Establishing Running A Medical College managerial challenges

Establishing & Running A Medical College: managerial challenges Dr M Veera Prasad, MD (HA), DNB DIRECTOR Santhiram Medical College & Hospital NANDYAL (AP)

India: the potential hub India to emerge as a Health Care hub India requires 600, 000 to 700, 000 additional beds; about 300000 doctors & about 600000 nurses n paramedics by 2020 The overall Indian healthcare market is worth around US$ 100 billion and is expected to grow to US$ 280 billion by 2020, a Compound Annual Growth Rate (CAGR) of 22. 9 per cent (ref # Deloitte Touche Tohmatsu India report) Investment opportunity of US$ 25 -30 billion per year

Govt initiatives Pro-active government Ease policies to promote health care Many PPP intiatives to promote haelth care Reduced excise & customs duty Universal Community Health Insurance for BPL Encouraging pvt sector to expand hospitals Coverage for Govt employees, CHGS, ESI, PSUs in private hospitals More medical Colleges to establish to produce specialists/ super specialists and paramedics PPP concept for Medical Colleges

Health gap India requires 600, 000 to 700, 000 additional beds; about 300000 doctors & about 600000 nurses n paramedics by 2020 Total medical colleges---436 Total UG seats…. 52, 103 Total PG seats…. (excluding DNB)… 23, 686 (MD 13, 137; MS- 6, 735; Diplomas-3, 810 Many more medical colleges to come to cope up the staff-gap Recent relaxation of MCI for some country’s medical graduates Budget 2017 -18 mentions to add 5 ooo PGs every year

Market research A thorough market research or business intelligence is the crucial step before planning for a medical college A deep study on health care facilities available in new proposed place, their business and place for new comer are to be analyzed Availability of doctors, especially faculty Any nearby government medical college What are other private medical colleges in that district Connectivity Infra structure of town/city HA to lead the show

Challenges for HA- funding Own funding Identifying an appropriate, like-minded partner, if it is a JV Or for a merger /acquisition If a own unit, discussions with potential investors/doctors Identifying a PE funder PPP with government Proper documentation for Mo. U / Agreements

Challenges for HA- MCI guidelines MCI minimum standards criteria book is like a ‘bible’ Infrastructure Staffing Equipment & furniture Documentation Yearly enhancement planning Academic schedules & planning Faculty & their research papers ‘biometric attendance’ Plans for PG courses in future

Challenges for HA- how to initiate To follow the Minimum Standards criteria, as prescribed by MCI College for 100 OR 150 UG seats Green field OR partially brown field To have a 300 bed running hospital, for three years before applying to MCI Later this hospital shall be incorporated in to teaching hospital, with yearly expansion To identify a special architect To develop a project team

Challenges for HA- how to initiate Applying to state government for a medical college State govt inspection by appropriate authority Application for EC Inspection by Govt Officials with DME EC sanctioned Applying for Health University inspection Applying for MCI with all required documents & BG LOI & LOP inspections by MCI Permission accorded by Central Govt Health University affiliation inspection before

Challenges for HA- time lines Target for UG student intake…… 2021 Running 300 bed general hospital from 2017 Submission of application to MCI before 31 st Aug 2020 Lo. I inspection in and around Dec’ 20 OR Jan’ 21 Lo. P inspection in and around March ’ 21 OR Apr 21 No deficiencies----direct sanction Small deficiencies---submission of compliance Big deficiencies-----better luck next time

Challenges for HA- MCI inspections Yearly renewal inspections Inspections are ‘surprise’ Minimum 1200 OPD per day Minimum 75% bed occupancy in each department Adequately equipped areas Minimum number of tests in labs & radiology Running of UHC & RHC Faculty Identification Forms- proper data Supports for faculty eligibility

Challenges for HA- project management Nearly 1 M sft requirement for contruction Planning for a project team Involvement in the project management right from planning with hospital architect & promoter (s) Execution with contractors by preparing BOQs, commissioning and then operating. Operations management Planning and implementing efficient supply chain management Following timelines…. . inspections should not fail

Challenges for HA- statutorys Obtaining all licenses & legal obligations Radiology as per AERB Hospital Registration Fire NOC PCPNDT PCB & Mo. U with CTF Pharmacy running licenses Blood Bank valid license HR licenses Financial statutes

Challenges for HA- legal & statutes Legal compliance Following statutes Obtaining all licenses Union-related issues Labour issues compliance Financial related compliance

Challenges for HA- recruitment Identifying good doctors and roping in for ‘star professors’ is a challenge Because majority of the colleges are in rural areas, obtaining qualified & experienced staff is an issue, especially of Doctors & nurses Training them is a challenge Recruitment of staff as per MCI guidelines Faculty will have ‘some sort of immunity’ by MCI

Challenges for HA- equipment Equipment plan as per MCI Hi-end Bio medical equipment to be ordered and site should be ready Oragnising finances/LC Appropriate licenses from authorities before arrival of the equipment Blood bank licenses Necessary trainings To be ready for commission

Challenges for HA- technology Project Management software Implementation of HIS Software for students management Newer gadgets in patient care Training of staff e-library Paper less office-EHR/EMR digitalization Biometrics for students and staff Website management in lines with MCI

Challenges for HA- commissioning Pre-launch activities Trainings done Licenses ready for operations & tariff fixed Launching activities- soft launch- walk thru Equipment, wards, staff ready Labs, diagnostics equipped Accessories ready Review of operations Post launch activities-Regular CMEs/Health talks/Health camps

Challenges for HA- medical education Excellence in academics Making availability teaching material (clinical) Monitoring academics & exams and evaluation Training on simulators Teaching on UHS & MCI guidelines Promoting research and publications Faculty development programmes Guest lectures/zonal CMEs e-learning

Challenges for HA: college Establishing pre-clinical; para clinical depts. Labs, museums Lecture halls; demonstration rooms Central library & departmental libraries Animal house Research & academics College council room Exam hall Doctor is a. TEACHER

Challenge of medical college doctor (teacher)

Challenges for HA: hospital Patient safety Quality care Health Care Associated infections Clinical classes in hospital and monitoring Training of staff and students Maintaining adequate OP & IP- ‘always ready hospital’ for surprise MCI inspections Conferences/ workshops Faculty management Customer satisfaction (patient/student/doctors) Self sustainable hsopital

Challenges for HA- accreditation Providing Quality Care in a Teaching Hospital is a Challenge Right from planning itself, accreditation criteriae to be kept in mind NABH/JCI etc Documentation can be started before commissioning the hospital Trainings on SOPs can be started before launching Challenge to get accreditation at the earliest Sub-standard staff

Challenges for HA- financial viability Getting financial viability is a big challenge Only fees from students for college ‘Need to provide ‘almost free’ treatment No ‘paying category’ patients Top-line (revenue) is very less Doctors salaries are high & Other over heads too Minimum wages to nurses and paramedics, bleeds on P&L Gestation period is high Judicious use of resources ‘Paying Block’?

Challenges for HA- future plans 100/150 UG seats college is eligible for enhancement to 200/250 after 10 years So initial plans itself should have the ‘future’ ideas PG courses can be started after 6 th year Super specialty courses can be started in 9 th year Para medical courses Nursing courses Dental college Though MCI suggests minimum 20 acres in rural area, we need to procure a minimum of 50 acres

Different challenges: Medical College Hospital Vs Corporate Hospital Medical College Hospital Corporate Hospital Infrastructure Huge Not so huge Areas Very strict (measurable in Sq Mtrs) No rules Timelines As per MCI No regulation OP & IP Regulated No regulation Staffing Regulated No regulated Departments Can not be closed Can be Customers Students & patients Patients Type of Rx General Sophisticated Top line Very less Reasonably good Profitability Loss, if Hospital persae Profitable, if run good Overheads High Reasonable

Different challenges: Medical College Hospital Vs Corporate Hospital Medical College Hospital Corporate Hospital Focus Seat centric Patient centric Financial Not monitored P&L is highly monitored Orientation Academic and treatment Treatment (& academic, if DNB) Chain Usually solitary Can go to chain, if brand established Driving force Students Patients Inspections Periodically & surprise No inspections (few) Accountability To MCI; UHS; students to share holders For Quality No much emphasis Highly conscious Doctors Two extremes & casual Middle level & target oriented Documentation Huge & regulated Not so important

Lets all accept Challenges to lead for SUCCESS

There are many challenges for establishing & running a medical college…. . but in spite of challenges……

Thank you all Dr M Veera Prasad +91 9494 30 3535 drveera 2007@gmail. com