8/2/2019 PQM Final Hardcopy Wasim
1/22
Page | 1
8/2/2019 PQM Final Hardcopy Wasim
2/22
S.Y.BMS
(2011-2012)
K.C. College
SUBMITTED TO:
ASSOCIATE PROFESSOR
Page | 2
8/2/2019 PQM Final Hardcopy Wasim
3/22
Mr Vikram Shrotri
Group Members:
Rohit Ahuja (01)
Nipul Jain
Anand Rawal (37)
Wasim Shaikh (50)
Neel Poudel
Venugopal Maniar (68)
Page | 3
8/2/2019 PQM Final Hardcopy Wasim
4/22
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.
Page | 4
8/2/2019 PQM Final Hardcopy Wasim
5/22
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)
Page | 5
8/2/2019 PQM Final Hardcopy Wasim
6/22
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
Page | 6
8/2/2019 PQM Final Hardcopy Wasim
7/22
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
Page | 7
8/2/2019 PQM Final Hardcopy Wasim
8/22
8/2/2019 PQM Final Hardcopy Wasim
9/22
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.
Page | 9
8/2/2019 PQM Final Hardcopy Wasim
10/22
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.
Page | 10
8/2/2019 PQM Final Hardcopy Wasim
11/22
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.
Page | 11
8/2/2019 PQM Final Hardcopy Wasim
12/22
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.
Page | 12
8/2/2019 PQM Final Hardcopy Wasim
13/22
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.
Page | 13
8/2/2019 PQM Final Hardcopy Wasim
14/22
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.
Page | 14
8/2/2019 PQM Final Hardcopy Wasim
15/22
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.
Page | 15
8/2/2019 PQM Final Hardcopy Wasim
16/22
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.
Page | 16
8/2/2019 PQM Final Hardcopy Wasim
17/22
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.
Page | 17
8/2/2019 PQM Final Hardcopy Wasim
18/22
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.
Page | 18
8/2/2019 PQM Final Hardcopy Wasim
19/22
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."
Page | 19
8/2/2019 PQM Final Hardcopy Wasim
20/22
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.
Page | 20
8/2/2019 PQM Final Hardcopy Wasim
21/22
"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.
Page | 21
8/2/2019 PQM Final Hardcopy Wasim
22/22
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."
Page | 22