’ISO is an exercise that every hospital should undertake’

The first cancer hospital in India to be ISO certified, Dharamshila Cancer Hospital and Research Centre was established in 1994 with minimal infrastructural set up and day care facility. Today, the hospital has earned the reputation of being one of the finest hospitals for cancer care. Nidhi Srivastava in conversation a with Dr S Khannna, director, and the force behind Dharamshila.

Can you tell us your experience since the time you started the hospital?
We started as a small set up in 1994 but have now grown to become a state-of-the-art institution. Where there was equipment only for one OT, we have 4 OTs and a 10-bed intensive care unit, equipped with all kinds of endoscopes. Our medical oncology department now has a blood bank equipped with a blood cell separator, a leukemia wing, etc. Initially our staff comprised MDs who were trained in medical oncology, but now we have 2 DMs for medical as well as surgical oncology. So as a facility, now we are complete and naturally the workload has increased tremendously. Besides cancer treatment, Dharamshila is also into doctorate level education and research.

We already have a DNB in surgical oncology, and the National Board of Examinations has agreed in principle to allow us to start a DNB in radiation oncology. Hence people who have finished with their post-graduation can come here and continue with their education. As a cancer institute, the hospital’s responsibility does not finish with treating patients. Contribution towards prevention is equally important, although the people’s response to such camps isn’t usually over whelming. We started with three to four camps and public lectures that increased to 64 last year.

Currently we are running a one-month cancer awareness programme which has helped in timely detection of eight cases.

What are the problems that the hospital faces in its day to day activities?
The biggest problem in hospital administration is that of nurses. With the cream going abroad, there is always a shortage of good nurses in our country. We train the staff available here, but as soon as they become capable enough, they too, go for other options. This is not our problem alone but of the entire nation’s. Dharamshila is also facing a problem because of so many other cancer institutes coming up. They take our trained girls by paying slightly higher.

How are you tackling this problem?
We are now concentrating on being more of a training institute for nurses, which no other hospital is offering. We have applied for a doctorate course for nurses, Oncology Clinical Nurse (OCN) which is a one year full time course.

Here, we are planning to take only those girls who have an experience of 2-3 years in the oncology sector, besides their graduation degree. This will be almost similar to senior residency and these nurses will be better than MBBS doctors who have spent almost the same time learning about many other things along with oncology. In this manner, we shall not fall short of nurses. After they have finished with their course, we can retain the good students as teachers in the institute. However, things will take time, as it has taken us four years to get the course approved at the national level and one year to get enrolled for the same. The government will do things at its own pace.

What are the value-added services that Dharamshila provides to its customers?
The hospital has its own insurance scheme for the cancer patients known as Dharamshila Cancer Rahat Yojna. The screening programmes under the hospital are also value for money. Like many other hospitals, our health check packages are almost 40 per cent lower from the normal schedule of charges.

The hospital has recently acquired ISO certification. What is the kind of upgradation that went in for qualifying the standards?
As far as the management and administration of the hospital are concerned, we were doing most of the things. Only documentation was not being done. So we had to work towards recording every small thing happening in the hospital. It was a big hassle to begin with. Moreover, this is an on going process, as new manuals have to be generated each time an improvement is made. For upgrading the environmental standards, plenty of work and money went in. We have invested about Rs 5-6 lakh for improving the environment, and will have to bear an expense of Rs 4-5 lakh per year for maintenance. Honestly, in the start I was quite reluctant simply because of the expenses.

However after doing it, I feel it was an exercise worth doing and every hospital should go for it. With everything being on records, there is a sense of accountability that has come in for all employees. To add to this, we gave double increment to all our employees this year. One part was what they normally get and the other is an incentive for their no non-conformity. To err is human - earlier people would make mistakes and hide them, but with this money incentive, they tend to rectify the mistakes rather than hide them. This has brought a drastic change in employee performance.

What is the kind of progress that is being made in the field of cancer treatment?
Case studies show that 40 per cent medical professionals in Europe died a premature death between 32-47 years of age because of their tobacco intake, till sometime back. The same trend now seems to be coming in our country, though the coming generation seems to be slightly serious. So as far as preventable cancers are concerned, their numbers are coming down worldwide. For example, mass screening, genital cleaning, use of condoms have all led to a decrease in the cancer of cervix. According to WHO there are 23 million people living with cancer, over the period of last five years.

More then 50 per cent of those developing the disease live in the developing world. This year, more than 6 million people will die of cancer. Within the next 25 years 75 per cent more people will live with cancer in this country. By 2020, cancer will kill more than 10 million people annually and more than 7 million in the developing world.