HospiArch Bangalore: Voices from the Conference

The latest edition of AMEN’s series of conferences on Hospital Planning, Design and Architecture, aptly named as HospiArch, was organized on August 18^th and 19^th at API Bhavan, Bangalore. The event saw participation from over 100 delegates from different hospitals, architectural firms, consulting companies, engineering professionals and healthcare management students. The conference, supported by Hospaccx India Systems, is one of its kind event in India which attracts such a diverse set of audience. HospiArch is a 2-day conference which involves talks, panel discussion and Q&A sessions which are a rich source of knowledge to understand planning and design related issues for hospitals.

The Day 1 of the conference started with the Keynote address, delivered by Dr. (Wg Cdr) M.D. Marker, Medical Director - Bhagwan Mahaveer Jain Hospital Bangalore. In his speech, he addressed issues pertaining to architectural challenges involved in building a new hospital. He stressed the need for a hospital planner while designing a hospital and advocated a functional design approach.

His talk was followed by a presentation on “Planning & Designing a new hospital” by Dr. Alexander Kuruvilla, CEO - Medica Synergie Pvt. Ltd. Bangalore. He shared his vast experience in the field and the general steps for building a hospital such as feasibility study, market survey and project cost estimation & management. The highlights of his talk were his suggestions on having greenery, pipe music, aquarium & pleasant colours to keep the patients and relatives calm with in the hospital.

Dr. P. Satyanarayana, Retd. Professor of NIMS Hyderabad & Director of SVIMS Tirupati, took a session on “Factors that influence the bed utilization”. According to him, high cost of constructing physical infrastructure & facilities, high costs of running the hospital, high customer expectations and high cost of hospital expansion, modernization and modification bring sharp focus on bed utilization. He shared a few bed utilization indices, like Average Length of Stay (ALOS), Bed Occupancy Rate (BOR), Bed Turnover Interval (BTI) and Bed Turnover Ratio (BTR) as performance indicators. He advised to hospitals that while deciding to create more beds, they should consider factors like current availability of beds in an area, prevalent payment methods in the area (like cash or cashless), age of population (a higher life expectancy tends to raise general bed utilization), bed distribution (no. of ICU, PICU, ER and ward beds), availability of extramural medical services and medical customers & social patterns.

His presentation was followed by another talk by Mr. Radhakrishna, CEO - Narayana Hrudayalaya Hyderabad, on the topic of “Budgeting & financial planning for a new hospital project”. He gave elaborate prescription on planning of hospital project involving multiple steps. He suggested going for a market research, which would cover statistics on demographics, performance analysis of top 4-5 leading hospitals in the vicinity, identification of specialties and specialists, financial feasibility and project report. Next factor was the Land, its location and cost, legal formalities and statutory requirements for use of land for hospital purpose. When it comes to hospital building, he discussed factors such as cost of construction, various approvals, Floor Area ratio and determining built-up area per bed. Next thing he covered was medical equipment, its purchase costs and technology-relevance. He also touched various means of financing the project, such as equity or unsecured loans and debt/external funding. He finished his discussion by sharing some key ratios, such as debt-equity ratio, debt service coverage, bed occupancy rate, EBITDA margins and ALOS for measuring project performance.

Mr. Naresh Duble, DGM - Business Development at Armstrong World Industries (India) Pvt Ltd. Mumbai, presented on “Hospitals are for people - Design Solutions” and touched various facets of Acoustic comfort, green building and thermal comforts. Another presentation on “Designing a CSSD - Techniques and Trends” was given by Ms. Anuradha Desai, Manager - Getinge India Pvt. Ltd. Mumbai. She used elaborate layouts to explain her points. An interesting topic she discussed was about Super-CSSD which is out sourced CSSD for various hospital in countries like France, U.K, Singapore in which linen is sent for sterilization in super CSSD and dispatched back to hospital.

The last presentation of the first day was given by Dr. Marker on “Planning & designing lab & other diagnostics areas of the hospital”. His advice for planning and designing a lab was to focus on three areas: Strategic Planning, Structure Planning (scope of services & future expansion) and Operational Planning (functional lab Area). He also discussed about location and space requirements for a lab.

The Day 1 also witnessed a power-packed panel discussion on the topic of “Hospital Planning, Design & Architecture - Issues, Current Trends and Challenges”. The panel of 5 included Dr. P. Mohanakrishnan, CEO – Malabar Institute of Medical Sciences Calicut & Kottakal, Dr. Narendranath V., Chief Administrator – MS Ramaiah Hospitals, Mr. Tarun Katiyar, Principal Consultant – Hospaccx India Systems, Mr. Ramanand Prabhu, Director for Sourcing & Marketing – Global Healthcare Solutions and Dr. (Wg Cdr) M.D. Marker, Medical Director - Bhagwan Mahaveer Jain Hospital Bangalore. The panel discussion was moderated by Mr. Anuj Jindal, Senior Consultant – Hospaccx India Systems.

The discussion started with Mr. Jindal asking the hospital administrators on the panel to share their insights on common mistakes that they have come across that administrators have made while designing their hospitals. Dr. Mohan highlighted that administrators make a mistake when they do not create people-centric hospital designs. The structures are not built keeping in mind the needs of the employees and of the patients and their attenders.

Dr. Narendranath shared his experience with respect to the balance which needs to be maintained between academic and patient care requirements in the teaching hospital.

Dr. Marker gave an example from his professional experience wherein the statutory compliances and regulations were not completed understood before taking up the hospital project, thereby leading to considerable escalation of project cost and delay of the project by a couple of years. Mr. Tarun Katiyar took the example of small hospitals and their owners, wherein the doctors pump in their hard earned savings in building the hospital, but by the time the structure is built, either they lack enough funds to buy the medical equipments or they do not have enough working capital to run the hospital during the initial years of the hospital before it achieves profitability. This leads to the unfortunate situation in which the doctor either has to dump the hospital project or he starts looking out for buyers for his dream project.

Mr. Ramanand Prabhu highlighted the fact that hospital infrastructure and equipment is an important project cost and it has to be budgeted at the very beginning of the project and sourcing of same has to be identified well in advance. The panel also discussed innovative contemporary models of outsourcing certain departments to other specialized agencies who can co-invest in the projects, thus reducing the burden on the hospital administrators.

Day 2 of the conference witnessed 6 more speakers share their valuable experiences with the audience. The day began with Dr. Vinod Singh, Senior Consultant – Hospaccx India Systems, discussing the experience of their company in the field of hospital architecture. He stressed the fact that hospital architecture is very different from conventional architecture given the complex nature of hospital buildings and various loads requirements for the floors owing to heavy medical equipments and their power requirements.

This was followed by Prof. Dr. Usha Manjunath, Associate Professor – IHMR Bangalore, speaking on the topic of “Manpower planning for a new hospital”. She identified the importance of manpower planning as part of a new hospital project because of changing healthcare business paradigm, issues with availability of skilled manpower, vision of hospital promoters and the impact of policy issues on manpower requirements. Dr. Joy Bannerjee, Managing Director – Wiesermanner, discussed quality standards applicable to hospital planning, while Mr. Joseph Alexander, CTO - dWise Solutions & Services, discussed challenges in Hospital IT & Networking Design. Dr. Rajesh Kumar, Managing Director - Vijay Hospital Hosur, made a presentation on “Challenges in building hospitals in 2 tier towns” like the cost involved in the projects and the comparison of taking up a Brownfield project and a Greenfield project.

Lastly, Mr. Tarun Katiyar, Principal Consultant – Hospaccx India Systems, spoke on the topic “Re-planning & Re-designing an existing hospital”. His talk focused on the need for hospital renovation and how to go about it systematically. He gave elaborate examples of common mistakes hospital owners make while deciding to go for renovation of their buildings and suggested ways and means to avoid these mistakes.

In the end, HospiArch lived upto its expectation of being a source of great amount of learning for the participants and a good networking opportunity with the leaders in the hospital planning, designing and architecture services.

The next edition of HospiArch will be in Kochi next month. With the kind of conferences that happened earlier in Chennai, Hyderabad and Mumbai and now in Bangalore, HospiArch seems to be getting bigger and better. Let’s see what is in store for the audiences at Kochi in September. The last conference in the series in 2012 will be held in Delhi in December.

PeopleHosp Bangalore: Voices from the Conference

The conference on Human Resource Management in Healthcare, named PeopleHosp, was organized by AMEN on July 4^th at Ashraya International Hotel in Bangalore. The conference attracted HR professionals from hospitals from Bangalore and outside.

The conference opened with an interesting talk by Mr. Siddharth N, General Manager & Head HR for Cloudnine Hospitals, Bangalore. His topic covered a futuristic view on HR competencies required in healthcare. The presentation, made enjoyable with a healthy dose of cartoons, discussed some key challenges facing the industry, like training, retention, sourcing, lack of discipline among the new breed of employees, lack of English speaking skills among the prospective employees, professionalism, skill-levels, employability and ramping-up of operations.

He put forth questions on how to deal with a large employee-base who is required to deliver personalized care to the patients, how to design systems that ensure customer centricity at each employee level and how to ensure sensitivity among the staff on medico-legal aspects of their profession. In the end, he emphasized the role of HR in driving critical circuits in the organization, in being the advisor to the business head while managing the core responsibilities of the function, managing risk, creating change and making a difference to the enterprise. He signed off by proposing the ‘competency way of thinking’ for managing HR in healthcare.

Ms. Nagarathna A, Asst. Prof. of Law at National Law School – Bangalore, shared her insights on ‘Statutory and Legal issues related to HRM in hospitals. Dr. Navin Chugh, who heads Quality at Global Group of Hospitals – Bangalore, discussed the requirements of NABH quality standards applicable to HRM. He took up the discussion based on the latest 3^rd edition of NABH standards for hospital and provided suggestions to audience on implementing the standards and facing the audit. When asked whether doctors practicing alternative medicine (AYUSH) can work in an allopathic hospital through privileging, he cited MCI regulations and said that this practice is illegal and therefore will attractive non-conformance in an NABH Audit. He also shared the practice of daily quality rounds as a means to monitor process compliance in his hospital.

Ms. Reshma Lobo, Principal – Padmashree College of Hospital Administration Bangalore, gave a talk on ‘Manpower Requirement & Planning for hospitals’. The topic on training of hospital staff was taken up by Mr. Schreyas Nair, GM – Training and Development, at Fortis Hospital Bangalore. She explained the approach followed at Fortis hospital in ensuring that the staff is appropriately trained to work in the hospital. Her talk began with a discussion on finding out how the training fits into the agenda of the organization. This, she said, is achieved through an identity statement for the training department, which in their case covers aspects like anticipates requirements of the business, be a catalyst of change, contribute to performance excellence, have people focus and connect, raise the bar of excellence and enable the organization to fulfill its vision.

She explained that the training department plans its activities through a 4 step process, which involves training needs investigation, needs analysis, creation of training modules and creation of training calendar. One interesting insight she shared about training at Fortis hospital was the Nurses Leadership program. The program is undertaken for nurses who show commitment at their work and consistently excel among their team members. The nurses who undergo this program are selected to lead floor teams or even head smaller hospitals’ nursing teams. For their performance management, the balanced scorecard is used which even includes financial metrics. The metrics focuses on cost reduction through a reduced Average Length of Stay (ALOS). She highlighted the importance of nurses in implementing strict infection control processes, thereby reducing the overall risk to the patients and ensuring a lower ALOS.

Mr. Kiran Gautham, Dy. Director at Alliance University Bangalore spoke about strategies for effective selection, recruitment and employee retention. This was followed by a talk by Mr. Marian Jayson on ‘Performance Appraisals – Tools and Techniques’. His talk focused on managing performance in the organization and linking the same through a robust appraisal system where the superior performance is rewarded and a below-expectation performance attracts strong feedback and strict action. He also shared insights on ways and means for deciding KRAs (Key Result Areas) and KPIs (Key Performance Indicators) of various staff levels.

The conference ended with Mr. Ganesh Selvaraj, VP – HR at Manipal Health Enterprises, sharing his views on ‘Motivating today’s hospital staff’. His presentation was centered on techniques used at Manipal for motivating its employees. The methods which were employed by the company included staff-management interaction, employee engagement exercise, appreciating contribution by senior-most employees of the company at important events etc.

The conference successfully touched upon the various aspects of Healthcare HRM with the views of various industry leaders. The audiences were thoroughly engaged by the speakers and the question-answer sessions saw good participation from them.

The success of PeopleHosp in Bangalore has raised the expectations from the conferences which are going to be part of this series at other cities of India. The next edition is going to happen in Mumbai on August 29th.

Technology in Human Resource Management in Healthcare

I had the privilege to be a speaker during the PeopleHosp conference organized by AMEN at Bangalore on July 4th. The topic of my talk was "Technology in HRM in Healthcare". For the benefit of the community, the presentation is available for reference on Scribd.
Technology in Human Resource Management in Healthcare

HospiArch comes home in Bangalore in August

Are we serious about Performance Appraisals?

In the upcoming conference PeopleHosp on the issues pertaining to human resource management in healthcare industry, one of the topics for discussion is performance appraisals. Having spent couple of years in IT and healthcare industry, I belong to the category of cynics for the relevance of performance appraisals. This is not to mean that I do not believe in performance appraisals. My disappointment is with the way appraisals are carried out. In our corporate scenario, both appraiser and appraisee are clueless about the concept of performance measurement and performance management. Appraisals are thought to be an activity which has to be performed during April-May and are seen as a burden and not as a performance improvement exercise. Most people would agree with me that, as employees, we have lost trust in the appraisal process because our managers never set performance goals on time, they are not clear about how to measure the performance itself, ratings are seen as a subjective indicator of the satisfaction or dissatisfaction of the manager with his juniors and favouritism is a norm rather than being an exception.

So what can be done to respond positively to this situation? Can something be done to transform performance appraisals as an employee motivation exercise?

As you would have noticed, primarily the organizations need to drill down the concept of performance linked to organization’s goals at every level. For doing that, the company leadership should have goal-setting exercises during February-March of the year so that it sets the direction for goal-setting for the individuals down the hierarchy.

Another important aspect here is for the managers to understand the job description and scope of the work of their subordinates. The performance goals have to be set ultimately in the scope of the work of the subordinates. This is where the HR comes into sharp focus. Each year the HR should engage the managers in a discussion to re-emphasize the concept of job descriptions. The scope helps the manager and the subordinate to understand whether the performance was as per the expectations or not and in which aspect did the subordinate performance outstandingly. No work outside the purview of job description can be seen as exceeding expectations because it may not be useful to company goals. For example, if person X does person Y’s job, it can’t be said that person X did more work, rather it was the inability of the manager to get the work done from Y. in the instance that Y was not able to function, say because of medical leave or pregnancy, then one can appreciate X for taking the burden of her colleague.

Most organizations follow the bell-curve (normal distribution) or the forced ranking method for rating their employees. Again, most employees don’t understand how it works and even HR people lack confidence in explaining the functioning of the method. Forced ranking method requires that each individual in a unit/department be compared to each other (forced comparison) and then a descending list of performance is prepared. So if there are 20 employees in a department and all happen to be great performers, still the manager has to arrange their performances in a descending order. How you do it is the trick. The manager and the HR have to carefully develop metrics that can objectively measure the performance of these set of people and arrive at a score. These scores can then be sorted in a descending order.

The normal distribution concept of appraisals relies on the fact that the organization has a pre-set budget to award compensation and increments to their staff. So the quartiles are identified and linked to increments. Therefore the 25^th percentile may get the lowest increments and the 75^th quartile may get the highest increments. The organization may also be using the concept of percentiles. So the 10^th or the 20^th percentiles get the lowest increments and the 80^th or the 90^th percentiles get the highest increments. Since the performances have been converted into a score and ranked in a descending order, identifying the employees who fall in which quartile or percentile is easy. What is difficult is to explain to a well-performing employee on why he has to be in a lower percentile even when his/her performance was very good. Probably that is where the HR needs to take efforts in explaining to the employees in advance how the forced ranking system works and what is the company policy in deciding the percentiles, the rationale behind it and the method of computing the same.

If we look at the situation from the NABH standards perspective, HRM 5 (Chapter 9, Human Resource Management, 3rd edition) also deals with performance appraisals in detail, requiring that such a system exists in the organization, employees should be aware of this system, pre-determined criteria for performance evaluation should exist and the evaluation should be carried out at pre-defined intervals and should be documented. Therefore, performance appraisals are linked to quality healthcare set-up in hospitals as well.

From my own experience, I have found that a communication in advance with the employees on performance goals, measurement technique and percentiles linked to company’s increment policy can reduce the heart-burning to a large extent when certain good performers have to be pushed down the percentiles because of the forced ranking.

We would be attending PeopleHosp in Bangalore on July 4^th, 2012. Hope to see you there. Talk to us and we’ll be happy to get you discount for attending PeopleHosp in Bangalore.

AMEN presents PeopleHosp - a Conference series on Strategic Human Resource Management for Hospitals