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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