Global Hospital’s Mumbai facility opened its doors to its first patients in October last year and will be fully operational this October. But its impressive 17-storeyed glass facade is a testimony to the fact that the best laid plans can go off track. And how perseverance and experience finally pays off.
Dr RV Karanjekar ED-Medical Services & CEO, Global Hospital, Mumbai was (and remains) the man in the hot seat. In a career spanning more than three decades, he has been on the clinical side as well as hospital administration, in both private hospital like Fortis, Lilavati Hospital, as well as civic hospitals like Tata Memorial Hospital-Mumbai, before he joined the Global Hospitals Group around three and half years back.
In line with the positioning of the Group, the Mumbai facility too is a high end super speciality tertiary care facility. The Group’s special focus is multi-organ transplant surgeries which is the expertise area of Dr K Ravindranath, Chairman & MD, Global Hospitals Group.
As Dr Karanjekar points out, Mumbai clearly lacked such a facility in 2007, when the Group did a feasibility study and first broke ground at the site in Lower Parel. This was underlined when Maharashtra’s former Chief Minister and Union Minister, Vilas Rao Deshmukh had to be flown to Global Hospital, Chennai for his liver transplant last year. Since its inception in 1998, the Group has positioned itself as a leader in performing liver, heart, lung, kidney and heart-lung transplantation, as well as bone marrow transplantation. The Mumbai centre aims to continue this tradition, as a high end super-speciality centre of excellence in digestive, liver, kidney, urological diseases, organ transplants, cardiology and orthopaedics as well as related oncology offering comprehensive, end-to-end therapeutic, surgical and diagnostic services, all under one roof.
 “By October this year, all 17 floors of Global Hospital’s Mumbai facility should be fully operational.”Dr R V Karanjekar Executive Director, Medical Services & CEO Global Hospitals – Mumbai |
Dr Karanjekar points out that while there may be many other high end tertiary care facilities in Mumbai, they aim to differentiate themselves by being “super specialists in sub speciality areas”. This is based on their gap analysis of Mumbai as a healthcare destination where they zeroed in on certain treatment lacunae in the city. This is the path to growth, says Dr Karanjekar, as without these sub specialities, diseases may go undiagnosed and under-treated.
For instance, the Baldota Institute of Digestive Sciences inaugurated at the Mumbai facility last October offers advanced gastroenterology and GI endoscopy under Dr Amit Maydeo. Similarly, Mumbai also got its first adrenal disorders clinic on January 31 this year, with a multidisciplinary team of endocrinologists, cardiologists, radiologists, pathologists, nephrologists and urologists – all under one roof at Global Hospitals. A vascular clinic and diabetic foot clinic are also on the cards, according to Dr Karanjekar.
Global Hospital, Mumbai has already conducted some of the most complex cases like India’s first incision-free surgery, called Per Oral Endoscopic Myotomy (POEM), performed by Dr Maydeo. This procedure treats achalasia, a distressing disorder which causes severe difficulty in swallowing, reflux, chest pain and eventually oesophageal cancer. This innovative surgery was performed through the mouth with no external cuts.
So also Dr Prashant Rao, Director of Gastro Intestinal & Minimal Access Surgery, Global Hospital performed the State’s first Whipple’s procedure also known as Whipple’s Surgery, which is a very complex abdominal operation done with an extensive resection followed by extensive reconstruction involving four to five organs and three to four anastomoses. A Whipple’s procedure is also called pancreaticoduodenectomy and is done for duodenal/ampullary/lower end bile duct (jointly called periampullary) and head pancreas malignancy. Dr Rao performed this complex surgery laparascopically through five small incisions instead of a single large incision. Compared to classic procedures, laparoscopic procedures may result in less blood loss, a shorter hospital stay, a quicker recovery, and fewer complications.
At the other end of the spectrum, the Group will also promote prevention. Dr Karanjekar says the Group’s philosophy is to promote a culture for health management rather than disease management. The Mumbai facility has already started implementing this by signing up some corporates in their locality and educating the staff on healthy lifestyle choices, organising free general health screening camps, etc.
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The core team
The Mumbai facility seemed to have everything going for it when construction started in mid 2007. The promoter-doctor team, besides the Chairman of the Group, comprises globally trained and reputed super specialists like Dr Amit Maydeo (a specialist in gastroenterology – medical with many first-in-India procedures to his name), Dr Prashant Rao (Chief of the Centre of Excellence for Minimal Access and Bariatric Surgery), Dr Bharat Shah (a nephrologist who heads Global Hospital’s Institute of Renal Sciences and Transplant), and Dr Pradeep Rao who heads the Department of Urology. Dr Sushil Shah and Ameera Shah (of the Metropolis Group) as well as Harsh Mariwala, Founder of the Marico Group are also co-promoters of the Mumbai facility.
The core team came as board as full-timers and collectively own 30 per cent equity stakes in the facility with Dr Ravindranath, on behalf of the Global Hospital Group, holding the rest. The trend of promoter-doctors investing in and having stakes in such facilities is catching on in India and serves to assure patients of a continuum of care at the same facility. For the hospital management, this arrangement provides a certain amount of stability as these key super specialists cannot be poached away by rival hospitals. This allows the hospital to standardise treatment protocols which results in better health outcomes as well. From a footfall point of view, these super specialists moved their practices and patients to Global Hospital,Mumbai. And thus, patient footfalls were assured from day one.
Mumbai’s medical Mecca
Location wise too, the hospital is at a prime location. Centrally located in Lower Parel, Global Hospital-Mumbai is less than a kilometre away from older medical facilities like Mumbai’s pioneer municipal hospital, the almost century old KEM Hospital, Tata Memorial Hospital that specialises in treatment of cancer, Wadia Hospitals, (one each for children and women), and MGM (an ESI hospital).
With Mumbai’s long defunct cotton mills of Lower Parel making way for luxury hotels like ITC Hotel-The Grand Central as well as high end malls like High Street Phoenix, the area is considered prime real estate. Global Hospital, Mumbai, with a planned built-up area of over 2,67,000 sq ft spread over 17 floors, is tucked away down the tree-shaded Dr E Borges Road, within walking distance from the ITC Grand Maratha. Thus it is conveniently located for the premium medical traveller segment as well.
The prime site is on a 99-year lease from Ajai Verma, a philanthropist who set up a trust to allocate prime real estate for the construction of a hospital. This is in line with his vision to provide Mumbai’s citizens with better healthcare facilities. Verma is carrying forward the vision of his father, the late Mangaldas Verma who founded the Maharshi Dayanand College, also in Parel, with a similar objective with education as well as other similar projects.
The facility was planned to accommodate around 425 beds. 150 wards plus 50 ICU beds were to be commissioned by end-2010, in the first phase, at an initial budget of Rs 175 crores. But a delay of 25-30 months, meant that Phase one was finally completed in April this year, with 210 beds (of which 85 are ICU beds) and 10 floors commissioned. Initially the cost of the first phase was estimated to be Rs 175 crores but this ballooned to Rs 240 crores due to the delays and design changes.
However, the bulk of the capital expenditure seems to be behind the Mumbai facility, as this represents almost 85 per cent of the facility. Dr Karanjekar says most of the heavy capex facilities like the radiology and pathology labs, operation theatres and all ICU beds are already in place.
According to Dr Karanjekar, work is on in full swing to get the remaining floors functional, at an estimated Rs 2.5 crores per floor and Rs 60-70 lakhs per bed. By October this year, all 17 floors of Global Hospital’s Mumbai facility should be fully operational. He estimates a total investment of Rs 260-265 crores and predicts that they will reach cash break even within six-eight months, and financial break-even in a minimum of two years.
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In hindsight
Dr Karanjekar breaks down the 25-30 month delay into phases. The initial delay of four-five months was due to the sudden and temporary non-availability of sand, a vital ingredient in the construction process. This in turn led to the management and architects re-thinking the hospital’s blueprints. In an attempt to reduce the amount of wall space to be constructed, the revised blueprint incorporated a fair amount of glass, but this meant a complete re-calibration of measurements and further slowed down the construction process.
As the management was eager to start treating patients in the first 10 floors, they applied for a partial Occupation Certificate (OC) with the usual labyrinth of paper work adding a further two-three months time lag to the process.
The fourth cause of delay was the lack of construction manpower. Dr Karanjekar narrates the frustration of putting in place all the equipment and material, only to realise that all migrant labour disappear from cities for six months, from May to the end of the monsoons, when they moonlight as farm labour in India’s hinterland.
Tips to peers
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None of these obstacles are permanent hindrances; in fact, in the long run, they will most likely go down as merely a small bump on the facility’s march towards many more medical milestones. But they hold some vital learnings and Dr Karanjekar shared a few tips for hospital managements planning greenfield facilities.
Firstly, he strongly advises them to have on board all the heads of the key speciality areas from the blueprint stage. The specialists should be encouraged to participate in the planning and design of the hospital and specifically their domain areas as they know best the congestion points, etc. Breaking down and reconstructing after the hospital is commissioned adds to the cost and is not desirable from the quality and patient safety perspective as well, he points out.
Secondly, his maxim is to choose utility rather than aesthetics. “Don’t go fancy unless you have the money in place or delays are guaranteed,” he says harking back to the decision to add the glass facade. A smaller hospital chain would have had the additional burden of financing the increased costs as well, which thankfully was not a constraint for the Global Hospitals Group.
Thirdly, he advises that managements should commission the hospital in stages, as each phase is completed after getting partial OCs from the civic authorities. This is crucial especially for smaller groups as having a revenue stream open up will ease the pressure and reassure financiers that they’ve made a good investment.
And his fourth suggestion is about putting in place the ‘soft’ infrastructure. He advices that hospital managements should hire directly rather than go to recruitment agencies. Discovering the right medical manpower will not be a problem in metros, but will be a constraint in smaller locations. Smaller hospital groups may also be hampered by the lack of personal contacts with reputed senior medical talent or the fact that their brands may not be strong enough to attract and retain key medical staff.
His final piece of advice is to plan ahead, harking back to an oft repeated yet very apt phrase: If you fail to plan, you are planning to fail.
Fast forward
Work on the remaining floors at Global Hospital’s Mumbai site seems to be in fast forward mode, even as the lobby sees a steady stream of patients and their families. No doubt the management will meet its deadline to be fully functional by October this year.
Today when Dr Karanjekar and his colleagues view the imposing glass facade already accepted as a part of the Lower Parel skyline, they have clearly put aside the frustration of the past months. Instead, there is a quiet pride that they will be part of a legacy that will serve Mumbai, nay the world, well in the decades to come.
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