P D Hinduja Hospital CEO Gautam Khanna’s experiences from the COVID-19 pandemic teach us how hospitals stay robust in times of crisis. He urges the industry to look for strategies that build a sturdy health system for India in future.
In less than 100 days, a virus brought the entire world to a standstill. Currently, it is just unimaginable that things could go back to normal after this unprecedented crisis – our nation’s economic policies, public health strategies, investments and collective imaginations, all overshadowed by a virus. Many healthcare organisations, pharma companies, diagnostics centres were asked to step up services specific to COVID-19 and pause the rest. As a consequence, these organisations, especially hospitals have been juggling between serving the nation in the fight against COVID and trying to sustain their businesses as most of them have incurred huge financial setback. It’s tough, especially for those hospitals that have limited resources to put forward at the battlefront, yet demonstrate great courage in serving the nation in these difficult times. However, this isn’t the time to be remorseful. It is time when healthcare providers reimagine our healthcare delivery systems and ensure that we tide over this storm and come out stronger.
Gautam Khanna, Co-Chair, FICCI Health Services Committee and CEO, P D Hinduja Hospital and Medical Research Centre in an exclusive conversation shares his key learnings from being betwixt in the pandemic. His hospital is one among the prime private healthcare centres for COVID-19 treatment in the city of Mumbai, the virus hotspot in the country. He insists that we adopt the one-health approach to solve our current problems and build new strategies for a resilient future.
He first begins with sharing his hospital’s experiences and how the outbreak compelled them to change infrastructure, disease management strategies and empower the limited resources they had to work with.
Strategic changes to infrastructure and hospital policy
When the outbreak first took place in the city, the hospital began its preparations to be part of the government programme for treating COVID-19 patients. They immediately had to make some strategic changes to infrastructure, policy and workforce in preparation to combat the virus.
“To deal with a pandemic of such magnitude, P D Hinduja Hospital had to make significant infrastructural changes. We built special isolation wards and isolation ICUs for COVID 19 patients and dedicated isolation wards for suspected COVID-19 patients whose test results were awaited. All these facilities were built in a separate hospital building away from any regular IPD and OPD areas to ensure the safety of patients and staff. Further, as per protocol, all patients with respiratory ailments were being kept at separate areas. All these required changes in infrastructure, special policies, training for doctors, nurses and paramedical staff as per government guidelines and equipment to treat COVID patients. We also ensured adequate social distancing everywhere in the hospital premises including waiting areas for patient screening or triaging before entering the hospital, in elevators, at admission and billing counters, OPD waiting areas, outside swab collection centres, in staff cafeterias, etc. As a safety measure, we also implemented triaging at the entrance to screen patients before they enter the hospital and a safe room to test suspected patients of the virus. Our lab has been approved for conducting RT PCR test for COVID-19 and we have also set up a special swab collection centre and protocols for conducting this test,” shares Khanna.
All these changes within the hospital had to be done quickly as Mumbai became the hotspot for the virus spread. P D Hinduja hospital still remains in the thick of things and continues its battle. It is one of the major private hospitals being part of the state health programme during the pandemic. “As the disease spread, and in line with government norms, we thereafter changed the screening norms, limited our OPD and IPD services, and started triaging of patients for the safety of all. Once the lockdown was effective, we had to immediately arrange for transport for our employees and also make special arrangements like stay and food for staff deployed in the COVID ward. Supply of personal protective equipment (PPE) kits and medical consumables and equipment was another challenge, but we were proactive in anticipating the demand and ordered in advance, so that treatment for COVID and non-COVID patients could be provided. The state governments’ guidelines for treating and testing COVID patients kept changing regularly, basis the changing situation and latest data trends and we had to adapt by modifying our protocols accordingly”, he goes on.
The roll-out of teleconsultations
When the lockdown began, hospitals were refrained from operating OPD services, conducting elective surgeries and were asked to discourage people to come to hospitals unless there was an emergency. P D Hinduja hospital had to make some tough decisions then to ensure that government rules are followed but at the same time, patients don’t have to bear much brunt. “Even during the lockdown, we continued providing services like emergency and urgent surgeries, chemotherapy, dialysis, emergency OPD services, with adequate safety protocols. A dedicated helpline managed by experienced nurses was set up to guide the patients seeking services at the hospital. We have also rolled out teleconsultation services for our patients. Most of our doctors are now just a video call away to solve any needs of our patients”, he confirms.
All these response actions are working well at the moment, Khanna corroborates. It is now time to think about post-lockdown strategies. How will the hospital manage patient load in the era of social distancing, and how will the new protocols for hospitals look like?
Hospital services in the era of social distancing
“People have been avoiding coming to hospitals due to travel restrictions and for their own safety. So, when the lockdown gets lifted, there is bound to be an increase in demand for all services, including OPD, IPD, diagnostic services, etc. However, in these days of lockdown, we have learnt how important it is to maintain social distancing, so we will continue to implement social distancing norm in the hospitals. Hospitals also have to set up appropriate protocols to ensure that there is no overcrowding and safety of all patients and staff is maintained. We will open up our services in a phased manner, initially limiting the number of OPDs, IPD admissions for surgeries, appointments for diagnostics/imaging services and increase gradually. This is essential for the safety of patients and staff. We will continue to promote our teleconsultation services which have received a good response so far,” Khanna discloses.
Once the social distancing protocols are taken care of, the next hurdle is dealing with patient fears, anxiety and stigma. So, how is the hospital prepped up for this change?
“There may be some fear factor amongst patients while visiting hospitals, but I think a lot of them are aware of the precautions they have to take. Hospitals also need to reassure the patients on the safety aspect. We will continue with our safety protocols as mentioned earlier, including maintaining social distancing, screening and triaging of patients, phased opening up of our services to prevent overcrowding, etc. We will also be communicating these safety measures adopted by the hospitals to the patients to reassure them about their safety at the hospital,” Khanna assures.
The next tough part is securing financial strength.
Dealing with a liquidity crisis
The financial losses that hospitals and healthcare companies have incurred in the pandemics are huge. Finding opportunities that lie beneath uncertainty isn’t a cakewalk either, but maintaining simple financial hygiene practices can be helpful, points out Khanna. He further goes on to say, “Hospitals are in fact facing significant revenue disruptions and financial issues currently. On one hand, heavy investments have been made to set up facilities for treating COVID patients; on the other, revenues have dropped considerably, with limited OPDs, IPDs and other services. Being an essential service, we have to keep our hospital operational, so overhead costs continue. Having said that, I feel that once the lockdown is lifted, we will see a gradual recovery of revenues. Our patients have a lot of trust and faith in our hospital and will come back to us for their healthcare needs. We will be communicating to our patients, corporate and institutional clients suitably at the appropriate time. However, since we will be opening our services gradually due to safety reasons, I see more of a hockey stick kind of recovery, rather than a V-shaped one.”
One thing for sure is that coping with the pandemic has slowed down the hospital business. Despite that, the more worrying factor that haunts most hospital CEOs and administrators is the burnout experienced by the workforce who have been constant on the battlefield. Khanna cites examples of what his team did to keep his people motivated.
Uplifting the spirits of employees
“As we fight this pandemic, currently the hospital has taken several measures for motivation and safety of our employees. These include transport for employees who are required to report to work maintaining social distancing norms, having a panel of psychologists who are available for counselling our staff, having the staff come on alternate days wherever possible, without disrupting our services. Each of our directors and managers keep a daily track about the safety of their respective teams and report accordingly on WhatsApp groups.”
He further goes on to appeal to the government saying, “To help the government tackle COVID-19, the private players are doing their bit. The government needs to fullfill the gap of the shortage of PPE and also make sure that adequate testing is done, and necessary precautions are taken to flatten the curve. Some state governments have announced insurance schemes for healthcare workers treating COVID patients, which is a welcome move. Going forward, we hope that the government gives healthcare a priority sector status that would help organisations to get loans at a reduced or subsidised rate. The private healthcare sector needs emergency assistance loans, tax waivers and clearing of pending dues from the government schemes. Other exemptions could include GST or Income Tax exemption.”
One-Health approach and the future it holds
As Khanna continues, he also hints at a multi-sectoral, One-Health approach that promotes coordination to better understand and manage risks in future epidemic management. The concept takes inferences from the silver lining of lessons learned, capacity improved, and critical collaborations formed during this pandemic. This is something that many health economists and the World Bank, have been vouching for, for a long time. Khanna believes, “While the concept of One Health is not new, its first use came by in 2003 during the SARS outbreak. With the recent COVID-19 outbreak, it is clear that the majority of the novel zoonotic infectious diseases originate in animals and drivers of these diseases are due to changes in the ecosystem and other human activities. To fight viruses such as the coronavirus, there is an immediate need for countries to have the capability and capacity to detect and roll out an effective response and alert system which are of international concern. COVID-19 has made us believe that the One Health approach now needs implementation at the grass-root level. Globally, there has been a lot of talk on how there needs to be a collaborative approach. Maybe, India too needs to look at that approach and create sync between research and education at the medical school. The other crucial part would be played by insurance players to cover such pandemics.”
Interesting as Khanna’s suggestion is, indeed, this approach could in future be a panacea that country and the entire world is looking forward to.
Here are some takeaways from the World Bank framework for a One-Health-approach policy:
- Starting points for One Health vary by context, disease and objectives. Therefore, public health systems must be agile enough to address all hazards. For a One Health-approach, countries need strong human, animal, and environmental health/management systems and coordination between them to determine which sectors are relevant for understanding and managing risk.
- One Health is integral to the success of multisectoral national action plans for health security, to address antimicrobial resistance, and for disaster risk reduction. It can optimise pandemic preparedness planning and enhance climate change vulnerability assessments as well.
- One-Health approaches should be built into project design from the outset. Engaging all relevant stakeholders early on can help optimise project success by promoting a common understanding of issues and joint solutions to address them, anticipating risks, targeting gaps, reducing duplication and facilitating relevant coordination channels.
- Communication is a key priority for One Health understanding and implementation. Planning for disease events and maintaining strong multi-sector coordination channels helps ensure consistent and effective messaging to manage risk, enhance efficiency and promote the credibility of all sectors.
Having said that, to implement One-Health approaches, India will require innovative financing models. The World Bank supports countries in their efforts to prevent pandemics by strengthening veterinary and human health systems, but it also rests upon individual nations to invest in the same. Will India truly understand the significance of One-health approach? Will Indian stakeholders continue to join forces for such a cause even after the pandemic ends?
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