Case studies

Case Study of Planning and Establishment of a Greenfield Hospital

CLIENT:  

A charitable Trust which embarked upon establishment of a  Comprehensive Cancer hospital project in tier  Two city of Maharashtra

SITUATION:

The trust had managed  to create an initial corpus for planning and implementation of this project and being the arm of a cooperative bank it could bank on possibility of additional infusion from the parent but the planning team lacked the experience in healthcare project specifics  for a Greenfield  hospital project and required expertise sharing , knowledge transfer and navigation with active involvement through the entire length of the project.

We were selected on the basis of our huge previous experience of active clinical areas and understanding of  end user requirements, Project planning prowess and facility and services planning insights.

INTERVENTION :

  1. We started with freezing the Concept to Launch which is a very critical step in planning stage and involves a critical knowledge transfer from experts for Concept development and recommendations on an APT facility and services model. It was based upon a scientific needs analysis and critically analyzing the concept for suitability
  2. Financial planning with Capital formations and business model and business plan and precise  budgets and financial plans were outlined. Though the trust functioned on infusion in form of donations we had to get built in mechanism to make it sustainable over long term . with Pros and cons clearly laid down on table.
  3. With our previous experience and a deep insight into project planning, we help develop a well aligned Proof of concept for a given project to  targeted business objective with a charitable trust specific  differently aligned strategy to suit their different formations and objectives.
  4. Impact assessment of Construction costs, Equipment costs and allied  costs of the project.
  5. We could offer end to end hand holding negotiating thro   design of the proposed building, ideal Facility and Services Plan, addressing Patient flow and work flow requirements at the same time satisfying the norms of regulatory authorities of the area . Special emphasis was on functional planning of Radiotherapy, critical care and Surgical areas taking in to account impact factors for  infection control activities
  6. Major inputs were into establishing Project monitoring mechanisms for Construction phase and later phases.
  7. We could provide a comprehensive Equipment advisory and HR planning process. It would deign optimum process plans based on applicable standards in clinical and management areas to set up the work culture right from the day of commissioning in Greenfield projects.

Impact:

We could deliver for the Charitable trust a state of the art Comprehensive Cancer care facility in this tier Two city with a sustainable business model with several key USPs  with built in mechanisms to  help for long term survival and sustain the competition IN THIS CITY FOR THE LAST DECADE.

Case study of a Brownfield hospital set up with strategic interventions in process areas to improve governance

Client :

This is a  very reputed  Trust in Central Pune who owns and administers  Two Prestigious  Nursing home set ups each of around  100 bed  complement. The hospitals are fully equipped  to handle secondary care and few specialties in tertiary care. Both the hospitals had almost 100 percent occupancy lavels.

Situation :

The  Trust management with very reputed board of trustees who were  not from Healthcare background were unable to figure out           the missing links in administering these  set ups including the administrative and management process. They  did not have a defined pattern and lines of governance so essential for the quality administration of these Two  large set ups.

Hence they sought our  assistance with a mandate to do Organizational diagnostic and then forward the recommendations for administrative processes to improves quality of care and governance. We were preferred on the basis of our previous vast experience of over 30 Process designs and Process modulation assignments in hospitals of various sizes. Our  NABH training and certification as  assessor in Quality processes  proved an asset.

Intervention : 

  1. Comprehensive exercise for organizational diagnostics to identify and locate the problem areas with Stake holder interviews to identify the pain points across departments as a part of Organizational diagnostics
  2. Complete organizational restructuring  to facilitate processes for the Board of  Management in Clinical and management areas as well as  eventual change management by the Trust.
  3. The solution and recommendation to offer complete system accountability and improved  quality of care
  4. To establish a clinical governance to improve clinical accountability and quality of outcomes
  5. To link the Clinical and administrative reforms to eventual business process and to facilitate improved

Impact :

  • The interventions brought complete accountability in the administrative processes and the Board of trustees could achieve an independent process based  person independent administrative system.
  • This new system had the identified Key process areas  and process flows in both clinical and administrative areas. They also had defined lines of reporting and were supported by Standard HR process plans.
  • Complete Organizational diagnostic with Recommendations on Organizational restructuring with defined Organogram, Key Positions identified in governance with  defined job descriptions and roles and responsibility and authority mandates.
  • There were built in mechanisms for appraisal and accommodation of change to suit new requirements with Five year horizon. This “
  • The Management was very happy  as the new structure clearly earmarked the spectrums of responsibilities in Clinical and Non Clinical administration areas. The outcome based and KPI based STRUCTURE HAS MADE THE SET UP ACCOUNTABLE AT ALL POSITIONS. The setup has become process based and person independent and hence is able to address the challenge of attrition.

Case study of planning and execution of a medical education project

Client:

A rural medical college project in Western Maharashtra planned by a Medical entrepreneur under a charitable trust arm. The project belonged to an Educationist and was in a Rural area of Maharashtra.

Situation:

This was planned in a very half hazard manner and was over 6 years longing for an expertise exchange and knowledge exchange to progress. The promoters though had a strong desire they did not have the required vision and planning so necessary for the long term gestation, prolonged break evens and low ROI s which are hallmarks of Medical education projects.

Our services were sought for knowledge sharing and comprehensive planning and navigation of this project based on our previous experience of project planning of Greenfield hospitals as ell as Medical education projects.,

Interventions:

Our intervention was d from Concept till commissioning.

  1. Mechanisms to navigate the Medical education institute project within the realms of regulatory authorities like Medical council of India and to fit the limitation and challenges of the Promotors
  2. To identify the challenges of a rural set up and medical education institute in concept development  stage  like Resource constraints, Paucity of Clinical material, Getting quality manpower considering the Rural dispensation and  of  course  Project management mechanisms to  ADJUST TO Capital fund flow which was erratic.
  3. We needed to incorporate some out of box ideas to achieve this within the time frame of 3 years and we could offer a comprehensive leadership based on our complete knowledge of regulatory norms till the LOP was received from MCI.
  4. Major risk mitigated was a delay in timelines and compliance which can entail a severe rise of burden in form of Interest on debt and loss of revenue through the incoming fees of Year One. Hence the Project monitoring mechanisms needed to be developed and customized for that typical environment for eventual success on timelines.
  5. Architectural design innovations to suit a Rural Patent flow and workflow requirements within the limitations of MCI norms.
  6. Reduction and phasing of CAPEX, Large savings on equipment CAPEX thro specific negotiation mechanisms with vendors AND Mechanisms to Optimize OPEX within the limit of Free treatment norms.This backed up by Sound HR plans, HR Matrix, Incentives and retention policies. Long term project success.

The project success of a medical education institute project will depend on sustenance in view of a longer break even , a sound financial plan  and mechanisms to mitigate timeline delays and consequent risks. This is possible only thro our previous planning and implementation experience.

Impact :

The promoters received a comprehensive project road map for 8 years of operations to negotiate the specific yearly targeted needs  thro establishment of UG and PG  infrastructure and related targets.

Financial Objectives to achieve a total revenue target of Rs. 45 Crs by  year 4 of operations with a CAGR of 10% thereafter and  ensure effective revenue  surplus and donations deployment aligned with growth strategy. Planned Revenue  surplus reinvestments  in  advancing the infrastructure to support futuristic clinical services with effective combination of revenue deployment and debt.

Rational  operational costs  to advance the break evens. also ensure optimization of assets thro structured audit mechanisms and resources to achieve revenue and profit targets

A good Clinical  Services  Development and Technology plans and adoption to develop and establish new clinical services areas aligned to community needs of specific areas  and growth targets and  realign  actively  clinical services to enhance operational efficiency and reduce costs/ inconvenience at the same time  invest in infrastructure to support existing and futuristic clinical services

Plan the Business Processes and Systems Objectives with futuristic perspectives

To establish key  processes/ protocols in various departments based on standards and best practice norms at the same time aligned to expectations of specific rural client base.

The project negotiated well thro Stage of Planning, Stage of Construction including Phased rational capital inflow to suit the targets stipulated by  MCI perspective , Stage of Operations  to fit all the HR requirements in Faculty and clinical areas and to optimize the assets invested  and Stage of Phased expansion with Clinical  services and  Faculty additions in planned manner.

It had an enhanced Debt servicing capability due to sound operational processes and expenditure rationalization. This was possible due to SARATHY ADVISORY’s insights and experience of Medical education projects.

Case study of Banks and Financial Institutions for key healthcare specifics and pre-sanctioning evaluation of medical education project

CLIENT :

Large Public  sector  Bank  evaluating a Proposal from Kolkatta  on behalf  of a Charitable Trust to establish a Medical Education Institute at A Total Cost of  INR 263  crores

SITUATION:

The proposed project location was around  60 KMS from Kolkatta with the 300 bedded hospital constructed thro margin money by the promoters  and the dilemma for the Bank  was  to assess the feasibility of the proposed  hospital  and evaluate the   projections forwarded by the promontory in TEF  and DPR reports on project specifics .

We were  preferred  due to our previous experience of regulatory norms  as well  as the project planning and implementation experience of medical education projects.

INTERVENTION  :

  1. The documents  were  evaluated and key areas  required for Medical education projects like planned CAPEX with  continued fund flow during long project gestations, revenue  challenges
  2. Project visioning  to last thro  all project phases from Planning till PG inception including  Procurement of Finance.
  3. Assessment to  evaluate project concept to avoid the hospital becoming a liability and drain on resources as is common with PRIVATE MEDICAL ECUCATION INSTITUTIONS.IN THE LONG RUN.
  4. A  Site  visit to have a complete first hand assessment of project stage as well as management interviews to asses the capacity of promoters and understand their vision and mission for the project . It was also evaluated whether they are prepared for longer break evens and slow and low  ROI in near term which is hallmark of Medical education projects.

 

 

 

IMPACT:

Bank was rewarded with an expert assessment of compliance of regulatory norms as well as impressions on where the project stands on the parameters of Medical council of India, State Govt norms and fee fixation norms

It was forwarded a very comprehensive assessment of the forwarded TEF and DPR to guide the project finance unit of the bank.

Clear recommendations for improving project viability right from planning stage going through entire project gestation could be forwarded to help the Financier as well as borrower.

The SARATHY ADVISORY and it’s expert team is able to do complete end to end handholding for a Medical Education project till the Regulatory recognition is achieved. This experience helped the financial institutions in identifying key shortfalls in project projections and later helps both the stake holders in successfully navigating through the long gestation and develop USPs and Value additions in the longer term so that even if Survival of the Fittest principle applies in long term, they would not feel any stress for not just survival but they become the preferred  destinations for Medical aspirants..

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