r2i forum

thanks Natts,

No expectations. even in this pasport incident if I had my way I would pay bribes. but really my only dream is to start the healthcare facility, rain or shine by next feb, no more no less. Once it starts I can be in a little more in control of the immediate life around me.

RK

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Admin Note:

The discussion in the thread How life is coming back a full circle had gone into a tangent on medical practice in India. Those posts have been moved here in this thread.

Rajradio,

If you are going to Hyd, can I join your venture? You seem to have the passion and I could partner with you? That would be awesome - 2 people passionate about the adventure.

Money is not an obstacle.

Cheers

Nattusbs

please pm me.

RK

Hello,
I would love to join your venture, I love the enthusiasm to build. But I am still is US planning my r2i

please pm me

too bhaaari, it is a very busy monday, someother time.

RK

rajradio;323436please pm me

raj, I am unable to I am not sure why. But my email address is [email][email protected][/email] and I would like to discuss.

-Aneel

Raj:

Here are the 10 things that you MUST have in your new healthcare facility in India. Last week we were in a Mexican hospital with my dad and this week we were in a fairly expensive Hyd hospital (Omega, run by Dr.Mohan Vamsi and other top docs who came out of Indo-American Cancer center to form this new one). The difference is as clear and distinct as day and night.

1. Service with a smile: Make the nurses, ward boys, security guards every one provide service with a smile. The patient and family's mood is already grim and doesn't need to see/deal with another frowing face.

2. Bed-side manners of Docs and other health-care professionals: There is no concept of walking into a room and introducing yourself. A doc walks in with the file, holds the patient's hand to take pulse, looks at couple of things in the chart and then walks away. Literally happened to my dad three times within 3 hours. I got so fed up that every time another person opens the door (without knocking of-course), I would rudely ask him "who are you and why are you here?". Same thing with nurses and other staff.

3. IV Poles must have wheels. May be it is just this hospital but I was surprised that the IV pole does not have wheels and the floor is not completely even. So, going to the bathroom with the IV pole is a big task. I need to support my dad with one hand and lift (the heavy) pole with the other hand and make sure that neither of us fall.

4. Emergency Nurse-Call button: There is no emergency nurse-call button in the room. How would the patient ever call the nurse if s/he happens to be alone. When it is not there in the room, then I can't expect it to be in the bathroom, right.

5. Recliner or small couch/bed for the care-giver: We took a "Luxury Deluxe" room that is quite big but has only one patient bed and only one very uncomfortable chair. Myself, my brother and my mom accompanied my dad to the hospital with the expectation that my mom would always be by his side along with either me or my brother so that we can communicate with the docs. I had to literally sleep on the floor (no extra bedsheets or pillows either). I took my mom's extra saree and put it on the floor and used my dad's extra dhoti to cover myself.

6. Cafeteria: I can never undestand why all Indian hospitals that I have dealt with so far don't have their own cafeteria. My dad can't chew any hard food and prefers a blended diet. He also likes coffee at 6:00 AM in the morning. Because there is no cafeteria attached, we have to hunt the roads of Banjara hills at 6:00 AM in the morning to find a cup of coffee. It being a very rich/posh area, couldn't find any coffee shop (open at ~6-7 AM) that is within walking distance of the hospital. Ended up buying coffee from the foot-path guy. For meals, there is no such thing as a "low sodium diet" or "blended diet" or any other special arrangement because we were forced to buy it from an outside commercial restaurant.

7. US Hospital style beds: Beds are like one-time investment for the hospital. Why not get good US style ones where the patient can raise/lower the head/feet to his comfort level. When we are charging an arm and a leg we might as well make those arms/feet more comfortable (and charge even more).

8. Little extras: such as a phone in the room, an Internet wi-fi connection, a bed-side table that can hold some stuff, couple of extra electric sockets to charge your laptop/cell phone, a clock, list of nearby stores/services, a sliding table that can come over the bed to be used as dining table for the patient (very common in the US), set of towels/rags in the bathroom, a hand-soap etc. that would make life more easier to deal during the hardship

9. Private Consultation Rooms: where the doc and the family can get together to discuss the current condition and review the available options. We spoke right in the corridor, next to the nursing station because there is no consultation room available. It would be nice if the room also had a phone line with conference call abilities so that we could get the family on the phone and make a collective decision on treatment options.

10. Please don't be so conjuicy: It is okay to make a little less money. IF the reputation is great, then people will come in and the facility will make enough money over time. No need to cut corners and make the customer feel that he is being charged through the nose.

When I left the Mexican facility (it was run with the American facilities combined with a "Athidi Devo Bhava" level of service) I was so happy with the service I got that I gladly wrote the cheque to them and then took the time to commend each of the people that touched our lives so positively. When I left the Hyd facility, I am so glad that it is over and hopefully would never have to see it again. When paying cash (yes, cash is preferred and personal cheques are not welcome and cards will attract a 3% service charge), I felt like I was literally being robbed for the shabby service I got.

Now, we are back to our home in Vizag and we are doing everything to avoid another hospital stay. I got the docs to come home and make all necessary testing/treatment in the home itself. It is so much more comforting both to us and to my dad.

Excellent thoughts Vizagdesi. remember in my 2nd post I talked about a service gap. You have alluded to the same thing. For the last 10 year I have been writing a diary as to how my hospital should look like, I have everyone of your points written, but thanks for reaffirming them

Personally I would never go Omega, some of the owners are well known to me and pat care is not the first thing on their minds.

As I am setting up closer to the dream project I am finding some sad realities.

1. Huge amount of monies need to be given under the table: This is reaching almost reaching 30 % of the project cost and this has to be done with black money. So it is becoming very important to cut corners to just to get started. For example I wanted I wanted a penuematic chute so that patients blood drawn does not have to be hand delivered by a ward boy. This would centralise so much of deliverables. I am not getting approval for this from 3 months.

2. arogya sri: again being a govt run animal the charges for arogyasri do not cover even the basics, so most hospitals are giving half the treatments and telling the pts it is over. I have decided not to take arogyasri.

3. bedside manners, I myslef hate that with our desi docs, but what can I do I can employ only the guys I get there. Most of the consultants in our project would Us and UK returned so maybe they will come back with some manners.

4. On average a US style bed is 1100 USd the ones you have are about 70 USD.
.
On average a chemotherapy in US for breast ca costs 20-25 K USD in india I ll have trouble convincing patients to pay 30,000 rupees. An MRI in US is 4650 (for self pay) in emory and India it is between 6-8000 rupees.

The thing I can promise is that we will give complete treatment, we will do what is current and appropriate for the patient. We will have some kind of electronic patient record keeping so that we have continiuity of care, we will hire only doctors passed out of govt colleges( no gulbarga treasures), we will respect patients, treat them as human beings, and if we cannot cure them we will try to comfort them the best we can.

So I am battling a kurukshetra here, I am chosing 1 enemy at a time. But after 2 -3 yrs if I can stay afloat we will certainly create a centre of excellence. But till then I have to play the game with this govt ..ores, and somehow keep thelonger term objective intact.

For example, now there is a fire sprinkler system that is mandatory and there are 26 tests that the fire supression system has to pass. Now I want to go by the book and and put in all these systems. The municipal guys are now very unhappy and are saying if you follow the rules we end up paying 1.1 crores for the fire system and 25 lakhs of bribe or we could just pay the bribe and have nothing at all. For now I have chosen the former, but my private equity investor wants to know why we are spending so much more when not a single hospital in HYD has a fire sprikler system.

So the fine balance of keeping the investors happy, babus happy, politicians happy, is a hard job, but maybe at the end if it all it might be worthwhile if someone like you says we are better than teh mexican hospital.

RK

I was between cases when I wrote that email, a few more additions.

1. I am very big on the IT part. we are trying to put in very modern IT services. You should have wifi and such services we we go live.

2. there will be a recliner couch in the special rooms.

3. The IV poles will have wheels(I thought that was standard).

4. What is the point in having an emergency on call buton when the 2nd yr nursing school nurse(they called papa sisters) come to you and speak in half malayalam. The key is to somehow have better nursing systems. We will create some from easy communications.

5. Cafeteria I am trying to outsource it to the Ohri group, it will be expensive but the food will be tasty.

6. service with a smile-will be considered standard practice.

But your advise is well taken.
RK