Apollo Hospitals Dhaka – Best Use of HR FINALIST– 2017

Apollo Hospitals Dhaka is the only JCI Accredited 450-bed multi-disciplinary super-specialty tertiary care hospital in Bangladesh, confidently providing comprehensive health care with the latest medical, surgical and diagnostic facilities. The hospital is a showcase of synergy of medical technology and advances in IT through paperless medical records. Dedicated to providing multidisciplinary medical care and backed by state-of-the-art facilities, Apollo Hospitals Dhaka offers team-based quality patient care that is widely acknowledged to be amongst the best in Bangladesh. At Apollo Hospitals Dhaka, patients have ready access to more than 29 specialized departments and services, which are established as national referral centres. We have five Centers of Excellence and five Strategic Business Units.

Modern lithotripsy service, i.e. the treatment of kidney and ureter stones without surgery, is provided by the hospital using extracorporeal shock wave. The hospital also offers a complete Dialysis Unit for the treatment of patients with kidney disorders. The hospital has 1.5 Tesla MRI, 64 Slice CT Scan, Color Doppler, Ultrasound, and Gamma Camera, which have created the most modern Radiology and Nuclear Medicine service in the country, with equipment that is faster and capable of conducting a wide range of examinations with a higher degree of detail. This is in addition to EEG, EMG, neurophysiology, ECG, stress test, pulmonary function test, etc. Our international standard Lab Medicine conducts External Quality Control Program with Bio-Rad, USA and offers a variety of modern tests and diagnostic tools, some of which are not available anywhere else in Bangladesh, with regular additions.

Facilities Available:
• Total 450 beds

• 24-hour Trauma and Emergency Care

• 24-hour Ambulance services

• OPD with all specialties • 9 Operating Rooms

• 24-hour diagnostic services

• 24-hour Pharmacy

• 24-hour Blood Bank

• Physical Medicine & Rehabilitation Centre

• Vaccination Centre

• Radial Lounge Total staff 1663 (Physicians 270, Nursing staff 415, Paramedics 200, support services 700, pharmacy 56 and contract 22).

Revenue number in September 2016: BDT 163,107,088 (EBITDA), USD $ 2,058,969.28

Medical Infrastructure
• The medical infrastructure at Apollo Hospitals Dhaka is among the best in the world
• Patients are provided with facilities that are conceited with what the best hospitals in the West offer
• In addition to excellent infrastructure, the medical equipment and technologies used are the latest and are continuously upgraded

International Affiliation OF APOLLO HOSPITALS GROUP
• Technical collaboration with Johns Hopkins University, USA
• Association with Mayo Clinic and Cleveland Heart Institute, USA
• Diagnostic imaging recognised by Royal College of Radiologists, UK for training for fellowship examinations like FRCR
• Exchange programs in the USA and Europe
• Recognised by Royal College of Physicians & Surgeons in Edinburgh for training of postgraduates in Radiology, Surgery and Trauma care
• Only international training organisation for American Heart Association; technical support is received from Texas Heart Institute and Minneapolis Heart Institute for Cardiology and Cardiothoracic Surgery

Patient safety & quality
We follow international patient safety goals (IPSG) in our patient areas as per Joint Commission International (JCI) protocol.

Our Strengths
• Critical lab result reporting
• Verbal orders with reading back
• Reduce delays in patient care by following Emergency Codes within the hospital
• Discharge coordinators: Unique concept to expedite the discharge process to enhance patient satisfaction and to provide quality service.
• Multidisciplinary team round-the-clock: This is designed to address the needs of patients within 24 hours of admission.
• Language interpreter: For the international patients, we have the facility of language entrepreneur.
• Spiritual Service: We provide spiritual services for patients from different religions, as and when required.

Collaborative Governance
• 22 Hospital Committees generate recommendations that enhance the safety and quality of services for our patients. Each committee comprises of Consultants and Senior Management personnel.
The Department of Medical Services encompasses a wide array of patient services consistent with the health care’s system on a continuum of patient care:
• Best practice is an idea that asserts that there is a technique, method, process, activity, incentive or reward that is more effective at delivering a particular outcome than any other technique, method, process, etc.
• According to the Centre for Evidence-Based Medicine, “Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients”.

Change 1: Being a JCI accredited corporate hospital, our first priority is to meet patient’s expectation on safety and quality. Through robust quality control measures, monitoring and adopting International guidelines we provide patient care to meet their expectations. In Bangladesh, the patients expect physicians to attend every small issues, to counsel, to answer small queries in all aspects of patient care. The different critical and non-critical unit has a team for patient care with representation from various departments but none of the areas other than critical areas have any dedicated physician in charge.

The nurses in noncritical areas attended the calls and if required they informed the physician which was not enough to satisfy the patients at times. Moreover, the unit team members did not have a single point of accountability. The problems were reported to their own supervisor and the response was delayed. This resulted in many communication errors. This system of operation lacked decision making at the point of care. The senior leaders felt the need of physician involvement in every unit to address this issues. The CEO shared his strategic plan with Director Medical Services and later to the senior management to meet patient expectations and improve patient satisfaction through involvement of physicians at the point of care.

The plan was shared and a committee was formed with relevant departmental coordinators; Medical, Nursing, Operations and Hospitality services to plan all the minor details. The committee had several sessions to discuss and finalize the job responsibility, job specifications, working process, reporting and their designation. All decided that the designation should signify and emphasize on their leadership role and involvement with patient care. The name “Floor Medical Superintendent” carried these significances and was approved by the committee and CEO. Seven physicians were chosen to lead the seven major units in the hospital. These physicians had at least 2 years’ experience of working in the organization, trained in patient safety, Infection control, facility safety, complaint management, culture of safety, ACLS, leadership skills as they were posted in their units. They were regularly monitored, assessed, evaluated by the seniors.

Change 2: They were provided with Leadership trainings and engaged in different improvement projects, invited in different leadership meetings and had direct interaction with the senior management. The concept of involving physician as leader was initiated in November 2015 and implemented in January 01, 2016. By making one physician accountable for ensuring the unit management and empowered to take decision at the point of service was thought as the best way to meet patient expectations. The physician leader was designated as Floor Medical Superintendent(FMS). This concept was a successful project to improve quality and safety as evident from the data.

The project was beneficial from the patient’s perspective and experience and improved patient care, patient safety or service: The physicians were given a target by senior management and was made responsible for • To follow up every patient to ensure planned care is provided thus ensure patient satisfaction. • To understand patient expectation, probable dissatisfaction • To coordinating between different departments and ensure early discharge. • To ensure referral consultants are informed and visit the patient within 2 hours. • To ensure timely investigation and availability of reports before consultant rounds. • To conduct daily safety rounds and take decisions immediately. • To act as the first respondent for any medical emergency and initiate early resuscitation. • To address any issues immediately or escalated to senior management. • To enhance culture of safety throughout the organization • To be a part of annual appraisal of the unit members and take the lead at the unit. • To be on call 24 hours and solve any issue arising at any time of the day or night. Thus the patient care was delivered in a well-coordinated and effective manner, patient safety was ensured. Patient experienced friendlier environment as their safety was ensured by a physician. The results showed significant improvement (January 2016 to October 2016) • Patient satisfaction from 95.5% to 98% • Turnaround time of cross referrals from 3.5 to 2 hours • incidences of monthly code blue from 6 to 0 • Discharge Against Medical Advice from 5.3% to 2.99% • Readmission to Hospital from 0.79% to 0% • Discharge process time from 4 to 2.5 hours

Month : January

Year : 2016

The main key performance indicators which were grouped to characterise the general relationships between HR and other elements of the AHD health system. At the most general level, the following indicators were suggested. The indicators were
• Patient Satisfaction Index
• Turnaround time of cross referrals
• Incidences of monthly code blue
• DAMA (Discharge Against Medical Advice) Cases
• Readmission to Hospital within 24 hours of discharge
• Discharge process time

The concept was to address
• Communication error
• Improve patient satisfaction
• Delay in patient care services
• Proper and timely escalation
• One-point accountability at the unit
• Leadership at unit level

The project could meet its target by the involving physicians in clinical and operational areas. It also gave some financial benefit. A total number of patient admission increased by 15%. The financial benefit achieved by the average of 50,000 BDT per patient. As discharge against medical advice reduced and the patient continued treatment, the average benefit for these patients was 150,000 BDT per patient requiring surgery and 30,000 BDT per patient requiring medical treatment. (attachment_2)

The data was validated by Quality department and analysed through statistical process control tools (control charts, Pareto charts etc.)

The team of physicians were self-motivated to accept the challenge, chosen carefully through stringent criteria. The job specifications and credentials were chosen and accepted after series of meetings and planning.
To achieve the success of this project which became sustainable, the negligible cost was involved and project implemented without any difficulty. There were no new recruits, a small raise of Taka 10,000 monthly (125 USD) per person (total 875 USD) was given as a critical allowance for their job enhancement and 24 hours on call.