer during surgery.

"It is not, unfortunately, uncommon to see them doing any number of thingswith that computer beyond patient care," Luczycki said, including checking

email and studying or entering logs on a separate case. He said that when he

was in training, he was admonished to not even study a textbook in surgery, so

he could focus on the rhythm and subtleties of the procedures. When he uses

computers in the intensive care unit, he regularly sees what his colleagues were

doing before him.

"Amazon, Gmail, I've seen all sorts of shopping, I've seen eBay," he said. "You

name it, I've seen it."

Luczycki is also a huge fan of technology's positive impact on medicine. So,

too, is Dio Sumagaysay, administrative director of 24 operating rooms at

Oregon Health and Science University hospitals, even though he has heard

about or witnessed instances of people using devices during critical moments.

In early 2010, he heard several complaints that doctors or nurses were using

their phones to check or send emails even though they were part of a team

preparing a patient before surgery. Sumagaysay established a policy to make

operating rooms "quiet zones," banning any activity that was not focused on

patient care. He later had to reprimand a nurse he saw checking airline prices

using an operating room computer during a spinal operation.

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Medical professionals say young doctors can be particularly susceptible to

distraction because they have grown up being constantly connected. At

Stanford Medical School, for example, all students now get iPads, which they

use to read medical texts and carry with them in hospitals but are also

admonished not let get in the way of their work.

"Devices have a great capacity to reduce risk," said Dr. Charles G. Prober,

senior associate dean for medical education at the school. "But the last thing we

want to see, and what is happening in some cases now, is the computer coming

between the patient and his doctor."

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