Summer Internship Report

at

ARTEMIS HOSPITAL, GURUGRAM

(From 17th April to 18th June 2022)

A Report

By

DR. NEHA BANSAL

(PG/21/149)

PGDM (Hospital and Health Management)

2021-2023

International Institute of Health Management Research,

New Delhi

OBSERVATIONAL LEARNING

Artemis Health Institute, established in 2007, is a healthcare venture launched by the promoters of the Apollo Tyres Group. Artemis is the first Hospital in Gurgaon to get accredited by Joint Commission International (JCI) (in 2013). It is the first Hospital in Haryana to get NABH accreditation within 3 years of start-up.

Mission

Deliver world class patient care services

Excel in the delivery of specialized medical care supported by comprehensive research and education

Be the preferred choice for the world ' s leading medical professionals and scientific minds

Develop, apply, evaluate and share new technology

Be an active partner in local community initiatives and contribute to its well-being and development

Vision Statement

To create an Integrated World Class Healthcare System, Fostering, Protecting, Sustaining and Restoring Health through Best-in-Class Medical Practices and Cutting-Edge Technology developed through in-depth Research carried out by the World’s Best Scientific Minds.

Core Values

The corporate value system at Artemis is founded on three pillars – Service, Compassion and Integrity.

Care for customer

Respect for Associates

Excellence through Teamwork

Always Learning

Trust Mutually

Ethical Practices

Management Team

Onkar Kanwar

Dr. Devlina Chakravarty

Dr. Manju Aggarwal

Mr. Sanjiv Kothari

Dr. (Col) Manjinder Singh Sandhu

Flt. Lt. Saras Malik

Quality policy at Artemis:

Deliver world class patient care through medical excellence

Create a patient-centric environment

Ensure high standards and safety of treatment during the patient's stay

Continuous quality improvement through implementation of robust clinical and non-clinical process and protocols

Having world-class infrastructure and cutting-edge technology utilized by highly skilled employees

Complying with statutory regulations

About Artemis Health Sciences Foundation (AHSF)

AHSF is a registered not-for-profit society, established under the aegis of Artemis Hospitals. With ‘life’ as our sole focus we are relentlessly working towards serving the underprivileged communities.

For Artemis, social responsibility is visceral and deep rooted in both our values and core beliefs. As a result, the hospital is conjoined to its social arm-The Artemis Health Science Foundation, intrinsically. The foundation draws its strength from the hospital and is heavily committed towards spreading awareness about cancer and is successfully transforming lives through early detection and treatment of the underserved communities. The stakeholders too are a part of the same fabric and are partners in change and equal contributors towards enabling us nurture each life.

Acknowledgement

I would like to take this opportunity to express my deep sense of gratitude to all those people without whom this project could have never been completed. First and foremost, I would like to thank my Parents for their inexhaustible source of inspiration.

I would like to extend my gratitude to the Business Development and New Projects department of Artemis Hospital, Gurugram, for their constant guidance and providing this platform for me to learn. My special thanks to Dr. Davy Jindal and Ms. Charu Sinha for being my constant support and mentor at artemis.

I would like to thank my College IIHMR Delhi and my mentor Dr. Sumant Swain for his constant encouragement and support, without which I would have never been able to give in my best.

Their guidance and supervision was very helpful in bringing this work to conclusion.

Dr. Neha Bansal

PG/21/149

INTRODUCTION

In this era of demanding healthcare facilities,it has become very important to have good hospitals in the country which are planned and managed enough to cater the needs of the society.Covid has made us all realize the importance of good medical infrastructure and opening a hospital would not suffice the needs of the society until it is smartly planned,designed,constructed and operational to meet the health care demands of the community economically.Along with opening,there are various factors that are needed to make it work in long run.For any hospital to be successful,it must be well equipped with efficient medical and paramedical staff,latest machinery and good administrative strategic planning because without the strategy any hospital will fail to deliver the services to the society.

These days,any person who visits a multispeciality hospital expects an easy and smooth journey for them and their family so apart from being a patient centric hospital,it must also be sensitive to the needs of the visitors.

Hospital planning requires a complete feasibility study of the area that we are targeting to design the hospital according to the needs and requirements of the community.

The main aim of this study was to understand the complete hospital planning process and to make it functional in a way that if needed,it can be expanded to a bigger size hospital with added services keeping all the financial factors in the mind.

Objectives:

To design a hospital of international standards that cater the needs of the community in an economical manner.

To make the conceptual plan,architectural plan and the structural plan of a hospital building.

To do the preliminary and the strategic planning and to estimate its cost in detail.

To expand the services of a pre existing hospital and to start the new projects.

Methodology: An observational qualitative study design was followed to explore the knowledge,attitude,perception,awareness and concerns of the complete hospital planning process at the Artemis Hospitals,Gurugram.

Study period – The study was conducted from April to June 2022.

Study Area - The data was collected from the meetings held with different stakeholders like PwC,Stratmed,Departmentals HOD,Shyft,Matchmove,Tattavam etc.

Sampling Technique – Convenient sampling technique was carried out for the study based on feasibility and accessibility to collect maximum information from the participants.

Types Of Data – Primary Data which was collected with the help of direct interaction with PCS team,OPD,IPD, General Manager(New projects)

Tools – Direct Interaction, Check List (by observation)

Data Collection-In order to collect data every process was keenly observed ,various meetings were held with different stakeholders and regular visits to sites were planned. Mode of Data collection was ‘Primary’ and was tracked using MS Excel.

Sample Size-The sample were collected in the month of May and June and it was analysed after the data was collected.

RESULTS

DISCUSSION

Selection Of Site: For any hospital to be opened,loction is of primary importance and it is based upon the :

Needs of the community which includes the ease of accessibility,range of services offered,availability of technology and availability of specialities.

Study of existing hospitals

Requirements of staff and services

Defining catchment areas

Soil structure of the site

Availabilites of public amenities

Vulnerabilities to natural hazards

Transportation facilities

Scope Of Services:They are the services whose diagnosis and treatment is provided by hospital to the patient.It depends upon various factors including:

Epidemiology of the disease in the catchment area

Demography and the size of the population.

Climatic conditions of the population

Economic Conditions of the population

Socio-cultural infrastructure

Quality and quantity of the health resources

Availability of medical and paramedical staff.

Hospital services can be divided into- Clinical Services,Diagnostic Services,Supportive Services,Administrative Services.

Business plan and budget- There are a list of steps to form a comprehensive and user friendly Hospital business plan which are:

Having the keen information about the scope of services that a hospital is going to offer,type of hospital,whether it is a general multispeciality hospital,maternity hospital, a paediatric hospital or for any special treatment like cardiac care.

The type of population it is targeting for eg. there are luxury birthing centres are opening these days which target only the cream population.eg. Daffodils by Artemis, and Cloud 9 Hospitals.

By studying the requirements of the population i.e doing the need assessment of the nearby population,knowing the epidemiology of various diseases in the nearby geographical area,knowing the services provided by the competitor hospitals and how our healthcare services would be different from them.

Getting to know the information regarding pricing of the services from the top executives of the hospitals providing the same healthcare facilities to design the initiating cost.

Doing the proper equipment planning and judging which equipment needs investment in present and which equipment needs to be outsourced to reduce the Capex.

Formulating the community outreach programme and publicity budget and the promotional channels to disseminate the message.There are two different sections for an promotional plan; one for initial marketing and other for yearly marketing efforts.

Formulating the requirements related to personnel and assurance as per the size and scale of the hospital

Business plan for Hospital – Format

Executive Summary

Purpose

Mission of the Hospital

Vision of the Hospital Client Service Quality

Safety

Competence

Business Plan

Strategic Plan

Operational Plan - Services, Charges, Admission strategy, Strategic Policy, and Employee

Hospital features - Beds, staff, medical student recruitment, Operation Theatres, Intensive Care Units (ICUs), etc

Various Hospital Departments such as Radiology, Orthopedics, Obstetrics, General Medicine, etc

Hotel Expansion Plans

Brief on features of expansion

Hotel Tie-Ups

Expenses on various medical equipments and treatment

Operating Expenditure

Revenues

Strengths and Weaknesses

Prospects

Geographic

Demographic

Behavioural

Market Competitors

Income

Role and responsibilities of Executive Director, Operations and staff

Managerial Format

Remuneration

Plan for staff improvement / on the job Training

Fiscal Model Analysis - Recurring prices, initial expenses, etc

Fiscal Estimates

Advertising Plan

SWOT Analysis

Timeline

Contingency and Support Plan

Budgeting is very important to plan all the financial aspects of the project beforehand.

It helps to the understand the viability of the project in initial stages.

It helps us to prepare a roll-out plan

It is required to approach investors ,banks to get the funding smoothly.

• • • • • • Project cost Profit and loss Cash flow Break even point Internal Rate of Return Debt service coverage ratio It can later be used as an operational budget for all the functional departments.

A financial plan typically consists of

Project cost comprises of Land ,construction and equipment.

Profit and loss & Cash flow comprises of all the revenue generated from outpatient,inpatient services,lab and pharmacy.

Expenses including medicines & consumables,salaries & wages,power & fuel,equipment maintenance,marketing.

Thwe more the EBDITA,more will be the profit and usual EBDITA should be 22-28% for a hospital.

Standard of care –

Standard operating procedure –

It is a set of step by step instructions compiled by an organisation to help workers carry out routine operations.

Following them consistently assures the efficiency of the organisation and also reduces

the errors.

It provides the policies,standards and the processes needed for the organisation to achieve its goal.

It clearly explains the steps for the completion of the task and informs the employee of the associated risk.

Helps to predefine the schedule for each task.

Helps in training the - employees.

Key questions that should be answered in SOP are:

Who performs what role?



What does each role do?

What is the outcome of each person’s role?

Has what needs to happen been explained clearly? Here’s an example of SOP

SOP for transfer from Daffodils by Artemis to Artemis Hospitals

Objective:

Smooth transfer of patient needing urgent care.

Purpose:

Transffering patient from Daffodils by Artemis, Sector 40, Gurugram, to Artemis Hospitals, Sector 51, Gurugram. This will involve least hassle to the attendants.

Scope:

The scope of services at Daffodils by Artemis, Sector 40, Gurugram, is limited for higher critical care and therefore the patient can be shifted to Artemis Hospitals, Sector 51, Gurugram, for the same.

It is applicable to all patient, Emergency, PCS staff, OT staff, and LDR doctor and staff of the both Hospitals.

Policy:

Transfer policy for higher level of Critical care

Procedure and Guidelines:

In a situation where a patient who is admitted at Daffodils By Artemis, Sector 40 (hence forth, to be referred as, “Daffodils”) need some urgent medical attention for which he/she is requires to be shifted for higher critical care it will be done at Artemis Hospitals, Gurugram (Hence forth to be referred as “Artemis”).

The treating doctor will take a call on this, in consent with the Medical Administrator at Daffodils. The same must be conveyed to the center head.

The On Call doctor to be informed in Emergency, LDR or NICU as be the case, and the OT staff on the shift cell (as be the case).

The PCS staff on duty to inform admission team in case a bed in required for the patient.

The PCS staff to coordinate for the ambulance, while the Duty Doctor informs the on call doctors.

Transfer in case of Emergency situation:

Cash/TPA patient:

Treating doctor declares the requirement for Emergency stabilization or surgery at higher critical care center.

Information given to concerned department duty doctor and Emergency.

Ambulance coordinated by PCS staff.

Shifted to LDR/OT

Procedure done for the patient.

Patient to be stabilized and shifted back to Daffodils.

Surgery, Pharmacy and consumable sales added to patient bill at Daffodils.

Pharmacy and consumables should be physically returned to Artemis.

Transfer in situation of a case transfer to Artemis:

Planned transfer: Cash/TPA patient

Treating doctor declares requirement of transfer of the patient to Artemis for higher critical care.

Duty doctor informs the concerned Duty Doctors at Artemis.

PCS staff arranges for bed and Coordinates for ambulance if required.

Discharge summary is prepared.

Discharge billing process completed.

If insurance case, then follow the process, and close bill.

If cash case, then bill cleared by the patient attendant.

Once the bill is closed, the patient can be shifted to Artemis.

Emergency case transfer: Cash patient

Treating doctor declares requirement of transfer of the patient to Artemis for higher critical care.

Duty doctor informs the concerned Duty Doctors at Artemis.

PCS staff arranges for bed and Coordinates for ambulance if required.

Discharge summary is prepared.

Discharge bill prepared and informed to the doctor.

The attendant pays the bill and patient is shifted.

Emergency case transfer: TPA patient

Treating doctor declares requirement of transfer of the patient to Artemis for higher critical care.

Duty doctor informs the concerned Duty Doctors at Artemis.

PCS staff arranges for bed and Coordinates for ambulance if required.

Transfer summary is prepared.

Final bill prepared and informed to the doctor.

The patient shifted to Artemis.

Due bill raised and given to Artemis billing.

The due bill processed along with Discharge bill of Artemis.

The Due bill closed against payment received at Artemis.

Responsibility:

Sr. No.	Functions	Responsibilities
1.	Decision to transfer patient	Treating doctor, Medical Administrator, Center head
2.	Informing Concerned persons, and for ambulance	Duty doctor
3.	Coordination for bed/room, Ambulance	Patient care services
4.	Medical documentation and coordination	Duty doctor, Nurse
5.	Bill preparation	Patient care services
6.	Pharmacy and consumable H/O	Pharmacist
7.	Transferring of patient from emergency to ward / LDR/ ICU/ diagnostic area/OT	Nurse and GDA with on call duty doctor
8	Bill processing	PCS
9	Transfer of funds for due bill of Daffodils	Finance

Medical and paramedical staff –

Anchor doctors -They are the full time doctors associated with the hospital and form the backbone of the organisation.If the anchor doctors are well known and famous then they make any hospital a doctor driven hospital making hospital known by the name of the doctor.This situation fits in with the example of Medanta hospital,Gurugram which is run by Dr. Naresh Trehan who is the famous cardiovascular and cardiothoracic surgeon of India.Anchor doctors should be in the speciality of Cardio,Oncology,Neurology,Gynaecology,Orthopedics as they’re the most highest revenue generating branches of a hospital and also the most needed services in the society.

Visiting Consultants – They are the doctors who work part time with the organisation on the contractual basis.Either they have the fixed days of visiting to the hospital or they are called when there is any appropriate case/surgery for them to do.They also bring their own patients to the hospital.

Nurses-They form an integral part of the hospital and their no. Varies from department to department.

WARD	NO. OF NURSES
Normal ward	1 staff nurse for every 6 beds
Specific wards like burns,paediatrics,neuro	1 staff nurse for every 4 beds
Nursery	1 staff nurse for every 2 beds
ICU/ICCU/ICCR	1 staff nurse for every bed
Ventilator/Non ventilator beds	1:1/1:2
Major operation theatre	2 staff nurse for every functional operation table including recovery room
Labour room	1 staff nurse for ever labour table

Outsourced services –

Launch plan / Community outreach programme-

First step is to build the brand and it includes the selection of Name,Logo and colour scheme etc.and while selecting the name ,it should either resonate with the specialities that the hospital is offering,can be a mirror to the location of the hospital,it can relate to the founder of the hospital and most importantly it should be easy to retain.And logo for the hospital should be eye catching.

Once all the formalities for the name and logo is finalised,community outreach programme is started to make the entry in the market prominent.Engagement with the patients,doctors and community is held on regular basis till the launch date.It occurs in various phases:

Regular health awareness programs

Campus- focus rural areas

Corporate tie-ups

Tele-help services

Digital media presence

When in Artemis hospitals,I observed the complete community outreach programme for the Bansal’s hospital,New Friends Colony which is the upcoming project of the Artemis.

Economy Human Resources Hiring People Workplace As the NFC area is in close proximity to Okhla which is a predominantly a Muslim area so considering the fact Dr. Mujib & Dr. Israni who are Nephrologist by specialisation we’re given the utmost importance because of their great hold over the Muslim community.

Various tie ups with NFC community centre,New Friends Club,RWA we’re done.

Standees depicting the upcoming dates were placed at the Pebble street. Various cards and coupons providing free general check ups were distributed. Tie up with Mohan corporate industrial area was done.

And few dates before the launch date of the hospital ,dinners are organised with the predominant doctors,businessmen and all the esteemed people of the nearby area to introduce them with the

vision and mission of the organisation.

Digital Marketing plays an important role in getting the patient load.

Young people these days do a primary research on every social media platform before visiting any hospital so it is important to mark the regular updates of the hospital on social media platform.

Departmental Plans – Individual departmental plans are made according to the needs and requirements of each department for their smooth run.

Individual SOP’s are made for every department.

Human Resource Department – Human Resource Department decides the entire manpower of the the hospital.It helps in recruiting all the staff of the hospital,it trains them for their smooth joining in the organization and carries out their induction process.there are people at various level and post in the department with their assigned duties.They play an imp role in the functioning of the hospital as well as the expansion of the hospital.

Strategic

Management

SUPPLY CHAIN MANAGEMENT –SCM department for any organization is crucially important as it determines

What materials flow in the hospital.It deals with the sourcing of basic to advanced materials and machineries in respect to every department.

There are companies available in the market for eg. STRATMED to reduce the capex in terms of consumables

Procured that in turn increase the EBDITA of the hospital.They procure the materials for various numerous

Hospitals at comparative cheaper rates and takes some percentage of profit in return.

PHARMACY - To run a pharmacy in the hospital,particular drug licences are sanctioned.The central drugs

Standard control organization and state drugs standard control oraganisation control the issue of drug license

In India.They are of two types which are Retail Drug License and Wholesale drug license.there are also various requirements for obtaining drug licenses for eg. AREA,STORAGE FACILITY,TECHNICAL STAFF.

Documents required for obtaining frug licenses are;

Application form

Covering letter

Challan of the fee deposited

Declaration form

Key and Site plan for the premises

Proof of ownership of premises and Proof of constitution of the business

Affidavit of a registered pharmacist

FOOD AND BEVERAGES DEPARTMENT – F&B department is very important to maintain the diet of patients

Admitted in the hospital according to thye doctor’s suggestions.To maintain the quantity and quality of the food provided to the patients ,everything is kept under observation by the department.It is made sure that every

meal is delivered on time.

And in most cases the department is outsorced to cut the CAPEX.

HOUSEKEEPING – They ensure that every nook and corner of the hospital is clean and sanitized for the patients

to have a clean and sanitized environment and to prevent people from nosocomial infections.They have various duties towars the patients and for visitors in general .

GROUND DUTY ASSISTANT –

Does the job of sponging and dress change of every patient in the morning along with the nurse.

Takes the samples for transportation .

Assists patients to the washrooms and also helps in changing the diapers along with the nurse.

Dusting of the room

Does the job of laundry/linen.

Helps in patient’s transportation (wheelchairs and stretchers)

Keeps the check of water jug on the side table.

Bed pan.

HOUSEKEEPING –

Cleaning and mopping.

Room and floor service.

Cleans the doctor’s area as well.

Washroom cleaning.

IT DEPARTMENT –IT deptt. For any hospital plays a very important role specially these days when everything is become paperless.In addition to the medical records department they also maintain the record of each patient

Digitally.They ensure the smooth running of EHR application of the hospital and the clinical software of the

Hospital.They also maintain the HIMS of the hospital.

LICENSE AND NAME CHANGE PROCESS

LIMITATIONS OF THE STUDY

Some natural unpredictable factors can always occur without any preplanning

and their management requires immediate measures.

Limited Resourses sometimes creates a constraint of services that have to be provides.

Approvals(internal or governmental) may take longer than the expected time

and therefore can create delay in the timelimes predicted for the project.

Cost estimation and financial planning are not easy to do and comes with experience.

As an intern,there was limitation to confidential information was there and therefore

it limits down the learning as well.

INTERNSHIP EXPERIENCES

How to make a feasibility study for a new hospital or expansion of any previous facility.

Held an event for community outreach named Moms-to-be carnival at Daffodils

by Artemis.

Thorough Knowledge about the steps of hospital planning.

Community Outreach programmes

I have assisted Dr. Davy Jindal who is an alumni of IIM Ahmedabad and now working as

General Manager, New Projects in various meetings for the expansion of new projects by

Artemis ,attended meetings under his guidance with different consultancy services and stakeholders and it has made me confident enough to say that i have gained a very good

knowledge of planning a hospital.

CONCLUSION

The complete report covers extensive aspects such as:Need assessment and Site selection,legal formalities,services to be offered in the hospital,support facilities,

standard operationg procedure,SOC and different departmental plans.Acc. To this

report ,it is important to plan a hospital strategically along with a doctor’s team who

have good knowledge of the complete operations of the hospital and also plan the expansion phase in advance because when the planning is not done in advance no

matter how good the infrastructure and the doctor’s team are ,the hospital still fails to deliver the services and the reasons could be financial crunch,potential staff leaving the hospital,not being able to hire the good doctors because of improper branding in the market etc.It is advisable to do a well feasibility study to identify the scope of work

which includes the Market overview,demand, supply & competitive assessment ,Need

Gap Analysis,Business plan and also describe the methodology and clear project timelines.A well planned hospital serves both the patient and the doctors in a managed

way and have the smooth running operations.